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De Groote C, Dujardin K, Defebvre L, Flinois B, Herlin V, Carrière N, Wawrziczny E. Development of a Screening Tool for Assessing Sexual Difficulties Among Patients with Parkinson's Disease: The PD-SDS. JOURNAL OF PARKINSON'S DISEASE 2024:JPD240063. [PMID: 38905057 DOI: 10.3233/jpd-240063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/23/2024]
Abstract
Background People with Parkinson's disease (PwPD) exhibit various sexual difficulties (SDs) that may be due to motor and/or nonmotor symptoms or the use of antiparkinsonian medication. SDs are often underreported by PwPD and underexplored by physicians. Objective This study aimed to explore the SDs experienced by PwPD and create a scale for assessing them. Methods A corpus of items was generated from semistructured interviews to represent the experience of PwPD as closely as possible. The number of items was reduced according to the psychometric properties, and the scale's structure was subsequently examined. The final phase consisted of measuring the scale's validity and reliability. Results After assessment of the original corpus of 59 items by PwPD and clinicians, a 25-item version was obtained. The analysis of item properties led to the removal of fifteen items. An exploratory factor analysis of the first 10-item version with a first PwPD sample identified four components of the SDs among PwPD: "low sexual esteem," "sexual displeasure," "impact on sexual position" and "hypersexuality." With a second PwPD sample, a confirmatory factor analysis demonstrated a satisfactory fit between the model with four components and the data. The 10-item scale had good internal consistency and good temporal reliability. Conclusions The Parkinson's Disease Sexual Difficulties Scale (PD-SDS) is a valid screening tool that facilitates the investigation of and communication about PD-related SDs. It is intended to improve the identification of vulnerable PwPD and to target the domain of sexual experience impacted by PD to better support PwPD.
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Affiliation(s)
- Clara De Groote
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Lille, France
| | - Kathy Dujardin
- Neurology and Movement Disorders Department, Lille University Medical Centre, Lille, France
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Luc Defebvre
- Neurology and Movement Disorders Department, Lille University Medical Centre, Lille, France
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Bérengère Flinois
- Neurology and Movement Disorders Department, Lille University Medical Centre, Lille, France
| | - Virginie Herlin
- Neurology and Movement Disorders Department, Lille University Medical Centre, Lille, France
| | - Nicolas Carrière
- Neurology and Movement Disorders Department, Lille University Medical Centre, Lille, France
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Emilie Wawrziczny
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Lille, France
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Almalki DM, Kotb MA, Albarrak AM. Discussing sexuality with patients with neurological diseases: A survey among neurologists working in Saudi Arabia. Front Neurol 2023; 14:1083864. [PMID: 36798810 PMCID: PMC9928181 DOI: 10.3389/fneur.2023.1083864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/04/2023] [Indexed: 02/01/2023] Open
Abstract
Background Neurological diseases frequently affect sexual activity, and the resulting sexual dysfunction can cause much distress for patients. However, despite the importance of such complaints, neurologists frequently do not ask patients about their sexual symptoms or how their neurological illness and medications are affecting their sexual health. This study aimed to identify these difficulties as well as potential obstructions to conversations for addressing sexual dysfunction in patients with neurological diseases. Methods This cross-sectional study was performed by sending invitation letters and questionnaires to registered neurologists in Saudi Arabia. The questionnaire was constructed to determine the possibility of discussing sexual activities and function with patients with neurological diseases and the possible obstacles neurologists face in this regard. Statistical analyses were performed using the Statistical Package of Social Sciences (SPSS) program version 25, and p-values of <0.05 were considered statistically significant. Results A total of 258 of 750 neurologists (34.4%) returned the survey, of which 252 had completed the entire survey; therefore, their responses were considered suitable for further analysis. The majority of the respondents (63.1%) seldom discussed sexuality with their patients, more than half of the participants never discussed sexuality with female patients, and patients aged 60 years or older. The most commonly reported barriers were the lack of spontaneous communication by patients regarding their sexual problems (82.1%), insufficient consultation time (60.7%), and barriers based on language/culture/religion (53.6%). The majority of the respondents (61.9%) expressed the need for training on discussing sexuality as a measure that may enhance the discussion of sexual life with patients. Most of the respondents (92.9%) considered the patients responsible for bringing up problems in their sexual functioning during a patient interview. Conclusion Sexual dysfunction is rarely discussed with patients showing neurological diseases, particularly with female patients. This is due to the patient's inability to articulate their sexual problems freely as well as a lack of consultation time. Training on discussing sexuality may enhance the discussion of sexual life with patients.
