[Predictive validity of the risk SCORE model in a Mediterranean population with arterial hypertension]. / Validez en la predicción de riesgo de la escala SCORE en una población mediterránea con hipertensión arterial.

INTRODUCTION AND OBJECTIVES: Hypertension is the most prevalent risk factor globally. Calculation of cardiovascular risk in hypertensive patients before initiation of treatment is recommended. This study aimed to assess the predictive value and clinical utility of the SCORE scale in preventing cardiovascular events and all-cause mortality in patients with hypertension. METHODS: Patients with hypertension from the ESCARVAL-RISK cohort were included. Cardiovascular risk was calculated using the SCORE scale. All deaths and cardiovascular events were recorded during a 5-year follow-up period. Sensitivity, specificity and predictive values were calculated for different cut-off points and the effect of different risk factors on the diagnostic accuracy of SCORE charts were assessed. RESULTS: In a final cohort of 9834 patients, there were 555 cardiovascular events and 69 deaths. The recommended risk value for initiating drug treatment (5%) had a specificity of 92% for death and 91% for cardiovascular events, and a sensitivity of 20% for death and 22% for cardiovascular events. In addition, the scale classified 80.4% of patients who experienced a cardiovascular event and 78.3% of those who died as low risk. Age, body mass index, retinopathy and anticoagulant therapy were associated with reduced predictive ability of the SCORE scale, while being female was associated with better risk prediction. CONCLUSIONS: The predictive ability of the SCORE scale for cardiovascular disease and total mortality in patients with hypertension is limited.

Sexual functioning in women with mild and severe symptoms of Charcot-Marie-Tooth disease.

INTRODUCTION: Charcot-Marie-Tooth (CMT) disease is one of the most frequently inherited neurological disorders, and while it is known that individuals suffering from this condition have low quality of life, little is known about their sexual function and satisfaction. AIM: To describe the functioning on different domains of sexuality in a relatively large sample of women with CMT, provide comparisons between mildly and severely affected patients and between women with the two different types of CMT (demyelinating vs. axonal), and assess the relationship between sexual function and age of onset. METHODS: Fifty-seven women (age: 18-60 years) were approached in a CMT rehabilitation clinic by a psychologist and administered the Italian version of the McCoy Female Sexuality Questionnaire (MFSQ). Data from 40 patients who had had sexual intercourse in the previous 4 weeks were analyzed. MAIN OUTCOME MEASURE: The main outcome measures are the factors MFSQ-SEX and MFSQ-PARTNER, which describe sexual functioning and sexual satisfaction with a partner, respectively. RESULTS: Almost 30% of women did not engage in sexual intercourse with a partner. Overall sexual problems were more prominent in younger women and tended to be lower as age increased: this pattern was different from what was reported in previous studies in comparable samples of healthy Italian women. Severity of CMT was associated with better sexual functioning in the areas of desire, arousal, orgasm, and satisfaction, with women with more severe symptoms reporting greater functioning. Women with more severe CMT symptoms reported more pain during intercourse. Age of CMT onset and type of CMT (demyelinating vs. axonal) were not associated with differences in sexual functioning. CONCLUSIONS: Findings point to the importance of including assessment of sexual dysfunction in young women with mild CMT symptoms and the importance of providing sex therapy or counseling to these patients.

Genito Pelvic Pain/Penetration Disorder (GPPPD) in Spanish Women-Clinical Approach in Primary Health Care: Review and Meta-Analysis.

Sexuality is a component of great relevance in humans. Sexual disorders are a major public health problem representing a high prevalence in the general population. DSM-5 genito-pelvic pain/penetration disorder (GPPPD) includes dyspareunia and vaginismus (DSM-IV-TR). To assess the importance of research on these disorders in Spain, we evaluated the Spanish scientific publications of primary and community care. The objective was to quantify the magnitude of the publications of GPPPD in Spanish women in primary and community care. For this, we used the method of conducting a systematic review and meta-analysis of studies evaluating GPPPD. As main results, of the 551 items found, we selected 11 studies that met the inclusion criteria. In primary care in Spain, one in nine women has these disorders; the percentage of women with GPPPD in this study (raw data) was 11.23% (95% CI: 0-29%) (vaginismus 5%; penetration pain 8.33%; dyspareunia 16.45%). These percentages can differ of those from other countries, and they are at the top of the data of the European countries (9-11.9%). There is much variability in the studies found in the world with respect to the prevalence of these health problems.

Impact of Anal Fissure on Neuroticism, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness: A Case-Control Study.

