Journal of Mens Health最新文献

Background

Gender differences in glycaemic control and diabetes’ complications have been well studied overseas but not locally. Gender is one of the non-modifiable factors for the diabetes patient but it is an important factor for effective personalized diabetes care. This paper examined the gender differences in glycaemic control and diabetes’ complications.

Methods

This was a registry-based observational study from May–December 2008. An online standard case record form was available for site data providers to register their diabetes patients aged 18 years old and above annually. Demographic data, diabetes duration, treatment modalities, as well as various risk factors and diabetes complications were reported. Multivariate analysis was performed.

Results

A total of 20,646 diabetes patients were included. The majority (99.2%) had been diagnosed with type 2 diabetes mellitus (T2D); 42.8% of the sample were men; 57.1% were Malay. The mean age was 58.0 years (standard deviation (SD) = 11.49) with 77.6% of the sample being 50 years old and above. Despite similar diabetes control (HbA1c < 6.5%), females suffered more microvascular complications (estimated glomerular filtration rate (eGFR) <60 mls/min: X² = 753.54, P = <0.001) while men suffered more from macrovascular complications (ischaemic heart disease (X² = 57.61, P = <0.001) and stroke (X² = 13.87, P = <0.001)). Multivariate logistic regression analyses showed that T2D men were more likely to suffer from stroke (odds ratio (OR) = 1.21, 95% confidence interval (CI) = 0.89–1.64), ischaemic heart disease (OR = 1.55, CI = 1.35–1.78) and nephropathy (OR = 1.59, CI = 1.44–1.75).

Conclusion

We observed that men suffered more diabetes-related complications despite similar glycaemic control and better risk factor control. This finding requires further verification from future studies.

Evaluation of cardiometabolic risk has become vital in the primary prevention of adverse vascular events (coronary artery disease, heart attack, stroke or congestive heart failure), particularly in younger middle-aged men (aged 40–60 years old). To discern the prevalence of events in these men, clinicians often stratify cardiovascular risk and treat according to traditional Framingham risk criteria. The Framingham Risk Score (FRS) is a useful and often used tool for estimating the 10-year risk for myocardial infarction or coronary death of an individual. It is supported by the 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults. The FRS is based on data obtained from the Framingham Heart Study and it incorporates age, gender, total and high-density lipoprotein (HDL) cholesterol, smoking, systolic blood pressure (BP), and use of antihypertensive medications. However, it is important to note that the Framingham study includes few data from patients <40 years of age and few minority patients (African American and Hispanic). Thus, the FRS may not adequately estimate risk in younger patients and minorities. The FRS also lacks some important risk factors (e.g., family history, fasting glucose, testosterone) that should be considered when estimating cardiovascular risk in the man with ED. It is evident that the traditional Framingham risk assigned to intermediate and low-risk men will miss several of these individuals deemed at high “cardiometabolic risk”, also known as residual cardiovascular risk. This review will elaborate the definition of cardiometabolic risk, and apply the use of erectile dysfunction and testosterone deficiency as gender-specific surrogate markers for cardiovascular risk stratification in men in addition to the traditional Framingham-based markers. Lastly, it will examine minority men's health, racial differences and the need to include the role of social determinants in future research studies of cardiovascular risk.

Background

Low testosterone (T) has been associated with insulin resistance and diabetes mellitus (DM) among men in population-based studies. These studies included racially diverse men, but did not target for inclusion individuals with opiate use, Hepatitis C Virus (HCV) infection, or Human Immunodeficiency Virus (HIV) infection, which disproportionately affect inner-city populations and may alter the relationship between T and DM.

Methods

The association between free T (FT) and abnormal glucose metabolism was studied among male participants in the Study of HIV, Injection Drug Use, Nutrition, and Endocrinology (SHINE). Logistic regression was used to examine the relationship between log FT and both insulin resistance and prediabetes/DM.

Results

Of 175 men, 43 (24.6%) had low levels of FT (< 52 pg/ml). There were more men in the low FT group on methadone maintenance (39.5% vs. 15.2%, P = 0.001), but there was no difference in FT by HIV or HCV status. Overall, 23 men (13.1%) had prediabetes/DM, which was unrelated to FT (odds ratio (OR) of prediabetes/DM for each log increase in FT = 0.56, 95% Confidence Interval (CI) = 0.13–2.41). FT was also not related to insulin resistance.

Conclusions

The prevalence of hypogonadism was high in this inner-city cohort and was associated with methadone use. However, low FT was not related to insulin resistance or prediabetes/DM. Continued work to identify diabetes risk factors among inner-city populations will help determine targets for intervention to reduce diabetes incidence. Treatment trials of testosterone to reduce diabetes among hypogonadal men may be of particular relevance to opiate users, many of whom are hypogonadal.

