A consensus on men's health status and policy in Asia: a Delphi survey

OBJECTIVE

There is currently no documentation on the availability and implementation of policies related to men's health in Asia. This Delphi study aimed to achieve an Asian consensus on men's health policy based on the opinions and recommendations from men's health key opinion leaders.

STUDY DESIGN

A two-phase Delphi online survey was used to gather information from men's health stakeholders across Asian countries.

METHODS

All stakeholders were invited to participate in the survey through men's health conferences, personal contacts, recommendations from international men's health organizations and snowballing method. Stakeholders were asked about their concerns on 17 men's health key issues as well as their opinion on the availability and recommendations on men's health policies and programmes in their countries.

RESULTS

There were a total of 128 stakeholders (policy makers, clinicians, researchers and consumers), from 28 Asian countries, who responded in the survey. Up to 85% of stakeholders were concerned about various men's health issues in Asia and in their respective country, particularly in smoking, ischaemic heart disease and high blood pressure. There is a lack of men's health policies and programmes in Asia (availability = 11.6-43.5%) and up to 92.9% of stakeholders recommended that these should be developed.

CONCLUSIONS

These findings call for policy change and development, and more importantly a concerted effort to elevate men's health status in Asia.

A role of family doctors in taking care of men's health

The aim of this study was to investigate, based on routinely collected data, the scope of family doctors work in the field of men's health. Based on the Croatian Health Service Yearbook in the period from 1995 to 2012, we collected the morbidity data related to male urogenital disorders. The total number of urogenital disorders almost doubled, but the number of diagnoses related to the men increased fourfold, mostly among the oldest patients. The number of prostate hyperplasia increased fivefold, again among the oldest people. The morbidity from other male-specific diseases increased threefold, mostly in the age group 7-19 years. In spite of the increase in the number of newly diagnosed cases of prostate cancer, the percentage of the deaths stabilized after 2001. Men's health problems are frequent sees and with an upward trend. We are not sure if this means deterioration of men's health, or just indicates the problem of "overdiagnosis".

Multiple, but not traditional risk factors predict mortality in older people: the Concord Health and Ageing in Men Project

This study aims to identify the common risk factors for mortality in community-dwelling older men. A prospective population-based study was conducted with a median of 6.7 years of follow-up. Participants included 1705 men aged ≥70 years at baseline (2005-2007) living in the community in Sydney, Australia. Demographic information, lifestyle factors, health status, self-reported history of diseases, physical performance measures, blood pressure, height and weight, disability (activities of daily living (ADL) and instrumental ADLs, instrumental ADLs (IADLs)), cognitive status, depressive symptoms and blood analyte measures were considered. Cox regression analyses were conducted to model predictors delete time until of mortality. During follow-up, 461 men (27 %) died. Using Cox proportional hazards model, significant predictors of delete time to time to mortality included in the final model (p < 0.05) were older age, body mass index < 20 kg m(2), high white cell count, anaemia, low albumin, current smoking, history of cancer, history of myocardial infarction, history of congestive heart failure, depressive symptoms and ADL and IADL disability and impaired chair stands. We found that overweight and obesity and/or being a lifelong non-drinker of alcohol were protective against mortality. Compared to men with less than or equal to one risk factor, the hazard ratio in men with three risk factors was 2.5; with four risk factors, it was 4.0; with five risk factors, it was 4.9; and for six or more risk factors, it was 11.4, respectively. We have identified common risk factors that predict mortality that may be useful in making clinical decisions among older people living in the community. Our findings suggest that, in primary care, screening and management of multiple risk factors are important to consider for extending survival, rather than simply considering individual risk factors in isolation. Some of the "traditional" risk factors for mortality in a younger population, including high blood pressure, hypercholesterolaemia, overweight and obesity and diabetes, were not independent predictors of mortality in this population of older men.

Factors influencing the quality of preconception healthcare in China: applying a preconceptional instrument to assess healthcare needs

BACKGROUND

Preconception care is defined as the promotion of the health and well-being of a woman and her partner before pregnancy. Improving preconception health can result in improved reproductive health outcomes. China has issued latest version official guideline for preconception care in 2011. The objective of this cross-sectional study is to determine whether there is a variation in the quality of preconception healthcare services in distinct eastern and northern populations of China, and what factors are associated with such variation.