INTRODUCTION: Scientific literature on determining patterns of personality traits in patients with anal fissure is limited. OBJECTIVES: To determine whether certain common psychological traits are associated with anal fissure. METHODS: A case-control study was carried out in Spain in 2016-2017. Patients with acute or chronic idiopathic anal fissure (n = 35) and controls (n = 32) were recruited. The main outcome measures were those defined in the NEO-FFI questionnaire, validated in Spain, which was administered to all the participants. This questionnaire evaluates the following traits: neuroticism, extraversion, openness, agreeableness, and conscientiousness. RESULTS: Three significant traits were noted: (1) greater neuroticism in the cases (OR 1.19, 95% CI 1.08-1.32, p < 0.001, AUC 0.77), (2) greater openness to experience in the controls (OR 0.90, 95% CI 0.83-0.98, p = 0.015, AUC 0.69), and (3) greater conscientiousness in the controls (OR 0.91, 95% CI 0.83-1.00, p = 0.049, AUC 0.69). CONCLUSIONS: The cases mainly presented higher levels of neuroticism and lower levels of openness to experience and conscientiousness. Further studies are needed to corroborate our results.

Sexuality, Quality of Life, Anxiety, Depression, and Anger in Patients with Anal Fissure. A Case-Control Study.

Anal fissures (AFs) are lesions located in the lower anal canal. They can be primary (chronic or acute) or secondary to a basic disease. There is high comorbidity of depression and anxiety in patients with chronic AF, with poorer quality of life (QoL) and sexual function. This is a case-control study carried out in the San Juan Hospital (Alicante, Spain). Sixty-seven participants were included in the study, including 35 cases and 32 controls: 36 males and 31 females. This study aims to investigate the association of presenting AFs with sexuality, quality of life, anxiety, depression, and anger. The instruments used were the Spanish validated versions of the validated original selected questionnaires. These instruments were used to assess health-related quality of life, anxiety, anger, depression, and sexual function. Results show higher values in cases than in controls with statistical significance in anxiety state and trait; anxiety and depression; bodily pain, general health, and vitality; and 10 of the 12 anger factors. Higher values in controls than in cases with statistical significance in sexuality and many of the QoL factors were found. Addressing these issues in AF surgical patients would be beneficial for their clinical assessment and intervention.

Validation of the Center of Applied Psychology Female Sexuality Questionnaire (CAPFS-Q).

Instruments for the measurement of human sexuality include self-report measures used to assess sexual functioning, but many of them have not yet been validated. The Center of Applied Psychology Female Sexual Questionnaire (CAPFS-Q) is an original self-report instrument. It has been developed for the study of sexuality in specific non-clinical populations, such as female university students of Medicine and other Health Sciences. The CAPFS-Q includes 26 items, organized as follows: sociodemographic and relevant data (four items); aspects of sexual relations with partner (five items); sexual practices (12 from 13 items); and dysfunctional aspects of sexual relations (four items). CAPFS-Q validity and reliability were examined in a sample of Spanish female university students of Health Sciences. Exploratory and confirmatory factor analysis (FA) showed a four-factor structure which explained 71.6% of the variance. This initial version of the CAPFS-Q is a reliable measure of women's sexual behavior, with a dimensionality that replicates the initial theoretical content and with adequate indicators of internal consistency, validity, and test-retest reliability. It is easy to administer and to complete.

Male Sexual Desire: An Overview of Biological, Psychological, Sexual, Relational, and Cultural Factors Influencing Desire.

INTRODUCTION: The literature showed the need for a better understanding of the male sexual response, which has historically been considered as simpler and more mechanistic compared with that in women. AIM: To examine the literature on biopsychosocial factors associated with the level of sexual desire in men and discuss some interesting directions for future research. METHODS: A systematic literature review was conducted. MAIN OUTCOME MEASURES: 169 articles published in Google Scholar, Web of Science, Scopus, EBSCO, and Cochrane Library about male sexual desire and related biopsychosocial factors. RESULTS: We found a lack of multidimensional studies on male sexual desire. Most existing research has focused on hypoactive sexual desire disorder in coupled heterosexual men. Biological factors play important roles in the level of sexual desire, but they are insufficient to explain the male sexual response. Psychological, relational, and sexual factors (eg depression, anxiety, emotions, attraction, conflicts, communication, sexual functioning, distress, satisfaction) are involved in the development/maintenance of lack of sexual interest in men. Cultural influence is also relevant, with cognitive factors linked to gender roles and sexual scripts of masculinity identified as important predictors of low sexual desire. CONCLUSION: Male sexual desire is characterized by an interplay among biological, psychological, sexual, relational, and cultural elements. This interplay merits further study to better understand how sexual desire works and how treatments for low sexual interest could be improved. Nimbi FM,Tripodi F, Rossi R, et al. Male Sexual Desire: An Overview of Biological, Psychological, Sexual, Relational, and Cultural Factors Influencing Desire. Sex Med Rev 2020;8:59-91.

