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Kitaw TA, Abate BB, Tilahun BD, Yilak G, Haile RN. Umbrella review protocol: Global burden and risk factors of erectile dysfunction in diabetic population. Health Sci Rep 2024; 7:e2159. [PMID: 38826618 PMCID: PMC11139671 DOI: 10.1002/hsr2.2159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/13/2024] [Accepted: 05/16/2024] [Indexed: 06/04/2024] Open
Abstract
Background Erectile dysfunction (ED) is no longer a whisper in the shadows; it's a rising tide threatening the sexual health of millions of men in different regions. This worrying trend shows no signs of slowing down, with projections claiming a staggering 322 million men globally could be affected in the near future. In the cases of diabetes, the condition worsens and has a potent cocktail of physical and psychological distress, chipping away at men's confidence, self-esteem, and mental health. This urgent issue demands immediate attention and action. Thus, this umbrella review intended to estimate the current burden of ED and associated risk factors among diabetic patients in the global context. Methods Following PRISMA guidelines will be searched for relevant Systematic Review and Meta-analysis studies in PubMed, Embase, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar. The quality of the included studies will be assessed using the new regress tool, the Assessment of Multiple Systematic Reviews 2 tool. To estimate the pooled prevalence of ED, we will employ a weighted inverse variance random-effects model. We will further conduct subgroup analyses, assess heterogeneity and publication bias, and perform sensitivity analyses to strengthen the robustness of our findings. Prediction intervals will also calculated to estimate the range within which future observations will likely fall. In all statistical analyses, the statistical significance will be declared at p value < 0.05. Discussion This umbrella review of systemic review and meta-analysis will be the first to systematically explore and integrate evidence regarding the burden of ED and associated risk factors in the diabetic population in a global context. By estimating the worldwide burden and identifying risk factors of ED in this population, the study will contribute to uncovering the hidden burden. Thereby, the issue will get international attention to reduce its consequences on the sexual health of the diabetic population. Besides, it will also provide input and direction for future research outlook.
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Affiliation(s)
| | - Biruk Beletew Abate
- Department of Nursing, College of Health ScienceWoldia UniversityWoldiaEthiopia
| | | | - Gizachew Yilak
- Department of Nursing, College of Health ScienceWoldia UniversityWoldiaEthiopia
| | - Ribka Nigatu Haile
- Department of Nursing, College of Health ScienceWoldia UniversityWoldiaEthiopia
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van Pinxteren M, Delobelle P, Levitt N, Smith K, Majikela-Dlangamandla B, McGrath N. 'I accept his manhood is on life-support': A qualitative understanding of the impact of diabetes on sexual relationships among men and women living with type 2 diabetes and their partners in South Africa. Diabet Med 2023; 40:e15203. [PMID: 37594410 DOI: 10.1111/dme.15203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/12/2023] [Accepted: 08/16/2023] [Indexed: 08/19/2023]
Abstract
AIMS To explore the impact of diabetes on sexual relationships among men and women living with type 2 diabetes People living with type 2 diabetes (PLWD) and their partners in Cape Town, South Africa. METHODS As part of a larger study developing an intervention to improve type 2 diabetes mellitus (T2DM) self management, we conducted in-depth individual interviews with 10 PLWD and their partners without diabetes about experiences living with T2DM, between July 2020 and January 2021. We used inductive thematic analysis. RESULTS Both PLWD and partners felt that their sexual relationships and desires changed post-diagnosis, in ways beyond biomedical issues. Although couples' reports on the quality of their sexual relationships were concordant, most participants had not communicated their sexual desires and concerns with each other, causing unhappiness and fears of disappointing or losing their partner. Participants felt uninformed about sexual dysfunction but had not discussed this with their healthcare provider, leading to increased anxiety. CONCLUSION PLWD and their partners need more informational support to increase their understanding of diabetes-associated sexual dysfunction and to decrease fears and anxiety. Strengthening communication within couples on sexual issues may empower them to find solutions to problems experienced. This may improve couples' relationships and quality of life, and indirectly result in better self management of T2DM.