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Affiliation(s)
- Daifallah Mohammed Almalki
- Department of Internal Medicine, College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia,*Correspondence: Daifallah Mohammed Almalki ✉
| | - Mamdouh Ali Kotb
- Department of Internal Medicine, College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia,Neurology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Anas Mohammed Albarrak
- Department of Internal Medicine, College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
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Van Overmeire R, Vesentini L, Vanclooster S, Bilsen J. Discussing sexual health among Flemish patients with Parkinson’s disease. Acta Neurol Belg 2022; 123:497-505. [PMID: 36153464 DOI: 10.1007/s13760-022-02086-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/01/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Parkinson's disease (PD) can lead to sexual dysfunction. Yet, studies have shown that neurologists do not often discuss possible sexual health consequences with their patients. Thus, in this study, we investigated the communication on sexual health between healthcare workers and PD patients in Flanders, Belgium. METHODS Through an online survey, PD patients were contacted. Sexual dysfunction was measured with the Arizona Sexual Experience Scale (ASEX), stage of PD with the Hoehn and Yahr scale, and self-made questions on the communication between healthcare workers and PD patients. RESULTS In total, 100 PD patients responded, of which 23% had possible sexual dysfunction. Of these respondents, 60% had never received any information about possible sexual health consequences. More than half (58%) of the patients felt their neurologist should provide information on possible sexual health consequences, though only 14% had ever received information from their neurologist. Male respondents expressed a greater need for information than female respondents (p = .049), although no difference between both groups in receiving information was found (p = .294). In addition, low to middle educated people generally received more information than higher educated people (p = .018).. The more severe the disease is, as measured by the Hoehn and Yahr scale, the more information a patient receives (p = .012). The most frequently mentioned barriers in discussing sexual health are a lack of initiative by the neurologist (41%) and awkwardness to discuss sexuality (41%). CONCLUSION This study showed that PD patients expect information from neurologists on possible sexual health consequences, but seldom receive information. More attention should be given to training neurologists in discussing sexual health. Table 1 Characteristics of the sample (N = 100) N % Gender Male 59 59 Female 41 41 Education level Lower 4 4 Middle 42 42 Higher 54 54 Relationship status No partner 10 10 Partner 90 90 Stage of Parkinson (Hoehn & Yahr scale) Stage 0 3 3 Stage 1 36 36 Stage 1.5 12 12 Stage 2 9 9 Stage 2.5 6 6 Stage 3 21 21 Stage 4 9 9 Stage 5 4 4 Time since diagnosis Less than 1 years ago 10 10 1-2 years 13 13 2-5 years 32 32 5-10 years 29 29 Longer than 20 years 13 13 10-15 years 2 2 15-20 years 1 1 Received information on sexual health consequences from… Treating neurologist 14 14 GP 9 9 Geriater 0 0 Nurses 2 2 Psychotherapist 3 3 Sexuologist 1 1 Kinesitherapist 2 2 Other 4 4 Who do you think should provide you information on sexual health consequences Treating neurologist 58 58 GP 43 43 Geriater 3 3 Nurses 6 6 Psychotherapist 23 23 Sexuologist 17 17 Kinesitherapist 3 3 Other 2 2 How would you like to receive information on possible sexual health consequences? Brochure 38 38 Online (e.g. website) 38 38 Posters in waiting room 3 3 Personal conversation with healthcare worker 51 51 Other 1 1 From what moment do you think possible sexual health consequences of Parkinson's disease should be discussed? From the moment of diagnosis 52 52 From moment patient indicates he/she experiences problems 33 33 From moment that the neurologist feels it should be discussed 9 9 Should not be discussed 6 6 Need for information on possible sexual health consequences No need 31 31 A little need 19 19 Some need 21 21 Need 24 24 A lot of need 5 5 How often has healthcare personnel given you information on sexual health consequences Never 60 60 Seldom 25 25 Sometimes 12 12 Regularly 3 3 At every consultation 0 0 ASEX No possible sexual dysfunction 77 77 Possible Sexual dysfunction (score equal to or higher than 19) 23 23 How important are sexual activities for you? Not important 20 20 Slightly important 33 33 Somewhat important 22 22 Important 18 18 Very important 7 7 I avoid sexual contact because of my disease Agree completely 8 8 Agree 16 16 Agree somewhat 30 30 Disagree 28 28 Completely disagree 18 18 I feel unsatisfied with my sex life due to my disease Agree completely 