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Sonawane T, Kashte S, Khera S, Bahulkar A, Cuddapah C, Kadam S. Interrogating erectile dysfunction and evaluating novel therapeutic frontiers, with emphasis on stem cell strategies. J Assist Reprod Genet 2024; 41:2037-2051. [PMID: 39023828 PMCID: PMC11339218 DOI: 10.1007/s10815-024-03165-y] [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: 02/19/2024] [Accepted: 06/02/2024] [Indexed: 07/20/2024] Open
Abstract
Male infertility arises from a complex interplay of factors affecting reproductive organs and various physiological pathways. Among these, erectile dysfunction (ED), a widespread global issue, plays a key role. While existing ED treatments address some aspects, achieving complete reversibility and avoiding side effects remains a challenge. In this context, stem cell therapy emerges as a promising, potentially transformative approach. Preliminary evidence from preclinical animal models and clinical trials highlights stem cell therapy's remarkable efficacy and effectiveness for ED. This novel strategy offers several advantages, including enhanced effectiveness and a reported absence of adverse side effects. This review delves into the causes of male infertility, with a particular focus on ED and its pathophysiology. We explore the current treatment landscape, highlighting therapy's existing strategies' limitations and stem cell therapy's unique potential. By examining relevant preclinical and clinical studies, we provide a comprehensive picture of this innovative approach and its promising future in restoring men's fertility and quality of life.
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Affiliation(s)
- Tareeka Sonawane
- Amity Institute of Biotechnology, Amity University, Bhatan, Post-Somathne, Panvel, Mumbai, 410206, India
| | - Shivaji Kashte
- Center For Interdisciplinary Research, D Y Patil Education Society, Kasaba Bawada, Kolhapur, 416006, India
| | - Simran Khera
- Amity Institute of Biotechnology, Amity University, Bhatan, Post-Somathne, Panvel, Mumbai, 410206, India
| | - Ashutosh Bahulkar
- Department of Obstetrics and Gynecology, Krishna Institute of Medical Sciences, Malkapur, Karad, Dist. Satara, Maharashtra , 415539, India
| | | | - Sachin Kadam
- Sophisticated Analytical and Technical Help Institute, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, 110016, India.
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Hwang JHA, Downing MG, Specht RAG, Ponsford JL. Co-designing for behavioural change: understanding barriers and enablers to addressing sexuality after traumatic brain injury and mapping intervention strategies in a multi-disciplinary rehabilitation unit. BRAIN IMPAIR 2024; 25:IB23068. [PMID: 38566291 DOI: 10.1071/ib23068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/24/2023] [Indexed: 04/04/2024]
Abstract
Background Persistent changes in sexuality often follow traumatic brain injury (TBI). However, health professionals remain reticent about discussing sexuality and have reported barriers including uncertainties around whose role it is and limited educational and institutional support. This study employed a co-design and implementation process, aiming to promote team-wide behavioural change, whereby health professionals at a TBI rehabilitation unit would attempt to address sexuality with patients routinely. Methods Focus group sessions with multidisciplinary health professionals were conducted to identify barriers and enablers to behavioural change, identify areas for development, and co-design intervention options. Implementation deliverables were then finalised and provided to the team. The Theoretical Domains Framework was used to map factors influencing behaviours and the Behaviour Change Wheel was used to map interventions. Thematic analysis was used to further analyse barrier themes. Results Thirty-five barriers and eight enablers falling within 12 theoretical domains to behavioural change were identified. Thematic analysis revealed highly correlated barriers in initiating and sustaining change. Nine co-designed intervention options aligned with five intervention functions of the Behaviour Change Wheel, resulting in six final implementation deliverables. Conclusions Barriers were highly interrelated, influencing the approach to implementation deliverables. Simultaneously addressing multiple barriers could potentially alleviate discomfort associated with discussing sexuality. Concerns around initiating change were related to confidence in achieving sustainable changes. Achieving change requires organisational and team-level environmental restructuring and enablement. The next step involves evaluating the effectiveness of the co-design and implementation process in driving behavioural change and potential impacts on patient satisfaction and sexuality outcomes.
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Affiliation(s)
- Jill H A Hwang
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Vic. 3121, Australia; and Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Richmond, Vic. 3121 Australia
| | - Marina G Downing
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Vic. 3121, Australia; and Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Richmond, Vic. 3121 Australia
| | - Riccarda A G Specht
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Jennie L Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Vic. 3121, Australia; and Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Richmond, Vic. 3121 Australia
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Hwang JHA, Fraser EE, Downing MG, Ponsford JL. A qualitative study on the attitudes and approaches of Australian clinicians in addressing sexuality after acquired brain injury. Disabil Rehabil 2022; 44:8294-8302. [PMID: 34951561 DOI: 10.1080/09638288.2021.2012605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE Studies indicate that up to 50% of survivors of acquired brain injury (ABI) experience persistent changes in sexuality. However, research on clinicians' perspectives in addressing sexuality issues post-ABI is limited. This study explored the attitudes and approaches, barriers and facilitators, and training preferences of Australian clinicians in addressing sexuality in individuals post-ABI. METHOD Purposive sampling was used to recruit 20 Australian multi-disciplinary clinicians from a related survey study. Semi-structured interviews were conducted and qualitatively analysed using thematic analysis. RESULTS Three broad themes were identified: ABI results in multi-faceted changes in sexuality; there is a fundamental discomfort in talking about sexuality; and, strategies proposed by clinicians may help to improve sexuality support. Participants also provided suggestions for sexuality training, which they believed should start at university. CONCLUSION Most clinicians are aware of sexuality issues post-ABI but fail to adequately address sexuality in individuals post-ABI due to personal levels of discomfort, perpetuated by institutional factors. Therefore, participants believe that changes made at individual and institutional levels may increase sexuality support for individuals with ABI. However, further research on the causes and treatment of sexual problems and patient perspectives is required to provide the evidence-based guidelines and training programs that clinicians require.Implications for rehabilitationUp to half of individuals experience changes in sexuality after ABI that restrict quality of life and relationships.The consequences of ABI and their impacts on sexuality are understood by Australian clinicians but remain largely unaddressed due to individual discomfort, perpetuated by institutional factors.This study suggests that professional training targeted towards understanding, assessing and treating sexuality issues post-ABI may help to reduce the discomfort.Adjustments should also be made at individual, policy and procedural levels to ensure that sexuality is addressed within rehabilitation post-ABI.