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Affiliation(s)
- Myrna van Pinxteren
- Department of Medicine, Chronic Diseases Initiative for Africa (CDIA), University of Cape Town, Cape Town, South Africa
| | - Peter Delobelle
- Department of Medicine, Chronic Diseases Initiative for Africa (CDIA), University of Cape Town, Cape Town, South Africa
- Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium
| | - Naomi Levitt
- Department of Medicine, Chronic Diseases Initiative for Africa (CDIA), University of Cape Town, Cape Town, South Africa
| | - Kirsten Smith
- Computing, Faculty of Technology, University of Portsmouth, Portsmouth, UK
| | - Buyelwa Majikela-Dlangamandla
- Department of Medicine, Chronic Diseases Initiative for Africa (CDIA), University of Cape Town, Cape Town, South Africa
| | - Nuala McGrath
- Faculty of Medicine, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
- Department of Social Statistics and Demography, Faculty of Social Sciences, University of Southampton, Southampton, UK
- Africa Health Research Institute, KwaZulu-Natal, South Africa
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Yin J, Rämgård M, Wangel AM. Sexual health in diabetes care is a 'hot topic'-A qualitative study with Diabetes Specialist Nurses. J Clin Nurs 2023; 32:7568-7577. [PMID: 37475608 DOI: 10.1111/jocn.16832] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 06/30/2023] [Accepted: 07/11/2023] [Indexed: 07/22/2023]
Abstract
AIM The aim of this study is to illuminate Diabetes Specialist Nurses' experiences of having a conversation about sexual health with adults with diabetes. BACKGROUND It is well known that diabetes mellitus may affect a person's sexual function. Interview studies with men and women living with diabetes show that conversations about sexual health are important. However, research on Diabetes Specialist Nurses' experiences of having such conversations is limited. DESIGN A qualitative approach, with individual interviews, was used. METHOD Purposive sampling was used to recruit 12 informants from adult diabetes care, within primary health care and within hospital settings in southern Sweden, between September and November 2021. A qualitative latent content analysis was used for data analysis. The COREQ guidelines were followed to ensure rigour for this study. RESULTS One theme, 'Sexual health is a hot topic', could be understood in light of three categories: 'Obstructive factors that complicate the conversation', 'Promoting factors that facilitate the conversation' and 'Improvements that may facilitate the conversation'. The findings embrace the Diabetes Specialist Nurses' experiences of having a conversation about sexual health with persons with diabetes. CONCLUSIONS Diabetes Specialist Nurses often experience difficulty having a conversation about sexual health with their patients. The findings provide a deeper understanding of their experiences of obstructive as well as promoting factors related to conversations about what is considered a 'hot topic'. RELEVANCE TO CLINICAL PRACTICE To increase knowledge on how to have a conversation about sexual health within diabetes care, support is needed from the organisation; the organisation could, for instance, support the diabetes care staff in gaining education and training regarding sexual health. PATIENT OR PUBLIC CONTRIBUTION Not applicable due to the current method.
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Affiliation(s)
- Janina Yin
- Faculty of Health and Society, Department of Care Science, Malmo University, Malmo, Sweden
- Department of Endocrinology, Scania University Hospital, Malmo, Sweden
| | - Margaret Rämgård
- Faculty of Health and Society, Department of Care Science, Malmo University, Malmo, Sweden
| | - Anne-Marie Wangel
- Faculty of Health and Society, Department of Care Science, Malmo University, Malmo, Sweden
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Igerc I, Schrems B. Sexual well-being needs of patients with chronic illness expressed in health care: A scoping review. J Clin Nurs 2023; 32:6832-6848. [PMID: 37323097 DOI: 10.1111/jocn.16773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/22/2022] [Accepted: 05/17/2023] [Indexed: 06/17/2023]
Abstract
AIMS To systematically identify and summarize the needs of chronically ill people concerning their sexual well-being in peer-reviewed published literature, to enable healthcare professionals to provide support in self-management satisfying the needs. DESIGN A scoping review was performed according to the framework of (JBI Manual for Evidence Synthesis. JBI Global Wiki, 2020). Findings are reported in line with the PRISMA extension for scoping reviews. REVIEW METHODS A literature search and thematic analysis were conducted. DATA SOURCES Full research was carried out in 2022 in the search engine BASE and the following databases: Scopus, MEDLINE, Science Citation Index Expanded, Social Sciences Citation Index and CINAHL. Peer-reviewed articles published after 2011 were included. RESULTS Fifty articles could be found. Seven categories of needs could be identified. People with chronic diseases want their providers to initiate discussions about sexual concerns and treat them trustfully and respectfully. Most of the patients would like the issue of sexuality to be included in routine care. They perceive their medical specialists and psychologists as preferred providers to talk to about this issue. Nurses are seen as primary contact persons but in a smaller number of studies. CONCLUSION Although the scoping review included different types of chronic diseases, the needs of chronically ill patients concerning their sexual well-being are not very different. Healthcare professionals, especially nurses, who are often the first point of contact for people with chronic illnesses, should take the initiative for open discussions about sexual issues. That requires a new understanding of the role of nurses, training and further education. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Providing patient education and facilitating an open discussion about sexuality require further training in the new understanding of the role of the nurse and the concept of sexual well-being. IMPACT What problem did the study address? Chronic diseases have an impact on patients' sexuality. Patients want to be informed about sexual issues, but providers often do not address them. What were the main findings? Patients with a chronic condition expect providers to initiate discussions about sexual well-being, regardless of the type of chronic disease. Where and on whom will the research have an impact? The research will impact healthcare professionals', especially nurses', future educational standards and ultimately patients. REPORTING METHOD PRISMA extension for scoping reviews. NO PATIENT OR PUBLIC CONTRIBUTION Not required as it was a literary work (scoping review).