Sexual Quality of Life After Treatment of Stress Urinary Incontinence With Adjustable Tension-free Mesh System in Women Who Were Sexually Active Before Surgery.

OBJECTIVE: To assess the sexuality and quality of life of sexually active women with stress or mixed urinary incontinence (SUI or MUI) after surgery with adjustable tension-free suburethral mesh system (transobturator adjustable tape or transvaginal adjustable tape). MATERIALS AND METHODS: This intervention study with 2 years of follow-up (visits at 3 months, 1 year, and 2 years) involved 60 women with SUI or MUI who underwent surgery using transobturator adjustable tape or transvaginal adjustable tape during 2008-2014 in a Spanish region. The variables of interest measured pre- and postintervention were the global scores on the following questionnaires: (1) the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire-12; (2) the International Consultation on Incontinence Questionnaire; and (3) the Incontinence Quality of Life Questionnaire. Mixed linear models were constructed to determine the effect of the intervention on the outcome variables. RESULTS: A significant improvement (P <.001) was seen over time in all the questionnaires, although between the 1- and 2-year visits there was a slight deterioration in all of them. CONCLUSION: The technique provided an improved quality of life and sexuality, which was maintained at all the postoperative visits compared with baseline.

Sexual disorders beyond DSM-5: the unfinished affaire.

PURPOSE OF REVIEW: To provide an overview of post-The Diagnostic and Statistical Manual of Mental Disorders, 5th ed. classifications related to human sexuality. After reviewing the literature on classification and clinical practice of sexual disorders, some of the most important contributions on main sexological classifications and frameworks were selected, especially from January 2016 till June 2017. RECENT FINDINGS: New relevant contributions on psychiatric and sexological classifications and frameworks have been proposed, such as the international classification of diseases 11th revision (ICD-11), research domain criteria, the third edition of the Diagnostic Manual in Sexology and the person-centered psychiatry perspective. SUMMARY: ICD-11 proposals regarding conditions related to sexual health including sexual dysfunctions and gender incongruence as well as vaginismus, such as sexual pain disorder, paraphilic disorders as mental Disorders. The disorders associated with sexual development and orientation, are proposed for deletion. The other perspectives aforementioned are also presented.

Factors Associated with Increased Pain in Primary Dysmenorrhea: Analysis Using a Multivariate Ordered Logistic Regression Model.

STUDY OBJECTIVE: In the literature about primary dysmenorrhea (PD), either a pain gradient has been studied just in women with PD or pain was assessed as a binary variable (presence or absence). Accordingly, we decided to carry out a study in young women to determine possible factors associated with intense pain. DESIGN: A cross-sectional observational study. SETTING: A Spanish University in 2016. PARTICIPANTS: A total of 306 women, aged 18-30 years. INTERVENTIONS: A questionnaire was filled in by the participants to assess associated factors with dysmenorrhoea. MAIN OUTCOME MEASURES: Our outcome measure was the Andersch and Milsom scale (grade from 0 to 3). DEFINITION: grade 0 (menstruation is not painful and daily activity is unaffected), grade 1 (menstruation is painful but seldom inhibits normal activity, analgesics are seldom required, and mild pain), grade 2 (daily activity affected, analgesics required and give relief so that absence from work or school is unusual, and moderate pain), and grade 3 (activity clearly inhibited, poor effect of analgesics, vegetative symptoms and severe pain). RESULTS: Factors significantly associated with more extreme pain: a higher menstrual flow (odds ratio [OR], 2.11; P < .001), a worse quality of life (OR, 0.97; P < .001) and use of medication for PD (OR, 8.22; P < .001). CONCLUSION: We determined factors associated with extreme pain in PD in a novel way. Further studies are required to corroborate our results.

Sexual behaviour and risk of sexually transmitted infections in young female healthcare students in Spain.