Male breast cancer is rare, and many patients and health care providers are not familiar with this entity. Although the underlying causes are not well understood, certain populations are at higher risk, including certain gene mutation carriers, men with Klinefelter syndrome, and certain ethnic groups. Male breast cancer typically presents at a later stage than female breast cancer. A palpable mass is the most common presentation, but nipple discharge or other nipple changes may be seen. Because the number of affected individuals is small, prospective trials have not been conducted; thus, treatment recommendations are typically taken from large trials involving female breast cancer populations. Although outcomes in male breast cancer were previously thought to be worse than female breast cancer outcomes, it appears that they are similar. Questions regarding the most effective surgical and adjuvant therapies remain. Mastectomy with axillary lymph node evaluation, adjuvant hormonal therapy, and chemotherapy are commonly used. Providers of health care to male patients must be aware of the possibility of breast cancer and appropriately evaluate any suspicious changes.

The social determinants unique to African-American men's health contribute to limited access and utilization of health and mental health care services and can have a deleterious effect on their overall health and well-being. There is a need to examine the complex issues concerning African-American men's help-seeking behaviors relative to mental health concerns. Current research estimates that African-American men are approximately 30% more likely to report having a mental illness compared to non-Hispanic Whites and are less likely to receive proper diagnosis and treatment. There is an extensive body of research that supports the view that women are more likely to seek help for psychological problems than African-American men. This review explores the psychosocial, environmental and socio-cultural factors that influence mental health help-seeking behavior among African-American men and explains the urgency to engage various stakeholders to pursue effective behavioral strategies. Research literature concerning the relationships between social determinants of health and their mental health help-seeking behaviors is reviewed and discussed in this paper. The article illustrates the need for mental health providers and researchers to establish feasible, culturally competent prevention and intervention strategies to increase help seeking behavior among African-American men, thereby contributing to the reduction of mental health disparities.

Background

Adolescent boys in India constitute a large group with unmet sexual and reproductive health (SRH) needs. However, their problems and needs are poorly addressed by researchers and policy makers. Socio-demographic factors are considered to enrich the SRH knowledge and awareness of adolescents and to shape their behaviours. The present study investigated SRH awareness, attitudes and practices among adolescent males by place of residence and age. Furthermore, the study aimed to understand the socio-demographic correlates of SRH awareness and behaviours among them.

Methods

The study sample constituted 220 adolescent boys from rural (101) and urban (119) areas. These boys all belonged to a Bengali-speaking Hindu ethnic group. Data on socio-demographic characteristics, SRH awareness, attitudes and practices were collected using pretested questionnaires.

Results

Rural and urban boys differed significantly (P < 0.05) in their sexual attitudes and practices. Place of residence and exposure to media were found to be significant predictors of sexual activity among adolescents. Urban boys were significantly less likely to be involved in penetrative sexual activity (OR = 0.42) compared to rural ones.

Conclusion

Awareness of SRH issues was found to be associated with responsible sexual behaviours among adolescents. Media, along with schools, had an important role in educating adolescent boys on SRH issues and in promoting healthy sexual behaviours among them.

Objective

To gain a greater understanding of masculinity and its potential influence on health-improving behavior in midlife and older African American (AA) men.

Methods

Forty-nine AA men aged 45–88 years completed in-depth interviews to ascertain their perspectives on masculinity, how masculine identity in this population might be influenced by age and physical activity level, or how it might impact health. Taped interviews were transcribed and organized for analysis with common themes identified by multiple researchers.

Results

Most often cited attributes of someone considered “manly” included a leader of a family/household, provider, strong work ethic, and masculine physique. Terms such as responsible, principled, and man of character also described the typical man. Potential negative and positive influences of manhood on health included avoiding health care appointments and being a good example to children/others, respectively. Themes associated with age-related changes in manhood were acceptance and being more health conscious. Elements associated with how manhood was influenced by AA race included stress and perseverance.

Conclusions

Midlife and older AA men in this study primarily expressed views of masculinity that fit the traditional perception of manhood. However, the attributes revealed, such as family provider, responsibility, self-reliance, and perseverance, were viewed as having potential for both negative and positive impacts on health and health-improving behaviors. It will be essential to integrate these prevalent attributes of masculine identity into health promotion interventions such that they facilitate positive behavior change while not competing with gender role norms among this vulnerable group of men.

Oral diseases are among the most prevalent chronic diseases in the United States (U.S.), disproportionately affect males, and exhibit profound disparities among socioeconomic and ethnic groups. The potentially modifiable proximal risk factors for these diseases are relatively small in number though difficult to modify at the individual level, and largely are the same as those associated with increased risk for the major chronic diseases affecting Americans. This paper gives a brief overview of disparities in oral health in the U.S., presents a conceptual model of social determinants involved in one of the most common oral diseases, and discusses the implications of a social determinant perspective for oral health policy and research.