journal of men's health

AUA_061109_COL_210x280.pdf

2010-03-01

Contents page

2010-03-01

Making the global case for Men's Health

Siegfried Meryn, April M.W. Young — 2010-03-01

Siegfried Meryn

SAVE THE DATE for the 7th World Congress on Men's Health 2010

2010-03-01

EMHF join ENGENDER steering group

2010-03-01

News From the European Men's Health Forum

2010-03-01

Social determinants of health among African–American men

Clare Xanthos, Henrie M. Treadwell, Kisha Braithwaite Holden — 2010-03-01

Abstract: The health disparities among African–American men are staggering when compared to other racial, ethnic, and gender groups in the United States. While there have been considerable efforts to eliminate health disparities in recent years, disparity elimination efforts have often focused on changing health behavior with regard to African–American men, and grave health disparities continue to exist among this population. This article argues that a consideration of the social determinants of health among African–American men is long overdue. It highlights the serious health disparities among this population, and considers the social determinants of health of African–American men in relation to health status, health behavior, and health care. Finally, suggestions are offered for addressing the social determinants of health among African–American men.

Attitudes, beliefs, and values regarding the sexual experience in men: development of the Sexual Experience Questionnaire

2010-03-01

Abstract: Background: Although treatment of erectile dysfunction improves clinical outcomes and quality-of-life, a significant proportion of men remain undiagnosed with this disorder and male attitudes towards sexual experiences are poorly understood. Being uncomfortable about discussing these issues with others may contribute to men not seeking appropriate medical care. We sought to increase understanding of male attitudes, beliefs, and values regarding “better” sexual experience and to use these outcomes to develop a novel patient-reported outcomes questionnaire capturing important aspects of such experiences.Methods: We conducted focus groups and individual in-depth interviews in Germany, Spain, the United Kingdom, and the United States in treatment-naive men with erectile dysfunction, treatment-experienced men with erectile dysfunction, and men without erectile dysfunction. Sexually active men aged 35–69 years were recruited from a research database, by newspaper advertisement, and at physician offices. Literature reviews and evidence-based practice methods informed the development of focus group and individual interview guides. All sessions were tape-recorded and transcribed, and transcripts were qualitatively analyzed using grounded theory methods.Results: Participants reported that erections were very important. Treatment-naive men placed greater emphasis on ejaculation compared with the other men. Satisfaction was an important concept, with more substantial between-group differences; treatment-naive men expressed decreased satisfaction with their physical sex life and the belief that their relationship would improve if their erectile dysfunction resolved. The majority of participants indicated relationship as an important concept. Responses differed little between countries.Conclusions: The erection, relationship, and satisfaction concepts, which have not previously appeared together and exclusively in a single patient-reported outcomes instrument, emerged as important and will be incorporated in the initial version of the SEX-Q, for which psychometric validation analyses are ongoing. The finding that both physical and emotional concepts are key to a positive sexual experience can help medical personnel guide patients toward the most relevant care.

Socioeconomic status, obesity and lifestyle in men: The Geelong Osteoporosis Study

2010-03-01

Abstract: Background: Although the association between lower socioeconomic status (SES) and obesity in women in developed countries is well-documented, current evidence regarding the relationship between obesity in men and area-based SES (equivalised for advantage and disadvantage) is inconsistent. Therefore, we aimed to examine obesity, lifestyle behaviours, physical activity in different domains and demographics in men using area-based SES.Methods: We performed a descriptive cross-sectional study of 1467 randomly selected white men (mean age 56 year (inter-quartile range (IQR)=39–73 year)) recruited from the Barwon Statistical Division, South Western Victoria, Australia between 2001–06.Results: Age-adjusted BMI, waist circumference, % fat and lean mass and blood pressure were inversely associated with SES, with differences between low and upper SES (P for difference <0.05), independent of country of birth. Age-adjusted lifestyle behaviours associated with obesity and/or adverse health (especially cardiovascular disease), were also associated with lower SES.Conclusions: Subjects from lower SES had greater measures of obesity despite being more physically active at work, but were less likely to be physically active in the domains of sports and/or leisure. These findings suggest the possible influence of lifestyle behaviours and occupation upon obesity in men and should be investigated further.

