Men's health in primary care: an emerging paradigm of sexual function and cardiometabolic risk

Fertility Health Knowledge in U.S. Adults: Men Narrowing the Knowledge Gap

Much of young people's fertility health knowledge has been limited to avoiding sexually transmitted infections and preventing pregnancy thus lacking what is necessary to support future overall health as well as reproductive goals. This study assesses university students' knowledge related to fertility health factors to verify consistencies and discrepancies in fertility health knowledge, with a sub-assessment focusing on men's knowledge. The Fertility Health Knowledge survey was delivered to 17,189 students at three American universities. Twenty percent or 546 of the 2,692 participants were male. The 30-question survey addresses knowledge of modifiable and non-modifiable risk factors on fertility health in men and women, and four questions regarding fertility intentions. Across all 30 questions, 63% of female responses were correct and 61% of male responses were correct. For 10 questions, less than 70% of males and females answered correctly, with men answering correctly more often than females for six of the questions. Males exhibited more knowledge regarding male fertility. Knowledge of fertility health was consistently limited, regardless of site or demographics. Men demonstrated improved overall fertility health knowledge and more knowledge regarding male factors. There are still considerable gaps in knowledge of modifiable risk factors that may impact fertility health and future overall health. Fertility health promotion through education should be comprehensive and widely available in secondary schools, colleges, and universities. As well, increased education regarding fertility health in primary care settings should become the norm-with male inclusion as a standard of their care.

A scoping review on health education programs for improving Men's engagement with health services in low- and middle- income countries

Objectives

This study aimed to map evidence on health education programs (HEPs) for men engagement in health services in LMICs to guide future research.

Study design

A scoping review was conducted.

Methods

We searched Google Scholar, PubMed, EBSCOhost (CINAHL, MEDLINE, Health Source, Nursing, Academic Edition and Academic Search Complete) and WEB of Science electronic databases for publications from January 2000 to March 2019. We also searched Researchgate, the WHO library, and universities repositories for grey literature such as dissertations, theses, and reports. The search terms included “health,” “education,” “program,” “men”, with Boolean terms, AND and OR, being used to separate the keywords. Articles reporting evidence on HEPs for men aged 15 and older in LMICs and HEPs improving men's engagement in health services in LMICs published in any language between January 2000 to March 2019 were included in this review. We appraised included studies using the 2018 version of the Mixed Methods Appraisal Tool. We used thematic content analysis to extract emerging themes and presented a narrative account of the findings.

Results

Database search retrieved 8905 eligible articles. Of these, only six studies met the inclusion criteria and were included for data extraction. All included studies reported evidence of health education for men engagement in health services. The total number of men reported in the studies was 4372 with an age range of 15–54. Included studies were conducted in Uganda, Kenya, Ghana, and Zimbabwe. Included studies presented evidence on HEPs for men engagement in health services. Two main themes emerged from thematic content analysis of included studies: mode of health delivery (the process of enabling men and boys to become involved in health services as patients/clients) and health benefits to men (to achieve better health outcomes).

Conclusion

Our review revealed limited evidence of HEPs for men engagement in health service. Regardless of mode of health education delivery, notable health benefits to men were reported. We recommend implementation research on HEPs for men engagement in health services to better understand the social, cultural and economic influences in LMICs.

Measuring Fertility Health Knowledge in University Students: Development and Testing of a Survey Tool

BACKGROUND AND PURPOSE

Few surveys address fertility health in both men and women. This report details development of a fertility knowledge assessment tool for clinical and research settings that would sensitize young adults to habits that would promote healthy fertility.

METHODS

A pilot study (N = 31) followed by a larger study of students at three schools (N = 465, 335, & 375) at a midwestern university using a new 30-item survey.

RESULTS

Face and content validity of the survey tool were determined by a panel of experts. Internal consistency and reliability were acceptable for a new instrument (α = .81 for the total group; α = .80 for each school.

CONCLUSIONS

This instrument is a valid and reliable short screening tool that can be used to assess knowledge of fertility and possibly open discussions about fertility self-care.

The implications of low testosterone on mortality in men

Testosterone levels in men slowly decline with aging and also decline more abruptly due to medical illness or medications. Prescriptions for testosterone have increased dramatically over the past decade, since a testosterone-gel formulation was approved and since numerous studies reported an association between low serum testosterone and increased mortality. However, recent observational studies of testosterone treatment have reported conflicting results with some studies reporting decreased risks for mortality while others reported increased mortality risks with testosterone treatment. This paper will summarize recent studies of low serum testosterone and mortality and testosterone treatment and mortality and what the potential implications of these studies are for the clinician.

Health improvement for men and hard-to-engage-men delivered in English Premier League football clubs

Unhealthy behaviours represent modifiable causes of non-communicable disease. In men, concern focuses on those (i) demonstrating the poorest health, exacerbated by a lack of awareness of the risks that their lifestyles pose and (ii) who neither consult their doctor nor use health services. Classed as 'hard-to-engage', distinctive strategies are needed to reach these men. Impact and process evaluations assessed the effect of a programme of men's health-delivered in/by English Premier League football clubs. Men attended match-day events and/or weekly classes involving physical activity and health education. Validated self-report measures for demographics and lifestyle behaviours were completed pre- and post-intervention. Intention-to-treat analysis was performed on pre-versus-post-intervention differences in lifestyle profiles, whereas interviews (n = 57) provided men's accounts of programme experience. Participants were predominantly white British (70.4%/n = 2669), 18-44 (80.2%/n = 3032) and employed (60.7%/n = 1907). One-third (n = 860) 'never' visited their doctor. Over 85% (n = 1428) presented with combinations of lifestyle risk factors. Intention-to-treat analysis showed improvements (P < 0.001) in lifestyle profiles. Interviews confirmed recruitment of men who were hard-to-engage and unhealthy. Men were attracted through football and/or the clubs, whereas specific design factors impacted on participation. Limitations include use of self-reports, narrow demographics, small effect sizes, lack of follow-up and the absence of non-completers in interviews.