16 16 Agree 22 22 Agree somewhat 32 32 Disagree 20 20 Completely disagree 10 10 Mean Standard deviation Age 66.97 8.88 ASEX 16.02 4.53 Table 2 Associations of ASEX, need for information, receiving information ASEX p Need for information p Receiving information p Gender Male 16.08 0.948 55.31 0.049 48.69 0.294 Female 16.11 44.13 43.38 Education level Low-middle 15.83 0.068 53.26 0.356 53.41 0.018 High 16.20 48.06 41.49 Need for information and receiving information scores are mean ranks due to non-parametric tests ASEX scores are means Table 3 Correlations between variables ASEX Age Need for information Receiving information Hoehn and Yahr Importance of sex life Avoiding sex Unsatisfied with sex life ASEX - - 0.04 0.27* 0.07 - 0.09 - 0.12 - 0.10 - 0.23* Age - - 0.20 0.10 0.41*** - 0.28** - 0.16 0.08 Need for information - 0.14 - 0.11 0.38*** - 0.13 - 0.46*** Receiving information - 0.22* - 0.03 - 0.08 - 0.08 Hoehn and Yahr - - 0.17 - 0.32** - 0.17 Importance of sex life - 0.24* - 0.07 Avoiding sex - 0.48*** Unsatisfied with sex life - *p < .05 **p < .01 ***p < .001 Table 4 Regression analyses B (S.E.) Exp(B) P Pseudo R2 Nagelkerke Pseudo R2 Cox & Snell Need for information 0.013 0.19 0.14 Gender - 1.23 (0.48) 0.29 0.010 Education level - 0.62 (0.43) 0.54 0.149 Hoehn and Yahr 0.01 (0.11) 1.01 0.925 ASEX 0.10 (0.06) 1.11 0.060 Receiving information 0.047 0.14 0.11 Gender - 0.53 (0.45) 0.59 0.232 Education level - 0.61 (0.41) 0.54 0.137 Hoehn and Yahr 0.29 (0.14) 1.33 0.012 ASEX 0.01 (0.05) 1.01 0.788 Table 5 Barriers to discuss sexual health % (that agree with statements) I do not feel comfortable to discuss sexuality with my neurologist 33 I wait until the neurologist begins discussing it 41 My neurologist is either too young or too old 11 My neurologist is of the other gender 26 Reasons that have to do with my faith or attitude towards sexuality 12 I do not have the feeling there is a solution for these problems (with sexual health) 31 My Parkinson related symptoms overshadow my possible sexual health problems 39 It feels awkward to discuss sexual acts like masturbation or discuss buying of sexual aiding tools 41 My family/partner/friends are present during consultation 37 Reasons that have to do with my sexual orientation 11.
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Affiliation(s)
- Roel Van Overmeire
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Lara Vesentini
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Stephanie Vanclooster
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Johan Bilsen
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussels, Belgium
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Contaldi E, Magistrelli L, Gallo S, Comi C. Striatal dopamine transporter imaging in Parkinson’s disease drug-naïve patients: focus on sexual dysfunction. Neurol Sci 2022; 43:4769-4776. [PMID: 35386018 PMCID: PMC9349118 DOI: 10.1007/s10072-022-06050-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 03/31/2022] [Indexed: 11/28/2022]
Abstract
Introduction Dopamine is involved in sexual behavior, but dopaminergic imaging studies establishing the relationship between nigrostriatal dopaminergic degeneration and sexual dysfunction (SD) in Parkinson’s disease (PD) are lacking. Methods We retrospectively analyzed clinical and 123I-FP-CIT SPECT data of 43 drug-naïve PD patients. Based on the sexual function domain of the Non-Motor Symptoms Scale (NMSS), we identified 23 patients with sexual concerns (WSC), reporting a score ≥ 2 due to hyposexuality, and 20 patients without sexual concerns (NoSC). Dopamine transporter (DAT) uptake was assessed through semi-quantitative analysis in the most and least affected putamen (maP, laP), and most and least affected caudate (maC, laC). Total putamen-to-caudate ratio and total striatal binding ratio (tSBR) were also quantified. Results WSC and NoSC had similar demographic and disease-related characteristics. WSC displayed lower uptake values in maC (p = 0.016), maP (p = 0.004), laC (p = 0.019), laP (p = 0.009), and tSBR (p = 0.006). Pearson correlation analysis revealed, in the WSC group, moderate inverse correlations between the log-transformed SD scores and the uptake in maP (r = − 0.473, p = 0.023), maC (r = − 0.428, p = 0.042), laP (r = -0.437, p = 0.037), and tSBR (r = − 0.460, p = 0.027). After controlling in a two-way ANCOVA model for age and sex, between-group differences,between WSC and NoSC remained statistically significant only for dopaminergic denervation in maP [F(1,38) = 7.478, p = 0.009)], laP [F(1,38) = 4.684, p = 0.037)], and tSBR [F(1,38) = 5.069, p = 0.030]. Conclusion To the best of our knowledge, this is the first study reporting the relationship between the severity of SD and specific patterns of nigrostriatal dopaminergic denervation (especially involving both putamina) in newly diagnosed drug-naïve PD patients.
