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Female sexual pain is a common problem affecting women worldwide yet remains a poorly researched area of women’s sexual health. Dyspareunia and vaginismus are two types of sexual pain disorder each having psychological and physical health consequences for women and their partners. Part 1: A literature review of the qualitative research literature exploring women’s experiences of sexual pain disorders and their treatment was conducted adopting a narrative synthesis approach. Searches of psychological and medical electronic databases highlighted the paucity of research exploring women’s experiences of sexual pain disorders. Ten studies met the inclusion criteria for the review. The type of qualitative method and quality varied. Findings highlighted the complexity of women’s experiences of sexual pain. Positive experiences of treatment identified alternative benefits of treatment in addition to the traditional outcome of vaginal penetration and penetration without pain. Existing literature has focussed on dyspareunia, and further research is needed on vaginismus. Part 2: The research study used an Interpretative Phenomenological Analysis (IPA) of women’s experiences of vaginismus. Three women were interviewed about their experiences of vaginismus and the treatment they received. Interview transcripts were analysed using IPA. The findings identified the complexity of experiencing vaginismus, the struggle the women faced when trying to make sense of their vaginismus and the wider impact of these experiences on their identity. The findings highlight the value of psychological therapy with this client group and of the need to raise awareness amongst primary care professionals whom women with vaginismus are likely to consult in the first instance. Part 3: A critical appraisal of the research process is presented with focus on the experience of conducting qualitative research as a trainee clinical psychologist. A discussion of the findings is presented in the context of critical reflections on both the strengths and limitations of the study.

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<p>Sexual violence leaves the victims psychologically traumatised and stigmatised in the eyes of its community. Used on a large scale, sexual violence can destabilise a society as a whole and when used during armed conflicts, it serves as a powerful weapon against members of a community. During armed conflicts, sexual violence is widespread and systematically used as a tool of war and this makes sexual violence amount to crimes against humanity, genocide and war crimes. This research paper critically analyses and evaluates sexual violence as an international crime, as well as its prosecution under international criminal law mainly by the International Criminal Court (hereafter ICC), International Criminal Tribunal for the Former Yugoslavia (hereafter ICTY) and International Criminal Tribunal for Rwanda (hereafter ICTR). It discusses the problem of selectivity that can be observed in prosecuting sexual violence that has in fact, left many victims of sexual violence dissatisfied. By doing so, it analyses the law as it is to determine whether the law applied during sexual violence prosecutions is sufficient. The paper also states recommendations that can contribute to the effective prosecution of sexual crimes under international criminal law.</p>

<p>Sexual violence leaves the victims psychologically traumatised and stigmatised in the eyes of its community. Used on a large scale, sexual violence can destabilise a society as a whole and when used during armed conflicts, it serves as a powerful weapon against members of a community. During armed conflicts, sexual violence is widespread and systematically used as a tool of war and this makes sexual violence amount to crimes against humanity, genocide and war crimes. This research paper critically analyses and evaluates sexual violence as an international crime, as well as its prosecution under international criminal law mainly by the International Criminal Court (hereafter ICC), International Criminal Tribunal for the Former Yugoslavia (hereafter ICTY) and International Criminal Tribunal for Rwanda (hereafter ICTR). It discusses the problem of selectivity that can be observed in prosecuting sexual violence that has in fact, left many victims of sexual violence dissatisfied. By doing so, it analyses the law as it is to determine whether the law applied during sexual violence prosecutions is sufficient. The paper also states recommendations that can contribute to the effective prosecution of sexual crimes under international criminal law.</p>

Magister Legum - LLM / Sexual violence leaves the victims psychologically traumatised and stigmatised in the eyes of its community. Used on a large scale, sexual violence can destabilise a society as a whole and when used during armed conflicts, it serves as a powerful weapon against members of a community. During armed conflicts, sexual violence is widespread and systematically used as a tool of war and this makes sexual violence amount to crimes against humanity, genocide and war crimes. This research paper critically analyses and evaluates sexual violence as an international crime, as well as its prosecution under international criminal law mainly by the International Criminal Court (hereafter ICC), International Criminal Tribunal for the Former Yugoslavia (hereafter ICTY) and International Criminal Tribunal for Rwanda (hereafter ICTR). It discusses the problem of selectivity that can be observed in prosecuting sexual violence that has in fact, left many victims of sexual violence dissatisfied. By doing so, it analyses the law as it is to determine whether the law applied during sexual violence prosecutions is sufficient. The paper also states recommendations that can contribute to the effective prosecution of sexual crimes under international criminal law. / South Africa

