Joost Dekker

Negative affect, pain and disability in osteoarthritis patients: the mediating role of muscle weakness.

Negative affect has been shown to be associated with high levels of pain and disability in osteoarthritis (OA) patients. As an explanation of this association, it was hypothesized that muscle weakness is a mediating factor between negative affect, pain and disability. Accordingly, negative affect enhances the patients tendency to avoid pain-related activities; a low activity level induces muscle weakness, instability of joints and thus pain and disability. This theory leads to the prediction that the association between negative affect, pain and disability is most pronounced in patients with weak muscles. The prediction was tested in a study on patients with OA of the hip and/or knee. Regarding disability (but not pain), the prediction was confirmed. This study indicates that muscle weakness is a mediating factor between negative affect and disability in OA-patients.

Attending to stimuli or to images of sexual feelings: Effects on sexual arousal

Abstract In cognitive processing of sexual stimuli a distinction was made between analysis of stimuli and generation of the sexual response. The distinction was derived from the theories of Lang and others. Using a within-Ss design, 24 men and 24 women listened twice to an erotic story. Prior instructions encouraged Ss to attend to the description of situations and events (stimuli: S) or to attend to images of sexual feelings in such situations (stimuli + response: SR). Subjective sexual arousal of both men and women was higher after the SR-instruction than after the S-instruction, which corroborated our hypothesis. In addition, correlations between the ability to generate the sexual response and the frequency of sexual behavior and fantasies outside the laboratory were studied. Certain correlations were predicted from social learning theory. Sexual arousal after the SR-instruction correlated with frequency of masturbation, but not with the taking of initiatives in sexual interactions. Unexpectedly, sexual arousal correlated negatively with frequency of sexual contact with a partner. Sexual arousal correlated near- significantly with sexual daydreaming and fantasies during masturbation. Ss stimulated themselves also by means of fantasy in the absence of an erotic tape—almost identical correlations between sexual arousal and sexual behavior and fantasies were found.

DOING THE RIGHT THING AND DOING IT RIGHT: TOWARD A FRAMEWORK FOR ASSESSING THE POLICY RELEVANCE OF HEALTH SERVICES RESEARCH

OBJECTIVES Health services research is atypical instance of applied research, meaning that its research findings should contribute to a more evidence-based health policy. A basic assumption for the usefulness of policy research is that it is of good scientific quality, but evaluation of health services research would be incomplete without an assessment of its societal relevance. However, there is no generally accepted framework in which criteria to assess societal relevance are defined. METHODS In this study, we made an effort to specify criteria and indicators for policy relevance. RESULTS AND CONCLUSIONS In general, we concluded that it is important to define from the start of a research project, what kind of answers are being sought to the questions at hand, who the intended users of these answers will be, and how they can be reached. Furthermore, a productive dialogue between researchers and policy makers is indispensable for remaining in tune with policy thinking. In addition, we specified domains and a list of potential criteria for assessing policy relevance. For the purpose of quality assurance, these criteria have to be integrated into a quality improvement cycle. This means that the societal output of health services research should be related to the aims and missions at the level of projects, programs, and institutes. Furthermore, it is important that consensus is reached about (the weighting of) relevant indicators and that routines are developed for collecting information on these indicators.

Psychological determinants of sexual arousal: a review

The literature on the psychological determinants of genital and subjective sexual arousal is reviewed. Various psychological mechanisms are identified and in each instance the available empirical evidence is summarized. Areas requiring further research are indicated and suggestions for methodological improvements are presented.

A Comparison of Sex Therapy and Communication Therapy: Couples Complaining of Orgasmic Dysfunction

Forty-eight couples who complained of female orgasmic dysfunction received one of two therapies: sex therapy and communication therapy. Each couple was treated by a team of one male and one female therapist. Pretherapeutic, posttherapeutic and follow-up measurements showed that female sexual satisfaction increased in both therapies, but that the increase came more quickly in sex therapy. Male sexual satisfaction increased in sex therapy, but diminished in communication therapy. A two-phase model of the sexual response was tested against the therapeutic results. The experience of sexual interaction and the orgasmic experience improved in males and females in sex therapy, and in females in communication therapy. The male experience of sexual interaction deteriorated in communication therapy, while the male orgasmic experience initially increased and subsequently diminished again. Satisfaction with the total relationship increased in the males in communication therapy, and in the females in sex therapy.

Treatment of homosexual and heterosexual sexual dysfunction in male-only groups of mixed sexual orientation.

Males complaining of erectile and ejaculatory dysfunctions were treated in a structured therapy program. Twenty-one males of heterosexual, homosexual, or bisexual orientation were divided into five groups, with two male therapists for each group. Patients were those usually considered difficult to treat in that 16 had a primary sexual dysfunction with an average duration of 6 years. Extensive evaluations were made before therapy, at the completion of therapy, and at 2-months follow-up. Pre-therapeutic, post-therapeutic, and follow-up measurements indicated that the program was highly successful.

A long-term follow-up study of couples treated for sexual dysfunctions.

A 5-8 year follow-up was conducted on 140 couples treated for sexual dysfunctions, of whom 88 couples (63%) actually participated. Differences between participant and nonparticipant clients were analyzed. Clients evaluated various aspects of their sexual and nonsexual functioning before and after therapy and in the follow-up period. The correlation between retrospective and original pre- and posttherapeutic data was determined. The effects of treatment for couples not divorced or given additional therapy, couples who separated, and couples given additional therapy were analyzed and compared. The treatments generally led to increased satisfaction about sexual and nonsexual interaction with the partner. The improvement was found to be fairly stable in the follow-up.

A study suggesting two kinds of information processing of the sexual response

Genital and subjective sexual arousal in response to sexual imagery was studied. In a previous study subjects who were encouraged to process information on sexual stimuli and sexual responses were more sexually aroused than subjects encouraged to process information on sexual stimuli only. In the present study, the reverse effect was found in subjects who had received further verbal training to differentially process information on sexual stimuli or responses. This suggests two different kinds of processing information on sexual responses. They may result from simple encouragement or verbal training to process sexual information.

Treatment of Sexual Dysfunctions in Male-Only Groups: Predicting Outcome

Forty men complaining of sexual dysfunctions were treated in male-only groups, using RET, masturbation exercises and social skills training. Sexual functioning improved and social anxiety decreased. Combining these data with previously reported data on 21 men, we tried to predict treatment outcome. Sexual functioning of men with a steady partner and men with varying partners improved; in men without partner(s) no effect could be demonstrated, probably due to a methodological artifact. Inhibited sexual desire was associated with a poor outcome. Several other variables (among them type of dysfunction, social anxiety, age, educational level) did not predict improvement of sexual functioning. This method seems to provide adequate treatment for various complaints of men with quite different backgrounds.