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Affiliation(s)
- Irina Igerc
- Department of Nursing Science, University of Vienna, Vienna, Austria
| | - Berta Schrems
- Department of Nursing Science, University of Vienna, Vienna, Austria
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Søholm U, Zaremba N, Broadley M, Axelsen JL, Divilly P, Martine-Edith G, Amiel SA, Mader JK, Pedersen-Bjergaard U, McCrimmon RJ, Renard E, Evans M, de Galan B, Heller S, Hendrieckx C, Choudhary P, Speight J, Pouwer F. Assessing the Content Validity, Acceptability, and Feasibility of the Hypo-METRICS App: Survey and Interview Study. JMIR Diabetes 2023; 8:e42100. [PMID: 37773626 PMCID: PMC10576226 DOI: 10.2196/42100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 06/02/2023] [Accepted: 08/16/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND The Hypoglycaemia - MEasurement, ThResholds and ImpaCtS (Hypo-METRICS) smartphone app was developed to investigate the impact of hypoglycemia on daily functioning in adults with type 1 diabetes mellitus or insulin-treated type 2 diabetes mellitus. The app uses ecological momentary assessments, thereby minimizing recall bias and maximizing ecological validity. It was used in the Hypo-METRICS study, a European multicenter observational study wherein participants wore a blinded continuous glucose monitoring device and completed the app assessments 3 times daily for 70 days. OBJECTIVE The 3 aims of the study were to explore the content validity of the app, the acceptability and feasibility of using the app for the duration of the Hypo-METRICS study, and suggestions for future versions of the app. METHODS Participants who had completed the 70-day Hypo-METRICS study in the United Kingdom were invited to participate in a brief web-based survey and an interview (approximately 1h) to explore their experiences with the app during the Hypo-METRICS study. Thematic analysis of the qualitative data was conducted using both deductive and inductive methods. RESULTS A total of 18 adults with diabetes (type 1 diabetes: n=10, 56%; 5/10, 50% female; mean age 47, SD 16 years; type 2 diabetes: n=8, 44%; 2/8, 25% female; mean age 61, SD 9 years) filled out the survey and were interviewed. In exploring content validity, participants overall described the Hypo-METRICS app as relevant, understandable, and comprehensive. In total, 3 themes were derived: hypoglycemia symptoms and experiences are idiosyncratic; it was easy to select ratings on the app, but day-to-day changes were perceived as minimal; and instructions could be improved. Participants offered suggestions for changes or additional questions and functions that could increase engagement and improve content (such as providing more examples with the questions). In exploring acceptability and feasibility, 5 themes were derived: helping science and people with diabetes; easy to fit in, but more flexibility wanted; hypoglycemia delaying responses and increasing completion time; design, functionality, and customizability of the app; and limited change in awareness of symptoms and impact. Participants described using the app as a positive experience overall and as having a possible, although limited, intervention effect in terms of both hypoglycemia awareness and personal impact. CONCLUSIONS The Hypo-METRICS app shows promise as a new research tool to assess the impact of hypoglycemia on an individual's daily functioning. Despite suggested improvements, participants' responses indicated that the app has satisfactory content validity, overall fits in with everyday life, and is suitable for a 10-week research study. Although developed for research purposes, real-time assessments may have clinical value for monitoring and reviewing hypoglycemia symptom awareness and personal impact.
