The effect of tadalafil on psychosocial outcomes in Swedish men with erectile distress: a multicentre, non-randomised, open-label clinical study.

A multicentre, non-randomised, open-label study assessed whether personal distress caused by erectile dysfunction (ED) affected psychosocial outcomes of tadalafil treatment. Eligible Swedish men at least 18 years old reporting > or =3-month history of ED were stratified into two groups (manifest or mild/no distress) based upon a distress question administered at enrollment. Tadalafil 20 mg was taken as needed for 8 weeks. The primary outcome was the difference between the two distress groups in change from baseline in the Psychological and Interpersonal Relationship Scales (PAIRS) spontaneity domain. Secondary outcome measures were PAIRS sexual self-confidence and time concerns domains, Life Satisfaction (LiSat-11) checklist and a Global Assessment of Treatment Response. The study also assessed tolerability. Of 662 men enrolled, 88% had manifest distress and 12% had mild/no distress. Baseline-to-endpoint changes for PAIRS domains were not significantly different between groups. Baseline-to-endpoint changes in LiSat-11 items were not significantly different between groups except for satisfaction with sexual life. Compared with men without ED, below normal baseline satisfaction with partner relationship and family life were normalised at endpoint. Over 90% of men reported improved erection and ability to engage in sexual activity. The most common treatment-emergent adverse events were headache, myalgia, dyspepsia, flushing and back pain. One man discontinued because of myalgia; 630 (95%) completed the study. In conclusion, erectile distress levels vary among patients with ED and distress can affect intra-familiar aspects of life, which may have implications for clinical practise. However, distress does not appear to hinder improvement in both mechanical and psychosocial outcomes of tadalafil treatment.

Use of healthcare a long time after severe burn injury; relation to perceived health and personality characteristics.

PURPOSE: The aim of the study was to evaluate which factors are associated with the use of healthcare a long time after severe burn injury. METHOD: After a review process based on clinical reasoning, 69 former burn patients out of a consecutive group treated at the Uppsala Burn Unit from 1980--1995 were visited in their homes and their use of care and support was assessed in a semi-structured interview. Post-burn health was assessed with the Burn-Specific Health Scale-Brief (BSHS-B) and personality was assessed with the Swedish universities Scales of Personality (SSP). RESULTS: The participants were injured on average eight years previously. Thirty-four had current contact with healthcare due to their burn injury and had significantly lower scores on three BSHS-B-domains: Simple Abilities, Work and Hand function, and significantly higher scores for the SSP-domain Neuroticism and the SSP-scales Stress Susceptibility, Lack of Assertiveness, and lower scores for Social Desirability. There was no relation to age, gender, time since injury, length of stay, or to the surface area burned. CONCLUSIONS: A routine screening of personality traits as a supplement to long-term follow-ups may help in identifying the patient's need for care.

Early conceptual and linguistic development of a patient and partner treatment satisfaction scale (TSS) for erectile dysfunction.

OBJECTIVE: To describe the early development of a pluri-language self-report questionnaire to assess male patients and their female partners' satisfaction with drug treatment for erectile dysfunction (ED). METHODS: This first development phase proceeded in several parts. Item generation followed literature review, hypothesized characteristics of the drug and in-depth interviews with patients and their partners. Perceptions and feelings related to ED and patients' expectations of treatment were explored. Items were generated simultaneously in 5 languages (American English, Canadian French, English, French and German). Content and face validity were empirically assessed by interviews with a few patients and partners in each country. Conceptual equivalence between languages was ascertained. RESULTS: The final content domains included satisfaction with: sexual spontaneity, quality of erection, quality of ejaculation, sexual pleasure, orgasm, confidence, reliability of treatment, side effects, convenience, overall satisfaction, conformity to treatment expectations and intent to continue use of drug. Cognitive debriefing with patients and partners found few issues with comprehension, however some words were considered problematic. The simultaneous development for the different languages allowed adaptation of the content at this stage and ensured consistency of all language versions. The final questionnaire consisted of 4 modules: unmedicated patient, medicated patient, unmedicated partner, and medicated partner modules. The questionnaire was then linguistically validated into 15 additional languages for further psychometric validation. CONCLUSIONS: The Treatment Satisfaction Scale (TSS) is a multi-facetted measure of patients' and partners' satisfaction with their sexual life relating to erectile dysfunction and intended for prospective use. Its simultaneous development for a variety of countries and languages has fostered true item equivalence across language versions. However, further work is needed to validate the TSS psychometrically, including identification of domains, test responsiveness and determination of appropriate scoring prior to its clinical use.