Fluoroscopy guided implantation of penile prosthesis in cases of severe fibrosis

Omar Pacha, William E. Cohn, Tue Dinh, Irving J. Fishman — 2010-03-01

Abstract: Penile prosthesis implantation in men with scarred corpora presents a challenge to surgeons due to the fibrosis created and the loss of normal anatomic boundaries. We present a new technique to recreate corporal spaces and preserve circulation in a patient with a neophallus that we believe can be used in other circumstances of atypical anatomy such as extensive fibrotic scarring. The operation was performed in a hybrid operating room that was capable of complete angiography as well as complete sterility for operative procedures. Angiography of the femoral vessels documented the blood supply to the neophallus and decreased the risk of accidental injury to its vascular supply. Under fluoroscopic guidance a 16cm needle was extended through the pseudo-corpora of the neophallus to provide a channel for a super stiff guide-wire to be advanced. The needle was then removed and an inflatable Amplatz dilator was advanced along the wire. The balloons were inflated with contrast media under fluoroscopic guidance to create two pseudo corporeal spaces. Appropriately sized inflatable penile prosthesis cylinders were then advanced into these spaces. Successful outcome was maintained at 2 year and 5 months follow-up. Corporoplasty provides an alternative to standard approaches in patients with fibrosis and atypical blood vessel anatomy.

Association between family history of cancers and risk of prostate cancer

2010-03-01

Abstract: Introduction: Family history of prostate cancer is an established risk factor for prostate cancer. However, the relationship between family history of cancers other than prostate cancer and prostate cancer risk is inconclusive. This study sought to examine the association between family history of cancers and prostate cancer.Methods: A case–control study was conducted in which cases and controls were randomly selected from a large urology clinic in Central Virginia. Cases were 600 histologically confirmed prostate cancer patients who were diagnosed between January 2000 and December 2005, and controls were 686 patients who visited the clinic during the same period and were diagnosed with urological illnesses other than cancers and prostate-related problems. Data on family history of cancers, lifestyle and demographic factors were collected through mail survey utilizing the method suggested by Dillman. Unconditional logistic regression analysis was used to estimate the odds ratios (OR) and the corresponding 95% confidence intervals (CI) after adjustment for potential confounding factors including body mass index (BMI), alcohol intake, physical activity, smoking, diet, history of vasectomy and sexually transmitted disease (STD), age, race, marital history, education, and income. Multiple comparisons adjustments were made using the Bonferroni adjustment.Results: Men with a family history of any cancer in first-degree relatives including parents (OR=2.42, 95% CI=1.53–3.84) and parents only (OR=1.90, 95% CI=1.23– 2.94) were at increased risk of developing prostate cancer. Significant increased risk was also observed with family history of prostate cancer in first-degree relatives (OR=2.68, 95% CI=1.53–4.69) and parents only (OR=3.26, 95% CI=1.71–6.24). Even after adjustments for multiple comparisons, the significance persisted both in first-degree relatives (OR=2.68, 95% CI=1.16–6.21) and parents alone (OR=3.26, 95% CI=1.24– 8.63).Conclusion: This study demonstrated an increased prostate cancer risk for men with a family history of any cancer or prostate cancer in first-degree relatives and parents alone. Health care providers need to be aware of the potential risk of family history of cancers on prostate cancer.

Factors associated with self-rated health among older men in a medium-sized city in Brazil

Lívia Maria Santiago, Cristiane de Oliveira Novaes, Inês Echenique Mattos — 2010-03-01

Abstract: Background: This study aimed to characterize self-rated health and to investigate associations between that variable and socio-demographic and health conditions in older men in a medium-sized Brazilian city.Methods: Subjects eligible for this cross-sectional study included older males residing in the municipality who were interviewed during the influenza immunisation campaign in 2006. A descriptive analysis of the variables was performed, exploring associations between self-rated health and a number of co-variables, using prevalence ratios (PR). Multivariate analysis used Poisson regression.Results: The study population consisted of 2,876 men with a mean age of 70.01 years (standard deviation=7.21), the majority were married and with low schooling. A major portion reported having a regular physician, using public health care services, and making regular use of medication. Fair to poor health was reported by nearly 40% of these older men. In the bivariate analysis, different factors were associated with negative self-rated health, whilst in the multivariate model the following remained associated with fair or poor self-rated health: number of chronic conditions, regular use of medication (PR=1.67, 95% confidence interval (CI)=1.43–1.94), recent hospitalization (PR=1.48, 95% CI=1.33–1.65), not currently working (PR=1.34, 95% CI=1.17–1.52), low schooling (PR=1.29, 95% CI=1.13–1.48), and being a user of the public health care system (PR=1.37, 95% CI=1.21–1.54).Conclusion: These findings corroborate the hypothesis that various issues are related to self-rated health in the elderly. Considering that self-rated health is a good indicator of objective health conditions in this age group, health services should develop strategies to capture older men with a risk profile for poor self-rated health.

