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Objective: To assess the impact of ejaculatory dysfunction (EjD; failure of emission or retrograde ejaculation) on health‐related quality of life (HRQoL) after retroperitoneal lymph node dissection (RPLND) for testicular cancer and explore the efficacy of pseudoephedrine hydrochloride as treatment. Patients and Methods: In a single arm, phase II trial, patients at ≥6 months after RPLND were invited to complete patient‐reported outcome measures (European Organisation for Research and Treatment of Cancer [EORTC] quality of life questionnaire [QLQ]‐30‐item core, EORTC QLQ‐testicular cancer‐26, and Brief Male Sexual Function Inventory) evaluating HRQoL and sexual function in follow‐up (ACTRN12622000537752/12622000542796). If EjD was reported, post‐ejaculatory urine ± semen analysis was undertaken. In eligible patients, pseudoephedrine hydrochloride 60 mg was administered orally every 6 h for six doses. The primary endpoint was sperm count >39 million sperm/ejaculate (>5th centile) following treatment. The trial was powered to detect a clinically relevant 36% achieving sperm count of >39 million sperm/ejaculate. Secondary endpoints included semen volume >1.5 mL, total motile sperm count, safety, and HRQoL impacts. Results: Of the 58 patients enrolled, the median (interquartile range [IQR]) age was 35 (29–41) years, with a median (IQR) of 37 (18–60) months from RPLND. EjD was reported in 33 (57%), including 27/52 (52%) receiving follow‐up at our centre. There were no differences in global HRQoL; however, role functioning (P = 0.045), sexual problems (P < 0.005), and sexual enjoyment (P = 0.005) was poorer if EjD was present. In all, 24/33 (73%) patients with EjD consented to pseudoephedrine treatment. Of 22 evaluable patients, four (18%) achieved a sperm count of >39 million/ejaculate (P = 0.20), and four (18%) had a semen volume of >1.5 mL (P = 0.20). There was a mean increase of 105 million sperm/ejaculate (P = 0.051) and 1.47 mL increase in semen volume (P = 0.01). No safety concerns arose. Conclusion: Ejaculatory dysfunction is common after RPLND but did not impact global HRQoL in our cohort. Pseudoephedrine improved EjD for some; however, its efficacy was lower than expected. Pseudoephedrine may be considered on an individualised basis. [ABSTRACT FROM AUTHOR]

This observational, cross-sectional study examined students' retrospective recall of emotional distress when studying sensitive topics in psychology, and whether hardiness had a mediated pathway to emotional distress through a mental health condition (MHC). Psychology undergraduates (155 women, 34 men) from South Australian universities completed self-report questionnaires assessing hardiness, retrospective measures of emotional distress when studying a range of topics, their concurrent MHC and lifetime cumulative trauma. As hypothesised, students reported more emotional distress to sensitive topics relative to nonsensitive ones, p < 0.001 (r = -0.69). Hardiness was significantly negatively correlated with MHC, p < 0.001 (r = -0.38). Causal mediation analysis revealed, as predicted, that MHC mediated the effect of hardiness on emotional distress (p < 0.001). These results are consistent with existing literature on students' reactions to sensitive topics in medical, law and social work education, as well as previous findings of negative associations between hardiness and mental health outcomes. Implications for higher education policy and practice are discussed, including the use of hardiness assessments as an early screening tool for mental health decline. Future research should identify the specific MHCs involved in the mediated pathway from hardiness to course-related emotional distress, and employ longitudinal designs to confirm the temporal ordering of variables.

BackgroundInnovative strategies are required to reduce care fragmentation for people with multimorbidity. Coordinated models of health care delivery need to be adopted to deliver consumer-centered continuity of care. Nurse-led services have emerged over the past 20 years as evidence-based structured models of care delivery, providing a range of positive and coordinated health care outcomes. Although nurse-led services are effective in a range of clinical settings, strategies to improve continuity of care across the secondary and primary health care sectors for people with multimorbidity have not been examined. ObjectiveTo implement a nurse-led model of care coordination from a multidisciplinary outpatient setting and provide continuity of care between the secondary and primary health care sectors for people with multimorbidity. MethodsThis action research mixed methods study will have two phases. Phase 1 includes a systematic review, stakeholder forums, and validation workshop to collaboratively develop a model of care for a nurse-led care coordination service. Phase 2, through a series of iterative action research cycles, will implement a nurse-led model of care coordination in a multidisciplinary outpatient setting. Three to five iterative action research cycles will allow the model to be refined and further developed with multiple data collection points throughout. ResultsPilot implementation of the model of care coordination commenced in October 2018. Formal study recruitment commenced in May 2019 and the intervention and follow-up phases are ongoing. The results of the data analysis are expected to be available by March 2020. ConclusionsNursing, clinician, and patient outcomes and experiences with the nurse-led model of care coordination will provide a template to improve continuity of care between the secondary and primary health care systems. The model template may provide a future pathway for implementation of nurse-led services both nationally and internationally. International Registered Report Identifier (IRRID)DERR1-10.2196/15006