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Affiliation(s)
- Jill H A Hwang
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Elinor E Fraser
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Marina G Downing
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
| | - Jennie L Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
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Wang TM, Chou CH, Lee YL, Chung CH, Huang YC, Lai XC, Sun CA, Kang CY, Wu GJ, Chien WC. Clinical Characteristics of Hyperandrogenism Include Hirsutism, Polycystic Ovary Syndrome, and Acne: Association with Psychiatric Disease in Women -A Nationwide Population-Based Cohort Study in Taiwan. Int J Womens Health 2022; 14:1173-1189. [PMID: 36059578 PMCID: PMC9432384 DOI: 10.2147/ijwh.s376244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/10/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Previous studies have shown an increased in psychiatric disorders in women with disorders associated with hyperandrogenism, but few nationwide cohorts have studied this phenomenon. Therefore, this study is aimed to examine the association between the clinical manifestations of hyperandrogenism and subsequent psychiatric disorders. Methods Based on the National Health Insurance Research Database, 49,770 enrolled participants were matched for age and index date between January 1, 2000, and December 31, 2015. Hirsutism, polycystic ovary syndrome, and acne are characterized by hyperandrogenism. After adjusting for confounding factors, we used Cox proportional analysis to compare the risk of psychiatric disorders during the 16 years of follow-up. Results Of all the participants, 1319 (13.25%) had psychiatric disorders in the study group, whereas only 3900(9.80%) had psychiatric disorders in the control group. After adjusting for age, and monthly income, the Cox regression analysis showed that the study patients were more likely to develop psychiatric disorders (hazard ratio [HR]: 2.004, 95% confidence interval [CI] = 1.327–2.724, P < 0.001). The results demonstrated that women aged 20–29 years had a more significant risk. Conclusion Women with clinical characteristics of hyperandrogenism have a higher risk of developing psychiatric disorders, especially those aged 20–29 years.
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Affiliation(s)
- Tsan-Min Wang
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan
- Taipei Municipal Jianguo High School, Taipei, Taiwan
| | - Cheng-Hao Chou
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan
- Taipei Municipal Jianguo High School, Taipei, Taiwan
| | - Yi-Liang Lee
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Department of Obstetrics and Gynecology, Kang Ning Hospital, Taipei, Taiwan, Republic of China
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei, Taiwan
| | - Yao-Ching Huang
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei, Taiwan
| | - Xiao-Cheng Lai
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chien-An Sun
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, Republic of China
- Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, Republic of China
| | - Chieh-Yi Kang
- Chi Mei Medical Center Gynecologic Oncologist Division, Department of Obstetrics & Gynecology, Tainan City, Taiwan, Republic of China
- Correspondence: Gwo-Jang Wu; Chieh-Yi Kang, Email ;
| | - Gwo-Jang Wu
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
- Correspondence: Gwo-Jang Wu; Chieh-Yi Kang, Email ;
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
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The Association between Comorbidities and Comorbid Injuries on Treatment Outcome in Pediatric and Elderly Patients with Injuries in Korea: An Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106277. [PMID: 35627814 PMCID: PMC9141990 DOI: 10.3390/ijerph19106277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 11/17/2022]
Abstract
We aimed to compare the characteristics and types of injuries affecting pediatric and elderly patients and to identify factors associated with treatment outcomes. We used data from the 2006−2017 Korea National Hospital Discharge Survey. The patients were divided into two groups, children (0−12 years) and elderly (≥65 years), based on their age at discharge. In total, 47,528 (11,842 children and 35,686 older adults) patients with injuries were identified. The number of deaths and the LOS were 36 (0.3%) and 7.6 days (±10.1), respectively, in the children group, and 861 (2.4%) and 18.5 days (±27.3), respectively, in the elderly group (p < 0.001). In the children group, there were increased odds for surgery among boys, Medicaid and health insurance subscribers, patients with multiple injuries, patients without a subdiagnosis, and an increasing number of hospital beds. In the elderly group, there were increased odds for surgery among women, Medicaid and health insurance subscribers, patients who died, patients with a single injury, patients with a subdiagnosis, and increasing numbers of hospital beds. Treatment outcomes could be improved by providing early diagnosis and prompt treatment in pediatric patients and by taking multilateral approaches for multiple injuries and comorbidities in elderly patients.
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Yang CC, Chien WC, Chung CH, Lai CY, Tzeng NS. The Usage of Histamine Type 1 Receptor Antagonist and Risk of Dementia in the Elderly: A Nationwide Cohort Study. Front Aging Neurosci 2022; 14:811494. [PMID: 35370616 PMCID: PMC8972197 DOI: 10.3389/fnagi.2022.811494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe histamine type 1 receptor antagonist (H1RA) has been commonly used. This study aimed to examine the association between the usage of H1RA and the risk of dementia.MethodsA total of 8,986 H1RA users aged ≥50 and 26,958 controls matched a ratio of 1:3 for age, sex, and comorbidity, were selected between January 1, and December 31, 2000, from Taiwan’s National Health Insurance Research Database. Fine and Gray’s survival analysis (competing with mortality) was used to compare the risk of developing dementia during a 15-year follow-up period (2000–2015).ResultsIn general, the H1RA usage was not significantly associated with dementia (adjusted subdistribution hazard ratio [SHR] = 1.025, 95% confidence interval [CI] = 0.883–1.297, p = 0.274) for the H1RA cohort. However, a differential risk was found among the groups at risk. The patients with the usage of H1RA aged ≥65 years (adjusted SHR: 1.782, 95% CI = 1.368–2.168, p < 0.001) were associated with a higher risk of dementia, in comparison to the control groups. Furthermore, the patients with the usage of H1RA that were male, or had more comorbidities, were also associated with an increased risk of dementia.ConclusionThe usage of H1RA was associated with the risk of developing dementia in the patients aged ≥ 65 years.
