RESUMEN
OBJECTIVES: This study explores the two-year housing- and non-housing-related outcomes for adults who are homeless with problematic substance use who received scattered-site housing and intensive case management services from a Housing First program in Ottawa, Canada, in comparison with a group of adults who are homeless with problematic substance use who had access to standard care in the community. METHODS: Housing First clients (n = 89) and members of a comparison group (n = 89) completed structured interviews at baseline and were followed for two years. RESULTS: Housing First clients moved into housing more quickly, reported a greater proportion of time housed, were more likely to spend the final six months housed, and had longer housing tenure at 24 months. There was a group by time interaction on problematic alcohol use with more rapid improvement for the comparison group; however, both groups improved over time. The comparison group had a greater decrease on problematic drug use by 24 months. There was no change in physical health and only the comparison group had improvements in mental health by 24 months. The groups had similar improvement on community functioning by 24 months. The comparison group had a greater increase in total quality of life. More specifically, the comparison group had an increase in the family relations-related quality of life, whereas the clients did not. There was a significant interaction for safety-related quality of life, but both groups experienced improvements over time and had comparable levels of satisfaction with safety at each time point. The Housing First clients reported higher levels of satisfaction with living conditions than the comparison group at baseline and 12 months, but not at 24 months. There was significant improvement over time and no main effect of group for finances, leisure, and social relations. CONCLUSIONS: Adults who are homeless with problematic substance use can successfully be housed using a Housing First approach. However, further targeted services might be required to address other areas of functioning, such as health, substance use, and quality of life.
Asunto(s)
Vivienda , Personas con Mala Vivienda , Trastornos Relacionados con Sustancias/rehabilitación , Adulto , Ciudades , Femenino , Humanos , Entrevistas como Asunto , Masculino , Ontario , Calidad de Vida , Factores de TiempoRESUMEN
Vaginismus is classified as a sexual dysfunction, yet limited research is available on the sexual function and behavior of women with this condition. Comparing women with lifelong vaginismus to women with lifelong dyspareunia and women with no pain during intercourse, this study explored sexual function, anxiety, and behavior along with cognitions related to vaginal penetration. A total of 152 women completed an online survey that included a series of validated questionnaires. Main findings indicated that, relative to both comparison groups, women in the vaginismus group reported a more limited range of sexual behavior across the lifespan and more maladaptive cognitions related to fear of losing control of one's body and the situation during penetration. Compared to the no-pain group, both symptomatic groups reported more difficulties across several indicators of sexual function, more limited sexual behavior in the past year and past month, and more maladaptive cognitions related to vaginal penetration. However, women with vaginismus reported more sexual desire and less difficulty with lubrication compared to women with dyspareunia. Numerous sexual problems extending beyond vaginal penetration difficulties were confirmed, suggesting a need for broader treatment approaches not limited to the experience of vaginal penetration. Results were discussed as they relate to the fear-avoidance model of vaginismus.
Asunto(s)
Cognición , Coito/psicología , Dispareunia/psicología , Conducta Sexual/psicología , Vagina/fisiopatología , Vaginismo/psicología , Adulto , Nivel de Alerta , Dispareunia/diagnóstico , Miedo/psicología , Femenino , Humanos , Dolor/psicología , Factores Socioeconómicos , Encuestas y Cuestionarios , Vaginismo/diagnóstico , Adulto JovenRESUMEN
INTRODUCTION: Relatively little is known about the subjective reactions of women with lifelong vaginismus to erotic stimuli and genital arousal has never been investigated. Reports of maladaptive cognitions and fears regarding sexuality and intercourse suggest that anxiety may interfere with sexual arousal in women with vaginismus. AIMS: To examine the genital and subjective responses to sexually explicit film stimuli of women with lifelong vaginismus compared with women with lifelong dyspareunia and women with no pain. METHODS: Forty-five women (15 vaginismus, 15 dyspareunia, and 15 no pain) viewed two neutral and two erotic film sets, one depicting sexual activity without vaginal penetration and the other depicting intercourse, over two testing sessions. MAIN OUTCOME MEASURES: Vulvar temperature was recorded using an infrared camera. Participants completed a measure of subjective responses after viewing each film. RESULTS: All groups experienced increased vulvar temperature during the erotic films regardless of activity depicted. In response to the erotic films, the vaginismus group reported less mental arousal than the no-pain group and a range of negative subjective responses, including threat and disgust. Overall, participants showed concordance between peak subjective sexual arousal and temperature change from baseline to peak arousal. CONCLUSION: Despite negative subjective responses, women with vaginismus responded with increased genital sexual arousal to erotic films. The resilience of genital arousal may have resulted from moderate levels of anxiety experienced in the laboratory setting facilitating sexual response regardless of subjective appraisal; however, anxiety experienced in a dyadic context may interfere more substantially.