Male erectile dysfunction and health-related quality of life.

OBJECTIVE: The purpose of this work was to assess the health-related quality of life factors associated with erectile dysfunction (ED). METHODS: 2476 non-institutionalised Spanish males, age ranging from 25 to 70 years, were interviewed. ED was defined using two instruments: a simple self-assessment question (ED-sq) and the International Index of Erectile Function (IIEF). Health-related quality of life (HRQoL) was measured through the SF-36 questionnaire. RESULTS: The severity of ED (measured both through the ED-sq and with the IIEF) increased as the scores of the scales of the SF-36 decreased (Mantel-Hänszel chi(2)-test statistic range: [26-305]; p<0.001). The two summary components (physical and mental) showed a downward trend, more for the physical than for the mental component. CONCLUSION: We found a clear pattern of negative association between self-perceived erectile dysfunction and HRQoL. This association was clearer when ED-sq (rather than IIEF) was used, and stronger for the physical summary component than for the mental one.

Quality of life before intensive care unit admission and its influence on resource utilization and mortality rate.

OBJECTIVE: To analyze the quality of life of critically ill patients before their intensive care admission and its relation to age, variables measured in the intensive care unit (ICU; severity of illness, therapeutic effort, resource utilization, and length of stay), and in-hospital mortality rate. DESIGN: Observational prospective multicenter study. SETTING: Eighty-six medical-surgical ICUs in Spain, including coronary patients. PATIENTS: We studied 8,685 patients between 1992 and 1993. Patients <16 yrs old and those dying within the first 6 hrs were excluded. MEASUREMENTS AND MAIN RESULTS: Data collection included age, gender, admission diagnosis, severity level by Acute Physiology and Chronic Health Evaluation (APACHE) III, quality of life survey score, therapeutic activity level by Therapeutic Intervention Scoring System (TISS), and ICU and hospital mortality rate. Pre-ICU quality-of-life score was 3.74 +/- 4.42 points; 33.24% of patients had a normal quality of life (0 points), and numbers of patients declined logarithmically in relationship to increasing quality-of-life scores, with only 189 patients having a score >15 points. Pre-ICU quality-of-life score correlated with age (r =.289, p <.001), with severity level by APACHE III score (r =.217, p <.001), and weakly with TISS (r =.067, p <.001). There was no correlation between quality of life and length of ICU stay. Patients dying in hospital after ICU discharge (n = 429) had worse quality of life (5.88 +/- 5.38 points) than those dying in the ICU (n = 1,453, 4.8 +/- 4.94), who themselves had a worse quality of life than hospital survivors (n = 6,803, 5.05 +/- 5.07; p <.0001 by analysis of variance), with significant differences between all three groups. In the multivariate analysis, pre-ICU quality-of-life was related to age, APACHE III score, and hospital mortality rate but not to TISS or ICU length of stay. Pre-ICU quality of life was introduced as a variable in the APACHE III prediction model and entered the model after acute physiology score, diagnosis, and age and before prior patient location and comorbidities. The area under the receiver operating characteristics curve was 0.834 when quality-of-life was included and 0.83 when not. CONCLUSIONS: In Spain, the quality of life of critically ill patients before their ICU admission is good, and only a small proportion of patients have a low quality of life before admission. Previous quality of life is related to hospital mortality rate but contributes very little to the discriminatory ability of the APACHE III prediction model and has little influence on ICU resource utilization as measured by length of stay and therapeutic activity.

Prevalence and independent risk factors for erectile dysfunction in Spain: results of the Epidemiologia de la Disfuncion Erectil Masculina Study.

PURPOSE: We determined the prevalence of and risks factors for erectile dysfunction in Spain in a cross-sectional study. MATERIALS AND METHODS: A total of 2,476 noninstitutionalized Spanish men 25 to 70 years old were interviewed at home and answered a self-administered questionnaire of 71 items, including 2 instruments to define erectile dysfunction, a simple self-assessment question to estimate erectile function and the International Index of Erectile Function. Data on disease, medication and toxic habits were also obtained. RESULTS: With an overall participation rate of 75% the prevalence of erectile dysfunction according to the simple question was 12.1%. According to the erectile function domain of the International Index of Erectile Function the overall prevalence was 18.9%. Several independent risk factors were significantly associated with the probability of erectile dysfunction. Some differences arose according to the tool used to define the condition. However, there was a strong relationship of patient age with frequency or severity no matter which instrument was used to define erectile dysfunction. Diabetes (age adjusted odds ratio 4), high blood pressure (odds ratio 1.58), high cholesterol (1.63), peripheral vascular disorder (2.63), lung disease (3.11), prostate disease (2.93), cardiac problems (1.79), rheumatism (2.37) and allergy (3.08) were significantly associated with erectile dysfunction. Drug intake, which respondents called medication for nerves and sleeping pills, correlated strongly (odds ratio 2.78 and 4.27, respectively), as did tobacco use (2.5) and alcohol consumption (1.53). CONCLUSIONS: This study provides data on the prevalence of and risks factors for erectile dysfunction in Spain. The relationship of erectile dysfunction with certain risk factors, such as cardiovascular risk factors and drugs intake, are well known and our study corroborates these associations. Other associations with erectile dysfunction, such as prostate disease, allergy and rheumatism, support findings in previous reports, although to our knowledge the pathophysiological mechanisms remain unclear. Estimating the strength of the association of erectile dysfunction with distinct risk factors in terms of odds ratios enabled us to identify the factors to pursue when seeking to prevent erectile dysfunction. Furthermore, the relationship of tobacco with erectile dysfunction, which has been controversial in previous series, was well characterized in our study.

