Male reproductive health disorders among Aboriginal and Torres Strait Islander men: a hidden problem?

Global prevalence of sexual dysfunction among diabetic patients from 2008 to 2022: Systematic review and meta-analysis

Background

Both men and women can have a wide range of physical, emotional, and sexual issues as a result of diabetes. One of them is sexual dysfunction, which has an effect on marital relationships as well as the effectiveness of therapy and can develop into a serious social and psychological condition. As a result, the purpose of this study was to identify the global prevalence of sexual dysfunction among diabetic patients.

Methods

Science Direct, Scopus, Google Scholar, and PubMed were all searched for information. Data were extracted using Microsoft Excel (v. 14), STATA statistical software, and STATA. Publication bias was investigated by a forest plot, rank test, and Egger's regression test. To detect heterogeneity, I² was calculated and an overall estimated analysis was performed. Subgroup analysis was done by study region and sample size. The pooled odds ratio was also computed.

Results

The study was able to include 15 of the 654 publications that were evaluated since they met the criteria. 67,040 people participated in the survey in all. The pooled global prevalence of sexual dysfunction among diabetic patients was 61.4% (95% CI: 51.80, 70.99), I2 = 71.6%. The frequency of sexual dysfunction was highest in the European region (66.05%). For males, the prevalence of sexual dysfunction was 65.91%, while for females, it was 58.81%. Patients with type 2 diabetes mellitus were more likely (71.03%) to experience sexual dysfunction.

Conclusion

Finally, sexual dysfunction was fairly common all across the world. There were variations in the prevalence of sexual dysfunction depending on the sex, type of diabetes, and location of the study participant. Our findings imply that screening and appropriate treatment are required for diabetes persons exhibiting sexual dysfunction.

Prevalence and predictors of lower urinary tract symptoms in Solomon Islander adult men

Background:

Despite growing interest in the prevention of lower urinary tract symptoms (LUTS) globally and in the Asia-Pacific region, population-based evidence is limited in the smaller Pacific Island countries such as in the Solomon Islands. This study aimed to investigate the prevalence and describe the risk factors associated with moderate to severe LUTS among Solomon Islander men.

Methods:

A cross-sectional survey was conducted among 400 men aged ⩾18 years living in Honiara, Solomon Islands. LUTS were assessed using the International Prostate Symptom Score (IPSS). The association between moderate to severe LUTS and sociodemographic, health conditions and health-related factors were estimated using logistic regression adjusted for age.

Results:

Overall, 13.8% reported moderate LUTS, and 0.8% reported severe LUTS. Frequent night-time urination was the most commonly reported LUTS. The adjusted odds of moderate to severe LUTS decreased with increasing level of education. The odds increased among men reporting elevated psychological distress, increased stressful events in the past 12 months and depression.

Conclusions:

About one in six Solomon Islander men experience moderate to severe LUTS, having a negative impact on their mental health and general well-being.

Sexual dysfunction among men with diabetes mellitus attending chronic out-patient department at the three hospitals of Northwest Amhara region, Ethiopia: Prevalence and associated factors

Background

Sexual dysfunction is the commonest reproductive health problem observed among men with diabetes mellitus affecting their quality of life. Previous studies conducted in this area were concentrated on the specific domains of sexual dysfunction, and factors were not well-addressed. Therefore, this study was aimed to determine the prevalence of all forms of sexual dysfunction and to identify its associated factors among diabetic men patients attending at the three hospitals of the Amhara region, Ethiopia.

Method

An institutional-based cross-sectional study was conducted involving 462 men diabetic patients at the three hospitals of the northwest Amhara region. A systemic random sampling technique was employed. A face-to-face interviewer-administered change in the sexual functioning questionnaire was used to collect the required data from the 20^th of February to the 15^th of April 2020. The binary logistic regression was employed and a multivariable logistic regressions model was used to control the effect of confounders. Variables that had an independent correlation with the sexual dysfunction were identified based on a p-value≤ 0.05. Likewise, the direction and strength of association were interpreted using Adjusted Odds Ratio (AOR) with its corresponding 95% CI.