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Affiliation(s)
- Uffe Søholm
- Medical & Science, Patient Focused Drug Development, Novo Nordisk A/S, Søborg, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Natalie Zaremba
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Melanie Broadley
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | | | - Patrick Divilly
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Gilberte Martine-Edith
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Stephanie A Amiel
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Julia K Mader
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ulrik Pedersen-Bjergaard
- Department of Endocrinology and Nephrology, Nordsjællands Hospital Hillerød, Hillerød, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Rory J McCrimmon
- Systems Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Eric Renard
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Montpellier, France
| | - Mark Evans
- Welcome-MRC Institute of Metabolic Science and Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Bastiaan de Galan
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
- Department of Internal Medicine, Division of Endocrinology and Metabolic Disease, Maastricht University Medical Centre, Maastricht, Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands
| | - Simon Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Christel Hendrieckx
- School of Psychology, Institute for Health Transformation, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Carlton, Australia
| | - Pratik Choudhary
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - Jane Speight
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- School of Psychology, Institute for Health Transformation, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Carlton, Australia
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- School of Psychology, Institute for Health Transformation, Deakin University, Geelong, Australia
- Steno Diabetes Center Odense, Odense, Denmark
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Hadisuyatmana S, Malik G, Efendi F, Reisenhofer S, Boyd J. The experiences and barriers in addressing type 2 diabetes mellitus-associated erectile dysfunction: a mixed method systematic review. Syst Rev 2023; 12:138. [PMID: 37563662 PMCID: PMC10416416 DOI: 10.1186/s13643-023-02303-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 07/28/2023] [Indexed: 08/12/2023] Open
Abstract
INTRODUCTION Experiences and determinants connected with type 2 diabetes mellitus-associated erectile dysfunction (T2DMED) in health appointments are not well understood and infrequently reported. This systematic review was undertaken to synthesise evidence of the experiences, facilitators, and barriers around screening ED in men with T2DM during health service consultations. METHODS The review report was based on the guidelines provided by the Joanna Briggs Institute for conducting mixed-method systematic reviews. Eight electronic databases were searched, including Web of Science, Embase via Ovid, Cumulative Index to Nursing and Allied Health Literature (CINAHL) via EBSCO, ProQuest, PubMed, PsychInfo via Ovid, MEDLINE via Ovid, Portal Garuda. Additionally, the review manually looked through the reference lists of the studies we included. Erectile dysfunction, type 2 diabetes mellitus, screening and barriers were initially used as keywords in the search strategy. All identified primary studies written in English and Bahasa Indonesia, and published between 2001 and 2022 were meticulously screened following an agreed set of inclusion criteria. FINDINGS Out of 3468 papers screened, only six were chosen for the review. These included three cross-sectional studies, two qualitative studies, and one mixed-method study. The study quality of the included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. Based on the checklist criteria, the studies ranged between 5/10 to 9/10 in terms of quality. After synthesizing the findings, four main categories were identified including the willingness to discuss T2DMED, the barriers experienced and perceived, the limited understanding of T2DMED, and the support expected by men with T2DM. DISCUSSION Many men kept quiet about their struggles with T2DMED, hoping to bring it up as a topic of discussion during healthcare consultations. Barriers such as embarrassment, a sense of helplessness and reluctance to seek help, financial constraints, and dismissive healthcare professionals hindered them from addressing this issue. Both the participating men and healthcare professionals lacked a comprehensive understanding of T2DMED. RECOMMENDATIONS It is important to provide education tailored to men's specific needs and improve awareness about T2DM-associated ED. Creating a more T2DMED-friendly environment could be a potential solution to increase early screening and management. Future research should investigate potential barriers that prevent HCPs from identifying and addressing T2MED since their absence in the identified studies highlights this need. SYSTEMATIC REVIEW REGISTRATION CRD42021292454.
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Affiliation(s)
- Setho Hadisuyatmana
- The School of Psychology & Public Health, La Trobe University, Kingsbury Drive, Bundoora, Victoria, 3086, Australia.
- The Faculty of Nursing, Universitas Airlangga Indonesia, Kampus C Jln Mulyorejo 60115, Surabaya, East Java, Indonesia.
| | - Gulzar Malik
- The Faculty of Nursing, Universitas Airlangga Indonesia, Kampus C Jln Mulyorejo 60115, Surabaya, East Java, Indonesia
- The School of Nursing and Midwifery, La Trobe University, Kingsbury Drive, Bundoora, Victoria, 3086, Australia
| | - Ferry Efendi
- The Faculty of Nursing, Universitas Airlangga Indonesia, Kampus C Jln Mulyorejo 60115, Surabaya, East Java, Indonesia
- The School of Nursing and Midwifery, La Trobe University, Kingsbury Drive, Bundoora, Victoria, 3086, Australia
| | - Sonia Reisenhofer
- The School of Nursing and Midwifery, La Trobe University, Kingsbury Drive, Bundoora, Victoria, 3086, Australia
- Bairnsdale Regional Health Service, 122 Day Street, Bairnsdale, Victoria, 3875, Australia
| | - James Boyd
- The School of Psychology & Public Health, La Trobe University, Kingsbury Drive, Bundoora, Victoria, 3086, Australia
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Mphasha MH, Mothiba TM, Skaal L. Daily living activities' performance by male diabetics with sexual dysfunction in South Africa. Afr J Prim Health Care Fam Med 2023; 15:e1-e6. [PMID: 37526558 PMCID: PMC10476452 DOI: 10.4102/phcfm.v15i1.3885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/11/2022] [Accepted: 01/11/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Sexual dysfunction (SD) is a common complication among men living with diabetes (MLWD), which adds to stresses induced by medical condition. Effect of stress on their daily living activities has been only poorly described. AIM This study aimed to explore the behaviour and challenges of MLWD experiencing SD in respect of daily living activities. SETTING Five clinics in Senwabarwana in Limpopo province. METHODS Qualitative approach and phenomenological exploratory design were adopted to collect data from 15 male participants selected from five clinics using purposive homogeneous sampling. One-on-one interviews were conducted using voice recorders, and field notes were taken of non-verbal cues. Unstructured interview guide with principal question enabled instructive probing to be conducted. Data were analysed using eight steps of Tesch's inductive, descriptive and open coding technique. RESULTS Participants reported stressful experiences, difficulty coping with diabetes and its accompanying complication of SD that led to fear of losing their wives. They indicated that as a result of stress and difficulty in coping with the condition, they were engaged in less physical activity than before their diagnosis. CONCLUSION Sexual dysfunction is prevalent among male diabetics and often feel stressed and worried about losing their wives. They struggle to cope with conditions to the point where they are less capable of performing tasks than they were before diagnosis. These outcomes are critical issues that should be addressed in any diabetes treatment strategy.Contribution: Support-based collaboration of healthcare providers with spouses and revision of South African diabetes management strategy to incorporate healthy coping strategies are recommended.
