Affluent Men Research Articles

Survival from prostate cancer in England and Wales up to 2001

Within the last 10 years, prostate cancer has become the most common malignancy among men in England and Wales. The age-standardised incidence rate exceeded that for colorectal cancer by 1993, and overtook the (declining) rate for lung cancer in 1999 (Quinn et al, 2001). By the early 2000s, approximately 29 000 men were diagnosed each year with prostate cancer, accounting for one in four of all new cancers in men (excluding nonmelanoma skin cancer). Prostate cancer is rare under the age of 50 years, but incidence rises steeply with age, reaching nearly 1000 cases per 100 000 per year (1% annual risk) in men aged 85 years and more. Each year, there are some 9000 deaths from prostate cancer, approximately one in eight of all cancer deaths in men (Office for National Statistics, 2003). The causes of prostate cancer are not well known. Family history in first-degree relatives is a risk factor, and incidence is 60% higher in African Americans and 38% lower in Asian Americans than in US Whites (Platz and Giovannucci, 2006), but possible risk factors related to nutrition, environment, lifestyle, sexual history, occupation and ethnicity have not been conclusively identified. The natural history of prostate cancer is poorly understood, ranging from clinically indolent cancers to highly aggressive and often fatal disease (Breslow et al, 1977). Treatment in the 1990s included various combinations of surgery, radiotherapy, chemotherapy and endocrine therapy, but early disease was sometimes managed by ‘watchful waiting', and other modalities, such as cryotherapy, ultrasound and laser treatment have also been used for local disease control (Kirby, 1996a, 1996b). Age-standardised incidence of prostate cancer rose slowly from 1971 up to the late 1980s, but tripled during the 1990s to more than 90 cases per 100 000 per year. This rapid increase is largely attributable to the increasingly widespread use of prostate-specific antigen (PSA) testing, which has led to an increase in the recorded incidence of localised prostate cancer (Evans and Moller, 2003; Pashayan et al, 2006a, 2006b). Prostate cancer is now more common among the affluent. In the early 1980s, incidence was 35–40 cases per 100 000 per year in all deprivation groups. In the decade up to the mid-1990s, however, incidence increased more than two-fold among the most affluent men, more rapidly than among the most deprived men, and is now about 40% higher in the most affluent groups (Quinn et al, 2001). Age-standardised mortality rates remained stable from 1950 to the 1980s before rising gradually, reaching a peak of 31 cases per 100 000 per year in 1993, then declining slightly thereafter. We analysed the data for over 201 000 men diagnosed with a first, primary, malignant neoplasm of the prostate in England and Wales during the 14-year period 1986–1999 and who were followed up to the end of 2001, some 86% of the 233 000 men potentially eligible for inclusion. Approximately 9% (19 800 men) had a recorded survival of zero, most of them who were registered solely from a death certificate, but for a further 1.4% (3300) the vital status was unknown on 5 November 2002, when the data were extracted for analysis, and 3.2% (7500) of men were excluded because the prostate cancer was not their first primary cancer. The vast majority of prostate cancers are adenocarcinoma (Ross and Schottenfeld, 1996). The proportion so described in England and Wales rose from just under 60% of all cases in the early 1990s to approximately 85% by the early 2000s, in parallel with a decline in the proportion coded as epithelial malignancy without further specification, from 28 to approximately 10% (data not shown). This pattern suggests steady improvement in the recording of pathological data, rather than a shift in the type of malignancy.

Survival from prostate cancer in England and Wales up to 2001

Survival from prostate cancer in England and Wales up to 2001

Race to the Top

This article focuses on the myth of hegemonic masculinity in the context of discourses of gender, sport, and nature in advertising, with reference to Der Spiegel, the leading German news magazine, and to Dav Panorama, the largest European mountaineering magazine. The article considers commodity advertisements that employ masculinist sports metaphors (in Der Spiegel) and contrasts them with others designed to sell a range of outdoor sports equipment and/or to promote the idea of sustainable human interaction with the natural environment (in Dav Panorama). Advertisements targeting affluent men are critically discussed, and the symbolic codes of masculinist aesthetics—visualizations of the desire to “conquer” all social constraint—are highlighted. Sports metaphors of all-out competition are compared with broader, less masculinist concepts of sport and nature to underline the ideological character of promotional constructs produced to exploit men's—and women's—fears of failing within a social and cultural order dominated by men.