Results

The prevalence of sexual dysfunction was found to be 69.5% (95%CI: (65.1–73.9)). The magnitude of sexual dysfunction was prevalently observed among participants who were older (> 50 years) (AOR = 8.7, 95%CI: (3.3–23.1)). Likewise, the odds of sexual dysfunction was significantly higher among men who have lived with diabetes for a longer duration (AOR = 10.8, 95%CI: (5.3–21.9)), with poor metabolic control (AOR = 3.57, 95%CI: (1.81–7.05)), with comorbid illnesses (AOR = 5.07, 95%CI: (2.16–11.9)), and diabetic-related complications (AOR = 3.01, 95%CI: 1.31–6.92). On the other hand, participants who were physically active (AOR = 0.41, 95%CI: (0.12–0.7)) and satisfied with their relationship (AOR = 0.15, 95%CI: (0.03–0.7)) showed a lesser risk of experiencing sexual dysfunction.

Conclusion

Well over two-thirds of men with diabetes mellitus have experienced sexual dysfunction, implying a public health pressing problem. Older age, lack of physical activity, living longer duration with diabetes, having diabetic complications, experiencing co-morbid illnesses, being unsatisfied with couple relationship, and poor metabolic control increased the risk of developing SD. Therefore, promoting physical exercise, preventing co-morbid illnesses, and couples counseling to build up a good couple relationship are recommended to promote the sexual and reproductive health of men with diabetes.

"We are only looking at the tip of the iceberg in infertility": perspectives of health providers about fertility issues and management among Aboriginal and Torres Strait Islander people

INTRODUCTION

Aboriginal and Torres Strait Islander women and men are disproportionately affected by a range of risk factors for infertility. However, remarkably little is known about the prevalence of infertility in this group, or how Aboriginal and Torres Strait Islander people access fertility treatments including assisted reproductive technology (ART). This qualitative study aims to explore health care provider (HCP) perspectives on the health burden of infertility among Aboriginal and Torres Strait Islander people, as well as factors that may affect access to infertility treatment for this group.

METHOD

Semi-structured interviews were conducted with HCPs (8 doctors; 3 nurses and 1 Aboriginal Health Practitioner) working in fertility care in the Northern Territory, Australia. Transcribed interviews were analysed using an iterative thematic approach using the NVivo-9 software package.

RESULTS

Providers perceive infertility as an underestimated health issue in this patient population, reporting a high prevalence of infertility-related risk factors but fewer clinical encounters of diagnosis and treatment. Perceived barriers to accessing fertility care included cultural differences such as the shame and stigma associated with reproductive health and the separation of men's business and women's business; service-related barriers such as limited timely and affordable access to specialist health services and; a lack of culturally responsive and appropriate fertility services. Providers had mixed opinions on their role in ameliorating inequities of access, and hence a range of strategies to address barriers were suggested. These included a greater patient education, ongoing patient support and providing a culturally safe environment.

CONCLUSION

The current study adds to the understanding of how Aboriginal and Torres Strait Islander people access fertility treatments. There is a need for further research to quantify infertility in Aboriginal and Torres Strait Islander people, investigate community perceptions towards infertility and identify community-driven priorities to improve access to fertility care for this population.

Community-Based Sexual and Reproductive Health Promotion and Services for First Nations People in Urban Australia

Context

Little is known about sexual and reproductive health (SRH) access and health promotion for First Nations peoples in Australia. This study aimed to better understand community preferences, knowledge and access to contraception and SRH services, and use this understanding to make recommendations which support approaches led by local Aboriginal community-controlled health organisations (ACCHOs).

Methods

Qualitative First Nations-led yarning circles were conducted with 55 community members and health service providers using and/or working at ACCHOs in urban South East Queensland. Cultural protocols ensured women’s and men’s interviews were separately collected and analysed. Thematic analysis was conducted by multiple coders, privileging interpretations by First Nations researchers.

Results

Family, kin and friends were described as key knowledge holders and ACCHOs as knowledge spaces for sharing information about maintaining positive SRH and wellbeing for First Nations people. Interviewees wanted accurate and timely information in an accessible, culturally appropriate way. Making informed choices about family planning was described as an important process of agency and self-determination for First Nations people, and contextualized within broader aspirations for growing strong families and healthy relationships.

Conclusion

Understanding SRH through the concept of “knowledge spaces” and “knowledge holders” highlights the collective importance of community relationality to support individual agency and informed SRH decision-making. ACCHOs appear to be acceptable knowledge spaces for SRH information; and evidence-based recommendations may increase their reach. Health services should consider upskilling community SRH knowledge holders to share consistent, accurate and accessible SRH information.