METHODS

A cross-sectional survey using our previously developed preconception instrument was conducted. Women at reproductive age planning for pregnancy were surveyed along with their partners at hospitals during their pre-pregnancy health examination. Data collected include general health/life profiles, pregnancy history, alcohol/tobacco/drug exposures, immunizations, micronutrient supplements and the demands in preconception care. After quality assessment, statistical analysis were applied to evaluate the variations in preconception factors between people from Hebei and Jiangsu Provinces.

RESULTS

3202 women of reproductive age in from eastern province, Jiangsu, and in a northern province, Hebei, participated this study. 2806 of them and their partners have completed the questionnaire, at a rate of 87.6%, 1011 were from Jiangsu and 1795 were from Hebei. Statistical significance was obtained for maternal age (P < 0.001), body mass index (u =13.590, P <0.001), education (χ2 = 916.33, P < 0.001), occupation (χ2 = 901.78, P < 0.001), health status/common disease, immunization status, and need for preconception care.

CONCLUSIONS

For a country as large as China, the centralized guideline for standardized preconception healthcare does have a very crucial positive role in reproductive healthcare, but it may not be suited for all populations. Regional authorities should consider the demographics and healthcare needs of the local population and modify the centralized guideline accordingly, as well as provide a better education and professional services for the public, to improve the quality of preconception services at both the regional and the national level.

Black men and utilisation of healthcare services

Health disparities is described as inequalities signified by differences in environment, access, utilization, quality of care, health status, or particular health outcomes. On a variety of health measures, healthcare access and other social determinants of health, minority men fare worse than white men. Nurses have the responsibility to eliminate health disparities among people from diverse racial, ethnic, and cultural backgrounds. To do this, nurses must become more knowledgeable about the health disparities among the racial and ethnic groups they serve.

Beating to the sound of an HIV men's health drum

The recent international AIDS 2014 conference, which attracted a record 14,000 delegates to Melbourne, put a bright spotlight not only on the challenges facing the medical profession, but also on the passion, commitment and dedication of nurses and carers to help those living with and affected by HIV.

Swimming and other sporting activities and the rate of falls in older men: longitudinal findings from the Concord Health and Ageing in Men Project

Balance training is the most efficacious exercise to prevent falls. This study examined the associations between common sporting activities and the incidence of falls, and whether lower risks can be attributed to the superior balance of sports participants. We studied a population-based cohort of 1,667 older Australian men (mean age = 76.8 years) in the Concord Health and Ageing in Men Project (CHAMP) between 2005 and 2011. Data on incident falls were captured by 12 triannual telephone call cycles per participant and were analyzed using negative binomial regression. The length of follow-up averaged 43.8 months (median, 48 months), during which time 2,662 falls were recorded. In unadjusted models, golfers (n = 160; incidence rate ratio (IRR) = 0.65, 95% confidence interval (CI): 0.47, 0.89) and swimmers (n = 88; IRR = 0.47, 95% CI: 0.30, 0.71) had significantly lower risks of falling. After adjustment for leisure-time physical activity, walking, lifestyle physical activity score (e.g., chores, gardening), and conventional risk factors for falling, swimming was the only activity that was associated with a protective effect (IRR = 0.67, 95% CI: 0.45, 1.00). Swimmers had significantly lower postural sway (β = -5.23 cm(2), P < 0.05) and shorter time to complete a narrow walk test than men who took part in only lifestyle physical activities. Balance indicators were strong predictors of the incidence of falls. The IRR for swimmers was 0.71 (95% CI: 0.48, 1.06) after adding balance measures to the adjusted model.

Dietary advice for muscularity, leanness and weight control in Men's Health magazine: a content analysis

BACKGROUND

The dietary content of advice in men's lifestyle magazines has not been closely scrutinised.

METHODS

We carried out an analysis of such content in all 2009 issues (n = 11) of Men's Health (MH) focusing on muscularity, leanness and weight control.