The aim of this dissertation is to examine empirically what Evidence-based practice (EBP) and its standardized procedures become when put into practice in social work. EBP builds on the idea that professional practice should be based on systematic and reliable knowledge of the interventions and instruments used in this work. This implies a standardization of both research and practice that has been highly contested. Inspired by works within science and technology studies (STS), this dissertation analyses the actual content of the standardized procedures and their uses in social work practice. The dissertation examines a ‘critical case’, a substance abuse social services agency that has worked extensively for several years at implementing EBP, and consists of four papers focusing on three standardized procedures used by the agency in order to enact EBP: 1) the Addiction severity index (ASI) assessment instrument; 2) the psychosocial intervention Motivational interviewing, and 3) the decision-making model Critical appraisal (CA). Ethnographic methods were employed to study the agency’s concrete uses of the standardized procedures in daily practice. MI was also followed in the research literature as it became established as an ‘evidence-based’ intervention. Fundamentally, the development of the standards of EBP can be a messy and paradoxical process. In the stabilization of MI, its differences and ‘fluidity’ have eventually been made to disappear and left a stable ‘evidence-based’ object. Findings from the ethnographic studies show that EBP, as enacted in the agency’s daily practice, is a bureaucratic project where the agency’s managers have decided on and control the use of a set of standards. Thus, what constitutes relevant evidence is based not on professional discussion within the agency but is ultimately determined by the managers. In practice, the standards introduce new logics that cause tensions within the agency, tensions which the social workers are left to handle. Main conflicts concern how the client work is ordered and contradictory organizational rationales. The three standards are used to varying extent, which can be understood by examining what they seek to standardize and how they are put to work. CA was not used at all, mainly due to its design. Disregarding organizational rationales that are unavoidable within the social services, it could not be adapted to the agency’s work. With ASI and MI the situation was different, mostly because of their organizational adaptability. ASI could be implemented in several phases of the agency’s work flow resulting in adjustments of both the instrument and the work flow. As a ‘fluid intervention’, MI was constrained by, but also adjustable to the organization. It was thus possible for both ASI and MI to transform and be transformed by pre-existing practices, in effect creating new practices. A major conclusion is that EBP and its standardized procedures is a more dynamic and multifaceted process than previously acknowledged in social work. Rather than a deterministic one-way path, there are different kinds, degrees, and mutual transformations of standardization processes, which must be appreciated in research and in practical efforts to implement EBP. Given the importance of the organization in professional social work, there is a need to move away from individualistic conceptions of EBP and to consider what evidence use might mean from an organizational perspective. / <p>At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 4: Manuscript.</p>