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Affiliation(s)
- Chuan-Chi Yang
- Department of Psychiatry, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
- Department of Psychiatry, Taoyuan Armed Forces General Hospital, Hsinchu Branch, Hsinchu City, Taiwan
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Chung-Yu Lai
- Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
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Hwang JH, Ong HL, Chen YC. Surgical treatments for obstructive sleep apnea decrease the risk of erectile dysfunction: A nationwide cohort study. Andrology 2021; 10:477-485. [PMID: 34748688 DOI: 10.1111/andr.13126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/26/2021] [Accepted: 11/02/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND It has been reported that the risk of erectile dysfunction (ED) is significantly higher in patients with obstructive sleep apnea (OSA), compared with patients without OSA. However, there is limited evidence on whether surgical treatments in patients with OSA could decrease ED risk. OBJECTIVES To assess the impact of surgical treatments for OSA on the risk of ED by analysis of claims data from the Taiwan National Health Insurance Research Database between 1997 and 2012. MATERIAL AND METHODS We identified 20,675 male adults with newly diagnosed OSA during the study period; 16,040 patients ever received surgical treatments (treated cohort) and 4635 patients never received surgical treatments (untreated cohort). According to 3:1 propensity score matching, we analyzed 8337 patients in the treated cohort and 2779 controls in the untreated cohort. We estimated the incidence rates (IRs) and hazard ratios (HRs) of incident ED in both cohorts through the end of 2012. RESULTS In a total study follow-up of 64,916 person-years, 396 (3.6%) patients developed impotence. The IRs of ED for the treated and untreated cohorts, respectively, were 55.8 (95% confidence interval [CI], 55.6-55.9) and 76.1 (95% CI, 76.0-76.3) per 1000 person-years. Multivariate Cox proportional hazard analysis showed that surgical treatments for OSA patients were associated with a lower risk for ED (adjusted HR, 0.79; 95% CI, 0.64-0.98). Multivariate stratified analysis further verified that significant risk reduction of ED was present in OSA patients without hypertension, diabetes, hyperlipidemia, hyperuricemia, obesity, chronic kidney disease, and chronic liver disease. CONCLUSIONS We found that OSA patients who received surgical treatments were associated with a lower risk for developing ED by 21%.
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Affiliation(s)
- Juen-Haur Hwang
- Department of Otolaryngology-Head and Neck Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Hueih-Ling Ong
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Urology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Yi-Chun Chen
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
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Wang SC, Chien WC, Chung CH, Tzeng NS, Liu YP. Posttraumatic stress disorder and the risk of erectile dysfunction: a nationwide cohort study in Taiwan : PTSD and erectile dysfunction. Ann Gen Psychiatry 2021; 20:48. [PMID: 34583712 PMCID: PMC8480081 DOI: 10.1186/s12991-021-00368-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 09/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to investigate the association between posttraumatic stress disorder and the risk of developing erectile dysfunction. METHODS In this population-based retrospective cohort study, we used Taiwan's National Health Insurance Research Database to analyze patients who were newly diagnosed with posttraumatic stress disorder (PTSD) between 2000 and 2013, with a 1:3 ratio by age and index year matched with patients in a non-PTSD comparison group, for the risk of erectile dysfunction. RESULTS In total, 5 out of 1079 patients in the PTSD group developed erectile dysfunction, and 3 out of 3237 patients in the non-PTSD group (47.58 vs. 9.03 per 100,000 per person-year) developed erectile dysfunction. The Kaplan-Meier analysis showed that the PTSD cohort had a significantly higher risk of erectile dysfunction (log-rank, p < 0.001). The Cox regression analysis revealed that the study subjects were more likely to develop an injury (hazard ratio: 12.898, 95% confidence intervals = 2.453-67.811, p = 0.003) after adjusting for age, monthly income, urbanization level, geographic region, and comorbidities. Psychotropic medications used by the patients with PTSD were not associated with the risk of erectile dysfunction. CONCLUSIONS Patients who suffered from PTSD had a higher risk of developing erectile dysfunction.
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Affiliation(s)
- Sheng-Chiang Wang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Songshan Branch, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, Tri-Service General Hospital, National Defense Medical Center, 325, Section 2, Cheng-Gung Road, Nei-Hu District, Taipei, Taiwan.,Laboratory of Cognitive Neuroscience, Departments of Physiology and Biophysics, National Defense Medical Center, 161, Minquan East Road, Neihu District, Taipei, 11490, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, School of Medicine, Tri-Service General Hospital, National Defense Medical Center, 325, Section 2, Cheng-Gung Road, Nei-Hu District, Taipei, Taiwan. .,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan.
| | - Yia-Ping Liu
- Department of Psychiatry, School of Medicine, Tri-Service General Hospital, National Defense Medical Center, 325, Section 2, Cheng-Gung Road, Nei-Hu District, Taipei, Taiwan. .,Laboratory of Cognitive Neuroscience, Departments of Physiology and Biophysics, National Defense Medical Center, 161, Minquan East Road, Neihu District, Taipei, 11490, Taiwan. .,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan. .,Department of Psychiatry, Chen Hsin General Hospital, Taipei, Taiwan.
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Bayrak A, Duramaz A. Erectile Dysfunction after Conservative Treatment of Sacral Fractures in Males without Injury to the Urinary System. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021; 161:154-159. [PMID: 34544164 DOI: 10.1055/a-1611-0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND This study aimed to determine the incidence of erectile dysfunction (ED) reported by patients, and to define the prognostic relationship between ED and conservatively treated sacral fracture without urethral injury. METHODS Patients aged between 20 - 50 years who were sexually active and had no known sexual dysfunction prior to the trauma were included in the study. Seventy-seven patients (47 married, 30 single) treated conservatively for sacral fracture between April 2012 and February 2017 were retrospectively screened. Patients were compared in terms of age, marital status, body mass index (BMI), trauma mechanism, additional system injury, functional outcomes, and complications. Functional outcomes were assessed using the International Index of Erectile Function (IIEF-5) and the Majeed pelvic fracture functional assessment scale (MPS). RESULTS No statistically significant difference was observed between fracture types with respect to age, BMI, follow-up, marital status, trauma mechanism, and accompanying injury. The incidence of ED was 27.3% for those that received conservative treatment after sacrum fracture. The mean score of IIEF-5 was 18.6 ± 6.6 and MPS was 77.2 ± 13.2. There was no significant relationship between the injury type of the patients and the IIEF-5 and MPS scores (p = 0.593 and p = 0.907, respectively). The lowest IIEF-5 score was found in Denis type 2 fractures (p = 0.020). CONCLUSION The frequency of ED was higher in Denis type 2 sacrum fractures. Sexual function should be questioned in the follow-up, especially in those fracture types.