Prevalence of, and risk factors for erectile dysfunction in male type 2 diabetic outpatient attendees in Enugu, South East Nigeria

Context:

Erectile dysfunction (ED) is a strong predictor of poor quality of life in men with type 2 Diabetes mellitus (T2DM). Several studies evaluating ED in men with diabetes mellitus have been carried out, but few of these have been done in Nigeria. In Enugu, South East Nigeria, paucity of studies on this subject was observed.

Aims:

This study aims to determine the prevalence and predictors of ED in men with T2DM attending the diabetes clinics.

Settings and Design:

A descriptive cross-sectional study of men with T2DM in UNTH and Saint Mary's Hospital, Enugu, was carried out. The systematic sampling method was used to recruit participants.

Subjects and Methods:

Data collection from participants and their hospital records was done using semi-structured questionnaire. ED was assessed using the 5 items, international index of erectile function questionnaire.

Statistical Analysis Used:

Data analysis was done using SPSS version 20 and results presented as texts and tables. P value was set at <0.05.

Results:

A total of 325 participants with mean age of 57.8 ± 13.2 years were involved out of which 94.7% had ED. The proportion of participants with ED had increased with its severity. Predictors of ED included poor glycemic control, longer duration of diabetes, overweight/obesity, and older age. Poor ED health-seeking behavior and treatment were noted.

Conclusions:

The prevalence of ED is high. Lifestyle interventions targeted at improving glycemic control and weight loss may reduce the burden of this complication. We recommend objective ED screening using standard but brief instruments as part of routine evaluation of men with T2DM.

Using Facebook to reduce smoking among Australian Aboriginal and Torres Strait Islander people: a participatory grounded action study

BACKGROUND

There is limited evidence for the effectiveness of social media to promote healthy behaviour among Indigenous Australians, including to reduce smoking. Social media has significant potential to stimulate interpersonal influence to quit, however an important knowledge gap is how and what content people choose to share with friends and family. This paper explores the decision making processes of community members for sharing tobacco control content with family and friends on Facebook.

METHODS

Community researchers were paid to choose and share at least one tobacco control post per week for a period of 6 months on their personal Facebook page. They documented reasons for their choices, which were coded and analysed to determine features of messages most likely to be shared, and salient considerations in the decision-making process.

RESULTS

Posts which are child-focused, feature Indigenous content, and are perceived as practical, relevant and credible, with a direct and unambiguous message, were most likely to be shared. Posts which included disgusting imagery about health impacts, were focused on the environment, or were ambiguous or sarcastic were less likely to be shared. Decisions were also based on whether content was perceived to contain new information, to be helpful for their friends, and to be consistent with the participant's online identity, as well as the perceived sensitivity of content. The potential impact on expensive mobile data for videos was also a factor.

CONCLUSIONS

When designing tobacco control messages to be shared on social media, health promoters should take into account how information will align with positive self-image and can contribute to social capital among the intended audience, and generate interpersonal engagement. Content should complement, rather than attempt to replicate, some message features that are effective on traditional broadcast media. This study shows the potential for health services to incorporate a strategy of using paid local social media 'champions' or 'ambassadors' to disseminate tobacco control messages on Facebook through community networks.

"I feel more comfortable speaking to a male": Aboriginal and Torres Strait Islander men's discourse on utilizing primary health care services

Background

Aboriginal and Torres Strait Islander men have the highest morbidity and mortality rates, and lowest rates of health service utilization in Australia. There is a current perception that Aboriginal and Torres Strait Islander men are disinterested in their health. This study aimed to identify the perceived motivators, barriers and enablers of Aboriginal and Torres Strait Islander men’s utilization of primary health care services, explore their experiences and obtain suggestions from them as to how services could be modified to improve utilization.

Methods

This study utilized the principles of Indigenist Research Methods. Semi-structured interviews with Aboriginal and Torres Strait Islander men (N = 19) took place in South Australia and far north Queensland. Participants were asked about their experiences with primary health care services, including what they could remember as a child. A thematic analysis of the qualitative data was completed without the use of computer software.

Results

Feelings of invincibility, shame, being uncomfortable, fearful, along with long waiting times, having a lack of knowledge, and culturally inappropriate staff/services were all found to be barriers to service utilization. Enabling factors included convenience, the perceived quality of the service, feeling culturally safe and/or a sense of belonging, and having a rapport with staff. Motivation for attending primary health care services included going when feeling sick/unwell, attending a particular service (dental or sexual health), visiting for check-ups and preventative health and family encouragement.

