IntroductionThe leading cause of erectile dysfunction (ED) is arterial dysfunction, with cardiovascular disease as the most common comorbidity. Therefore, ED is typically linked to a web of closely interrelated cardiovascular risk factors such as physical inactivity, obesity, hypertension, and metabolic syndrome. Physical activity (PA) has proved to be a protective factor against erectile problems, and it has been shown to improve erectile function for men affected by vascular ED. This systematic review estimated the levels of PA needed to decrease ED for men with physical inactivity, obesity, hypertension, metabolic syndrome, and/or manifest cardiovascular diseases.AimTo provide recommendations of levels of PA needed to decrease ED for men with physical inactivity, obesity, hypertension, metabolic syndrome, and/or cardiovascular diseases.MethodsIn accord with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was performed of research articles specifically investigating PA as a possible treatment of ED. The review included research on ED from physical inactivity, obesity, hypertension, metabolic syndrome, and/or cardiovascular diseases. All available studies from 2006 through 2016 were checked for the predetermined inclusion and exclusion criteria to analyze the levels of PA needed to decrease ED.Results10 articles met the inclusion criteria, all suggesting various levels of PA needed to decrease ED for men with relevant risk factors for ED. The results of the review provided sufficient research evidence for conclusions regarding the levels of PA necessary to decrease ED.ConclusionRecommendations of PA to decrease ED should include supervised training consisting of 40 minutes of aerobic exercise of moderate to vigorous intensity 4 times per week. Overall, weekly exercise of 160 minutes for 6 months contributes to decreasing erectile problems in men with ED caused by physical inactivity, obesity, hypertension, metabolic syndrome, and/or cardiovascular diseases.Gerbild H, Larsen CM, Graugaard C, Areskoug Josefsson K. Physical Activity to Improve Erectile Function: A Systematic Review of Intervention Studies. Sex Med 2018;6:75–89.

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Introduction Danish health professional (HP) students' attitudes toward addressing sexual health are unknown. Aim To investigate Danish HP students' attitudes toward addressing sexual health in their future professions, and to assess differences in perceived competences and preparedness between professional programs. Methods A Danish national survey of nursing, occupational therapy, and physiotherapy students was conducted. Totally, 1,212 students were invited to respond to an online questionnaire “The Students' Attitudes toward Addressing Sexual Health.” Main Outcome Measure The main outcome measures investigated were Danish HP students' attitudes toward addressing sexual health in their future professions, and differences in perceived competences and preparedness depending on the professional program. Results A total of 584 students (48%; nursing 44%, occupational therapy 70%, physiotherapy 43%) responded. Mean total score ranged between 63.7 and 66.3 (±8.3–8.8) classifying students in the low-end of the class: “comfortable and prepared in some situations.” No clinically relevant differences were determined between the professional programs with respect to perceived competences and preparedness to address sexual health. Conclusion In the field of addressing sexual health, most Danish HP students reported positive attitudes and a need for basic knowledge, competences, communication training, and education. H Gerbild, C M Larsen, T. Junge, B. S. Laursen, K. Areskoug-Josefsson. Danish Health Professional Students' Attitudes Toward Addressing Sexual Health: A Cross-Sectional Survey. Sex Med 2021;9:100323.

Introduction In the developing phase of the complex health intervention: Physical Activity to reduce Vascular Erectile Dysfunction (PAVED), it is crucial to explore whether men can accept the communicative component regarding information that regular aerobe Physical Activity can reduce Erectile Dysfunction (i-PAVED). This information is provided by health professionals (HPs) in cardiac rehabilitation, where sexuality issues such as erectile dysfunction (ED) are otherwise rarely addressed. Aim To explore how acceptance of cardiac HPs’ address of sexuality, ED, and i-PAVED can be identified in men's narratives. Methods In this descriptive qualitative study, we conducted semi-structured individual interviews with 20 men (range 48-78 years of age) attending municipal cardiac secondary prevention and rehabilitation programmes on their acceptance of HPs’ address of sexuality, ED, and i-PAVED. The Theoretical Framework of Acceptability components (affective attitude, burden, ethicality, intervention coherence, perceived effectiveness, opportunity costs and self-efficacy) and three temporal perspectives (retrospective, concurrent and prospective) were used in the concept-driven first step of a content analysis, which was followed by a thematically data-driven second step. Main Outcome Measures Men anticipated and experiential acceptance was identified in six out of seven components of Theoretical Framework of Acceptability. Results Men acceptance was identified as “expression of interest,” “addressing sexuality,” “attitudes and values,” “understandable and meaningful,” “insights” and “motivation,” whereas no narratives were identified in relation to the component of opportunity costs. Conclusion As an aspect of the development of the complex cardiovascular health care intervention PAVED, this qualitative study showed that men attending cardiac secondary prevention and rehabilitation seemed to prospectively accept the communicative component of PAVED being HPs’ address of sexuality, ED, and i-PAVED, if the HPs are professional, educated and competent in the field of sexual health. Gerbild H, Areskoug-Josefsson K, Larsen CM, et al. Acceptability of Health Professionals’ Address of Sexuality and Erectile Dysfunction - A Qualitative Interview Study with Men in Cardiac Rehabilitation. Sex Med 2021;9:100369.