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Affiliation(s)
- Alkan Bayrak
- Orthopedics and Traumatology, Bakirkoy Dr Sadi Konuk Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| | - Altug Duramaz
- Orthopedics and Traumatology, Bakirkoy Dr Sadi Konuk Egitim ve Arastirma Hastanesi, Istanbul, Turkey
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Grashow R, Weisskopf MG, Miller KK, Nathan DM, Zafonte R, Speizer FE, Courtney TK, Baggish A, Taylor HA, Pascual-Leone A, Nadler LM, Roberts AL. Association of Concussion Symptoms With Testosterone Levels and Erectile Dysfunction in Former Professional US-Style Football Players. JAMA Neurol 2021; 76:1428-1438. [PMID: 31449296 PMCID: PMC6714010 DOI: 10.1001/jamaneurol.2019.2664] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Question Are professional US-style football players with a history of multiple concussion symptoms more likely to report indicators of low testosterone levels or erectile dysfunction (ED)? Findings In this cross-sectional study of 3409 former players, a monotonically increasing association was found between the number of concussion symptoms and the odds of reporting an indicator of low testosterone level and ED. Meaning Concussion symptoms among former football players were associated with low testosterone levels and ED indicators, suggesting that men with a history of head injury may benefit from discussions with their health care clinicians regarding these treatable outcomes. Importance Small studies suggest that head trauma in men may be associated with low testosterone levels and sexual dysfunction through mechanisms that likely include hypopituitarism secondary to ischemic injury and pituitary axonal tract damage. Athletes in contact sports may be at risk for pituitary insufficiencies or erectile dysfunction (ED) because of the high number of head traumas experienced during their careers. Whether multiple symptomatic concussive events are associated with later indicators of low testosterone levels and ED is unknown. Objective To explore the associations between concussion symptom history and participant-reported indicators of low testosterone levels and ED. Design, Setting, and Participants This cross-sectional study of former professional US-style football players was conducted in Boston, Massachusetts, from January 2015 to March 2017. Surveys on past football exposures, demographic factors, and current health conditions were sent via electronic and postal mail to participants within and outside of the United States. Analyses were conducted in Boston, Massachusetts; the data analysis began in March 2018 and additional analyses were performed through June 2019. Of the 13 720 male former players eligible to enroll who were contacted, 3506 (25.6%) responded. Exposures Concussion symptom score was calculated by summing the frequency with which participants reported 10 symptoms, such as loss of consciousness, disorientation, nausea, memory problems, and dizziness, at the time of football-related head injury. Main Outcomes and Measures Self-reported recommendations or prescriptions for low testosterone or ED medication served as indicators for testosterone insufficiency and ED. Results In 3409 former players (mean [SD] age, 52.5 [14.1] years), the prevalence of indicators of low testosterone levels and ED was 18.3% and 22.7%, respectively. The odds of reporting low testosterone levels or ED indicators were elevated for previously established risk factors (eg, diabetes, sleep apnea, and mood disorders). Models adjusted for demographic characteristics, football exposures, and current health factors showed a significant monotonically increasing association of concussion symptom score with the odds of reporting the low testosterone indicator (highest vs lowest quartile, odds ratio, 2.39; 95% CI, 1.79-3.19; P < .001). The ED indicator showed a similar association (highest quartile vs lowest, odds ratio, 1.72; 95% CI, 1.30-2.27; P < .001). Conclusions and Relevance Concussion symptoms at the time of injury among former football players were associated with current participant-reported low testosterone levels and ED indicators. These findings suggest that men with a history of head injury may benefit from discussions with their health care clinicians regarding testosterone deficiency and sexual dysfunction.
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Affiliation(s)
- Rachel Grashow
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Football Players Health Study, Harvard Medical School, Boston, Massachusetts
| | - Marc G Weisskopf
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Environmental and Occupational Medicine and Epidemiology Program, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Karen K Miller
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, Massachusetts
| | - David M Nathan
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital Diabetes Center, Boston.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Ross Zafonte
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts.,Massachusetts General Hospital, Harvard Medical School, Boston.,Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Frank E Speizer
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Theodore K Courtney
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Environmental and Occupational Medicine and Epidemiology Program, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Aaron Baggish
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Cardiovascular Performance Program, Massachusetts General Hospital, Boston
| | - Herman A Taylor
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia
| | - Alvaro Pascual-Leone
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Lee M Nadler
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Dana Farber Cancer Institute, Boston, Massachusetts
| | - Andrea L Roberts
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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11
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Chen TY, Chung CH, Chang HA, Kao YC, Chang SY, Kuo TBJ, Yang CCH, Chien WC, Tzeng NS. Long-term atomoxetine-oxybutynin combination use may be beneficial for the prevention of obstructive sleep apnea. Sci Rep 2021; 11:12526. [PMID: 34131226 PMCID: PMC8206122 DOI: 10.1038/s41598-021-91988-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 05/07/2021] [Indexed: 11/09/2022] Open
Abstract
One recent study showed that atomoxetine-oxybutynin combination (AOC) use is effective in reducing obstructive sleep apnea (OSA) severity. We used a nationwide database to examine the association between AOC use and the risk of OSA incidence. This retrospective cohort study used Taiwan's National Health Insurance Research Database between the years 2000 and 2015. The patients who used atomoxetine or oxybutynin were included as an exposed cohort. The exposed and unexposed groups were selected in a ratio of 1:3 with sex, age, and index year matching. We used the multivariate Cox proportional regression model to evaluate the association between AOC use and the risk of an incident diagnosis of OSA. The incidence rates of OSA in the exposed cohort (N = 8940) and the unexposed cohort (N = 26,820), were 21.92 and 22.93 per 100,000 person-years, respectively. The adjusted hazard ratio of oxybutynin use only and AOC with a treatment duration of ≥ 366 days were 0.307 (95% CI 0.204-0.995, P = 0.045) and 0.299 (95% CI 0.102-0.933, P = 0.002), respectively. Long-term atomoxetine-oxybutynin combination therapy may be beneficial to reduce the risk of obstructive sleep apnea. Further studies to examine these mechanisms are warranted.
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Affiliation(s)
- Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Shan-Yueh Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Terry B J Kuo
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei 112, Taiwan.,Clinical Research Center, Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Cheryl C H Yang
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. .,School of Public Health, National Defense Medical Center, Taipei, Taiwan. .,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan. .,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan.
