James H. Sorrell

An exploratory study of constructions of masculinity sexuality and HIV / AIDS in Namibia Southern Africa.

The goal of the current study was to explore notions of masculinity and their linkages to HIV/AIDS among Owambo men and women in Namibia, where an estimated one‐fifth of 15–49 year‐olds have acquired HIV. Thirteen open‐ended interviews and three focus groups were conducted with 50 male and female participants aged 19–50 in rural and urban Namibia. Qualitative analysis revealed six central themes: the evolving meanings of masculinity, power dynamics between men and women, women as active agents, the tension between formal and informal education and HIV transmission, alcohol and masculinity, and the blending of masculinity and explanations of HIV and AIDS. The findings suggest both direct and indirect linkages between notions of masculinity and AIDS, and highlight the need for prevention efforts that focus on providing alternative avenues for attaining culturally recognized markers of masculinity.

Waiting for a Liver Transplant

The waiting period for liver transplantation is a difficult time fraught with uncertainty and associated with a high rate of morbidity and mortality. To understand better what it means for a transplant patient to wait, the authors explore in this phenomenological study the meaning that people with liver failure ascribe to the experience of waiting for a transplant. They conducted 9 interviews using phenomenological methods of inquiry as a guide for analysis. Eight core themes emerged from 146 significant statements and corresponding meaning units. The experience of waiting includes transformations, doctors, teams and trust, elation to despair, loss, questioning the process, searching, coping, and the paradox of time. The essence of the experience is discussed in light of the theory of chronic illness as a disruption of biographical narrative. The authors highlight implications for the transplant teams and other health care providers.

Cognitive impairment in people diagnosed with end-stage liver disease evaluated for liver transplantation.

Abstract  Cognitive impairments are common in patients with end‐stage liver disease (ESLD). The aim of the present study was to identify and characterize the neuropsychological deficits between groups of patients with a variety of causes of ESLD and to assess the impact of heavy alcohol use on cognitive functioning. Cognitive functioning in 300 consecutive outpatients presenting for liver transplantation evaluation was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). All patients underwent a psychiatric interview and a physical and laboratory assessment. The prevalence of neuropsychological impairment was highest among patients with liver disease secondary to alcohol. Poor performance on neuropsychological testing was correlated strongly with the severity of liver disease as measured by the model for end‐stage liver disease (MELD). After controlling for the linear effects of MELD in subsequent analysis, a group difference emerged in patients with cholestatic liver disease showing less cognitive impairment when compared to all other groups. After controlling for the severity of liver disease, those patients with a history of alcohol abuse or dependence were found to perform more poorly on neuropsychological testing than those patients without such a history. Furthermore, the presence of these cognitive impairments predicted disability independent of the severity of the underlying liver disease.

Sexual functioning in patients with end-stage liver disease before and after transplantation.

The effects of end‐stage liver disease (ESLD) on sexual functioning are complex and often overlooked in the context of chronic illness and the transplantation evaluation. The aim of the present study is to report on the prevalence of sexual dysfunction in patients with ESLD presenting for liver transplantation evaluation, as well as to examine a cohort after transplantation. Participants included 173 consecutive adult outpatients with ESLD who presented for orthotopic liver transplantation evaluation. All transplant candidates underwent a psychiatric evaluation, and a sexual history was taken by the transplant psychiatrist. Patients who received a liver transplant were contacted by telephone for follow‐up (n = 39). The following domains were explored: sexual frequency, satisfaction, ability to orgasm, sexual interest, and, for men, erectile dysfunction. Before transplantation, high levels of sexual dysfunction were found, with women showing higher levels of dysfunction than men. Increased age and more severe liver disease were related to lower sexual frequency and satisfaction. Contrary to previous work, the cause of disease (alcoholic liver disease) was not related to sexual functioning before transplantation. Those with erectile dysfunction before transplantation showed continued dysfunction after transplantation. An additional finding was an age and gender bias against taking a sexual history from older women. Overall, for both men and women, the findings point to continued and persistent sexual dysfunction after transplantation. Findings may help transplant teams routinely inquire into the sensitive domain of sexual functioning early on and thereby provide an opportunity for treatment. Liver Transpl 12:1473‐1477, 2006.

The ethical dilemmas of a rural physician.

Physicians in rural settings confront many of the same ethical dilemmas as their urban counterparts: confidentiality, quality-of-life decisions, resource allocation, and their moral responsibility for bettering the life of the community. However, the courses of action they choose as morally justifiable are influenced by distance from other professional facilities, the interrelationship of private and professional roles in a small community, and the non-specialized orientation of their practices.

Electroconvulsive Therapy in Patients With Vagus Nerve Stimulation

Numerous studies have demonstrated the safety and efficacy of electroconvulsive therapy (ECT) for various psychiatric conditions, and it has been approved by the Food and Drug Administration for the treatment of refractory depression. Recently, the Food and Drug Administration also approved vagus nerve stimulation as a treatment for chronic or recurrent depression. Although electrical stimulation is used for both ECT and vagus nerve stimulation, the mechanisms of their action are very different. The American Psychiatric Association task force identifies no absolute contraindications to the use of ECT. The authors present 2 interesting cases of successful ECT in combination with vagus nerve stimulator.