UNLABELLED: Background. Several authors have examined the risk for sexually transmitted infections (STI), but no study has yet analyzed it solely in relation with sexual behaviour in women. We analyzed the association of sexual behaviour with STI risk in female university students of healthcare sciences. Methods. We designed a cross-sectional study assessing over three months vaginal intercourse with a man. The study involved 175 female university students, without a stable partner, studying healthcare sciences in Spain. MAIN OUTCOME VARIABLE: STI risk (not always using male condoms). Secondary variables: sexual behaviour, method of orgasm, desire to increase the frequency of sexual relations, desire to have more variety in sexual relations, frequency of sexual intercourse with the partner, and age. The information was collected with an original questionnaire. A logistic regression model was used to estimate the adjusted odds ratios (ORs) in order to analyze the association between the STI risk and the study variables. Results. Of the 175 women, 52 were positive for STI risk (29.7%, 95% CI [22.9-36.5%]). Factors significantly associated with STI risk (p < 0.05) included: orgasm (not having orgasms →OR = 7.01, 95% CI [1.49-33.00]; several methods →OR = 0.77, 95% CI [0.31-1.90]; one single method →OR = 1; p = 0.008) and desiring an increased frequency of sexual activities (OR = 0.27, 95% CI [0.13-0.59], p < 0.001). Conclusions. Women's desire for sexual activities and their sexual function were significant predictors of their risk for STI. Information about sexual function is an intrinsic aspect of sexual behaviour and should be taken into consideration when seeking approaches to reduce risks for STI.

Sexual side-effects of antidepressant and antipsychotic drugs.

PURPOSE OF REVIEW: Psychotropic-related sexual dysfunction is a quite frequent issue in clinical practice, mainly in chronic treatments affecting both quality of life and compliance. RECENT FINDINGS: In the last decade fortunately antidepressants and antipsychotic compounds have been deeply screened in order to identify sexual adverse events that were commonly underdiagnosed and previously underestimated by clinicians and perhaps by pharmaceutical companies as well. Some differences in the mechanism of action are the nucleus of this poorly tolerated adverse event. All antidepressants with serotonergic activity can cause mild to severe sexual dysfunction such as decreased libido and delayed orgasm frequently (>60%) or anorgasmia and arousal difficulties sometimes (30%). In contrast, noradrenergic, dopaminergic, or melatonergic antidepressants do not cause sexual dysfunction but perhaps the clinical profile of patients receiving these compounds could be different. Antipsychotics that highly increase prolactin levels and strongly block dopamine receptors could be related to sexual dysfunction as well. Unfortunately, these dysfunctions are present during the long term after the antipsychotic onset to provide continued symptom control and enable recovery. Young patients suffering psychosis and concomitant sexual dysfunction (erectile and/or orgasmic difficulties) tend to show poor compliance in chronic treatments affecting the outcomes. SUMMARY: The implications of psychotropic-related sexual dysfunction in clinical practice are relevant mainly in patients under long-term treatment with previous satisfactory sexual life. Implications for future research about sexual dysfunction in all new treatments should be strongly taken into account.

Diagnostic inertia in dyslipidaemia: results of a preventative programme in Spain.

Others have analysed the relationship between inadequate behaviour by healthcare professionals in the diagnosis of dyslipidaemia (diagnostic inertia) and the history of cardiovascular risk factors. However, since no study has assessed cardiovascular risk scores as associated factors, we carried out a study to quantify diagnostic inertia in dyslipidaemia and to determine if cardiovascular risk scores are associated with this inertia. In the Valencian Community (Spain), a preventive programme (cardiovascular, gynaecologic and vaccination) was started in 2003 inviting persons aged ≥40 years to undergo a health check-up at their health centre. This cross-sectional study examined persons with no known dyslipidaemia seen during the first six months of the programme (n = 16, 905) but whose total cholesterol (TC) was ≥5.17 mmol/L. Diagnostic inertia was defined as lack of follow-up to confirm/discard the dyslipidaemia diagnosis. Other variables included in the analysis were gender, history of cardiovascular risk factors/cardiovascular disease, counselling (diet/exercise), body mass index (BMI), age, blood pressure, fasting blood glucose and lipids. TC was grouped as ≥/<6.20 mmol/L. In patients without cardiovascular disease and <75/≤65 years (n = 15, 778/13, 597), the REGICOR (REgistre GIroní del COr)/SCORE (Systematic COronary Risk Evaluation) cardiovascular risk functions were used to classify risk (high/low). Inertia was quantified and the adjusted odds ratios calculated from multivariate models. In the overall sample, the rate of diagnostic inertia was 52% (95% CI [51.2-52.7]); associated factors were TC ≥ 6.20 mmol/L, high or "not measured" BMI, hypertension, smoking and higher values of fasting blood glucose, systolic blood pressure and TC. In the REGICOR sample, the rate of diagnostic inertia was 51.9% (95% CI [51.1-52.7]); associated factors were REGICOR high and high or "not measured" BMI. In the SCORE sample the rate of diagnostic inertia was 51.7% (95% CI [50.9-52.5]); associated factors were SCORE high and high or "not measured" BMI. Diagnostic inertia existed in over half the patients and was associated with a greater cardiovascular risk.