On categorization and quantification of women's sexual dysfunctions: an epidemiological approach.

The objectives of this study are to compare the two definitions of female sexual dysfunction, namely dysfunction per se (A category) and personal distress caused by dysfunction (B category), and to gauge their associations with some sociodemographic aspects and level of sexual well-being. The subjects were a nationally representative sample of sexually active Swedish women (n: 1056) aged 18-65 y, who participated in a combined structured interview/questionnaire investigation. The functions analysed were: self-reported sexual desire, interest, lubrication, orgasm, genital pain and vaginism, which were subclassified for the A and B categories into no, mild (sporadically occurring) and manifest dysfunction. Sexual well-being was reported along a six-grade scale ranging from very satisfied to very dissatisfied. The sociodemographic items registered were: education, occupation, financial situation, social group, immigrant status, location of domicile and church-going. Aggregated mild and manifest dysfunction per se of sexual interest, orgasm and vaginal lubrication were reported by about 60-90%. More than one-third had dyspareunia, but few reported vaginism. Mild dysfunctions were clearly more common than manifest dysfunctions. Not fully 45% of those with manifest low interest and orgasm perceived these dysfunctions as manifestly distressing, while in 60-70% lubricational insufficiency of dyspareunia led to manifest distress. Age and the included sociodemographic variables had marginal or no influence on sexual functions. A four-factor sexual function pattern was identified, closely linking A and B categories in a pairwise manner. Three factors, labelled sexual desire, orgasm and genital function were powerful classifiers (discriminant analysis) of level of sexual well-being. Hence, it is a matter of taste whether to use the A or the B category. Together, they can explain the gross level of satisfaction with sexual life to an adequate extent.

Epidemiology of erectile dysfunction.

This review of the current epidemiological literature on erectile dysfunction (ED) suggests that approximately 5-20% of men have moderate-to-severe ED. Different definitions of ED, age distributions and concomitant medical conditions, as well as methodological differences, may explain much of the variance in reported prevalence rates. Various chronic disorders are associated with elevated rates of ED including depression, diabetes, and cardiovascular and neurological diseases. Such disorders are more common in the elderly, which may partially explain the elevated prevalence of ED in men over 60 y of age. Currently, up to 70% of men with ED are not treated. However, so many men experience considerable distress from their condition, that the increasing awareness of ED as well as the availability of noninvasive treatments may result in a greater proportion of patients seeking treatment, and eventually regaining satisfaction with their sex life.

Sexual disabilities are not singularities.

This report is based on a survey (performed 1996) of sex life in a nationally representative sample of Swedish women (n=1335) and men (n=1475) aged 18-74 y. From that survey we have previously reported on prevalence of sexual disabilities and problems caused by them (1). The main object of this article is to describe intra- and inter-gender concurrence of sexual disabilities and problems in sexually active subjects. Furthermore, the relative risk of low level of sexual well-being as predicted by sexual disabilities and distress is addressed. Respondents (59% of target sample) participated in an investigation which combined structured interviews with questionnaires/checklists. Main results are that within and across genders sexual disabilities concur to significant degrees. Of the women 48 and 26% reported at least one own and partner sexual disability or distress caused by them, respectively. For the men the corresponding proportions were 26 and 17%, respectively. Odds ratios showed that for the women low sexual interest, difficulties in obtaining orgasm and partner's early ejaculation were significant predictors of low level of sexual well-being. For the men low level of interest and partner's difficulties in obtaining orgasm were the only, but equally powerful, predictors. It is concluded that in clinical practice and for those who have a partner, sexual disabilities and distress caused by them should be regarded from the partner relationship perspective.

Development of a brief version of the Burn Specific Health Scale (BSHS-B).