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Affiliation(s)
- Elena Contaldi
- Department of Translational Medicine, Movement Disorders Centre, "Maggiore Della Carità" University Hospital, University of Piemonte Orientale, Corso Mazzini 18, 28100, Novara, Italy.
- PhD Program in Medical Sciences and Biotechnology, University of Piemonte Orientale, Novara, Italy.
| | - Luca Magistrelli
- Department of Translational Medicine, Movement Disorders Centre, "Maggiore Della Carità" University Hospital, University of Piemonte Orientale, Corso Mazzini 18, 28100, Novara, Italy
- PhD Program in Clinical and Experimental Medicine and Medical Humanities, University of Insubria, Varese, Italy
| | - Silvia Gallo
- Department of Translational Medicine, Movement Disorders Centre, "Maggiore Della Carità" University Hospital, University of Piemonte Orientale, Corso Mazzini 18, 28100, Novara, Italy
| | - Cristoforo Comi
- Department of Translational Medicine, Neurology Unit, S. Andrea Hospital, University of Piemonte Orientale, Vercelli, Italy
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Valeiro C, Matos C, Scholl J, van Hunsel F. Drug-Induced Sexual Dysfunction: An Analysis of Reports to a National Pharmacovigilance Database. Drug Saf 2022; 45:639-650. [PMID: 35386045 DOI: 10.1007/s40264-022-01174-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Sexual dysfunction (SD) is a problem that can affect any phase of the sexual response cycle (such as sexual desire, arousal and orgasm) and individuals of any age. SD can be caused by physical reasons, such as medical conditions, alcoholism or drug abuse; psychological factors, such as stress and anxiety; and different medicines, such as selective serotonin reuptake inhibitors (SSRIs), and their associated adverse effects. AIM The aim of this study was to characterise drugs suspected to have caused SD adverse drug reactions (ADRs) in patients, by conducting a descriptive study based on pharmacovigilance reports. METHODS Reports submitted to the Netherlands Pharmacovigilance Centre Lareb from January 2003 to December 2019 were used to investigate drug-induced sexual disorders. Selected reports had at least one ADR reported in the Medical Dictionary for Regulatory Activities (MedDRA®) System Organ Class (SOC) 'Reproductive system and breast disorders' and the SOC 'Psychiatric disorders' relating to sexual disorders and corrected for drug utilisation (expenditure) for the Dutch population. RESULTS A total of 2815 SD ADRs were reported in the observed period. Data were divided according to three variables: pharmacotherapeutic group, the drug itself, and sex. A total of 722 different SD/pharmacotherapeutic group pairs were observed. The pharmacotherapeutic groups with the highest frequency of SD reports were SSRIs (n = 488, 17.58%), other antidepressants (n = 172, 6.20%) and HMG-CoA reductase inhibitors (n = 149, 5.37%). Distinguishing ADRs by sex, men suffered more from erectile dysfunction, decreased libido and ejaculation disorders, while among women, libido disorders, dyspareunia and SD were the most common ADRs. CONCLUSION Different reactions and disproportionality of reactions were detected between the sexes. Antidepressants, antihypertensives, oral contraceptives, α-blockers, and anti-androgens were the pharmacotherapeutic groups with the highest number of SD reports and corresponding high odds ratios.