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12
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Salvio G, Martino M, Giancola G, Arnaldi G, Balercia G. Hypothalamic-Pituitary Diseases and Erectile Dysfunction. J Clin Med 2021; 10:2551. [PMID: 34207687 PMCID: PMC8229897 DOI: 10.3390/jcm10122551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 12/11/2022] Open
Abstract
Several hormones contribute to ensure penile erection, a neurovascular phenomenon in which nitric oxide plays a major role. Erectile dysfunction (ED), which is defined as the persistent inability to obtain or maintain penile erection sufficient for a satisfactory sexual performance, may be due to arteriogenic, neurogenic, iatrogenic, but also endocrinological causes. The hypothalamus-pituitary axis plays a central role in the endocrine system and represents a fundamental link between the brain and peripheral glands, including gonads. Therefore, the hormonal production of the hypothalamic-pituitary axis can control various aspects of sexual function and its dysregulation can compromise erectile function. In addition, excess and deficiency of pituitary hormones or metabolic alterations that are associated with some pituitary diseases (e.g., Cushing's disease and acromegaly, hypopituitarism) can determine the development of ED with different mechanisms. Thus, the present review aimed to explore the relationship between hypothalamic and pituitary diseases based on the most recent clinical and experimental evidence.
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Affiliation(s)
- Gianmaria Salvio
- Division of Endocrinology, Department of Clinical and Molecular Sciences (DISCLIMO), Polytechnic University of Marche, Umberto I Hospital, 60126 Ancona, Italy; (M.M.); (G.G.); (G.A.); (G.B.)
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13
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Lin IJ, Tzeng NS, Chung CH, Chien WC. Psychiatric disorders in female psychosexual disorders-a nationwide, cohort study in Taiwan : Psychiatric disorders and female psychosexual disorders. BMC Psychiatry 2021; 21:63. [PMID: 33509146 PMCID: PMC7845000 DOI: 10.1186/s12888-021-03060-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 01/18/2021] [Indexed: 12/02/2022] Open
Abstract
We aimed to investigate whether females with psychosexual disorders were associated with the risk of affective and other psychiatric disorders. A total of 2240 enrolled individuals, with 560 patients with psychosexual disorders and 1680 subjects without psychosexual disorders (1:3) matched for age and index year, from the Longitudinal Health Insurance Database, retrieved from the National Health Insurance Research Database (NHIRD), between 2000 and 2015 in Taiwan. The multivariate Cox regression model was used to compare the risk of developing psychiatric disorders during the 15 years of follow-up. There were 98 in the cohort with psychosexual disorders (736.07 per 100,000 person-year) and 119 in the non-cohort without psychosexual disorders (736.07 per 100,000 person-year) that developed psychiatric disorders. The multivariate Cox regression model revealed that the adjusted hazard ratio (HR) was 9.848 (95% CI = 7.298 - 13.291, p < 0.001), after the adjustment of age, monthly income, urbanization level, geographic region, and comorbidities. Female patients with psychosexual disorders were associated with the risk of psychiatric disorders. This finding could be a reminder for clinicians about the mental health problems in patients with psychosexual disorders.
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Affiliation(s)
- Iau-Jin Lin
- grid.260565.20000 0004 0634 0356Graduate Institute of Life Sciences, National Defense Medical Center, 9314R, No.161, Section 6, Min-Chuan East Road, Neihu District, Taipei, 11490 Taiwan, Republic of China
| | - Nian-Sheng Tzeng
- grid.260565.20000 0004 0634 0356Department of Psychiatry, School of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China ,grid.260565.20000 0004 0634 0356Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chi-Hsiang Chung
- grid.260565.20000 0004 0634 0356Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, 7115R, No.325, Section 2, Cheng-Gung Road, Neihu District, Taipei, 11490 Taiwan, Republic of China ,grid.260565.20000 0004 0634 0356School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China ,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, Republic of China
| | - Wu-Chien Chien
- Graduate Institute of Life Sciences, National Defense Medical Center, 9314R, No.161, Section 6, Min-Chuan East Road, Neihu District, Taipei, 11490, Taiwan, Republic of China. .,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, 7115R, No.325, Section 2, Cheng-Gung Road, Neihu District, Taipei, 11490, Taiwan, Republic of China. .,School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China. .,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, Republic of China.
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14
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Baguley IJ, Barden HL, Nott MT. Altered sexual function after central neurological system trauma is reflective of region of injury; brain vs spinal cord. Brain Inj 2020; 34:1732-1740. [PMID: 33190566 DOI: 10.1080/02699052.2020.1832258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To compare and contrast the contributory effects of traumatic brain injury (TBI) and spinal cord injury (SCI) on sexual function and social relationship opportunities, hypothesizing that patterns of change in sexual function would follow etiology. DESIGN Cross-sectional, case-matched survey of community living individuals with TBI, SCI or both (termed dual diagnosis). PARTICIPANTS Consecutive sample of participants with TBI (n = 25), SCI (n = 24) and dual diagnosis (n = 28), an average 3.6 years post-rehabilitation discharge. METHODS Participants were interviewed using a modified version of the 'Sexuality after Spinal Injury Questionnaire.' RESULTS Almost all respondents (97%) perceived adverse post-injury change in their experience of neurosexual function and/or social relationships. Physiological aspects of sexual function (e.g., erection, orgasm) were most affected by SCI whereas social relationships appeared more affected by TBI. People with dual diagnoses exhibited a combination of features. Participants with SCI (with or without TBI) were significantly more likely to have their concerns about sexual function discussed during rehabilitation than the TBI group. CONCLUSION TBI and SCI produce predictable impacts upon sexual function following injury, the impact of which were less frequently addressed during inpatient rehabilitation for those with TBI.