BACKGROUND: The Burn Specific Health Scale (BSHS) is an outcome scale designed specifically for burn patients. The scale has been abbreviated (BSHS-A) and revised (BSHS-R). We used a factor analytic approach to further improve the scale for clinical use. METHODS: Two hundred forty-eight of 350 former patients (70.9%) treated at the Uppsala Burn Unit between 1980 and 1995 responded to 94 questions from previous versions of the BSHS. RESULTS: Principal components factor analyses were used to derive an instrument with 40 items called the Burn Specific Health Scale-Brief (BSHS-B), resulting in nine well-defined domains with intercorrelations ranging from 0.11 to 0.56, and Chronbach's factor alphas ranging from 0.75 to 0.93. The domains describe function with respect to Heat Sensitivity, Affect, Hand Function, Treatment Regimens, Work, Sexuality, Interpersonal Relationships, Simple Abilities, and Body Image. CONCLUSION: The BSHS-B is a valid but shorter alternative to the previously described BSHS-A. Important domains of postburn distress are captured better in the BSHS-B than in the BSHS-R.

Life satisfaction in persons with spinal cord injury: a comparative investigation between Sweden and Japan.

STUDY DESIGN: A cross-sectional and comparative investigation using the unified questionnaire. OBJECTIVES: To investigate the cultural (East Asian versus North European) differences in life satisfaction between long-term survivors of spinal cord injuries (SCI). SETTING: Uppsala county in Sweden and Fukuoka prefecture in Japan. METHODS: A questionnaire dealing with life satisfaction was prepared by the authors. It focused mainly on sexual life and accompanied a self-rating Barthel Index Score. The questionnaire was mailed to male SCI persons in the two communities, Uppsala county (Sweden) and Fukuoka prefecture (Japan). Forty (77%) Swedish and 85 (71%) Japanese SCI replied. RESULTS: (1) Swedish SCI appeared to be more satisfied than Japanese SCI in general health, economy, social activity, social service, family life and sexual life. (2) Several life domains indicated significant difference in life satisfaction between with- and without-partner group in Japanese SCI. No life domains indicated significant difference in Swedish SCI. (3) No statistically significant difference was indicated in all of life domains between the degree of life satisfaction and interval since spinal cord damage. CONCLUSION: The more expanded cross-cultural study is expected to be helpful for discussing the QOL of SCI.

Impact of erectile dysfunction on quality of life: patient and partner perspectives.

Quality of life (QoL) has become one of the important parameters in the evaluation of treatment and assessment of medical conditions, and it may be an important tool in determining the urgency of the need for therapeutic intervention for erectile dysfunction (ED). It is important to evaluate QoL of the couple, because men and women alike will suffer because of male erectile disability. Future drug trials, as well as studies of sexological intervention programs, should involve both partners. International Journal of Impotence Research (2000) 12, Suppl 4, S144-S146.

On life satisfaction in male erectile dysfunction.

A consecutive series of 413 impotent men and 109 References rated their satisfaction with life as a whole and with seven different domains of life along a six graded scale ranging from very satisfied to very dissatisfied. In a subsample of impotent men treated with PGE1 these self-ratings were repeated applying the concept that dissatisfaction reflects an aspirations/achievement gap and successful treatment leads not only to increased sexual well-being but also to increased satisfaction with life as a whole. Regardless of the etiology of impotence pre-treatment level of sexual satisfaction was very low. In assumedly psychogenically impotent men levels of satisfaction with life as a whole, partnership and family life were also low. Using factor analytic technique satisfaction with sexual life was found to be a powerful predictor for satisfaction with life as a whole. In successfully PGE1-treated men pre-treatment decreased levels of satisfaction were significantly increased and generally normalization occurred.

Long-term prevalence of impairments and disabilities after multiple trauma.

The prevalence of impairments and disabilities in activities of daily living (ADL), nonwork activities, and work were registered in a consecutive series (n = 69) of subjects with severe injuries. At follow-up 3 years after trauma, residual impairments prevailed in 80%. Only a few (6%) were ADL-dependent. Seventy-six percent had lost at least one nonwork activity, while vocational disability caused by the trauma occurred in 19%. Cognitive impairment was significantly associated with vocational disability, while physical impairment and pain were significantly associated with nonwork disability. Other parameters that influenced vocational disability negatively were age and blue-collar employment status. Although overall changes in social network quantity and quality were small, significantly more subjects with cognitive impairment or vocational disability experienced a decline in the quality and quantity of their social network after trauma. Furthermore, 25% of the subjects reported an increase in feelings of loneliness after trauma. We recommend the design of individualized, multidisciplinary rehabilitation plans before discharge from departments of surgery.