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Affiliation(s)
- Mabitsela H Mphasha
- Department of Public Health, Faculty of Healthcare Sciences, University of Limpopo, Polokwane.
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Huang C, Tsai L, Chung C, Shih F, Wang Y. The effect of design thinking approach in interprofessional education programme of human sexuality course: A quasi-experimental design. Nurs Open 2022; 10:967-976. [PMID: 36114695 PMCID: PMC9834516 DOI: 10.1002/nop2.1363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 03/12/2022] [Accepted: 08/23/2022] [Indexed: 01/16/2023] Open
Abstract
AIMS To determine the effect of design thinking approach in interprofessional education programme of human sexuality course. DESIGN A pre-test and post-test of single-group quasi-experimental study. METHODS The 35 nursing students and seven psychology students in their third year were selected by the computer randomly sampling through the lottery method. The course proceeded between September 2019 and January 2020. The participants had received an 8-week, 16-hr design thinking approach in interprofessional education programme of human sexuality course (one section per week, 2 hr per section). We used the nursing attitude toward sexual healthcare scale, nursing intervention toward sexual healthcare scale to assess students' attitude and behaviour intention toward sexual health care and competence of interprofessional education scale to assess students' competence of cooperation before and after the teaching programme. Data analysis used descriptive statistics and t-tests. A qualitative reflection log was also provided and analysed for themes. The SQUIRE-EDU checklist was followed. RESULTS The students' attitude and behavioural intention dimension score in the post-test is higher than those in the pre-test and reach statistically significant differences both in total and subscale. Interprofessional core competence score of Observation Experience, Reflective Feedback, Interprofessional Cooperation, Innovative Design, and Applied Technology score in the post-test is higher than those in the pre-test and reach statistically significant differences both in total and subscale. Design thinking in interprofessional education programme of human sexuality course could significantly improve both nursing and psychology students' attitude, behaviour intention of providing sexual health care and competence of interprofessional cooperation.
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Affiliation(s)
- Cheng‐Yi Huang
- Department of NursingChung Shan Medical UniversityTaichungTaiwan,Department of NursingChung Shan Medical University HospitalTaichungTaiwan
| | - Li‐Ya Tsai
- School of Nursing, College of NursingAsia UniversityTaichungTaiwan
| | - Chu‐Hua Chung
- Department of NursingChung Shan Medical University HospitalTaichungTaiwan,Department of Nursing, FacultyChung Shan Medical UniversityTaichungTaiwan
| | - Fen‐Fen Shih
- Department of NursingChung Shan Medical UniversityTaichungTaiwan,Department of NursingChung Shan Medical University HospitalTaichungTaiwan
| | - Yu‐Ming Wang
- Department of Psychology, Chung Shan Medical University Clinical Psychological RoomChung Shan Medical UniversityTaichungTaiwan
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de Silva NL, Athukorala T, Gamage JL, Katulanda G, de Silva P, Sumanatilleke M, Somasundaram N. Sexual dysfunction among men with diabetes; a cross-sectional study at a specialised diabetes clinic in Sri Lanka. BMC Endocr Disord 2022; 22:206. [PMID: 35978307 PMCID: PMC9382620 DOI: 10.1186/s12902-022-01108-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Male sexual dysfunction in diabetes is often an unrevealed clinical issue. Though many publications report the prevalence, there is limited data on its associations, impact, and health-seeking behaviour. The objectives were to assess the prevalence of male sexual dysfunction, its associations, impact and treatment-seeking among men with diabetes in a selected tertiary care Diabetes Clinic. METHODS A cross-sectional study was conducted at the Diabetes Clinic, National Hospital of Sri Lanka, from January to September 2020. Men with diabetes aged 18 to 70 years undergoing annual assessment were recruited consecutively. Socio-demographic and clinical information were collected using an interviewer-administered questionnaire. Erectile dysfunction (ED), premature ejaculation, mental health and quality of life were assessed using validated self-administered questionnaires. Cardiovascular autonomic reflex tests and total testosterone levels were performed. Penile colour Doppler ultrasonography was performed on consenting participants with erectile dysfunction. Associations were assessed using the chi-square test or Fisher's exact for dichotomous variables and independent sample t-test for continuous variables. RESULTS Two hundred and twelve participants were recruited with a mean age of 54.1 (SD = 10.1) years. Erectile dysfunction was present in 168 (79.2%), (mild: 45, mild-moderate: 56, moderate: 26, severe: 41). Premature ejaculation was present in 26 (18.7%). Libido