[Analysis of the clinical decision in the initial management of BPH]. / Análisis de la decisión clínica en el manejo inicial de la HBP.

RATIONALE: Diagnostic management of prostate benign hyperplasia remains a controversial issue subject to variations as made evident in surveys conducted in our country showing that 47.9% urologists regularly perform intravenous urography. The aim of this paper was to determine the preferred strategy from the standpoint of a more accurate diagnosis for evaluation of patients with prostate benign hyperplasia and no absolute indication for surgery. MATERIAL AND METHODS: The methodology used was an analysis of the decision taken by elucidation of the problem using a decision tree with three major choices: (a) to perform IPSS, flowmetry and ultrasound: (b) to perform IPSS and flowmetry, or (c) to perform IPSS alone. Basic analysis by estimation of the expected value and three sensitivity analysis, one-tailed and two-tailed, were used to see whether the dominant choice changed. RESULTS: The choice of performing IPSS alone, resulted in accurate diagnosis adjustment in 80.5% cases. When flowmetry was added from the beginning, this percentage declined to 66.2%; if ultrasound was also done, the decline reached down to 11.2%. The Odds Ratio (OR) for diagnosis imbalance was 15.52 and 33, in choice (a) versus choices (b) and (c), respectively. The OR for the IPSS and flowmetry choice to cause imbalance versus IPSS alone was 2, 12. Also, the choice with greater expected value was IPSS, and this result did not change with the sensitivity analysis. CONCLUSIONS: The choice that considers the possibility of symptom quantification in the IPSS scale and, based on the results, continuation of the diagnostic sequence is the one that should be followed, since it provides higher effectiveness from the standpoint of diagnosis adjustment.

Prevalence of benign prostatic hyperplasia in Spanish men 40 years old or older.

PURPOSE: We estimate the prevalence of benign prostatic hyperplasia (BPH) according to symptoms as well as prostate obstruction determined by uroflowmetry and prostate size. MATERIALS AND METHODS: A cross-sectional study was performed at the autonomous community of Andalusia in 1,106 men 40 years old or older. The International Prostate Symptom Score (I-PSS) questionnaire was used to establish symptoms, abdominal and transrectal ultrasonography was done to measure prostate size and uroflowmetry was performed to measure urinary flow obstruction. RESULTS: The prevalence of moderate or severe symptoms was 24.94% and it increased with age. Of the 1,106 subjects 4.19% had severe prostatism, while 12.45% had poor quality of life (I-PSS greater than 3). Average prostate size was greater than 30 gm. in men 60 years old or older. Maximum urine flow was less than 10 and 15 ml. per second in 25.97 and 55.67% of the men, respectively. The prevalence of BPH, defined as I-PSS greater than 7, maximum flow less than 15 ml. per second and prostate size greater than 30 gm., was 11.77% (range 0.75 to 30 at ages 40 to 49 and greater than 70 years, respectively). CONCLUSIONS: The prevalence of BPH increases with age. Moderate prostatism is perceived as resulting in poor quality of life by young subjects and good quality of life by some older subjects. In some men there were symptoms and obstruction but no prostate enlargement. This percentage persists with age after 50 years, when the prevalence of BPH starts to increase.

[Comparison of knowledge and risk behavior regarding AIDS among HIV+ and HIV- inmates at the provincial prison of Granada]. / Comparación de los conocimientos y los comportamientos de riesgo sobre el SIDA de los internos VIH+ y VIH- de la prisión provincial de Granada.

We have studied at the Provincial Prison of Granada, during the months of July and August of 1993 the knowledges of the prison inmates about the transmission of the AIDS, measures of prevention, risk behaviors like not use of condoms, use of intravenous drugs and sharing syringes. In total, there were 75 human immunodeficiency virus infected (HIV+) and 78 not infected (HIV-). The percentage of correct answers about transmission were significant, similar to the other studies done population in general. For the risk behaviors among HIV+, only 34.7% of HIV+, reported the of condoms all the times with their partners. Within the HIV+ reported have used intravenous drugs, sometimes 85.3%, sharing syringes only 43% last time. These data suggest that it is necessary to update the in Jail Health Promotion Programmes, in particular stressing the use of condoms and the risk sharing syringes by the HIV+ inmates, and informing about the risk of i.v. drugs consumption in general.

A population survey of childhood accidents in Andalusia (Spain).

The aim of this study was to quantify the incidence of childhood accidents and to describe the morbidity profile of accidents in the autonomous region of Andalusia, Spain, for a three-month period (January to March) in 1990. For that purpose, a population survey based on a stratified multiphase sample design was carried out. We collected information about the most serious accident each child had suffered during the study period according to the opinion of the person interviewed (the mother in most of the cases). The cumulative incidence of childhood accidents in Andalusia for a three-month period was 19.4%, higher in urban areas than in rural ones, and lower as the age of the age group increased. As had occurred in previous studies, a higher number of accidents was observed among the male population, however, this result was not statistically significant. During the same period of time, the incidence of traffic accidents for population 0 to 14 years was 0.8%. Accidents among younger children (0 to 4 years of age) occurred mainly at home, while for children of a higher age (5 to 9 and 10 to 14) they took place, in a larger number of cases, either outdoors or at school. When the accident happened, those from the first group were mainly in the presence of their parents or other adults; in the other two groups, there were more friends or schoolmates present. Fractures and injuries, of minor severity, mainly on the head and the extremities and with no sequelae, were the most frequent types of accident.(ABSTRACT TRUNCATED AT 250 WORDS)