This pilot study aimed to explore if healthcare professional students participating in a 2-week elective course, Sexual Health in Rehabilitation (SHR), led to significant and sustained change in experienced competence and attitudes towards addressing sexual health in their future professions, when measured with the Students’ Attitudes towards Sexual Health-Danish version (SA-SH-D). Comparison-group design, using the SA-SH-D at baseline, after the 2 weeks course and 3 months after completing the course. Participation in the SHR course significantly changed the students’ attitudes; decreasing their fears of offending the patients and increasing their feelings of comfort in communicating about sexual health, and the results sustained during the follow-up period of 3 months. The results of the intervention suggest that a 2-week elective SHR course leads to sustained change healthcare students’ attitudes towards addressing sexual health in their future profession. Sexual health education positively changed the students’ attitudes, decreased their fears of offending the patients and increased their feelings of comfort in communicating about sexual health. The SA-SH-D is a useful tool to measure results of educational interventions aiming to change healthcare students’ attitudes towards addressing sexual health in their future profession. Future research is recommended regarding students’ attitudes towards addressing sexual health with persons living with disabilities. There is also a need to further research the effect of elective versus compulsory sexual health education in healthcare programs, to lessen the risk that healthcare students in their future profession will not be able to give equal care due to variation in competence and attitude.

Background Physical activity, a core intervention in cardiac rehabilitation, can reduce vascular erectile dysfunction (ED). ED is a common sensitive problem for men with cardiac diseases, decreasing their quality of life. Cardiac health professionals rarely provide information about ED or its relation to physical activity. Developing health professionals’ communicative component of the complex intervention ‘Physical Activity to reduce Vascular Erectile Dysfunction’ (PAVED) is important. Understanding the receiver needs is essential in designing a complex intervention. Aim To elucidate men's perspectives on cardiac health professionals’ communication about PAVED. Ethical issues An Institutional Data Protection Agency approved the study. Methods An interpretive data‐driven thematic analysis was applied to individual, qualitative semi‐structured interviews with 20 Danish men attending cardiac rehabilitation. Results The men wanted health professionals’ communicating about ED, as it was perceived as a major problem diminishing masculinity and tabooed by health professionals. Men wanted help for self‐help, which may be possible with the aid of competent health professionals’ communication about how to prevent, reduce and cope with ED ‐ including information about PAVED. The men wanted health professionals’ communication about ED in various contexts: general information in groups, sexual counselling for individuals and couples and written material. Study limitations Recruitment was done from a Danish municipality's cardiac rehabilitation, and the transferability of the results may be limited to similar contexts. Conclusion Erectile dysfunction was experienced as a major biopsychosocial problem for the men and their partners. The men had a need for health professionals’ communication about sexuality, ED and information about PAVED as well as about prevention, reduction and management of ED. The men had a need for professional communication about sexual health.

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IntroductionThe term defensive medicine, referring to actions motivated primarily by litigious concerns, originates from the USA and has been used in medical research literature since the late 1960s. Differences in medical legal systems between the US and most European countries with no tort legislation raise the question whether the US definition of defensive medicine holds true in Europe.AimTo present the protocol of a systematic review investigating variations in definitions and understandings of the term ‘defensive medicine’ in European research articles.Methods and analysisIn concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of all medical research literature that investigate defensive medicine will be performed by two independent reviewers. The databases PubMed, Embase and Cochrane will be systematically searched on the basis of predetermined criteria. Data from all included European studies will systematically be extracted including the studies’ definitions and understandings of defensive medicine, especially the motives for doing medical actions that the study regards as ‘defensive’.Ethics and disseminationNo ethics clearance is required as no primary data will be collected. The results of the systematic review will be published in a peer-reviewed, international journal.PROSPERO registration numberThis review has been submitted to International Prospective Register of Systematic Reviews (PROSPERO) and is awaiting registration.