Adult Obesity Does Not Predict 6‐Year Weight Gain in Men: The Aerobics Center Longitudinal Study

To determine the longitudinal relation between history of adult obesity and the 6-year trajectory of weight change in men. Subjects were healthy, affluent men (n = 761) between the ages of 20 and 78 years who completed at least four comprehensive medical exams at the Cooper Clinic between 1987 and 2003. Maximum adult weight was reported, and current height was measured at baseline. Body weight and cardiorespiratory fitness were measured at all examinations. Adult obesity status was determined from self-reported maximum weight and measured height at baseline as BMI > or = 30 kg/m(2). Weight at all examinations was regressed on a history of adult obesity using linear mixed effects modeling. At baseline, men reporting a history of adult obesity were significantly heavier than men reporting no such history (BMI 29.8 vs. 25.0 kg/m(2); p < 0.05). However, the rate of weight gain among men with a history of obesity was slower than among men without a history of adult obesity (0.04 vs. 0.18 kg/yr; p = 0.09), although this difference was only marginally significant. Fitness modulated the relationship between history of obesity and weight change over time, and both higher levels of fitness and greater frequency of dieting were associated with attenuated weight gain. In contrast, chronic disease and depression were associated with accelerated weight gain. Although a history of obesity was associated with higher weight, it did not seem to result in accelerated weight gain over time. Additionally, dieting and fitness were important for minimizing weight gain.

Skin cancer trends in Northern Ireland and consequences for provision of dermatology services

The incidence of skin cancer, both melanoma and nonmelanoma skin cancer (NMSC), is rising throughout the world. The evaluation of trends in skin cancer will allow better planning of the future development of skin cancer services. Using data collected from the Northern Ireland Cancer Registry (NICR), the incidence of the three major cutaneous cancers, basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and malignant melanoma (MM), was determined and the workload associated with their management assessed. The records of patients with a first diagnosis of BCC, SCC or MM occurring between 1993 and 2002 were retrieved from the NICR database. The annual age- and sex-adjusted incidence rates of all three skin cancers were computed per 100 000 person-years by direct standardization according to the European Standard Population. Trends in incidence were estimated by calculating the estimated annual percentage change using Microsoft Excel. For patients registered with the NICR as having BCC, SCC or MM, the number of pathological reports where malignant samples had been examined was counted and then summed to provide the number of specimens examined each year between 1993 and 2004. For all three cancers the age-specific rates for both males and females increased with age, except for MM in men aged 75 years and over, where the rates were seen to decrease. Over the 12-year period there was a 62% increase in the overall number of skin cancer samples processed by local pathology laboratories and a 20% increase in the number of patients. These data highlight the fact that many patients will have more than one skin cancer, which reinforces the benefit in collecting data for both patient and sample numbers in order to obtain a true reflection of the workload. The data have also shown that more affluent men and women have higher rates of BCC and MM than their less affluent counterparts. In view of the data presented it is clear that management of NMSC and MM will impose significant demands on services in the years ahead. This will impact on the entire multidisciplinary team. Future planning, in terms of manpower and resources, will prove essential if we are to remain in a position to manage our patients with these malignant tumours appropriately.

Designing a virtual grand tour

The Virtual Grand Tour (VGT) is a paradigm for integrating a presentation of an overview of a larger subject with the possibility of launching at any time an exploratory study of a given sub-topic. The name derives from the paradigm's emulation of those 18th-century travels intended to educate (especially) young, affluent British men; today, with the assistance of information and communication technology (ICT) tools, a similar kind of educational tour can be made available to a much wider audience and with far fewer pitfalls, social as well as practical. The paper addresses the issue of designing a VGT, especially from the point of view of keeping clear the relationships between its constituent parts and of finding out exactly which elements can and should be realized with ICT.

The young, the rich, and the beautiful: Secrecy, suspicion and discourses of AIDS in the South African lowveld

This article investigates emic accounts of the AIDS deaths that have occurred in a village in the Bushbuckridge district of the South African lowveld. I argue that whilst AIDS was publicly hidden and shrouded in secrecy, private gossip created moral scripts about those suspected of having died of AIDS. Details of 47 AIDS deaths revealed that young women and relatively wealthy, sometimes powerful men were vulnerable to AIDS. I suggest that AIDS constitutes a moral crisis; peoples' sexual secrets and desires for commodities and sex featured prominently in local AIDS discourses. The article explores the similarity between AIDS and witchcraft as a metaphorical analogy. Both were highly secretive, and subjective, and circumstantial evidence identified witches and AIDS victims. AIDS and witchcraft were also concerned with the problem of unnatural and uncontrolled desire. The article explores these themes with regard to men and women's experiences respectively. Young ‘beautiful women’ who used sex to acquire wealth were said to ‘buy their own coffins’ (die of AIDS), yet relationships with wealthy men ensured household survival. Relatively affluent men were labelled incorrigible ‘womanisers’ who spread AIDS. Discourses of masculine sexuality focussed on men's lack of agency in sexual decision making. The article points to the tendency to ignore men's vulnerability and its implications for AIDS prevention.