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Affiliation(s)
- Ian J Baguley
- Brain Injury Rehabilitation Service, Westmead Hospital , Sydney, Australia.,Sydney Medical School, The University of Sydney , Sydney, Australia
| | - Hannah L Barden
- Brain Injury Rehabilitation Service, Westmead Hospital , Sydney, Australia.,School of Community Health, Charles Sturt University , Albury, Australia
| | - Melissa T Nott
- Brain Injury Rehabilitation Service, Westmead Hospital , Sydney, Australia.,School of Community Health, Charles Sturt University , Albury, Australia
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15
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Tzeng NS, Yeh HW, Chung CH, Chang HA, Kao YC, Chiang WS, Chien WC. Risk of Psychiatric Morbidity in Psychosexual Disorders in Male Patients: A Nationwide, Cohort Study in Taiwan. Am J Mens Health 2020; 13:1557988319842985. [PMID: 30971176 PMCID: PMC6460890 DOI: 10.1177/1557988319842985] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
This study aimed to investigate the association between males with psychosexual disorders (PSDs) and the risk of developing psychiatric disorders. A total of 34,972 enrolled patients, with 8,743 subjects who had suffered from PSD and 26,229 controls (1:3) matched for age and index year, from Taiwan’s Longitudinal Health Insurance Database (LHID) from 2000 to 2015, selected from the National Health Insurance Research Database (NHIRD). After adjusting all the confounding factors, the multivariate Cox regression model was used to compare the risk of developing psychiatric disorders, between the PSD and non-PSD groups, during the 15 years of follow-up. Of the all enrollees, 1,113 in the PSD cohort and 2,611 in the non-PSD cohort (1,180.96 vs. 954.68 per 100,000 person-year) developed psychiatric disorders. Multivariate Cox regression model survival analysis revealed that, after adjusting for gender, age, monthly income, urbanization level, geographic region, and comorbidities, the adjusted hazard ratio (HR) was 2.448 (95% CI [2.227, 2.633], p < .001). PSD has been associated with the increased risk in anxiety disorders, depressive disorders, bipolar disorders, sleep disorders, and psychotic disorders, respectively. Sexual dysfunctions, paraphilia, and gender identity disorders were associated with the overall psychiatric disorders with adjusted HRs as 1.990 (p < .001), 11.622 (p < .001), and 5.472 (p < .001), respectively. Male patients who suffered from PSD have a higher risk of developing psychiatric disorders, and this finding should be considered as a timely reminder for the clinicians to provide much more attention for these patients because of their mental health issues.
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Affiliation(s)
- Nian-Sheng Tzeng
- 1 Department of Psychiatry, School of Medicine, Tri-Service General hospital, National Defense Medical Center, Taipei, Republic of China.,2 Student Counseling Center, National Defense Medical Center, Taipei, Republic of China
| | - Hui-Wen Yeh
- 1 Department of Psychiatry, School of Medicine, Tri-Service General hospital, National Defense Medical Center, Taipei, Republic of China.,3 Institute of Bioinformatics and System Biology, National Chiao Tung University, Hsin-Chu, Republic of China.,4 Department of Nursing, Tri-Service General hospital, and School of Nursing, National Defense Medical Center, Taipei, Republic of China.,5 Department of Nursing, Kang-Ning University (Taipei Campus), Taipei, Republic of China
| | - Chi-Hsiang Chung
- 6 Department of Medical Research, Tri-Service General hospital, National Defense Medical Center, Taipei, Republic of China.,7 School of Public Health, National Defense Medical Center, Taipei, Republic of China.,8 Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Republic of China
| | - Hsin-An Chang
- 1 Department of Psychiatry, School of Medicine, Tri-Service General hospital, National Defense Medical Center, Taipei, Republic of China.,2 Student Counseling Center, National Defense Medical Center, Taipei, Republic of China
| | - Yu-Chen Kao
- 1 Department of Psychiatry, School of Medicine, Tri-Service General hospital, National Defense Medical Center, Taipei, Republic of China.,9 Department of Psychiatry, Song-Shan Branch, Tri-Service General hospital, National Defense Medical Center, Taipei, Republic of China
| | - Wei-Shan Chiang
- 1 Department of Psychiatry, School of Medicine, Tri-Service General hospital, National Defense Medical Center, Taipei, Republic of China
| | - Wu-Chien Chien
- 6 Department of Medical Research, Tri-Service General hospital, National Defense Medical Center, Taipei, Republic of China.,7 School of Public Health, National Defense Medical Center, Taipei, Republic of China.,10 Graduate of Life Sciences, National Defense Medical Center, Taipei, Republic of China
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16
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Marier-Deschênes P, Gagnon MP, Déry J, Lamontagne ME. Traumatic Brain Injury and Sexuality: User Experience Study of an Information Toolkit. J Particip Med 2020; 12:e14874. [PMID: 33064104 PMCID: PMC7434066 DOI: 10.2196/14874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 12/01/2019] [Accepted: 12/19/2019] [Indexed: 01/30/2023] Open
Abstract
Background After having sustained a traumatic brain injury (TBI), individuals are at risk of functional impairments in information processing, abstract reasoning, executive functioning, attention, and memory. This affects different aspects of communicative functioning. Specific strategies can be adopted to improve the provision of health information to individuals with TBI, including the development of written materials and nonwritten media. Objective A user-centered design was adopted to codevelop four audiovisual presentations, a double-sided information sheet, and a checklist aimed at informing individuals about post-TBI sexuality. The last phase of the project was the assessment of the user experience of the information toolkit, based on the User Experience Honeycomb model. Methods Overall, two small group discussions and one individual semistructured interview were conducted with individuals with moderate to severe TBI. Results The participants mentioned that the toolkit was easily usable and would have fulfilled a need for information on post-TBI sexuality during or after rehabilitation. They mostly agreed that the minimalist visual content was well-organized, attractive, and relevant. The information was easily located, the tools were accessible in terms of reading and visibility, and the content was also considered credible. Conclusions Aspects such as usability, usefulness, desirability, accessibility, credibility, and findability of information were viewed positively by the participants. Further piloting of the toolkit is recommended to explore its effects on the awareness of the potential sexual repercussions of TBI in individuals and partners.