On non-work activity preferences: relationships with occupational roles.

Occupational therapy is to a great extent based on the idea of engaging patients in meaningful activities. Using mailed checklists this investigation examines the preference attached to 50 activities by 201 adult (25-55 years old) northern Swedes using a four-grade ordinal scale. The self-reported levels of activity preferences were related to age and gender. Factor analysis was used to analyse the inter-relationships between activity preferences. The possible effects of activity preferences on self-reported occupational role internalization (10 items) were examined using discriminant analyses. Activity preferences were gender-dependent for more than half of the activities while only 14 of them were age-dependent. The factor analysis grouped 41 of the activities into 15 factors which were labelled 'activity goals'. Fourteen of these were distinct classifiers (discriminant analyses) of the self-reported degree of internalization of 8/10 occupational roles. In this sample occupational role internalization has elsewhere been demonstrated to be closely related to several domains of life satisfaction, which in turn are closely associated with satisfaction with life as a whole. Taken together with those results the present investigation leads the authors to suggest this model: activity preferences-->occupational roles-->domain-specific life satisfaction-->happiness.

Is the mean power frequency shift of the EMG a selective indicator of fatigue of the fast twitch motor units?

During repeated maximum isokinetic contractions parallel decreases in output and the mean power frequency (MPF) of the electromyogram (EMG) occur, followed by stable levels (the endurance level). This study aimed to investigate if hypoxia of the plantar flexors will result in a shift in MPF during the endurance level. Mechanical performance and simultaneous surface EMG activity of three plantar flexors (m. soleus, m. gastrocnemius medialis and m. gastrocnemius lateralis) were recorded during repeated isokinetic plantar flexions at 1.05 rad s-1 in 10 healthy women. The study consisted of two tests with 14 days in between: (1) a maximum test consisting of 125 maximum plantar flexions. After 100 contractions, using a tourniquet, a relative ischaemia (hypoxia) was induced. (2) a submaximum test performed at the level established between contractions 70-100 of the maximum test, consisting of 125 plantar flexions. During the maximum test mechanical performance output, the signal amplitude (RMS) of the EMG and the MPF decreased in parallel during the initial 50 contractions followed by stable levels during the subsequent 50 contractions. When hypoxia was induced decreases in mechanical performance and RMS appeared without significant decreases in MPF. The present study indicates that the MPF shift is mainly sensitive to biochemical changes in the type 2 fibres. Hypoxia mainly located to the type 1 fibres will not be detected using the MPF variable.

Self-reported prevalence of disability after subarachnoid haemorrhage, with special emphasis on return to leisure and work.

The prevalences of motor and language impairments and of disabilities in activities of daily living (ADL), leisure and work were investigated in a consecutive series (n = 296) of long-term survivors of subarachnoid haemorrhage (SAH). Motor and language impairments were present in 17 and 20%, respectively. The majority reported independence in self-care (91%) and instrumental (80%) ADL, but among the self-care independent, 23% reported need of personal assistance. Leisure disability occurred in 48% and vocational disability in 40%. Hence, disabilities are more common after SAH than is indicated by occurrences of motor and language impairments. It is concluded that the discrepancy between the prevalences of impairments and of disabilities may be to a great extent caused by coping difficulties in relation to socio-demographic and geographic circumstances. The findings indicate a need for rehabilitative follow-up for virtually all SAH-patients.

Traumatic brain injury in northern Sweden. Incidence and prevalence of long-standing impairments and disabilities.