Migration and the “Second Wife” in South China: Toward Cross-Border Polygyny

Rapid industrialization in southern China has brought together two types of migrants: young women from towns and villages seeking work and upward mobility and affluent men from Hong Kong sojourning in the coastal provinces to supervise or service export-oriented industries. The result is that many married Hong Kong men who cross the border regularly on business have taken “second wives” or mistresses in China. We analyze this phenomenon using government statistics, selected court cases, and personal interviews. We show that the emergence of the “second wife” phenomenon among migrants in southern China is consistent with recent studies on the causes of polygyny, and we make some predictions about the likelihood of this type of polygyny among migrants.

Migration, Culture Conflict and Psychological Well-being among TurkishBritish Married Couples

This study assessed culture conflict within marriage and the psychological well-being of Turkish men and women and their British partners. The hypothesis was tested that among migrants who are well established economically and socially within a new country, the perception of cultural conflict within marriage might override acculturation as a determinant of psychological well-being. Interviews were carried out with 33 relatively affluent Turkish men (n = 23) and women (n = 10) who had been born in Turkey and had been resident in the UK for an average of 12.2 - 6.2 years, and with their British partners. A marital cultural difficulties index was constructed from ratings of problems stemming from cultural differences in 22 aspects of daily living. Depression, assessed with the Beck Depression Inventory, was correlated with marital cultural difficulties in both Turkish and British respondents, independently of sex, age and duration of marriage. Depression scores were higher among respondents who reported greater cultural conflict. No associations of psychological well-being with acculturation (indexed by maintenance of traditional Turkish activities), age, years of marriage, or level of contact with Turkey were observed. The results highlight the implications of residual cultural conflict within mixed marriages for psychological well-being.

Behavioral medicine and the management of HIV/AIDS

Psychosocial treatment studies provide a method for conducting causal investigations within a clinical environment. They can also inform about relations between psychosocial or biobehavioral processes on the one hand, and disease on the other. Our studies conducted on HIV-positive (HIV+) homosexual men indicate that a group-based cognitive behavioral stress management (CBSM) intervention can decrease distress, buffer the psychological and immunological sequelae of HIV+ serostatus notification, and improve surveillance of herpes viruses. Decreased dysphoria induced by CBSM appears to be a significant mediator of control over cellular immunity. Poor HIV+ African American women, as well as more affluent gay men, benefit from group-based CBSM, but important gender and sociocultural differences must be taken into account in developing protocols. Adherence to highly active antiretroviral therapy (HAART), coupled with good health behavior, can contain HIV/AIDS in most instances. In contrast, poor HAART adherence coupled with poor health behavior (e.g., unprotected sex) can lead to drug resistance and infection of partners with virulent mutated strains. Thus, now more than ever, behavioral medicine approaches to management and secondary prevention of HIV/AIDS are needed.

Health-related quality of life in men with erectile dysfunction.

To assess health-related quality of life (HRQOL) in men with erectile dysfunction. Descriptive survey with general and disease-specific measures. The instrument contained three established, validated HRQOL measures, a validated comorbidity checklist, and sociodemographics. The RAND 36-Item Health Survey 1.0 (SF-36) was used to assess general HRQOL. Sexual function and sexual bother were assessed using the UCLA Prostate Cancer Index. The marital interaction scale from the Cancer Rehabilitation Evaluation System Short Form (CARES-SF) was used to assess each patient's relationship with his sexual partner. Urology clinics at a university medical center and the affiliated Veterans Affairs (VA) Medical Center. Thirty-five (67%) of 54 consecutive university patients presenting for erectile dysfunction and 22 (42%) of 52 VA patients who were awaiting a previously prescribed vacuum erection device participated. The university respondents scored slightly lower than population normals in social function, role limitations due to emotional problems, and emotional well-being. The VA respondents scored lower than expected in all eight domains. Scores for the VA population were significantly lower than those for the university population in physical function, role limitations due to physical problems, bodily pain, and social function. A significant correlation was seen between marital interaction and sexual function (r = -.33, p = .01) but not between marital interaction and sexual bother (r = -.15, p = .26) in the total sample. Sexual function also correlated significantly with general health perceptions (r = .34, p = .01), role limitations due to physical problems (r = .29, p = .03), and role limitations due to emotional problems (r = .30, p = .03). Sexual bother did not correlate with any of the general HRQOL domains. Affluent men reported better sexual function (p = .03). The emotional domains of the SF-36 are associated with more profound impairment than are the physical domains in men with erectile dysfunction. Erectile dysfunction and the bother it causes are discrete domains of HRQOL and distinct from each other in these patients. With increased attention to patient-centered medical outcomes, greater emphasis has been placed on such variables as HRQOL. This should be particularly true for a patient-driven symptom, such as erectile dysfunction.