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Affiliation(s)
- Carolina Valeiro
- Instituto Politécnico De Coimbra, ESTESC-Coimbra Health School, Farmácia, Coimbra, Portugal
| | - Cristiano Matos
- Instituto Politécnico De Coimbra, ESTESC-Coimbra Health School, Farmácia, Coimbra, Portugal.
| | - Joep Scholl
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands
| | - Florence van Hunsel
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands
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Introduction. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 162:xv-xvi. [PMID: 35397792 DOI: 10.1016/s0074-7742(22)00027-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Gordijn R, Teichert M, Nicolai MPJ, Elzevier HW, Guchelaar HJ, Hughes CM. Learning From Consultations Conducted by Community Pharmacists in Northern Ireland for Nonprescription Sildenafil: A Qualitative Study Using the Theoretical Domains Framework. Sex Med 2021; 9:100440. [PMID: 34628114 PMCID: PMC8766262 DOI: 10.1016/j.esxm.2021.100440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Nonprescription sildenafil was introduced to the United Kingdom in 2018 as the first pharmacy service concerning sexual function, an important but often ignored factor for quality of life. AIM This study aimed to evaluate pharmacists' views on providing nonprescription sildenafil, their perceptions of the barriers and facilitators to provide this service and strategies to overcome potential barriers, using a theory-based approach. METHODS Community pharmacists were purposefully sampled in Northern Ireland, followed by snowball sampling. Face-to-face interviews were conducted between October 2019 and January 2020. The semi-structured interviews used a piloted topic guide based on the 14-domain Theoretical Domains Framework (TDF). All interviews were audio-recorded, transcribed verbatim and anonymized. Transcripts were analyzed deductively in NVivo 13, utilizing the TDF domains as coding categories. Within each domain, content analysis was utilized to identify barriers and facilitators. MAIN OUTCOME MEASURE Barriers and facilitators within the TDF domains for pharmacists to provide nonprescription sildenafil. RESULTS Ten pharmacists were interviewed to reach data saturation. Eight pharmacists had experience with dispensing nonprescription sildenafil. They valued nonprescription sildenafil as an additional service ("Social/professional role and identity"). Training, concise product guidelines, and private consultation areas were important facilitators ("Environmental context and resources"). The service required trusting clients ("Optimism"), with concerns about abuse and men not visiting their GP. From experience gained, pharmacists became more confident dealing with difficult situations such as patients being vague about their medical history or alcoholism or mental problems as causes for erectile disfunction (ED) ("Skills" and "Beliefs about capabilities"). Pharmacists considered lifestyle and medication causes of ED important but preferred to focus on safe supply. In general, pharmacists were satisfied with the perceived professional recognition, using their clinical knowledge or helping patients resume sexual relationships ("Beliefs about consequences"). CONCLUSION Pharmacists welcomed nonprescription sildenafil to enhance their role as easily accessible healthcare providers for patients. Gordijn R, Teichert M, Nicolai MPJ, et al. Learning From Consultations Conducted by Community Pharmacists in Northern Ireland for Nonprescription Sildenafil: A Qualitative Study Using the Theoretical Domains Framework. Sex Med 2021;9:100440.
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Affiliation(s)
- Rineke Gordijn
- Leiden University Medical Center, Department of Clinical Pharmacy & Toxicology, Leiden, The Netherlands.