was low among 16%. Sexual dysfunction was not revealed to a health provider by 85.6% despite 60.5% experiencing psychological and/or relationship effects. Out of 18 who sought treatment, only 4 achieved a good response. Mean age (55.4 ± 9.5 vs 48.7 ± 10.6 years, p < 0.001) and duration of diabetes (10.9 ± 7.6 vs 5.8 ± 4.6 years, p < 0.001) were higher while eGFR was lower (73.9 ± 27.7 vs 100.51 ± 28.08 years, p < 0.008) among those with ED compared to those without. Diabetic retinopathy (4% vs 42%, p < 0.001), peripheral neuropathy (17.9% vs 38.4%, p = 0.041) and lower limb arterial disease (0% vs 12.2%, p = 0.04) were associated with ED. Arterial insufficiency was seen among 50% of the participants who underwent penile colour Doppler ultrasonography. CONCLUSIONS Male sexual dysfunction is a pervasive yet underappreciated problem in diabetes care despite its effect on the individual. Patient and disease characteristics would guide the identification of high-risk individuals for targeted screening in clinical practice.
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Affiliation(s)
- Nipun Lakshitha de Silva
- Department of Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Colombo, Sri Lanka.
- Diabetes and Endocrine Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka.
| | - Tharaka Athukorala
- Diabetes and Endocrine Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | | | - Gaya Katulanda
- Department of Chemical Pathology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Prasad de Silva
- Department of Radiology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | | | - Noel Somasundaram
- Diabetes and Endocrine Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
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Severina IC, Lima LRD, Funghetto SS, Santos WS, Volpe CRG, Stival MM. Ineffective sexuality pattern of elderly people with Diabetes mellitus. ESCOLA ANNA NERY 2022. [DOI: 10.1590/2177-9465-ean-2021-0326en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective to investigate the nursing diagnosis ineffective sexuality pattern in elderly people with Diabetes mellitus in primary care and analyze their sexuality profile. Method this is a cross-sectional study carried out in a Basic Health Unit with a sample of 134 elderly diabetics. Interviews were carried out between July and August 2019 with structured instruments and laboratory tests. An instrument was used to investigate the nursing diagnosis ineffective sexuality pattern with conceptual and operational definitions of the defining characteristics and related factors according to the NANDA-I taxonomy (2018-2020). Results women predominated, although men were more sexually active (p < 0.001). Younger people were more sexually active (p = 0.001). Regarding hormonal parameters, elderly people with higher testosterone levels reported being sexually active (p < 0.001). Most do not use condoms during sexual intercourse. When analyzing the nursing diagnosis of ineffective sexuality pattern, the most prevalent defining characteristic was “a change in sexual behavior” and the related factor was “skills deficit in sexuality-related alternatives”. Conclusions and implications for practice the nursing diagnosis ineffective sexuality pattern has importance in assessing elderly diabetics, as sexuality influences their behavior and personal satisfaction.
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Severina IC, Lima LRD, Funghetto SS, Santos WS, Volpe CRG, Stival MM. Padrão de sexualidade ineficaz de idosos com Diabetes mellitus. ESCOLA ANNA NERY 2022. [DOI: 10.1590/2177-9465-ean-2021-0326pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo investigar o diagnóstico de enfermagem Padrão de sexualidade ineficaz em idosos com Diabetes mellitus na atenção primária e analisar o seu perfil de sexualidade. Método estudo transversal realizado em uma Unidade Básica de Saúde com uma amostra de 134 idosos diabéticos. Entrevista foi realizada entre julho e agosto de 2019 com instrumentos estruturados, assim como foram coletados exames laboratoriais. Para investigação do diagnóstico de enfermagem Padrão de Sexualidade Ineficaz, foi utilizado um instrumento com as definições conceituais e operacionais das características definidoras e fatores relacionados de acordo com a taxonomia NANDA-I (2018-2020). Resultados predominaram mulheres, mas os homens eram mais ativos sexualmente (p<0,001). Os mais jovens eram sexualmente mais ativos (p = 0,001). Com relação aos parâmetros hormonais, idosos com maiores níveis de testosterona relataram serem ativos sexualmente (p<0,001). A maioria não utiliza preservativo durante a relação sexual. Ao analisar o diagnóstico de enfermagem Padrão de Sexualidade Ineficaz, a característica definidora mais prevalente foi “alteração no comportamento sexual”, e o fator relacionado foi “déficit de habilidades sobre alternativas relacionadas à sexualidade”. Conclusão e implicações para a prática o diagnóstico de enfermagem Padrão de Sexualidade Ineficaz tem sua importância na avaliação de idosos diabéticos, visto que a sexualidade tem influência em seu comportamento e sua satisfação pessoal.