Incidence and thickness of primary tumours and survival of patients with cutaneous malignant melanoma in relation to socioeconomic status

To study incidence of and survival from cutaneous malignant melanoma in relation to socioeconomic status. Application of Carstairs deprivation score to all malignant melanoma patients diagnosed in a geographically defined area over a 15 year period. West of Scotland (area population 2,716,900). 3142 patients first diagnosed with malignant melanoma in the period 1979-93. Surgical excision of primary malignant melanoma with additional treatment as appropriate and follow up until December 1994. Malignant melanoma incidence, primary tumour thickness and five year survival by socioeconomic status. From 1979 to 1993, the age standardised incidence rate for cutaneous malignant melanoma was 9.1/100,000 for the most affluent men and 2.4/100,000 for the least affluent men and 16.1/100,000 and 5.0/100,000 respectively for most and least affluent women (P < 0.001 for trend in both). The incidence increased steadily over time in both sexes in all socioeconomic groups. Good prognosis tumours ( < 1.5 mm thick) were most common in the most affluent men and women, and over the study period the proportion of such tumours increased most in the intermediate affluence group (both sexes) and in the least affluent women. Five year disease free survival from melanoma for the sexes combined was 81% for most affluent, 77% for intermediate, and 73% for least affluent groups. Even after adjustment for known prognostic factors of tumour thickness, ulceration, age, and body site of primary melanoma, the more affluent the group, the better the survival. Although the incidence of cutaneous malignant melanoma is higher among more affluent people, the prognosis is better in this group than for less affluent individuals. Early diagnosis campaigns should be targeted particularly to less affluent men and primary prevention campaigns should emphasise the greater risk in more affluent women.

Turkish Heart Study: lipids, lipoproteins, and apolipoproteins.

We examined the plasma lipids, lipoproteins, and selected apolipoproteins in approximately 9,000 men and women from six different regions of Turkey with markedly different diets, ranging from an Aegean coast diet high in olive oil (plasma cholesteryl ester fatty acids enriched in monounsaturated fatty acids) to an inland Anatolian diet high in meat and dairy products (plasma cholesteryl esters enriched in saturated fatty acids). The rural population consuming an olive oil-rich diet had the lowest plasma cholesterol levels (men, 149 mg/dl; women, 150 mg/dl). The urban populations of Istanbul and Adana had higher plasma cholesterol levels (men, 202 and 184 mg/dl, respectively; women, 181 and 190 mg/dl, respectively). Affluent men had the highest cholesterol levels (207 mg/dl). The low density lipoprotein (LDL) cholesterol levels tended to parallel the total cholesterol levels (highest for Istanbul men at 136 mg/dl and lowest for Aegean coast men and women at approximately 100 mg/dl). Strikingly, the Turkish people were found to have very low levels of high density lipoprotein (HDL) cholesterol (HDL-C) (mean values for all six regions: men, 34-38 mg/dl; women, 37-45 mg/dl) and total cholesterol/HDL-C ratios that were high (mean values for all six regions: men, 4.5-5.5; women, 3.9-5.0). The low HDL-C levels appear to be caused, at least in part, by a genetic factor. Triglyceride levels also tended to be high in Turkish men (approximately 120-150 mg/dl) and women (approximately 90-110 mg/dl). Thus, even though the total plasma cholesterol levels are not excessively elevated in comparison to those in other populations, the presence of low HDL-C or low HDL-C coupled with mildly elevated triglyceride levels may represent a significant risk factor for heart disease in the Turkish population. Affluence and higher education were associated with higher cholesterol levels. Lack of physical activity, smoking, and alcohol consumption also tended to be associated with a detrimental lipid profile. Lipoprotein[a] levels were identical among the regions surveyed (mean: 11-15 mg/dl) and displayed the typical distribution with an increased number of individuals with low levels. The 90th percentile value for lipoprotein[a] was about 30 mg/dl for both men and women. Smoking, a major risk factor for heart disease, was very prevalent in the Turkish population, especially in men (50-70% smokers) and women in urban areas (30-40% smokers). Hypertension, defined as a systolic pressure > 140 or a diastolic pressure of > 90 occurred in approximately 17% and 26% of the men and women surveyed, respectively.(ABSTRACT TRUNCATED AT 400 WORDS)