Higher Proportion Of Men Research Articles

Distribution of Lipid Phenotypes in Community-Living Men With Coronary Heart Disease

Risk factor modification, including treatment of dyslipidemias, has been recommended for the prevention of future coronary events in patients with coronary heart disease (CHD). Since the prevalence of various dyslipidemias among outpatients with CHD has not been well documented, the purpose of this study was to determine the frequency of specific lipid phenotypes among ambulatory men with CHD. Lipid profiles were obtained in 255 men (mean age, 65.5 +/- 9.1 years) with CHD in three Veterans Affairs medical centers. Desirable levels of lipids were defined according to National Cholesterol Education Program guidelines as follows: low-density lipoprotein cholesterol (LDL-C) levels less than 3.36 mmol/L (130 mg/dL); high-density lipoprotein cholesterol (HDL-C) levels equal to or greater than 0.90 mmol/L (35 mg/dL); and triglyceride levels less than 2.83 mmol/L. Seventy-six percent of the group had one or more abnormalities on lipid profile: 51% had high LDL-C levels with or without abnormalities of HDL-C and/or triglyceride levels; 22% had low HDL-C levels with desirable levels of LDL-C; and 3% had hypertriglyceridemia without any cholesterol abnormalities. Normal lipid profiles were significantly more prevalent in subjects over the age of 65 years than in younger patients (40% vs 14%). These data suggest that (1) a high proportion of men with CHD have dyslipidemia, including 50% with LDL-C level elevations. For these men, the potential benefits of therapeutic intervention have been documented in clinical trials, although the cost-efficiency of wide-scale treatment has not been determined; (2) isolated hypertriglyceridemia is rare in this population; and (3) low HDL-C levels in association with desirable LDL-C levels are present in more than one fifth of male patients with CHD. Clinical trials focusing on this large group are urgently needed to determine whether efforts to raise HDL-C levels result in reduced cardiac morbidity and/or mortality.

'Til death do us part: intimacy and sexuality in the marriages of Alzheimer's patients.

1. Alzheimer's disease (AD) is likely to have a significant effect on sexual behavior, but both patient and partner will still have sexual feelings and needs. 2. Research has shown that a high proportion of men with AD develop erection problems, but causes of their erection difficulties are not understood. 3. Research has shown that inappropriate sexual behavior in AD patients is uncommon, although it can be very troubling to the family and health-care provider if it occurs. 4. More professionals need to be trained to discuss sexual issues openly and sensitively with AD patients and partners and to offer useful clinical suggestions.

Contrasting Psychosexual Problems of Patients Attending a Genitourinary Medicine Clinic and a Community-Based Clinic

The presenting complaint in 100 consecutive patients attending the psychosexual session (PSS) attached to the Department of Genitourinary Medicine (GUM) in St Thomas's Hospital was compared with 100 consecutive patients seen at a community PSS attached to a family planning clinic in an outer London district. Patients attending the GUM PSS had a greater fear of infection and more relationship problems, but less erectile failure and loss of libido; there was also a higher proportion of men referred and more patients with no regular partner than in the community PSS. It is concluded that many patients with psychosexual problems sought help from the GUM clinic.

Physical activity and risk of coronary heart disease in a survey of adults in Kilkenny, Ireland

A questionnaire survey was carried out to estimate activity levels in a sample of 784 men and women aged 35 to 64 years in County Kilkenny, Ireland. Men were more likely to have sedentary, heavy or very heavy work activity while the majority of women had moderate activity during an average day. Only a small minority of respondents walked or cycled to work. 44% of those surveyed had leisure pursuits which were sedentary. At leisure, a higher proportion of men were involved in active sports or other vigorous activities for at least three hours per week. Men also spent longer each day walking, cycling or jogging. 16.5% of those surveyed engaged in vigorous activities for at least 20 minutes on one to three occasions weekly while 5.1% did so on four or more occasions. Younger people were more likely to take such exercise while older people were more likely to take less vigorous exercise. Path analysis using multiple regression techniques found that an increase in activity levels in this population could lead to substantial reductions in blood pressure, some of which would be mediated through changes in body weight.