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Affiliation(s)
- Pascale Marier-Deschênes
- Université Laval, Department of Rehabilitation, Québec, QC, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, QC, Canada.,Centre de recherche sur les soins et services de première ligne de l'Université Laval, Québec, QC, Canada
| | - Marie-Pierre Gagnon
- Centre de recherche sur les soins et services de première ligne de l'Université Laval, Québec, QC, Canada.,Université Laval, Faculty of Nursing, Québec, QC, Canada.,Centre de recherche du CHU de Québec, Québec, QC, Canada
| | - Julien Déry
- Université Laval, Department of Rehabilitation, Québec, QC, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, QC, Canada
| | - Marie-Eve Lamontagne
- Université Laval, Department of Rehabilitation, Québec, QC, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, QC, Canada
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17
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Wan FJ, Chien WC, Chung CH, Yang YJ, Tzeng NS. Association between traumatic spinal cord injury and affective and other psychiatric disorders-A nationwide cohort study and effects of rehabilitation therapies. J Affect Disord 2020; 265:381-388. [PMID: 32090763 DOI: 10.1016/j.jad.2020.01.063] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/06/2020] [Accepted: 01/14/2020] [Indexed: 02/09/2023]
Abstract
BACKGROUND This study aimed to investigate the association between traumatic spinal cord injury (TSCI) and the risk of affective and other psychiatric disorders, and the role of the rehabilitation therapies. METHODS In this population-based, retrospective cohort study, we used Taiwan's National Health Insurance Research Database to analyze the patients who were newly diagnosed with TSCI between 2000 and 2015 were included, with a 1:3 ratio by age, sex, and index year matched in the non-TSCI comparison group, for the risk of affective and other psychiatric disorders. RESULTS In total, 5375 out of 16,151 patients with TSCI developed psychiatric disorders, and 1467 out of 48,543 patients in the non-TSCI group developed psychiatric disorders (2930.88 vs 2823.29 per 100,000 persons/year). The Kaplan-Meier analysis showed that the TSCI cohort had a significantly higher risk of psychiatric disorders (log-rank, p < 0.001). Fine and Gray's survival analysis revealed that the adjusted hazard ratio was 1.977 (95% CI: 1.914-2.042, p < 0.001). Rehabilitation therapies, including physical and occupational therapies, within 90 days after the injury, was associated with a lowered risk of psychiatric disorders, including anxiety, depression, and bipolar disorder, in the TSCI cohort (adjusted HR = 0.702 [95% CI: 0.661-0.746, p < 0.001]). In the subgroups with low, medium, and high intensity, rehabilitation therapies were associated with a lowered risk of psychiatric disorders. CONCLUSIONS TSCI was associated with the risk of affective and other psychiatric disorders, and rehabilitation therapies were associated with a lowered risk of these in the TSCI cohort.
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Affiliation(s)
- Fang-Jung Wan
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC; School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC; Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC; School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC; Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, ROC
| | - Yun-Ju Yang
- Department of Neurological Surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC; Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, ROC.
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18
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Robert H, Pichon B, Haddad R. [Sexual dysfunctions after traumatic brain injury: Systematic review of the literature]. Prog Urol 2019; 29:529-543. [PMID: 31477433 DOI: 10.1016/j.purol.2019.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/23/2019] [Accepted: 08/03/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Sexual dysfunction (SD) is common in the general population, up to 50% in women and with no clearly defined prevalence in men but up to 30% in erectile dysfunction. Sexual dysfunctions (SD) are common after a traumatic brain injury (TBI) but remain underrated in clinical practice, yet it is a crucial aspect of the person with consequences for the relationship with the other, psychological wellbeing and quality of life. OBJECTIVE To determine, through a systematic literature review, the epidemiology, assessment tools and treatment of SD in the TBI population. SOURCES (keywords, languages): Medline, COCHRANE and OVID databases were used with specific keywords (MeSH), combined with Boolean operators: "sexual dysfunction", "sexuality", "erectile dysfunction" and "traumatic brain injury". STUDY SELECTION Only studies published in French or English, and with full-text available, have been included. Articles have been independently reviewed and extracted. RESULTS Of the 199 articles reviewed after exclusion of duplicates, 86 articles were reviewed in their full text. A total of 40 studies were included in the final analysis. After TBI, 6% to 83% of patients report SD: decreased frequency of sexual intercourse (47-62%), desire and/or arousal (24-86%), erectile dysfunction (24,2-57%), difficulties with orgasm (29-40%), inappropriate sexual behaviour (8,9%). There is no consensus method for evaluating SD in this population, with 16 tools identified. Among them, only two questionnaires were validated in this population, the Brain Injury Questionnary of Sexuality - not validated in French - and the Overt Behavior Scale, the latter being intended for the evaluation of sexual behaviour disorders. Several factors are significantly and positively associated with SD: age (P≤0.01), severity of TBI (P≤0.002), depression (P<0.001), anxiety (P<0.001), and fatigue (P=0.042). Others are negatively associated: time since injury (P=0.01), perceived physical health status (P<0.001) and social participation (P<0.001). There is little data on the treatment of SD outside of case studies. LIMITS Quantitative analysis could not be performed due to differences in the studies included in their design, evaluation tools, choice of TBI severity criteria, and post-TBI timeframes. Four unavailable articles could not be consulted. CONCLUSION SD are common after TBI but remain poorly evaluated in clinical practice, despite their impact on patients and their partners. Their evaluation and treatment should be part of the overall management of patients after TBI. Nevertheless, there is currently no validated tool in French to evaluate these SD, nor are there any guidelines on their treatment.
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Affiliation(s)
- H Robert
- GRC n°18, service de rééducation neurologique, Sorbonne université, UPMC université Paris 06, handicap moteur, cognitif et réadaptation (HaMCRe), Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, AP-HP, 75013 Paris, France.
| | - B Pichon
- GRC n°18, service de rééducation neurologique, Sorbonne université, UPMC université Paris 06, handicap moteur, cognitif et réadaptation (HaMCRe), Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, AP-HP, 75013 Paris, France; GRC 001, GREEN groupe de recherche en neuro-urologie, Sorbonne université, hôpital Rothschild, AP-HP, 75012 Paris, France
| | - R Haddad
- GRC 001, GREEN groupe de recherche en neuro-urologie, Sorbonne université, hôpital Rothschild, AP-HP, 75012 Paris, France
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19
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Wang QR, Lu YY, Su YJ, Qin H, Zhang L, Wu MK, Zhang CL, Wu CH. Migraine and traumatic brain injury: a cohort study in Taiwan. BMJ Open 2019; 9:e027251. [PMID: 31366644 PMCID: PMC6677981 DOI: 10.1136/bmjopen-2018-027251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 06/25/2019] [Accepted: 07/04/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Traumatic brain injury is now a major contributor to the global healthcare burden. Migraine is another debilitating disease with a global health impact. While most researchers agree that traumatic brain injury is a risk factor for migraine, whether migraine is a risk factor for traumatic brain injury still remains under debate. We therefore aimed to investigate whether migraine was a risk factor for developing traumatic brain injury. STUDY DESIGN Retrospective population-based cohort study. SETTING Data for people who had been diagnosed with migraine were retrieved from Taiwan's National Health Insurance Research Database. PARTICIPANTS We identified 7267 patients with newly diagnosed migraine during 1996-2010. The migraineurs to non-migraineurs ratio was set at 1:4 to enhance the power of statistical tests. PRIMARY AND SECONDARY OUTCOME MEASURES We used multivariate Cox proportional hazard regression models to assess the effects of migraines on the risk of traumatic brain injury after adjusting for potential confounders. RESULTS The overall traumatic brain injury risk was 1.78 times greater in the migraine group compared with the non-migraine group after controlling for covariates. Additionally, patients with previous diagnoses of alcohol-attributed disease, mental disorders and diabetes mellitus had a significantly higher traumatic brain injury risk compared with those with no history of these diagnoses. CONCLUSIONS This study of a population-based database indicated that migraine is a traumatic brain injury risk factor. Greater attention to migraine-targeted treatment modalities may reduce traumatic brain injury-related morbidity and mortality.