Testosterone deficiency: a determinant of aortic stiffness in men

OBJECTIVE

Low testosterone levels and increased aortic stiffness are predictors of cardiovascular events. The influence of androgen level on the age- and blood pressure-related increase in aortic stiffness is unknown.

METHODS

From January 2007 to June 2011 we enrolled 455 consecutive men with no evidence of cardiovascular disease from a large cohort followed in our Department for arterial function studies. Their total testosterone (TT) levels were measured and carotid-femoral pulse wave velocity (PWVc-f) was measured as an index of aortic stiffness.

RESULTS

In multivariable analysis, PWVc-f values were inversely correlated to TT after adjustment for confounders (β = -0.365, P < 0.001). In younger age categories (<50 yrs and 50-59 yrs), patients with testosterone deficiency (TD) had higher blood pressure-adjusted PWVc-f (P < 0.001 and P = 0.005, respectively) compared to subjects with normal TT, indicating an "aging effect" of 10 years, whereas in older age categories such a difference was not observed. Furthermore, in men with a higher mean pressure (102-108 mmHg and >108 mmHg), patients with TD had higher age-adjusted PWVc-f (P < 0.001) compared to subjects with normal TT, indicating a synergistic unfavorable effect of testosterone deficiency and blood pressure on aortic stiffness.

CONCLUSIONS

TT levels are independently associated with aortic stiffening. The effect of low testosterone concentration on aortic stiffness is more prominent in young men and in subjects with higher blood pressure levels. These findings identify testosterone as a marker of arterial damage with special emphasis on young and hypertensive individuals and support its role as predictor of events.

Is erectile dysfunction a reliable indicator of general health status in men?

Introduction

Erectile dysfunction (ED) is a common risk factor in men and its incidence increases with age. Ageing and older men frequently have comorbidities such as cardiovascular diseases (CVD), diabetes mellitus (DM), hypertension, chronic obstructive pulmonary disease and dyslipidaemia; likewise, they concurrently refer to a clinician for impairments in sexual function, mostly for ED. The association of ED and other organic, multi-organic or even systemic diseases is widely described, with a specific emphasis on the fact that they often share common pathophysiological factors and mechanisms. Thus we reviewed previous reports assessing the role of ED as a sentinel marker of overall men’s health.

Discussion

ED is considered an important sentinel marker for CVD. Numerous studies have highlighted the predictive role of ED for subsequent CV events in patients with a silent history of coronary artery disease. Indeed, ED might be considered as a clinical manifestation of a generalised vascular disease, and it should provoke clinicians to check for CVDs in those patients complaining of impaired erectile function. This concept appears to be even more important for men with DM, where ED has already been shown to have a significant predictive ability for major vascular complications. Moreover, data from large population-based studies showed that ED is a significant predictor of all-cause mortality, in addition to CV outcomes. The severity of erectile function is assessed with the International Index of Erectile Function-Erectile Function domain score, and this has emerged as a proxy for men’s general health status, as assessed with the Charlson Comorbidity Index score.

Conclusions

Patients complaining of ED should be evaluated with a comprehensive medical and sexual history, and a thorough physical examination, regardless of their age, considering ED as an opportunity to screen for the presence of health-threatening concomitant comorbidities.

Is erectile dysfunction a reliable proxy of general male health status? The case for the International Index of Erectile Function-Erectile Function domain

INTRODUCTION

Erectile dysfunction (ED) has emerged progressively as a sentinel marker of cardiovascular disease (CVD). The correlation between ED and the burden arising from multiple comorbid conditions has been incompletely analyzed.

AIM

Assess whether erectile function, defined with the International Index of Erectile Function-Erectile Function (IIEF-EF) domain score, is associated with health-significant comorbidities scored with the Charlson comorbidity index (CCI).

METHODS

Clinical and hemodynamic variables of the last 140 consecutive patients who underwent penile color Doppler ultrasonography for new-onset ED were considered. Patients were assessed with a thorough medical and sexual history. Health-significant comorbidities were scored with the CCI.

MAIN OUTCOME MEASURE

Descriptive statistics and either linear or logistic regression models tested the association among IIEF-EF, hemodynamic parameters, and CCI, which was included in the model both as continuous and categorized variable (0 vs. ≥1).

RESULTS

Complete data were available for 138 patients (98.6%) (mean age 46.6 years [standard deviation 13.0]; range 21-75 years). CCI was 0, 1, and ≥2 in 94 (68.1%), 23 (16.7%), and 21 (15.25%) patients, respectively. Of all, 35 patients (79.5%) did not have a CVD comorbidity. Mean IIEF-EF was 13.7 (9.3). ED severity was no ED, mild, mild to moderate, moderate, and severe in 12 (9.1%), 28 (20.2%), 12 (9.1%), 23 (16.2%), and 63 (45.5%) patients, respectively. At multivariable linear regression analysis, CCI significantly worsened with increased age (β=0.33; P=0.001) and decreased IIEF-EF values (β=-0.25; P=0.01). At logistic regression analysis, age (odds ratio [OR]: 1.05; P=0.004) and IIEF-EF (OR: 0.95; P=0.04) emerged as significant predictors of categorized CCI.

CONCLUSIONS

Severity of ED, as objectively interpreted with IIEF-EF, accounts for a higher CCI, which may be considered a reliable proxy of a lower general male health status regardless of the etiology of ED.