| | - Martina Teichert
- Leiden University Medical Center, Department of Clinical Pharmacy & Toxicology, Leiden, The Netherlands
| | - Melianthe P J Nicolai
- Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Department of Urology, Amsterdam, The Netherlands
| | - Henk W Elzevier
- Leiden University Medical Center, Department of Urology and Department of Medical Decision Making, Leiden, The Netherlands
| | - Henk-Jan Guchelaar
- Leiden University Medical Center, Department of Clinical Pharmacy & Toxicology, Leiden, The Netherlands
| | - Carmel M Hughes
- Primary Care Research Group, School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland
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Shalash A, Okubadejo NU, Doumbe J, Ojo OO, Hamid E, Kuate C, Calvo S, Helmi A, Agabi OP, Essam M, Aguado L, Elrassas H, Roushdy T, Tanner CM, Cubo E. Translation, Validation, Diagnostic Accuracy, and Reliability of Screening Questionnaire for Parkinsonism in Three African Countries. JOURNAL OF PARKINSON'S DISEASE 2021; 10:1113-1122. [PMID: 32568112 DOI: 10.3233/jpd-202040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Availability of validated Parkinson's disease (PD) questionnaires in languages spoken in Africa will enable the conduct of epidemiological studies. OBJECTIVE The aims of the current study were to develop cross-cultural translated and validated Arabic and French versions of a PD screening questionnaire, and determine its diagnostic accuracy for recognition of parkinsonism in early and moderate-advanced PD in three countries (Cameroon (French), Egypt (Arabic), and Nigeria (English)). METHODS This cross-sectional study screened 159 participants (81 PD and 78 controls) using the PD screening questionnaire. The questionnaire was translated into Arabic and French versions using standard protocols. Cognitive function was assessed using the Montreal Cognitive Assessment and the Identification and Intervention for Dementia in Elderly Africans cognitive screen. Co-morbidity burden was documented using the Charlson Comorbidity Index. PD severity and stage were evaluated using the MDS Unified Parkinson Disease Rating Scale and the Hoehn and Yahr scale respectively. RESULTS Both PD patients and controls were matched regarding age, gender, education, and co-morbidity burden. The PD screening questionnaire scores were significantly higher in PD (median 8.0, IQR 6.0-10.0) in contrast to controls (0.0, IQR 0.0-0.0) (p < 0.0001), with a similar pattern and level of significance across all country sites. In ROC analysis, the questionnaire demonstrated high diagnostic accuracy for PD overall, with an AUC of 0.992 (95% CI 0.981-1.002). CONCLUSION The Arabic, French, and English versions of this PD screening questionnaire are valid and accurate screening instruments for recognition of Parkinsonism. This paves the way for conducting epidemiological studies in many African countries.
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Affiliation(s)
- Ali Shalash
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Njideka U Okubadejo
- Neurology Unit, Department of Medicine, College of Medicine, University of Lagos & Lagos University Teaching Hospital, Idi Araba, Lagos State, Nigeria
| | - Jacques Doumbe
- Department of Neurology, University of Douala, Douala, Cameroon
| | - Oluwadamilola O Ojo
- Neurology Unit, Department of Medicine, College of Medicine, University of Lagos & Lagos University Teaching Hospital, Idi Araba, Lagos State, Nigeria
| | - Eman Hamid
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Callixte Kuate
- Department of Neurology, University of Douala, Douala, Cameroon
| | - Sara Calvo
- Neurology Department, University Hospital, Burgos, Spain
| | - Asmaa Helmi
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Osigwe P Agabi
- Neurology Unit, Department of Medicine, Lagos University Teaching Hospital, Idi Araba, Lagos State, Nigeria
| | - Mohamed Essam
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Laura Aguado
- Neurology Department, University Hospital, Burgos, Spain
| | - Hanan Elrassas
- Okasha Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Tamer Roushdy
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Caroline M Tanner
- Department of Neurology, Weill Institute for Neurosciences, University of California - San Francisco, San Francisco, CA, USA
| | - Esther Cubo
- Neurology Department, University Hospital, Burgos, Spain
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Gordijn R, Nicolai MPJ, Elzevier HW, Guchelaar HJ, Teichert M. An estimation of patients at potential risk for drug-induced sexual dysfunction using pharmacy dispensing data. Fam Pract 2021; 38:292-298. [PMID: 33140832 PMCID: PMC8211144 DOI: 10.1093/fampra/cmaa116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Adverse drug reactions on sexual functioning (sADRs) may seriously decrease a person's quality of life. A multitude of diseases and drugs are known risk factors for sexual dysfunction. To inform patients better about these potential effects, more insight is needed on the estimated number of patients at high risk for sADRs and their characteristics. METHODS This cross-sectional study estimated the number of patients in the Netherlands who were dispensed drugs with a potential very high risk (>10%) or high risk (1-10%) for sADRs as registered in the Summary of Product Characteristics, the official drug information text in Europe. RESULTS In April 2019, 2.06% of the inhabitants of the Netherlands received drugs with >10% risk for sADRs and 7.76% with 1-10% risk. The majority of these patients had at least one additional risk factor for decreased sexual function such as high age or depression. Almost half of the patients were identified with two or more morbidities influencing sexual functioning. Paroxetine, sertraline and spironolactone were the most dispensed drugs with a potential >10% risk for sADRs. One-third of their first dispenses were not followed by a second dispense, with a higher risk of discontinuation for a decreasing number of morbidities. CONCLUSION About 1 in 11 inhabitants of the Netherlands was dispensed a drug with a potential high risk for sADRs, often with other risk factors for sexual complaints. Further research is needed whether these users actually experience sADRs, to understand its impact on multimorbid patients and to provide alternatives if needed.