Diabetes screening: a pending issue in hypertense/obese patients.

The literature about possible cardiovascular consequences of diagnostic inertia in diabetes is scarce. We examined the influence of undetected high fasting blood glucose (FBG) levels on the cardiovascular risk and poor control of cardiovascular risk factors in hypertensive or obese patients, with no previous diagnosis of diabetes mellitus (i.e., diagnostic inertia). A cross-sectional study during a preventive program in a Spanish region was performed in 2003-2004. The participants were aged ≥40 years and did not have diabetes but were hypertensive (n = 5, 347) or obese (n = 7, 833). The outcomes were high cardiovascular risk (SCORE ≥5%), poor control of the blood pressure (≥140/90 mmHg) and class II obesity. The relationship was examined between FBG and the main parameters, calculating the adjusted odd ratios with multivariate models. Higher values of FBG were associated with all the outcomes. A more proactive attitude towards the diagnosis of diabetes mellitus in the hypertensive and obese population should be adopted.

Fear of becoming pregnant among female healthcare students in Spain.

The inconsistent use of hormonal contraceptive methods can result, during the first year of use, in one in twelve women still having an undesired pregnancy. This may lead to women experiencing fear of becoming pregnant (FBP). We have only found one study examining the proportion of FBP among women who used hormonal contraceptives. To gather further scientific evidence we undertook an observational, cross-sectional study involving 472 women at a Spanish university in 2005-2009. The inclusion criteria were having had vaginal intercourse with a man in the previous three months and usual use for contraception of a male condom or hormonal contraceptives, or no method of contraception. The outcome was FBP. The secondary variables were contraceptive method used (oral contraceptives; condom; none), desire to increase the frequency of sexual relations, frequency of sexual intercourse with the partner, the sexual partner not always able to ejaculate, desire to increase the partner's time before orgasm, age and being in a stable relationship. A multivariate logistic regression model was used to determine the associated factors. Of the 472 women, 171 experienced FBP (36.2%). Factors significantly associated (p < 0.05) with this FBP were method of contraception (condom and none), desire to increase the partner's ability to delay orgasm and higher frequency of sexual intercourse with the partner. There was a high proportion of FBP, depending on the use of efficient contraceptive methods. A possible solution to this problem may reside in educational programmes. Qualitative studies would be useful to design these programmes.

Diagnostic inertia in obesity and the impact on cardiovascular risk in primary care: a cross-sectional study.

BACKGROUND: Prevalence of diagnostic inertia (DI), defined as a failure to diagnose disease, has not been analysed in patients with obesity. AIM: To quantify DI for cardiovascular risk factors (CVRF) in patients with obesity, and determine its association with the cardiovascular risk score. DESIGN AND SETTING: Cross-sectional study of people ≥40 years attending a preventive programme in primary healthcare centres in Spain in 2003-2004. METHOD: All patients with obesity attending during the first 6 months of the preventive programme were analysed. Participants had to be free of CVD (myocardial ischaemia or stroke) and aged 40-65 years; the criteria used to measure SCORE (Systematic COronary Risk Evaluation). Three subgroups of patients with obesity with no personal history of CVRF but with poor control of risk factors were established. Outcome variable was DI, defined as poor control of risk factors and no action taken by the physician. Secondary variables were diabetes, fasting blood glucose (FBG), body mass index (BMI), and SCORE. Adjusted odds ratios (OR) was determined using multivariate logistic regression models. RESULTS: Of 8687 patients with obesity in the programme, 6230 fulfilled SCORE criteria. Prevalence of DI in the three subgroups was: hypertension, 1275/1816 (70.2%) patients affected (95% CI = 68.1 to 72.3%); diabetes, 335/359 (93.3%) patients affected (95% CI = 90.7 to 95.9%); dyslipidaemia subgroup, 1796/3341 (53.8%) patients affected (95% CI = 52.1 to 55.4%. Factors associated with DI for each subgroup were: for hypertension, absence of diabetes, higher BMI, and greater cardiovascular risk; for dyslipidaemia, diabetes, higher BMI, and greater cardiovascular risk (SCORE); and for diabetes, lower FBG levels, lower BMI, and greater cardiovascular risk. CONCLUSION: This study quantified DI in patients with obesity and determined that it was associated with a greater cardiovascular risk.