Based on a retrospective survey of hospital admissions and autopsies the incidence of traumatic brain injury (TBI) for the age range 16-60 was found to be 24.9/10,000 in the Umeå district of Northern Sweden. In male youngsters aged 16-19 the incidence was remarkably high in comparison with reports from other parts of the western hemisphere. Self-reports on the prevalence of impairments and disabilities 1 1/2-3 years after the injury were obtained by a mailed questionnaire. Among the subjects with brain concussion 1/3 reported impairments and 1/10 disabilities, most commonly leisure-disability. By factor analysis impairments and disabilities could be logically grouped into three factors. Two of these factors clearly circumscribed combinations of impairments and disabilities, one of them being dominated by instrumental ADL, the other by basic self-care ADL. The third factor incorporated the classic post-concussion triad and memory. Taken together the findings indicate that many subjects with an early diagnosis of brain concussion, hospitalized for only one day, experienced losses in pre-injury functions and abilities. It is therefore suggested that not only radiologically and/or operatively confirmed TBIs but also subjects with brain concussion should be followed after discharge in order to minimize losses in social well-being.

Vocational rehabilitation in northern Sweden. I. A socio-demographic description.

Some socio-demographic variables were registered by structured interview in a consecutive series (n = 149) of subjects referred for vocational rehabilitation with a diagnosis of somatic disease. Two years later the subjects were re-interviewed about current occupational and financial status. Initially 43% received sickness allowance and 18% unemployment compensation, the remaining 39% were vocationally active. Almost 19% needed only technical aids to be able to return to/remain in work; an intervention which was used significantly more often for the--relatively older--self-employed than for the rest of the sample. Two years later 80% of those who were vocationally active at the time of referral were still at work, the remaining 20% were undergoing training (11%) or were vocationally inactive (9%). Among those who were receiving sickness benefit/unemployment compensation at referral, 44% were at work and 20% were receiving education. Return to work after vocational inactivity was financially beneficial. It is concluded that vocational rehabilitation in Umeå had a fair rate of success. This may be due to the low rate of handicaps.

Vocational rehabilitation in northern Sweden. II. Some psycho-socio-demographic predictors.

In this prospective investigation a consecutively referred series of vocational rehabilitation clients was studied using eleven socio-demographic and psycho-social items. Subjected to a factor analyses these items were included in five factors which explained 74% of the variance. By discriminant analysis the items could correctly classify 57% of those subjects who faced major vocational changes or were vocationally inactive. The level of experienced health and belief in vocational return had the heaviest overall predictive impact. The findings may help specialists in medical and vocational rehabilitation to estimate the likelihood of vocational return for somatically impaired subjects.

Vocational rehabilitation in northern Sweden. III. Aspects of life satisfaction.

Levels of global (1 item) and domain-specific (8 items) life satisfaction were explored at the commencement of vocational rehabilitation and two years later in a consecutive series of subjects who were partly or completely vocationally disabled with a diagnosis of bodily impairment. At the onset of vocational rehabilitation, global life satisfaction (satisfaction with life as a whole) and satisfaction derived from performance- and provider-related (instrumental) domains of life were significantly lower than satisfaction derived from socio-emotional (expressive) facets of life. The eight domain-specific items of life satisfaction described a characteristic three-factor pattern (76% of variance) which resembled quite closely that of non-impaired subjects, one factor being expressive. The other two factors were instrumental and separated recreative from vocational domains of satisfaction. Successful vocational rehabilitation resulted in increases in vocational satisfaction. For those subjects who were successfully rehabilitated, satisfaction with other instrumental aspects of life and with life as a whole also increased. The results indicate that successful vocational rehabilitation leads to increased social well-being.

Isokinetic muscular performance of the quadriceps in elite ice hockey players.

On four occasions during a period of 17 months, isokinetic maximum knee extensor output (peak torque and contractional work) and input (integrated electromyographic activity) during single and repetitive contractions were measured in 10 male elite ice hockey players. The tests were performed in the middle and at the end of the competitive season, and after two office training periods involving different types of training. No significant changes in peak torque at single maximum contractions occurred for the whole group of players during the investigation. Nor did the slope of decline in contractional work or the plateau level of the ratio of contractional work:integrated electromyographic activity during repetitive contractions change significantly. The most obvious finding was great interindividual differences in muscular performance. Intraindividually, changes in both peak torque as well as in slope of decline in contractional work and in plateau level of the ratio of contractional work:integrated electromyographic activity occurred during the different training periods. We conclude that local muscle adaptations, measured by isokinetic procedures, occur in the quadriceps as a result of ordinary training and games in elite ice hockey players. Because of the great interindividual differences in muscular performance and the different responses to similar training, we suggest individual programs for leg muscle training in ice hockey players.