Primary transitional cell carcinoma of the prostate: a male disease with dismal prognosis despite cisplatin-based systemic chemotherapy

2010-03-01

Abstract: Background: Primary urothelial carcinoma of the prostate is an infrequent male malignancy with a dismal prognosis, that originates in the periurethral prostatic gland. This neoplasia is considered, in general terms, to be chemosensitive but prospective trials regarding therapy and prognosis are lacking, due to the infrequent nature of this entity. This paper is a case series regarding the accumulated experience in our institution with the use of cisplatin-based chemotherapeutic regimens in these patients.Methods: The clinico-pathological findings of a series of 12 patients with primary urothelial carcinoma of the prostate diagnosed and treated over a 10 year period are reviewed, with an emphasis on therapy and evolution.Results: No patient in the series reached long-term survival. Mean time to death was 24.1 months (range 5–48 months). The combination of local treatment plus cisplatin-based systemic chemotherapy did not achieve satisfactory results. However, patients treated with radical surgery (cystectomy or prostatectomy) and at least 3 cycles of multiple chemotherapy behaved better than the rest. Radical surgery achieved better local control than radiotherapy, but repeated transurethral resection of the prostate plus systemic chemotherapy may also provide local control in selected patients.Conclusion: Despite combined therapeutic efforts that pursued both local control and the prevention of a systemic relapse, the prognosis of advanced primary prostatic urothelial carcinoma remains dismal. Early diagnosis appears difficult because clinical presentation differs to that of males with adenocarcinoma of the prostate or invasive transitional cell carcinoma (TCC) of the bladder. Cisplatin-based systemic chemotherapy does not allow prolonged survival.

Psychosocial health screening and recognizing early signs of psychosocial distress

Sanford Herman, Richard Sadovsky — 2010-03-01

Abstract: Mental health issues are a common cause of psychosocial distress in men over the age of 55, and are a common cause of disability due to problems of disturbance of mood, substance use issues, and cognitive difficulties. The physician's ongoing relationship with the older male patient is highly personal and enables the clinician to key in on events and changes in his life that may predispose to mental illness. Doctors have the opportunity to reduce long-term disability and suffering caused by mental and emotional distress through early recognition and anticipation of common mental health problems.

Accreditation Pages

2010-03-01

High-sensitivity C-reactive protein and endothelin-1 in age-related macular degeneration

2010-03-01

Abstract: Background: Age-related macular degeneration (AMD) is the most common cause of elderly irreversible vision loss in the world. Since C-reactive protein (CRP) is a potential risk factor that has been known to induce AMD, this study was designed to explore the relationship between AMD and serum levels of high sensitivity C-reactive protein (hsCRP), and endothelin-1 (ET-1).Methods: The subjects were 48 males with AMD (28 with wet type and 20 with dry type) having a mean age of 69.4±9.6 years and a matched group of 45 apparently healthy control subjects. The AMD was diagnosed using a slit-lamp with super filled lens, fundus photography and fluorescein angiography. Levels of hsCRP and ET-1 were determined using ELISA methods.Results: hsCRP (6.96±5.15 vs. 3.64±4.67mg/l, P<0.0001) and ET-1 levels (0.66±0.31 vs. 0.52±0.25 pg/ml, P=0.025) in the patients were higher than in the controls, but the multivariate analysis also showed a significant difference in cholesterol level (P <0.001). There were no significant differences in the serum levels of hsCRP and ET-1 between the two types of AMD (P>0.05). ET-1 also correlated directly with hsCRP levels (r=0.284, P<0.01).Conclusions: The results suggest that although the serum levels of ET-1 and hsCRP are higher in the patients with AMD, they are a dependent risk factor.

Cardiometabolic disease in men: an integrative medicine approach to managing hormonal risk factors

Andrew Heyman, Lena Edwards, James B. Lavalle, Sahar Swidan — 2010-03-01

Abstract: This article reviews the known pathophysiology of cardiometabolic disease (CM) and discusses methods of diagnosis and evaluation of male patients who may be at risk for CM disease. The usefulness of integrative medicine treatment is also reviewed.These topics are illustrated by means of an actual case of a 55 year-old Caucasian male with no significant past medical history who presented to an integrative medicine clinic complaining of generalized fatigue and weight gain of 30 pounds during the preceding 4 years. After a comprehensive work-up, the patient was diagnosed with metabolic syndrome and advised to begin an exercise program, improve his diet, and lose weight.The patient was prescribed various supplements in addition to testosterone replacement. He was also advised on stress management techniques.After 3 months, the patient had successfully lost 25 pounds through dietary modifications, recommended dietary supplements, and exercise. He reported less daytime fatigue, particularly after meals, and improved sleep at night. His stress levels remained unchanged but he felt ‘more even’ and less susceptible to stressful events on the l-theanine. He had no adverse side effects from the medications or supplements and PSA levels remained unchanged. He was scheduled to return to the clinic in 3 months for re-evaluation.

Calendar

2010-03-01