RESULTS

Promotion of a mesomorphic body image underpinned advice to affect muscle building and control weight. Diet advice was underpinned by a strong pseudo-scientific discourse, with citation of expert sources widely used to legitimise the information. Frequently multiple dietary components were advocated within one article e.g. fat, omega-3 fatty acids, thiamine, zinc and high-glycaemic index foods. Furthermore advice would cover numerous nutritional effects, e.g. strengthening bones, reducing stress and boosting testosterone, with little contextualisation. The emphasis on attainment of a mesomorphic body image permitted promotion of slimming diets.Advice to increase calorie and protein intake to augment muscle mass was frequent (183 and 262 references, respectively). Such an anabolic diet was advised in various ways, including consumption of traditional protein foods (217 references) and sports foods (107 references), thereby replicating muscle magazines' support for nutritional supplements. Although advice to increase consumption of red meat was common (52 references), fish and non-flesh sources of protein (eggs, nuts & pulses, and soy products) together exceeded red meat in number of recommendations (206 references). Advice widely asserted micronutrients and phytochemicals from plant food (161 references) as being important in muscle building. This emphasis diverges from stereotypical gender-based food consumption patterns.Dietary advice for control of body weight largely replicated that of muscularity, with strong endorsement to consume fruits and vegetables (59 references), diets rich in nuts and pulses and fish (66 references), as well as specific micronutrients and phytochemicals (62 references). Notably there was emphasis on fat-burning, good fats and consumption of single foods, with relatively little mention of dietary restriction.

CONCLUSIONS

Despite the widespread use of scientific information to endorse dietary advice, the content, format and scientific basis of dietary content of MH leaves much to be desired. The dietary advice as provided may not be conducive to public health.

Sexual partner notification of HIV infection among a National United States-based sample of HIV-infected men

Limited data exist on whether sexual partner notification practices among HIV-infected men, particularly those who have sex with men (MSM), vary by HIV viral load. We examined factors associated with complete (all partners) versus incomplete partner notification in 760 HIV-infected individuals across the United States, 49 % of whom were MSM. Thirty-four percent reported incomplete partner notification. Incomplete partner notification was more likely among black men, MSM, and those reporting casual partners and non-condom use. Partner notification practices did not vary by HIV viral load except among those with casual partners in whom a detectable viral load was associated with incomplete partner notification. Increased sexual partner notification among HIV-infected men, especially MSM, is needed.

Patient Characteristics by Type of Hypersexuality Referral: A Quantitative Chart Review of 115 Consecutive Male Cases

Hypersexuality remains an increasingly common but poorly understood patient complaint. Despite diversity in clinical presentations of patients referred for hypersexuality, the literature has maintained treatment approaches that are assumed to apply to the entire phenomenon. This approach has proven ineffective, despite its application over several decades. The present study used quantitative methods to examine demographic, mental health, and sexological correlates of common clinical subtypes of hypersexuality referrals. Findings support the existence of subtypes, each with distinct clusters of features. Paraphilic hypersexuals reported greater numbers of sexual partners, more substance abuse, initiation to sexual activity at an earlier age, and novelty as a driving force behind their sexual behavior. Avoidant masturbators reported greater levels of anxiety, delayed ejaculation, and use of sex as an avoidance strategy. Chronic adulterers reported premature ejaculation and later onset of puberty. Designated patients were less likely to report substance abuse, employment, or finance problems. Although quantitative, this article nonetheless presents a descriptive study in which the underlying typology emerged from features most salient in routine sexological assessment. Future studies might apply purely empirical statistical techniques, such as cluster analyses, to ascertain to what extent similar typologies emerge when examined prospectively.

Evidence of a syndemic among young Canadian gay and bisexual men: uncovering the associations between anti-gay experiences, psychosocial issues, and HIV risk

Syndemic has become an important theoretical model toward understanding how psychosocial issues may interact to increase HIV acquisition among gay and bisexual men. We measured the extent to which anti-gay experiences are associated with psychosocial issues, which in turn were hypothesized to have an additive effect on HIV risk, in a sample of Canadian young gay and bisexual men. Sixty-eight percent of men reported at least one form of anti-gay experience. For each additional form of anti-gay experience, our data demonstrated increased likelihood of psychosocial issues. Psychosocial issues had an additive effect, increasing the risk of unprotected intercourse in the last 12 months (doubling the risk for those with 3+ issues OR 1.95 [1.39-2.75]). Overall, our findings suggest that a syndemic is occurring among young Canadian gay and bisexual men, highlighting the need to expand HIV prevention efforts beyond sexual risk, to address stigma and gay men's broader health concerns.