Younger Jordanian Husbands More Often Favor Family Planning, Joint Spousal Decision-Making

The 1985 Jordan Husbands Fertility Survey (JHFS) indicated that almost 40% of married men did not believe in practicing contraception and more than 53% believed that family planning should be left up to God. 66% of rural men offered this response compared to 51% of urban men. This response was most common among illiterate men (73%) compared to men with secondary education (31%). Most couples who supported family planning believed that the decision about it should be made jointly. The younger urban and more educated men were more positive about family planning. The 1985 survey was a follow-up to a similar survey conducted in 1983. The 1983 Jordan Fertility and Family Health Survey (JFFHS) showed a total fertility rate of 6.6 as a result of a short birth interval. The JHFS indicated that little communication transpired between spouses concerning the number of children they wanted. The 1983 JFFHS found that the average birth interval was only 27 months and in the 1985 JHFS more than 60% of husbands indicated that an interval of 25 months was ideal. Husbands favored prolonged breast feeding for up to 21 months. 27% of couples said that they were practicing contraception. The IUD was the most popular (11% used it in 1985 and 8% in 1983) followed by the pill sterilization and the rhythm method. 43% of husbands said that the decision to use contraception should be made jointly while 10% said the husband should make such a decision. Nearly 75% of those who supported a joint decision had discussed family planning with their wives. In view of the high proportion of men opposing family planning family planning programs should increase the availability of male methods and offer more educational programs about contraception to younger men.

Indirect estimation of maximal oxygen uptake for study of working populations.

A total of 345 shipyard workers (aged 23 to 47) volunteered to perform progressive exercise on a cycle ergometer (15 W/min increments) up to the symptom limited maximum. The results were used to obtain maximal oxygen uptake (nO2 max), the oxygen uptake at a respiratory exchange ratio of unity (nO2 at R1.0), and cardiac frequency at an oxygen uptake of 45 mmol/min (fC45). In this group 156 men (45% of initial population) attained nO2 max as defined, 108 (31%) withdrew or did not exercise maximally, and 49 (14%) had transient electrocardiographic abnormalities. For the 156 men extrapolation of the relation of cardiac frequency on oxygen uptake to the predicted maximal cardiac frequency resulted in overestimation of nO2 max by 9.6%. nO2 Max per kg body mass was negatively correlated with body mass. nO2 Max (mean value 130.6 mmol/min) was described in terms of age, fat free mass, smoking (yes or no), and level of habitual activity (rated 1 to 4): the standard error of the estimate (SEE) was 17.3 mmol/min (R2 0.42); the equation was suitable for reference values. For estimating the nO2 max of individual men an empirical relation based on nO2 at R1.0, fC45, fat free mass, and % body fat had an SEE of 12.1 mmol/min (R2 0.67). Seventy six per cent of men (88% of those who exercised) attained nO2 at R1.0 (oxygen uptake approximately 73% of maximum). Thus the nO2 max could be estimated in a higher proportion of men than could achieve nO2 max. The estimate is appropriate for assessing exercise capacity in relation to employment.(ABSTRACT TRUNCATED AT 250 WORDS)

6Endocrine approaches to male fertility control

As in the female, gametogenesis in the male is under the control of luteinizing hormone (LH) and follicle stimulating hormone (FSH). Their suppression should inhibit spermatogenesis. If a non-androgenic substance is used to suppress gonadotrophins, androgens must be supplemented to maintain virility, potency and metabolic processes. To avoid administration of several substances, testosterone and its esters were used to develop a male antifertility agent. Although azoospermia can be induced in a high proportion of men with administration of testosterone esters alone, this effect is not uniform. Even frequent injections with testosterone enanthate at weekly intervals fail to inhibit spermatogenesis in all participants. Combinations of gestagenic compounds with testosterone esters show a somewhat better effect, but again azoospermia is only achieved in around 50% of participants. LHRH analogues, although considered by many to offer a realistic potential for male fertility regulation, have not been proven to be successful for this purpose so far. Animal studies in monkeys and preliminary clinical trials demonstrate that agonistic analogues of LHRH have to be given continuously by pump or implant to achieve a pronounced effect on spermatogenesis. But even under these provisions, results in clinical trials have been worse than effects achieved with testosterone/gestagen combinations. Whether new antagonistic compounds offer a better potential awaits clinical trials. Studies in non-human primates demonstrate that testosterone by itself can maintain and initiate spermatogenesis. Based on these findings one could postulate an attenuating effect of high serum androgen levels after supplementation with available testosterone esters. Trials of alternative androgenic substances with slow-release characteristics and without high serum levels after single injections, like 19-nortestosterone hexyloxyphenylpropionate (19NT-HPP), tend to support this theory. With slow-release testosterone preparations under development by the WHO and more advanced delivery systems for LHRH analogues it is not unreasonable to speculate that an effective endocrine antifertility agent for the male will become available.