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Affiliation(s)
- Rineke Gordijn
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Henk W Elzevier
- Department of Urology and Department of Medical Decision Making
| | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martina Teichert
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, The Netherlands
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Moussa M, Papatsoris AG, Abou Chakra M, Dabboucy B, Fares Y. Erectile dysfunction in common neurological conditions: A narrative review. ACTA ACUST UNITED AC 2020; 92. [PMID: 33348971 DOI: 10.4081/aiua.2020.4.371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/08/2020] [Indexed: 11/23/2022]
Abstract
Neurogenic erectile dysfunction (NED) can be defined as the inability to achieve or maintain an erection due to central or peripheral neurologic disease. Neurologic diseases can also affect the physical ability and psychological status of the patient. All these factors may lead to a primary or secondary NED. Medication history plays an important role since there are many drugs commonly used in neurologic patients that can lead to ED. The assessment of NED in these patients is generally evolving with the application of evoked potentials technology in the test of somatic and autonomic nerves, and functional magnetic resonance imaging. With the electrophysiological examinations, neurogenic causes can be determined. These tools allow to categorize neurologic lesion and assess the patient prognosis. The first-line treatment for NED is phosphodiesterase inhibitors. Second-line treatments include intracavernous and intraurethral vasoactive injections. Third-line treatments are penile prostheses. The efficacy and safety of each treatment modality depend on the specific neurologic condition. This review discusses the physiology, pathophysiology, diagnosis, and treatment of ED in multiple peripheral and central neurologic conditions, as well as for future research.
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Affiliation(s)
- Mohamad Moussa
- Urology Department, Zahraa Hospital, University Medical Center, Beirut.
| | - Athanasios G Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens.
| | - Mohamad Abou Chakra
- Department of Urology, Faculty of Medical Sciences, Lebanese University, Beirut.
| | - Baraa Dabboucy
- Department of Neurosurgery, Faculty of Medical Sciences, Lebanese University, Beirut.
| | - Youssef Fares
- Department of Neurosurgery, Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut.
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Abstract
Recognition of the importance of nonmotor dysfunction as a component of Parkinson's disease has exploded over the past three decades. Autonomic dysfunction is a frequent and particularly important nonmotor feature because of the broad clinical spectrum it covers. Cardiovascular, gastrointestinal, urinary, sexual, and thermoregulatory abnormalities all can appear in the setting of Parkinson's disease. Cardiovascular dysfunction is characterized most prominently by orthostatic hypotension. Gastrointestinal dysfunction can involve virtually all levels of the gastrointestinal tract. Urinary dysfunction can entail either too frequent voiding or difficulty voiding. Sexual dysfunction is frequent and frustrating for both patient and partner. Alterations in sweating and body temperature are not widely recognized but often are present. Autonomic dysfunction can significantly and deleteriously impact quality of life for individuals with Parkinson's disease. Because effective treatment for many aspects of autonomic dysfunction is available, it is vitally important that assessment of autonomic dysfunction be a regular component of the neurologic history and exam and that appropriate treatment be initiated and maintained.
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Affiliation(s)
- Ronald F Pfeiffer
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239-3098, USA.