This study also highlights strategies surrounding logistical factors, promotion of services and improved communications, having culturally appropriate services and providing gender specific services all of which were suggested by the participants to improve service utilization.

Conclusion

Contrary to common misperceptions, this study demonstrated that most of the Aboriginal and Torres Strait Islander men participants were motivated to engage with primary health care services for preventative health care. Even though there were men that fitted the stereo-type who avoid doctors, there were usually underlying reasons and barriers accounting for this reluctance. This study suggests that if primary health care services commit to better understanding the barriers, enablers and motivators their cohort of men face, then utilization could be greatly improved.

Understanding the utilization of primary health care services by Indigenous men: a systematic review

BACKGROUND

Aboriginal and Torres Strait Islander men experience worse health outcomes and are the most marginalized and disadvantaged population group in Australia. Primary health care services are critical to providing both clinical and social and emotional support, however, remain underutilized by Aboriginal and Torres Strait Islander men. This review aims to better understand the utilization of primary health care services by Indigenous men and assess the effectiveness of strategies implemented to improve utilization.

METHODS

A four-step search strategy was employed across four databases to find peer-reviewed publications and grey literature from Australia, New Zealand, Canada and America. The search began in March 2015 and included the following databases PubMed, CINAHL, Informit (Indigenous collection) and Embase. Additional databases and websites were also searched for grey literature, reference lists of included publications were searched for additional studies and relevant experts were consulted.

RESULTS

The literature search found seven articles that met the inclusion criteria; four describing three research projects, plus three expert opinion pieces. The search was unable to find published research on strategies implemented to improve primary health care utilization by Indigenous men. There is limited published research focused on the utilization of primary health care by Indigenous men. From the identified papers Indigenous men described factors impacting utilization which were categorized into three primary organizing themes; those related to health services, the attitudes of Indigenous men and knowledge. It is evident from the identified papers that improvements in Indigenous health can only occur if future programs are developed in collaboration with health services and Indigenous men to address differing requirements.

CONCLUSIONS

Currently, health systems in Australia are limited in their ability to improve the health and wellbeing of Aboriginal and Torres Strait Islander males without such strategies. Future research should focus on evaluating the implementation of men specific utilization strategies. It is through evidence-based research that subsequent policies and programs can be made and implemented to improve Indigenous men's health.

"I Had a Little Bit of a Bloke Meltdown…But the Next Day, I Was Up": Understanding Cancer Experiences Among Aboriginal Men

BACKGROUND

Although cancer in indigenous populations is receiving increased research attention, there is a gap in understanding the particular experiences of Aboriginal men.

OBJECTIVE

The aim of this study is to integrate a range of primary and secondary accounts of the experiences of Aboriginal men in engaging with a cancer diagnosis and treatment in Australia.

METHODS

Secondary analysis of qualitative interviews (n = 54) conducted between 2008 and 2011 revealed recurrent themes regarding the cancer experiences of Aboriginal men in a subset of participant interviews (n = 23). The analysis reports themes that spanned the accounts of Aboriginal men with cancer (n = 6) and those of their carers (n = 12) and clinicians (n = 5).

RESULTS

Recurrent beliefs about the cancer experiences of Aboriginal men included that they "avoid seeking help" for health matters, including cancer symptoms, and to "get on with it," "not talk about it," and "manage without fuss" after a cancer diagnosis. Although some men described having to "accept vulnerability," emphasis was placed on appreciating men's desire to "protect cultural roles" and "connect with family and culture" throughout care and treatment, including through humor.

CONCLUSIONS

Men's accounts of the experiences of cancer diagnosis and care reveal more than simply individual challenge, extending to encompass the very real social and economic implications of illness and vulnerability for Aboriginal men today.

IMPLICATIONS FOR PRACTICE

Aboriginal men could be better engaged with cancer diagnosis and treatment if greater attention was paid to recognizing preferred approaches, including pragmatism and humor, and supporting connections to family and culture throughout the cancer journey.

Psychosexual care in prostate cancer survivorship: a systematic review

BACKGROUND

Prostate cancer (PC) is the most common cancer in men. Due to improvements in medical care, the number of PC survivors is increasing. Current literature demonstrates survivors have significant unmet needs including psychosexual care. We assess patients psychosexual needs by systematic review of literature over the past 20 years up to May 2015 in order to see what issues need to be addressed within psychosexual care.