Head injuries in a population study.

In a population study of altogether 1,112: 60-, 50-, and 30-year-old men performed in Göteborg, Sweden, data on head injuries suffered during life were obtained by personal interview. Two head injury concepts were used, one wide definition to cover all sorts of head injuries (HI-w) and one restricted only to delineate head injuries with evidence of presumed brain involvement (HI-r). 24% of the 60-year-old men, 21% of the 50-year-old men and 23% of the 30-year-old men reported at least one head injury with unconsciousness. When taking only the 3 first decades of life into account a significantly higher proportion of men in the youngest cohort had been unconscious than in the older ones, and the youngest men also had a significantly higher incidence of both HI-w and HI-r than the older men. Accidents at home, in roads and in sports/recreational areas dominated in childhood, place of work in adult age. HI-r accidents occurred somewhat more often in roads and sports/recreational areas than HI-w accidents. Falls, traffic and blows/impacts were the most common causes. Falls dominated in childhood. Motor vehicles were more often involved in childhood accidents in the youngest cohort than in the two older ones. The proportion of self-care decreased due to a strong secular trend. Out-patient care increased due to both a secular trend and to the age of the victim. The proportion of in-patient care increased with the age of the victim but showed no evident secular trend. 1/5 to 1/3 of all head injuries with unconsciousness were not medically attended.

The loss of the remaining natural teeth

Abstract A survey was carried out of 453 people who had their remaining teeth extracted in a dental teaching hospital between January 1980 and June 1983. Seventy-two individuals at risk to endocarditis formed a Cardiac group, of which 57 per cent were women. The remaining 381 formed a Normal group which had a higher proportion of men (67 per cent). The mean age at clearance of the 453 individuals was 53·6 ± 13 years (men 53·4 years, women 53·8 years). The Cardiac group mean age was 54·4 years and that of the Normal group 53·4 years. The mean number of teeth extracted was 15·6 ± 2·9, however, there was great variation at all ages. Comparisons with studies of British groups carried out during the past 15 years support the conclusions that the mean age at which people become edentulous has increased, particularly in women. There was little difference between the pattern of clearance in men and women.

Increased incidence of faecal Klebsiella pneumoniae in patients with HLA B7 CREG antigen and men with rheumatoid arthritis.

In a study of the carriage of faecal Klebsiella pneumoniae in 106 patients with rheumatoid arthritis the incidence of carriage was higher in men (28%) than women (14%) (p < 0.001) and klebsiellae were isolated on two or more occasions from a higher proportion of men than women (p < 0.002). The incidence of carriage was increased among patients with rheumatoid arthritis who had B7 cross-reacting (B7 CREG) antigens (32% v 13%--p < 0.001). Carriage of klebsiellae was not associated with clinical disease activity, raised erythrocyte sedimentation rate, drug treatment, or the presence of HLA Dw4 or DRw4 or both. Thus the carriage and prevalence of faecal Klebsiella pneumoniae appear to be partly determined by the sex and HLA state of the host.

Etiology, Manifestations and Therapy of Acute Epididymitis: Prospective Study of 50 Cases

There were 50 patients with acute epididymitis who were evaluated prospectively by history, examination and microbiologic studies, including cultures for aerobes, anaerobes, Neisseria gonorrhoeae, Chlamydia trachomatis and Ureaplasma urealyticum. Escherichia coli was the predominant pathogen isolated from the urine of men more than 35 years old, while Chlamydia trachomatis and Neisseria gonorrhoeae were the predominant pathogens isolated from the urethra of men less than 35 years old. The etiologic role of Escherichia coli and Chlamydia trachomatis was confirmed by isolation from epididymal aspirates from a high proportion of men with positive urine or urethral cultures for these agents. Chlamydia trachomatis epididymitis accounted for two-thirds of idiopathic epididymitis in young men and often was associated with oligospermia. Of 9 female sexual partners of men with Chlamydia trachomatis infection 6 had antibody to Chlamydia trachomatis, of whom 2 had positive cervical cultures for this organism and 2 others had non-gonococcal pelvic inflammatory disease. Antibiotic therapy with tetracycline was effective for the treatment of men with Chlamydia trachomatis epididymitis and should be offered to the female sex partners

Acute epididymitis: etiology and therapy.