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Komlenac N, Hochleitner M. Predictors for Low Frequencies of Patient-Physician Conversations Concerning Sexual Health at an Austrian University Hospital. Sex Med 2019; 8:100-106. [PMID: 31680029 PMCID: PMC7042158 DOI: 10.1016/j.esxm.2019.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/28/2019] [Accepted: 09/29/2019] [Indexed: 11/26/2022] Open
Abstract
Introduction Studies concerning barriers to patient-physician conversations about sexual health or, specifically, sexual functioning fail to go beyond descriptive analyses of such barriers. Aim To identify barriers that predict the frequency of patient-physician conversations concerning sexual health or sexual functioning. Methods An online survey among physicians was conducted at an Austrian university hospital. Self-constructed questionnaires assessed physicians’ sociodemographic information, frequency of holding a discussion on sexual health or sexual dysfunctions with their patients, and self-perceived barriers to asking patients about sexual health. Stepwise logistic regression models determined barriers that predicted the frequency of patient-physician conversations concerning sexual health or sexual dysfunctions in everyday clinical practice. Main Outcome Measure The outcome variables in the structural equation models were frequency of patient-physician conversations concerning sexual health or sexual dysfunctions in everyday clinical practice. Results One hundred two physicians (53.9% women, 46.1% men; mean age = 41.3 years; SD = 10.6) provided full responses. Of these physicians, 61.8% reported having a discussion on sexual health or sexual dysfunctions with their patients at least rarely in their everyday clinical practice. The barriers most influencing the frequency of such patient-physician conversations were not feeling responsible for this health issue and expecting the patient to initiate such a conversation. Fear of offending the patient and the physician’s own feelings of shame and discomfort were additional factors influencing the frequency of these patient-physician conversations. Clinical Implications Future physician training should address physicians’ responsibilities that include sexual health. Future physician training should also help physicians in overcoming fears of offending a patient, and one’s own feelings of shame and discomfort when addressing patients’ sexual health. Strengths & Limitations This study included physicians across a range of disciplines, who may encounter patients with sexual problems and with their treatments influence a patient’s sexual health and sexual functioning. However, the low response rate and the limited number of participants prevented generalization of findings. Conclusions At an Austrian university hospital, patient-physician conversations concerning sexual health are seldom part of a physician’s everyday clinical practice. Future training for physicians should focus on demonstrating the relevance of sexual health in the physician’s medical discipline and should tackle a physician’s feelings of shame or how to handle patients’ negative reactions during patient-physician conversations concerning sexual health. Komlenac N, Hochleitner M. Predictors for Low Frequencies of Patient-Physician Conversations Concerning Sexual Health at an Austrian University Hospital. Sex Med 2019; 8:100–106.
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Affiliation(s)
- Nikola Komlenac
- Gender Medicine Unit, Medical University of Innsbruck, Innsbruck, Austria.
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de Rooy FBB, Buhmann C, Schönwald B, Martinez-Martin P, Rodriguez-Blazquez C, Putter H, Elzevier HW, van der Plas AA. Discussing sexuality with Parkinson's disease patients: a multinational survey among neurologists. J Neural Transm (Vienna) 2019; 126:1273-1280. [PMID: 31396705 PMCID: PMC6765045 DOI: 10.1007/s00702-019-02053-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/24/2019] [Indexed: 01/23/2023]
Abstract
Sexual dysfunction is a major non-motor feature of Parkinson’s disease (PD) that may affect the quality of life of many patients. In a Dutch survey, we demonstrated that neurologists often fail to discuss sexuality with their patients. Our objective was to determine to which extent neurologists in Spain and Germany address sexuality with their patients and whether cross-cultural differences exist. A 30-item questionnaire was sent out to 1650 German and 460 Spanish neurologists. The questionnaire addressed attitudes, knowledge, barriers, and feelings of responsibility regarding sexuality in PD. 160 German and 32 Spanish respondents completed and returned the questionnaire. The majority of German and Spanish participants discuss sexual dysfunction ‘regularly’ with male patients (61.7% and 78.9%, respectively), but ‘seldom’ with female patients (68.8% and 78.1%, respectively). Important barriers for German and Spanish respondents to discuss sexual dysfunction were patients not expressing sexual complaints spontaneously (52.9% and 75.0%, respectively) and insufficient consultation time (32.2% and 71.9%, respectively). Sexual dysfunction in PD was considered important by 68.3% of German and 96.9% of Spanish participants. German and Spanish neurologists do not routinely discuss sexual dysfunction with their patients, although many of them consider it important to address this topic. It is unclear why this lack of discussing sexual dysfunction is especially found for female patients and whether cultural aspects are involved. We recommend a self-assessment tool for patients to track their symptoms prior to consultation visits and advocate local guidelines that formulate who is responsible for discussing sexual dysfunction.
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Affiliation(s)
- F B B de Rooy
- Department of Urology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
| | - C Buhmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraβe 52, 20246, Hamburg, Germany
| | - B Schönwald
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraβe 52, 20246, Hamburg, Germany
| | - P Martinez-Martin
- National Center of Epidemiology and CIBERNED, Institute of Health Carlos III, Madrid, Spain
| | - C Rodriguez-Blazquez
- National Center of Epidemiology and CIBERNED, Institute of Health Carlos III, Madrid, Spain
| | - H Putter
- Department of Medical Statistics, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - H W Elzevier
- Department of Urology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
- Department of Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - A A van der Plas
- Department of Neurology, Alrijne Hospital, Simon Smitweg 1, 2353 GA, Leiderdorp, The Netherlands
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