Diabetes screening: a pending issue in hypertense/obese patients

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

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

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

Fear of becoming pregnant among female healthcare students in Spain

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

Sexual dimorphism development in the brain: the origin of sexual identity and behavior

[ES] El cerebro es el órgano más complejo del organismo del que dependen las funciones mentales y la conducta. Es evidente que las diferencias que caracterizan el comportamiento de machos y hembras en los vertebrados son debidas a la existencia de diferencias estructurales en el cerebro. Hoy en día se conoce bastante sobre las bases moleculares y celulares que subyacen al desarrollo y mantenimiento de estas diferencias, y por lo tanto, de las bases neurobiológicas del comportamiento diferencial entre machos y hembras de una misma especie. Nos proponemos revisar los últimos hallazgos que explican el desarrollo y las principales características del dimorfismo sexual en el cerebro de mamíferos y del hombre. Veremos cómo la producción de hormonas gonadales durante el desarrollo actúa sobre receptores específicos que regulan procesos fundamentales en el desarrollo genital durante la etapa precoz del desarrollo, y del sistema nervioso central durante la etapa perinatal. En el cerebro embrionario la acción de estas hormonas regula la neurogenesis y la muerte celular en regiones localizadas. Las neuronas y los circuitos neuronales de estas regiones están fundamentalmente implicados en el control de respuestas autónomas y reflejos motores con claro dimorfismo sexual, así como en funciones cerebrales más complejas que determinan la identidad y la conducta sexual del individuo. Por otro lado, el dimorfismo sexual del cerebro es aparente en otras regiones, explicando la respuesta diferente de machos y hembras a procesos que producen alteraciones generales de la función cerebral.[EN] Mental functions and behavior are consequence of the complex brain structure and function. Therefore, the differences that characterize the behavior of males and females in vertebrates are due to the existence of structural differences in the brain. Today our knowledge about the molecular and cellular processes underlying the development and maintenance of these differences is progressively increasing, and thus, the understanding of the neurobiological basis of differential behavior between males and females. We propose to review the latest findings that explain the development and the main features of sexual dimorphism in the brain of mammals. We will see how the production of gonadal hormones during development, acting on specific receptors, regulates key processes in the central nervous system during the perinatal period. In embryonic brain the action of these hormones modulate neurogenesis and cell death in specific neural regions. Neurons and neural circuitry of these regions are primarily involved in the control of autonomous sexual dimorphic motor reflex responses, as well as more complex brain functions as sexual identity and behavior. Moreover, the brain sexual dimorphism is also apparent in other regions, which explain the different response of males and females to general processes that produce alterations in brain function.Peer reviewe

Male sexual desire: an overview of biological, psychological, sexual, relational, and cultural factors influencing desire

Introduction: The literature showed the need for a better understanding of the male sexual response, which has historically been considered as simpler and more mechanistic compared with that in women. Aim: To examine the literature on biopsychosocial factors associated with the level of sexual desire in men and discuss some interesting directions for future research. Methods: A systematic literature review was conducted. Main outcome measures: 169 articles published in Google Scholar, Web of Science, Scopus, EBSCO, and Cochrane Library about male sexual desire and related biopsychosocial factors. Results: We found a lack of multidimensional studies on male sexual desire. Most existing research has focused on hypoactive sexual desire disorder in coupled heterosexual men. Biological factors play important roles in the level of sexual desire, but they are insufficient to explain the male sexual response. Psychological, relational, and sexual factors (eg depression, anxiety, emotions, attraction, conflicts, communication, sexual functioning, distress, satisfaction) are involved in the development/maintenance of lack of sexual interest in men. Cultural influence is also relevant, with cognitive factors linked to gender roles and sexual scripts of masculinity identified as important predictors of low sexual desire. Conclusion: Male sexual desire is characterized by an interplay among biological, psychological, sexual, relational, and cultural elements. This interplay merits further study to better understand how sexual desire works and how treatments for low sexual interest could be improved

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

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

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

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

Differences in the management of hypertension, diabetes mellitus and dyslipidemia between obesity classes

We did not find any paper that assessed clinical inertia in obese patients. Therefore, no paper has compared the clinical inertia rates between morbidly and nonmorbidly obese patients. A cross-sectional observational study was carried out. We analysed 8687 obese patients greater than or equal to40 years of age who attended their health-care center for a checkup as part of a preventive program. The outcome was morbid obesity. Secondary variables were as follows: failure in the management of high blood pressure (HBP), high blood cholesterol (HBC) and high fasting blood glucose (HFBG); gender; personal history of hypertension, dyslipidemia, diabetes, smoking and cardiovascular disease; and age (years). We analysed the association between failures and morbid obesity by calculating the adjusted odds ratio (OR). Of 8687 obese patients, 421 had morbid obesity (4.8%, 95% confidence interval (CI): 4.4–5.3%). The prevalence rates for failures were as follows: HBP, 34.7%; HBC, 35.2%; and HFBG, 12.4%. Associated factors with morbid obesity related with failures were as follows: failure in the management of HBP (OR=1.42, 95% CI: 1.15–1.74, P=0.001); failure in the management of HBC (OR=0.73, 95% CI: 0.58–0.91, P=0.004); and failure in the management of HFBG (OR=2.24, 95% CI: 1.66–3.03, P<0.001). Morbidly obese patients faced worse management for HBP and HFBG, and better management for HBC. It would be interesting to integrate alarm systems to avoid this problem.This work was supported by a grant from the Conselleria de Sanitat (Valencian Community)