Fifty patients with acute epididymitis were evaluated prospectively by history, examination, and microbiologic studies, including cultures for aerobes, anaerobes, N. gonorrhoeae, Chlamydia trachomatis, and Ureaplasma urealyticum. E. Coli was the predominant pathogen isolated from the urine of men over 35 years old and C. trachomatis and N. gonnorrheae were the predominant pathogens isolated from the urethra of men under 35. The etiologic role of E. Coli and C. trachomatis was confirmed by isolation from epididymal aspirates from a high proportion of men with positive urine of urethral cultures for these agents. C. trachomatis epididymitis accounted for two thirds of "idiopathic epididymitis" in men, and was often associated with oligozoospermia. Of nine female sexual partners of men with C. trachomatis infection, six had antibody to C. trachomatis, of whom two had positive cervical cultures for this organism, and the others had nongonococcal pelvic inflammatory disease. Antibiotic therapy with tetracycline was effective for the treatment of men with C. trachomatis epididymitis, and should be offered to their female sex partner.

Late marriage and non-marriage as demographic responses: Are they similar?

Summary Late marriage and non-marriage are generally treated as similar demographic responses because they are highly correlated in cross-national comparisons. Theoretical considerations of social, economic, and demographic factors promoting delayed marriage on a national level also suggest that the same factors should cause high proportions of men and women to remain unmarried. An analysis of two deviant cases in which the proportions remaining unmarried are significantly lower (Japan) and higher (Ireland) than expected on the basis of the timing of marriages leads to a reformulation of the theory of determinants of the timing and prevalence of nuptiality.

Onychomycosis in elderly chiropody patients.

SUMMARY The thickened toe-nails of 168 patients attending a chiropody clinic for old age pensioners were examined for onychomycosis by a suction drill sampling method. The nails of sixty-eight (41%) of the patients were microscopically positive. Cultures from 12% of these were unsuccessful. Of the remainder, twenty (12%) were infected by dermatophytes and 42 (25%) by moulds. In addition, large quantities of several yeast species were grown from thirteen microscopically negative nails. A higher proportion of men than of women in the same age range were infected both by dermatophytes and moulds.

Psychological aspects of vasectomy in Malaysia.

246 men, aged 21-59, living on rubber estates on the outskirts of Kuala Lumpur, Malaysia, were interviewed 1-4 years after vasectomy in a study conducted by the International Institute for the Study of Human Reproduction of Columbia University and the National Family Planning Board of Malaysia. Most of the men were of Indian origin; 223 were Hindus. The incidence and nature of psychological and medical complications were investigated, but this article treats only the psychological effects. The basic interviews consisted of verbal questionnaires; care was taken to avoid drawing attention to the researchers' interest in psychosexual effects. Men claiming regrets, fears, ill effects, and problems in married life after the operation were 9%, 11%, 54%, and 4%, respectively, of the total population. 11.8% of the men claimed to have a loss of libido. The percentages of men expressing regrets and fears decreased with increasing age, parity, and pregnancies of wife; age here is probably the overriding variable. When the vasectomy decision was joint, rather than the individual decision of either husband or wife, regrets and fears were significantly less (p.05 for both regrets and fears). No couple in the sample was without at least 1 living son, this suggesting that men without heirs will refrain from vasectomy in Malaysia. Higher proportions of men who had lost children reported anxiety. Men reporting psychosexual complications were reinterviewed in depth. In these depth interviews a variety of fantasies associated with the operation was revealed.

Dietary and purgation factors in the epidemiology of gastric cancer.