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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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Pretorius D, Couper ID, Mlambo MG. Neglected sexual dysfunction symptoms amongst chronic patients during routine consultations in rural clinics in the North West province. Afr J Prim Health Care Fam Med 2021; 13:e1-e7. [PMID: 33970010 PMCID: PMC8111628 DOI: 10.4102/phcfm.v13i1.2850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/19/2021] [Accepted: 03/04/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Sexual dysfunction contributes to personal feelings of loss and despair and being a cause of exacerbated interpersonal conflict. Erectile dysfunction is also an early biomarker of cardiovascular disease. As doctors hardly ever ask about this problem, it is unknown how many patients presenting for routine consultations in primary care suffer from symptoms of sexual dysfunction. AIM To develop an understanding of sexual history taking events, this study aimed to assess the proportion of patients living with symptoms of sexual dysfunction that could have been elicited or addressed during routine chronic illness consultations. SETTING The research was carried out in 10 primary care facilities in Dr Kenneth Kaunda Health District, the North West province, South Africa. This rural area is known for farming and mining activities. METHODS This study contributed to a broader research project with a focus on sexual history taking during a routine consultation. A sample of 151 consultations involving patients with chronic illnesses were selected to observe sexual history taking events. In this study, the patients involved in these consultations completed demographic and sexual dysfunction questionnaires (FSFI and IIEF) to establish the proportions of patients with sexual dysfunction symptoms. RESULTS A total of 81 women (78%) and 46 men (98%) were sexually active. A total of 91% of the women reported sexual dysfunction symptoms, whilst 98% of men had erectile dysfunction symptoms. The youngest patients to experience sexual dysfunction were a 19-year-old woman and a 26-year-old man. Patients expressed trust in their doctors and 91% of patients did not consider discussion of sexual matters with their doctors as too sensitive. CONCLUSION Clinical guidelines, especially for chronic illness care, must include screening for sexual dysfunction as an essential element in the consultation. Clinical care of patients living with chronic disease cannot ignore sexual well-being, given the frequency of problems. A referral to a sexual medicine specialist, psychologist or social worker can address consequences of sexual dysfunction and improve relationships.
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Affiliation(s)
- Deidre Pretorius
- Division of Family Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg.
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14
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Hadisuyatmana S, Efendi F, Has EMM, Wahyuni SD, Bauer M, Boyd JH, Reisenhofer S. The Experience of Indonesian Men Living with Type-2 Diabetes Mellitus and Erectile Dysfunction: A Semi-structured Interview Study. SEXUALITY AND DISABILITY 2021. [DOI: 10.1007/s11195-021-09687-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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Leon N, Namadingo H, Bobrow K, Cooper S, Crampin A, Pauly B, Levitt N, Farmer A. Intervention development of a brief messaging intervention for a randomised controlled trial to improve diabetes treatment adherence in sub-Saharan Africa. BMC Public Health 2021; 21:147. [PMID: 33451308 PMCID: PMC7811237 DOI: 10.1186/s12889-020-10089-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 12/17/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Brief messaging interventions, including Short Message Service (SMS) text-messages, delivered via mobile device platforms, show promise to support and improve treatment adherence. To understand how these interventions work, and to facilitate transparency, we need clear descriptions of the intervention development process. METHOD We describe and reflect on the process of designing and pretesting an evidence- and theory-informed brief messaging intervention, to improve diabetes treatment adherence in sub-Saharan Africa. We followed the stepwise approach recommended by the Medical Research Council, United Kingdom (MRC UK) Framework for Development and Evaluation of Complex Health Interventions and guidance for mobile health intervention development. RESULTS We used a four-phase, iterative approach that first generated primary and secondary evidence on the lived experience of diabetes, diabetes treatment services and mobile-phone use. Second, we designed a type 2 diabetes-specific, brief text-message library, building on our previous hypertension text-message library, as well as drawing on the primary and secondary data from phase one, and on expert opinion. We then mapped the brief text-messages onto behaviour change (COM-B) theoretical constructs. Third, we refined and finalised the newly developed brief text-message library through stakeholder consultation and translated it into three local languages. Finally, we piloted the intervention by pre-testing the automated delivery of the brief text-messages in the trial sites in Malawi and South Africa. The final SMS text Adherence suppoRt for people with type 2 diabetes (StAR2D) intervention was tested in a randomised controlled trial in Malawi and South Africa (trial registration: ISRCTN70768808 ). CONCLUSION The complexity of public health interventions requires that we give more attention to intervention development work. Our documentation and reflection on the StAR2D intervention development process promotes transparency, replicability, assessment of intervention quality, and comparison with other studies.