METHODS

A systematic review was conducted on PC survivorship and psychosexual care. The search strategy aimed to identify all references related to PC survivorship programme components (parts of survivorship programmes) AND survivorship AND psychosexual concerns. Search terms used were as follows: (PC OR prostate neoplasms) AND (survivorship OR survivor*) OR [psychosexual impairment or sexual dysfunction or erectile dysfunction (ED)] AND [comorbidity or quality of life (QoL)].

RESULTS

The systematic review identified 17 papers, examining unmet needs in psychosexual care post PC therapy.

CONCLUSIONS

These findings of this review may change psychosexual care of PC survivors, as national and international guidance is needed.

Psychosocial factors that influence men's help-seeking for cancer symptoms: a systematic synthesis of mixed methods research

OBJECTIVE

Effectiveness of cancer control partly depends upon early identification and treatment. Men appear to be more likely to delay help-seeking for symptoms, resulting in later diagnosis. This review aims to provide a mixed research synthesis of the psychosocial barriers to and facilitators of help-seeking for cancer symptoms among men.

METHODS

Systematic methods were followed, including a predefined research question and search strategy. Searches retrieved 7131 international records from online databases: MEDLINE (n = 3011), PubMed (n = 471), SCOPUS (n = 896), Informit (n = 131), PsychINFO (n = 347), and Web of Science (n = 2275). Forty studies were eligible for inclusion in the review (25 qualitative studies, 11 quantitative studies, and 4 mixed-method studies).

RESULTS

There was strong observational evidence for several psychosocial barriers to men's help-seeking behaviour: low cancer knowledge and inaccurate symptom interpretation, embarrassment and fear, and conformity to masculine gender role norms. The strongest facilitating factor associated with men's help-seeking behaviour was encouragement and support of spouses and family members. The majority of research was qualitative and used small samples, making generalisations to the wider population difficult.

CONCLUSIONS

Men's help-seeking for cancer symptoms is influenced by several psychosocial factors, which, in part, may be gender-specific. Health promotion initiatives to improve help-seeking behaviour among men should aim to increase cancer knowledge, reduce embarrassment and fear, address social norms deterring timely help-seeking, and acknowledge informal help-seeking with spouses and family members. Increasing the theoretical grounding of research could aid cohesion across the research area and the design of effective health promotion interventions. Copyright © 2015 John Wiley & Sons, Ltd.

Prostate cancer mortality outcomes and patterns of primary treatment for Aboriginal men in New South Wales, Australia

OBJECTIVE

To compare prostate cancer mortality for Aboriginal and non-Aboriginal men and to describe prostate cancer treatments received by Aboriginal men.

PATIENTS AND METHODS

We analysed cancer registry records for all men diagnosed with prostate cancer in New South Wales (NSW) in 2001-2007 linked to hospital inpatient episodes and deaths. More detailed information on androgen-deprivation therapy and radiotherapy was obtained from medical records for 87 NSW Aboriginal men diagnosed in 2000-2011. The main outcomes were primary treatment for, and death from, prostate cancer. Analysis included Cox proportional hazards regression and logistic regression.

RESULTS

There were 259 Aboriginal men among 35,214 prostate cancer cases diagnosed in 2001-2007. Age and spread of disease at diagnosis were similar for Aboriginal and non-Aboriginal men. Prostate cancer mortality 5 years after diagnosis was higher for Aboriginal men (17.5%, 95% confidence interval (CI) 12.4-23.3) than non-Aboriginal men (11.4%, 95% CI 11.0-11.8). Aboriginal men were 49% more likely to die from prostate cancer (hazard ratio 1.49, 95% CI 1.07-1.99) after adjusting for differences in demographic factors, stage at diagnosis, health access and comorbidities. Aboriginal men were less likely to have a prostatectomy for localised or regional cancer than non-Aboriginal men (adjusted odds ratio 0.60, 95% CI 0.40-0.91). Of 87 Aboriginal men with full staging and treatment information, 60% were diagnosed with localised disease. Of these, 38% had a prostatectomy (± radiotherapy), 29% had radiotherapy only and 33% had neither.

CONCLUSION

More research is required to explain differences in treatment and mortality for Aboriginal men with prostate cancer compared with non-Aboriginal men. In the meantime, ongoing monitoring and efforts are needed to ensure Aboriginal men have equitable access to best care.