The role of civic engagement for men's health and well being in Norway-a contribution to public health

Objectives: Using the example of older men volunteering on teams that restore historic ships, this article examines the effects of volunteering on the well-being of older adults. We consider particularly how volunteering impacts levels of social engagement and explore how the men’s reminiscences as they bond with their fellows in highly skilled work helps integrate their life experiences. Methods: Data are based on 14 in-depth interviews with volunteers working on historic vessels in Norway. Self-rated health, functional dependency, and well-being measures were collected using semi-structured questionnaire. Results: Volunteering in a context of skilled, group-bonded, culturally prestigious activity adds considerably to social capital among elderly men in Norway. Respondents explain their involvement in terms of prior relationships and current social benefits. They spoke of the value of maintaining past personal connections to a particular ship, shipping company, or local community. These were reinforced by current social benefits, such as the experience of companionship, unity, and the feeling of making an important contribution to the society. The group dynamics and strong collective aspect of these voluntary associations maintains internal cohesion, and members only leave when forced by increasing age, poor health, or insufficient financial resources. Conclusions: This article illuminates a case study of gender-specific engagement of older adults in volunteer roles returning high benefits both to participants and society, and adds knowledge to public-health programs and policies in the volunteer- and cultural-heritage sector.

Unemployment and health: experiences narrated by young Finnish men

Studies have shown that the experiences and consequences of unemployment can affect people differently depending on, for example, age and gender. The purpose of the present study was to describe young Finnish men's experiences of being unemployed as well as how their experiences of health emerged. Fifteen young unemployed Finnish men in the age range 18 to 27 years were interviewed face to face. Purposive sampling was used to increase the variation among informants. The interview texts were analyzed using both manifest and latent qualitative content analysis. The present results showed that the young men were strongly negatively affected by being unemployed. They described how they had slowly lost their foothold. They also described feelings of shame and guilt as well as a flight from reality. The present results show that even young men who have only experienced shorter periods of unemployment, in this study periods between 2 and 6 months, are negatively affected, for example, with regard to their identity and emotional life. Further research is needed to describe and elucidate in more detail the effects of unemployment on men of different ages and living in different contexts.

[The analysis of the influence of short term physical effort on selected endothelial function parameters and blood vessels stiffness features among young and healthy men]

Endothelium dysfunction is well established factor contributing to the development of atheroslerotic plaque. It is characterized by, among other, impaired vasodilatation and increased expression of adhesion molecules. The aim of the study was to estimate changes of serum selectin levels and blood vessels stiffness under the influence of short term physical effort in young healthy men characterized by various lifestyles.

MATERIAL AND METHODS

The study was performed on 28 healthy men aged 22 to 34. The study involved personal interview, electrocardiography, treadmill exercise test, non-invasive endothelial function assessment (using PulseTrace PCA 2) and collecting blood samples for serum E-, L- and P-selectin measurement. The given population was divided into smoking and non-smoking groups, as well as into groups with different level of physical activity assessed according to the International Physical Activity Questionnaire.

RESULTS

In regard to serum selectin levels under the influence of short term physical effort E-selectin concentration didn't change significantly in any group, P-selectin level was lower in non-smoking group (p < 0.01) and in group with vigorous physical activity (p < 0.005), L-selectin level decreased in non-smokers (p < 0.005) and in groups taking moderate (p < 0.05) and vigorous exercise (p < 0.05). Baseline SI (stiffness index) value differed significantly between smoking and nonsmoking groups (p < 0.005). SI value didn't change significantly under effort in any group. RI (reflection index) value in measurements made after physical effort was significantly lower in each of examined groups, but decrease was better marked among non-smokers (p < 0.005) than in smokers (p < 0.05).

CONCLUSIONS

The study revealed that individuals who undertake physical activity regularly, benefit from each single physical effort, because of decrease in serum concentration of proinflammatory molecules such as L-selectin and P-selectin. Short term physical effort does not influence the level of selectins in smokers. Smokers are characterized by increased arterial stiffness compared to nonsmokers. Short term physical effort leads to peripheral vasodilatation, expressed by decreasing RI value, but vasodilatation effect does not appear in smokers. It seems that pulse contour analysis obtained by finger photopletysmography may be treated as method of endothelium function screening among healthy men with the presence of atherogenesis modifiable risk factors.