Increasing public knowledge remains one of the key aims of skin cancer awareness campaigns, yet diagnosis rates continue to rise. It is essential we measure skin cancer knowledge adequately so as to determine the nature of its relationship to sun-related behaviors. This study investigated the psychometric properties of a new measure of skin cancer knowledge, the Skin Cancer and Sun Knowledge (SCSK) scale. A total of 514 Western young adults (females n = 320, males n = 194) aged 18 to 26 years completed measures of skin type, skin cancer knowledge, tanning behavior, sun exposure, and sun protection. Two-week test-retest of the SCSK was conducted with 52 participants. Internal reliability of the SCSK scale was acceptable (KR-20 = 0.69), test--retest reliability was high (r = 0.83, n = 52), and acceptable levels of face, content, and incremental validity were demonstrated. Skin cancer knowledge (as measured by SCSK) correlated with sun protection, sun exposure, and tanning behaviors in the female sample, but not in the males. Skin cancer knowledge appears to be more relevant to the behavior of young women than that of young males. We recommend that future research establish the validity of the SCSK across a range of participant groups.

This study examined the potential mediating roles of mindfulness and body awareness in the relationship between exercise and eating behavior. Female exercisers (N = 159) recruited from fitness centers, yoga centers, and the community completed a questionnaire incorporating measures of exercise behavior, body awareness, trait mindfulness, mindful eating, dietary intake, and disordered eating symptoms. Participation in yoga was associated with significantly lower disordered eating (mediated by body awareness), whereas the amount of time spent participating in cardio-based exercise was associated with greater eating disturbance. The relationships between amount of exercise and actual food intake were not mediated by trait mindfulness or body awareness. The differential findings for dietary intake and disordered eating indicate that the body awareness cultivated in different forms of exercise may be more beneficial for clinical populations or those at risk for eating disorders than for modifying actual dietary intake in the general population. [ABSTRACT FROM AUTHOR]

Background: The clinical and preclinical exploration of the therapeutic properties of vitamin D have significantly increased in the past decade, owing to the growing associative evidence suggesting vitamin D is neuroprotective. However, whether depletion of vitamin D contributes to the onset of neurological disorders or is a symptom of neurological disease has yet to be defined. Much remains unclear about the causal role of vitamin D and the method of use and forms of vitamin D. Objectives: We sought to quantitatively assess if neuroprotective benefits from vitamin D in neurodegenerative diseases are dependent on route of administration: comparing the effect of endogenously sourced vitamin D from UV exposure to exogenously derived vitamin D through synthetic supplementation. Design: We systematically searched PubMed, Embase and PsycInfo databases which included both pre-clinical and clinical studies investigating vitamin D in neurodegenerative diseases. Articles were subject to strict inclusion criteria and objectively assessed for quality. Additionally, Medline data was analysed to identify trends in topic publications and linguistic characteristics of papers. Results: From a total of 231 screened articles, we identified 73 appropriate for review based on inclusion criteria: original studies that investigated vitamin D levels or levels of vitamin D supplementation in neurodegenerative diseases or investigated past/present sun exposure in disease cohorts. Results indicate there is insufficient evidence to comprehensively reflect on a potential neuroprotective role for vitamin D and if this was dependent on route of administration. The majority of current data supporting neuroprotective benefits from vitamin D are based on pre-clinical and observational studies. Solid evidence is lacking to support the current hypothesis that the beneficial effect of UV exposure results from the synthesis of vitamin D. Sun exposure, independent of vitamin D production, may be protective against multiple Sclerosis, Parkinson's disease and Alzheimer's disease. Yet, further research is required to elucidate the beneficial mechanism of actions of UV exposure. The literature of vitamin D and amyotrophic lateral sclerosis was limited, and no conclusions were drawn. Therefore, in cases where UV-derived vitamin D was hypothesized to be the beneficial mediator in the neuroprotective effects of sun exposure, we propose results are based only on associative evidence. Conclusion: On the basis of this systematic review, strong recommendations regarding therapeutic benefits of vitamin D in neurodegenerative disease cannot be made. It is unclear if vitamin D mediates a protective benefit in neurodegenerative disease or whether it is an associative marker of UV exposure, which may contribute to as of yet unidentified neuroprotective factors. [ABSTRACT FROM AUTHOR]