Angesichts der wachsenden Zahl an Patienten, die sich im Internet über medizinische Fragen informieren, untersuchten wir Informationen auf Webseiten zum Down-Syndrom. Im Anschluss an eine Suche nach "Down-Syndrom" mit den Suchmaschinen Altavista und Yahoo (in deutsch und in englisch), untersuchten wir medizinische und psychosoziale Informationen auf den ersten 100 Suchergebnissen, die jede Suchmaschine ergab. Ein vordefinierter Katalog an gesundheitsbezogenen Daten wurde zur Beurteilung der Webseiten verwendet. Grundlegende (geforderte) und zusätzliche (fakultative) Informationen wurde getrennt ausgewertet. Deutsch- und englischsprachige Webseiten wurden miteinander verglichen. Die Stichprobengröße betrug 324 Suchergebnisse (200 englische, 124 deutsche), von denen nur 77 (24%) medizinische Webseiten waren. Unter ihnen befanden sich 34 relevante deutschsprachige Webseiten (27% von 124 Treffern) und 43 relevante englischsprachige Webseiten (22% von 200 Treffern). In beiden Sprachen wurden sämtliche Informationsgrade (von schlecht bis hervorragend) gefunden. Nur 24% der deutschsprachigen Webseiten und 35% der englischsprachigen Webseiten enthielten mehr als 50% der grundlegenden medizinischen Informationen. Bei den zusätzlichen Informationen gab es nur eine deutschsprachige und fünf englischsprachige Webseiten, die mehr als 50% des erwarteten Inhalts enthielten. Ein Einfluss der Sprache und des Verfassers (von Universitäten bis hin zu privaten Homepages) auf den Inhalt konnte festgestellt werden. Englische Webseiten enthielten mehr Material als deutschsprachige. Da viele Homepages die meisten der geforderten Fakten weder behandelten noch dafür bestimmt waren, dies zu tun, ist der Nutzen sowohl der deutschsprachigen als auch der englischsprachigen Webseiten als Informationsquelle über das DS eingeschränkt. Sorgfältige Anstrengungen sind erforderlich um zu gewährleisten, dass das Internet eine Gestalt annimmt, in der den Bedürfnisse der Nutzer bezüglich Gesundheitsinformationen Rechnung getragen wird. Allerdings zeigen einige Beispiele auch das Potential des Internets, auch wenn die Möglichkeiten, über das DS zu informieren, nicht voll ausgeschöpft werden. / Considering the increasing number of people using the internet as an source of knowledge about medical issues, we analysed the information of websites on Down Syndrome (DS). After a search for "Down syndrome" with the search engines Altavista and Yahoo (in German and in English), we examined medical and/or psycho-social information of web-sites within the first 100 hits yielded by each search engine. A predefined catalogue of health related data was used for ranking of web-sites. Basic (required) and additional (facultative) information were evaluated separately.English and German web-sites were compared. The sample size was 324 hits (200 English, 124 German) of which only 77 (24%) were medical web-sites. Among these were 34 relevant German web-sites (27% of 124 hits) and 43 relevant English web-sites (22% of 200 hits). In both languages all levels of information (poor/excellent) were found. Only 24% of the German web-sites and 35% of the English web-sites gave more than 50% of the basic medical information. Looking at the additional information, there were 1 German and 5 English web-sites communicating more than 50% of the expected content. An impact of language and authorship (universities/personal homepage) on the substance could be established. English websites contained more material than Germans. Since many homepages don`t cover and are not intended to present most of the required facts, the usefullness of both German and English web-sites as a source of information on DS is limited. Careful work is essential to ensure that the Internet takes shape in ways that support customers needs of health information. However, some examples show the potential of the Internet, although the possibilities to educate people about DS are not completly realised.

Purpose: To 1) critically appraise available randomized controlled trials (RTCs) addressing the efficacy of long-chain ω-3 fatty acids as a secondary prevention agent of hypertriglyceridemia, and 2) make recommendations for clinical practice. Data Sources: All RCTs identified from several databases from 1993-2003 were reviewed by two independent reviewers who extracted data from each study and used the previously tested Boyack and Lookinland Methodological Quality Index (MQI) to determine study quality. Results: Ten studies reported long-chain ω-3 fatty acids to be effective in the treatment of hypertriglyceridemia. The average decrease in triglycerides (TG) was 29%, total cholesterol (TC) 11.6%, very low density lipoprotein (VLDL) 30.2%, and low-density lipoprotein (LDL) 32.5%. One study found LDLs to increase by 25%. The average increase in high-density lipoprotein (HDL) was 10%. The overall average MQI score was 36% (26%-54%). Many of the RCTs had serious shortcomings including short duration, lack of a power analysis, no intention to treat analysis, no report of blind assessment of outcome, and lack of dietary control as a confounding variable. Conclusions/Implications: Overall study methodology was weak. Although the evidence supporting the use of long-chain ω-3 fatty acids in the secondary prevention of hypertriglyceridemia is reasonably strong, until there are larger RCTs of stronger methodological quality, it is not recommended to treat hypertriglyceridemia with ω-3 fatty acid supplementation in lieu of lipid lowering medications.