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Affiliation(s)
- Natalie Leon
- South African Medical Research Council, Cape Town, South Africa.
| | - Hazel Namadingo
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Kirsty Bobrow
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa
| | - Sara Cooper
- South African Medical Research Council, Cape Town, South Africa
| | - Amelia Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bruno Pauly
- Department of Diabetes and Endocrinology, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Naomi Levitt
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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16
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Esen İ, Aktürk Esen S. Health Literacy and Quality of Life in Patients With Type 1 Diabetes Mellitus. Cureus 2020; 12:e10860. [PMID: 33178513 PMCID: PMC7652028 DOI: 10.7759/cureus.10860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2020] [Indexed: 11/11/2022] Open
Abstract
Aim The aim of this study was to investigate the relationship between health literacy (HL) and quality of life (QoL) in type 1 diabetes mellitus (DM) patients. Method This study was conducted between February 2020 and May 2020 at the University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, in Turkey. A total of 155 patients with type 1 DM between the ages of 18-65 were included in the study. QoL was evaluated with the Audit of Diabetes Dependent QoL questionnaire and HL was evaluated with the Newest Vital Sign (NVS) questionnaire and obtained results were compared. Results The weighted impact score for the overall QoL scale was higher for patients who did not have complications than those with complications (p=0.004). Retinopathy and nephropathy were higher in the group with low HL (p=<0.001; p=0.032; p=0.012, respectively). The weighted impact score for the overall QoL scale was lower in married individuals (p=0.040) and it was higher for high school and above education levels than those with lower education levels (p=0.004). The sex life weighted impact score was higher in the group with DM less than 10 years (p=0.045). Conclusion Patients with high HL status are more adaptable to their physician's recommendations, less frequent complications will occur in these patients and the QoL of the patients will be better in the absence of complications.
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Affiliation(s)
- İrfan Esen
- Internal Medicine, Yildirim Beyazit University Yenimahalle Research and Training Hospital, Ankara, TUR
| | - Selin Aktürk Esen
- Medical Oncology, Health of Science Ankara City Hospital, Ankara, TUR
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Shiferaw WS, Akalu TY, Aynalem YA. Prevalence of Erectile Dysfunction in Patients with Diabetes Mellitus and Its Association with Body Mass Index and Glycated Hemoglobin in Africa: A Systematic Review and Meta-Analysis. Int J Endocrinol 2020; 2020:5148370. [PMID: 32411224 PMCID: PMC7201640 DOI: 10.1155/2020/5148370] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/16/2019] [Accepted: 12/30/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Mortality and morbidity in patients with diabetes mellitus (DM) are attributed to both microvascular and macrovascular complications. However, there is a significant amount of variation in the primary studies on DM regarding the prevalence of erectile dysfunction (ED) in Africa. Therefore, this study was aimed to estimate the pooled prevalence of ED patients with DM and its association with body mass index (BMI) and glycated hemoglobin in Africa. METHODS PubMed, Web of Science, Cochrane Library, Scopus, PsycINFO, African Journals Online, and Google Scholar were searched for studies that looked at ED in DM patients. A funnel plot and Egger's regression test were used to determine publication bias. The I 2 statistic was used to check heterogeneity between the studies. DerSimonian and Laird random-effects model was applied to estimate the pooled effect size. The subgroup and meta-regression analyses were conducted by country, sample size, and year of publication. Sensitivity analysis was deployed to see the effect of a single study on the overall estimation. STATA version 14 statistical software was used for the meta-analysis. RESULT A total of 13 studies with 3,501 study participants were included in this study. We estimated that the pooled prevalence of ED in patients with DM in Africa was 71.45% (95% CI: 60.22-82.69). Diabetic patients whose BMI was ≥30 kg/m2 were 1.26 times more likely to develop ED (AOR = 1.26; 95% CI: 0.73-2.16) and whose glycated hemoglobin was <7% were 7% less likely to develop ED (AOR = 0.93; 95% CI: 0.5-5.9), although they were not significantly associated with ED. CONCLUSIONS The prevalence of ED in DM patients in Africa remains high. Therefore, situation-based interventions and country context-specific preventive strategies should be developed to reduce the prevalence of ED among patients with DM.
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Affiliation(s)
- Wondimeneh Shibabaw Shiferaw
- Lecturer of Nursing, Department of Nursing, College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Tadesse Yirga Akalu
- Lecturer of Nursing, Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Yared Asmare Aynalem
- Lecturer of Nursing, Department of Nursing, College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia
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