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Affiliation(s)
- Qing-Rui Wang
- Department of Neurosurgery, Qinghe County Central Hospital of Hebei Province, Qinghe, Hebei, China
| | - Ying-Yi Lu
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ying-Ju Su
- Department of Surgery, Kaohsiung Medical University Hospital,Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hao Qin
- Department of Neurosurgery, Zaozhuang Municipal Hospital, Zaozhuang, Shandong, China
| | - Li Zhang
- Department of Neurosurgery, The Affiliated Zhangjiagang Hospital of Soochow University, Zhangjiagang, Jiangsu, China
| | - Ming-Kung Wu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cong-Liang Zhang
- Department of Cardiology, Hebei Quyang Renji Hospital, Quyang, Hebei, China
| | - Chieh-Hsin Wu
- Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Tzeng NS, Chung CH, Chang SY, Yeh CB, Lu RB, Chang HA, Kao YC, Chou YC, Yeh HW, Chien WC. Risk of psychiatric disorders in pulmonary embolism: a nationwide cohort study. J Investig Med 2019; 67:977-986. [PMID: 31266811 DOI: 10.1136/jim-2018-000910] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2019] [Indexed: 12/11/2022]
Abstract
This study aims to investigate the association between pulmonary embolism (PE) and the risk of psychiatric disorders. A total of 21,916 patients aged ≥20 years with PE between January 1, 2000, and December 31, 2015, were selected from the National Health Insurance Research Database of Taiwan, along with 65,748 (1:3) controls matched for sex and age. Cox regression model revealed the crude HR was 1.539 (95% CI 1.481 to 1.599; p<0.001), and after adjusting all the covariates, the adjusted HR was 1.704 (95% CI 1.435 to 1.991, p<0.001), for the risk of psychiatric disorders in the PE cohort. PE was associated with the overall psychiatric disorders, dementia, anxiety, depression, and sleep disorders, after the exclusion of the psychiatric diagnoses in the first year. PE was associated with the overall psychiatric disorders, dementia, anxiety, and depression, after the exclusion of the psychiatric diagnoses in the first 5 years. The patients with PE were associated with psychiatric disorders. This finding could serve as a reminder to the physicians to be more watchful and aware in the long-term follow-up of patients with PE for their care and potential mental health problems.
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Affiliation(s)
- Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Shan-Yueh Chang
- Division of Chest and Critical Medicine, Department of Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chin-Bin Yeh
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Ru-Band Lu
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Department of Psychiatry, College of Medicine & Hospital, National Chen-Gung University, Tainan, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Department of Psychiatry, Tri-Service General Hospital, Songshan Branch, Taipei, Taiwan
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Hui-Wen Yeh
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Institute of Bioinformatics and System Biology, National Chiao Tung University, Hsinchu, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
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Tzeng NS, Chung CH, Chang HA, Chang CC, Lu RB, Yeh HW, Chiang WS, Kao YC, Chang SY, Chien WC. Obstructive Sleep Apnea in Children and Adolescents and the Risk of Major Adverse Cardiovascular Events: A Nationwide Cohort Study in Taiwan. J Clin Sleep Med 2019; 15:275-283. [PMID: 30736877 DOI: 10.5664/jcsm.7632] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 11/15/2018] [Indexed: 12/18/2022]
Abstract
STUDY OBJECTIVES This study has investigated the risk of major adverse cardiovascular events (MACEs), including acute myocardial infarction, coronary artery disease, peripheral artery disease, and acute stroke, among children and adolescents (age younger than 20 years) with obstructive sleep apnea (OSA). METHODS In this study, the population-based National Health Insurance Research Database of Taiwan was used to identify patients in whom OSA had been first diagnosed between 2000 and 2015. Children and adolescents with OSA (n = 6,535) were included with 1:3 ratio by age, sex, and index year of control participants without OSA (n = 19,605). The Cox proportional regression model was used to evaluate the risk of MACEs in this cohort study. RESULTS After a 15-year follow-up, the incidence rate of MACEs was higher in the OSA cohort when compared with the non-OSA control cohort (15.97 and 8.20 per 100,000 person-years, respectively). After adjusting for covariates, the risk of MACEs among children and adolescents with OSA was still significantly higher (hazard ratio = 2.050; 95% confidence interval = 1.312-3.107; P = .010). No MACEs were found in the children and adolescents with OSA who received continuous airway positive pressure treatment or pharyngeal surgery. CONCLUSIONS This study found a significantly higher risk of MACEs in children and adolescents with OSA. These findings strongly suggest that clinicians should provide careful follow-up and medical treatment for children and adolescents with OSA.
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Affiliation(s)
- Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, ROC
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chuan-Chia Chang
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ru-Band Lu
- Department of Psychiatry, College of Medicine and Hospital, National Cheng-Kung University, Tainan, Taiwan, ROC.,Institute of Behavioral Medicine, College of Medicine, National Cheng-Kung University, Tainan, Taiwan, ROC
| | - Hui-Wen Yeh
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.,Institute of Bioinformatics and System Biology, National Chiao Tung University, Hsin-Chu, Taiwan, ROC.,Department of Nursing, Tri-Service General Hospital, and School of Nursing, National Defense Medical Center, Taipei, Taiwan, ROC.,Department of Nursing, Kang-Ning University (Taipei Campus), Taipei, Taiwan, ROC
| | - Wei-Shan Chiang
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.,Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Shan-Yueh Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taiwan, ROC
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC.,Graduate Institute of Life Sciences, National Defense Medical Center, Taiwan, ROC
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Sexuality Re-education Program Logic Model for People with Traumatic Brain Injury (TBI): Synthesis via Scoping Literature Review. SEXUALITY AND DISABILITY 2018. [DOI: 10.1007/s11195-018-09556-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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