A study was made of 188 men and 88 women with gastric cancer plus controls of 800 men and 1400 women with non-neoplastic, nondigestive disease seen at Roswell Park Memorial Institute between 1957 and 1965. Sex and age-specific comparisons of cases and controls showed few positive results for men and almost none for women regarding ingestion of a large number of specific foods and beverages, including alcohol. Higher proportions of men with gastric cancer ate cabbage and potatoes than controls though the latter result was not significant. Eating infrequently also more often characterized patients with cancer; this result may parallel those of Segi and Wynder regarding “irregular” eating. The current finding of a higher risk for use of purgatives was similar to the one reported earlier by Boyd and Doll. Many sources of possible error in these results may inhere in the interview method used. Nevertheless, a number of considerations with regard to the interview approach suggest the need for similar research in the future to investigate the relationships found.

Reiter's syndrome in first cousins.

Stecher (1955) has pointed out that the train of events is always the same in establishing a familiohereditary element in disease. Once the diagnostic criteria of a condition have been established, individual family reports follow. When these reach sufficient numbers, they are assembled and analysed with a view to finding the nature of the underlying genetic factors. Hereditary factors are now well recognized as playing a part in nearly all rheumatic conditions. Many people who are genetically risk, however, do not develop these diseases. In gout, for example, it is now established that hyperuricaemia is genetically controlled, and dominant in males. (Smyth, Cotterman, and Freyberg, 1948; Stecher, Hersh, and Solomon, 1949). Infective, psychological, and metabolic factors influence the way in which the gene precipitates attacks. West (1949), who studied the aetiology of ankylosing spondylitis from many angles (geography, sex, occupation, etc.), reached the conclusion that the familial incidence of the disease was greater than might be expected on grounds of chance alone. Romanus and Yden (1955) considered the hereditary factor in spondylitis to be an autosomal dominant, not sex-linked, and with incomplete penetrance, i.e. not all those genetically prone actually develop the disease. Hersh, Stecher, Solomon, Wolpaw, and Hauser (1950) placed the penetrance level in males at 70 per cent. Romanus (1953) stated that irrefutable signs of prostato-vesiculitis could be found in a high proportion of men with spondylitis, and believed the infection to be significant in causation. Stecher (1955), in studying 224 families of patients with rheumatoid arthritis, found 250 cases in 1,054 brothers and sisters, which is about half of what might be expected if the disease were inherited as a single factor dominant. Analysing his figures in conjunction with an adequate randomized series showing the incidence as 0 58 per cent. in the general

Social Change through Imagery and Values of Teen-Age Africans in Northern Rhodesia

N ANY society undergoing rapid technological and social change, such as is occurring on the copper-belt of Northern Rhodesia, young people form an interesting focus for study of change. In the community where this study was made, there were some 50,000 Africans of many different Bantu tribes with Bemba as their lingua franca, some 5,000 Europeans, and few hundred Indians. The copper-mining industry, in existence since 1925, dominates the economic life and greatly influences the social life. The majority of men work in the mines. European culture is being communicated to the Africans in many ways, among which are the mass media. About third of the adults were literate in English or vernacular language, or both; half listened to the radio; twofifths attended movies. The percentages include men and women, but much higher proportion of men. These Africans are now in contact with, and to some degree participating in, new technical and moral order. As Redfield has pointed out, precivilized society was held together by largely undeclared but continually realized ethical conceptions (Redfield 1953:15). Today, the African's awareness of new moral order makes explicit what had been largely implied in the past. The new technical order is of course more explicit and easier to observe than the moral order. This is both explicit and implicit, and the rather limited degree of social contact between Europeans and Africans does not tend to give either group clear understanding of each other's moral order. Nor is the European moral order homogeneous. It is represented by upper, middle and working class Englishmen, South Africans, Boers, missionaries, government officials, mine officials, mine foremen, and the like, all of whom present different versions of European moral order. It is axiomatic that values are the core of moral order, and we use Kluckhohn's definition of value, a conception, explicit or implicit, distinctive of an individual or characteristic of group, of the desirable which influences the selection from available modes, means and ends of action (Kluckhohn 1951: 395). As Northrop points out, values are rarely transferred intact from one culture to another, and new facts coming into culture tend to be conceptualized in terms of old concepts (Northrop 1953: 330-332). We would add that the conceptualization may also be conditioned by psychological needs, including those growing out of anxieties induced by rapidly changing way of life. In the transition from traditional preindustrial culture to modern industrial one, all members of the society can be placed somewhere on continuum with traditional and modern values at opposite ends. Young people in their teens living in urban communities and attending schools, are obviously