Large Majority Of Men Research Articles

The WALK HOP program: a French innovative multicentric home-based cardiac rehabilitation initiative

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Fonds pour l'innovation du système de santé (FISS) - France. Background Cardiac rehabilitation (CR) has demonstrated scientific benefits in terms of morbidity and mortality. In France, 2019 national data indicates that only 22,3% of coronary patients benefit from CR. The development of alternative programs to center-based cardiac rehabilitation (CBCR) must be considered as a public health priority and requires a reorganization of ambulatory care pathways. Purpose The objective of the "Walk Hop" program is to demonstrate that home-based cardiac tele-rehabilitation (HBCT) is a complementary and safe approach to CBCR, able to increase the proportion of patients benefiting from a rehabilitation program. Methods This feasibility study started begin of 2022. 3,200 coronary patients will be recruited in 8 participating cardiac rehabilitation centers (CRC). Total duration of the experiment is 42 months. The program is financially supported by the French authorities. The HBCT solution developed for the study is proposed to patients by the CRC cardiologist. A multidisciplinary platform consisting of a secure portal and an application allows bidirectional communication. Patients are equiped with a cycle ergometer and a validated heart rate monitor. The application presents aerobic and muscle strenghtening activities and therapeutic education and collects data from the sessions carried out, adherence to the program, symptoms and quality of life. Results By october 2022, 157 active patients have been included in the program with a large majority of men (86%). Mean age is 53,9 ± 9,0. Hypercholesterolemia is noted in 36,9% of the included patients, smoking in 31%, arterial hypertension in 30,6% and diabetes in 11,1%. Obesity/overweight affects 60% of the population. Mean time from angioplasty to initiation of the rehabilitation is 81 ± 90 days. Mean number of home rehabilitation sessions is 21 and a total of 3342 home sessions have been realized. No cardiovascular event or rehospitalization have been registered since the beginnng. Mean adherence to the prescribed sessions is 80 ± 20% and the mean power gain at the end of the program is 14,6 ± 9,9 %. 94% of the patients expressed satisfaction or high satisfaction at the end of the program. Conclusion(s) The Walk Hop program is evaluating the feasibility and acceptability of HBCT with remote monitoring and digital assistance by smartphone. The preliminary data are encouraging in view of the final expected impact: greater cost-effective access to rehabilitation programs by removing obstacles like distance or resumption of work. It is also expected that HBCT will provide an improvement in the long-term maintenance benefits.

Outpatient Primary Care Practitioner Access: Gender-Based Preferences.

Background: Primary care practices are evolving under the pressure of modern-day challenges, with some clinics now introducing the choice of new nontraditional care models designed to maximize patients' needs with practitioner efficiency. These changes include team models consisting of advanced practitioners and physicians, as well as new care delivery formats such as virtual care. With a growing number of options for care, it is unclear whether patients' gender affects their visit preferences; therefore, we surveyed patients presenting to an outpatient internal medicine clinic in Arizona to understand how practice variations impact patient satisfaction of their primary care.Methods: Patients seen in an outpatient internal medicine clinic were surveyed. Multivariable models adjusting for age, marital status, education level, and income were used to evaluate gender-based care preferences.Results: Of 796 total participants (446 women, 350 men), women were more likely to prefer continuity of care with the same health care practitioner (90.2% women vs. 85.0% men, p = 0.028) and allied health staff (AHS) (36.3% women vs. 28.0% men, p = 0.0031) over convenience of appointment or quicker response time than men. However, after multivariable analysis, no statistically significant relationships remained.Discussion: Women favored both continuity of care with the same health care provider and AHS over faster access to primary care. A large majority of men had similar preferences for continuity of care. To provide the highest level of care with greatest patient satisfaction, understanding individual preferences for care delivery will be important.

Parental Leave Policy and Gender Equality in Europe

ABSTRACTThis article uses data from 2008–10 to analyze parental leave policies in twenty-one European countries and their influence on men's behavior. It examines entitlement characteristics, such as nontransferability, duration, payment, compulsory period, and other policies to assess their effect on the proportion of leave men use out of the total parental leave in each country. The findings, which suggest that a large majority of men take nontransferable and highly paid leave, and a small minority take other types, provide the basis for developing the Parental Leave Equality Index (PLEI). PLEI ranks countries by the degree to which parental leave policies reinforce or diminish the gendered division of labor. Results indicate that although Iceland's parental leave policies do the most to advance gender equity, no country has equal, nontransferable, and well-paid leave for each parent. This policy arrangement would be a precondition to men's and women's equal participation in childcare.

Response to Editorial Comment to Combination of lidocaine suppository and periprostatic nerve block during transrectal prostate biopsy: a prospective randomized trial.

We thank Dr Salagierski for his critical comments. Please find the responses to your questions below: 1 What might have been the mechanism of pain reduction by combined anesthesia during the sampling part of the prostate biopsy? 2 Was there an age-related difference in the perception of pain? 3 What was the reason for including patients undergoing subsequent prostate biopsy? We want to clarify that in our opinion, the mechanism of pain reduction during sampling is in large part due to the synergistic effect of neurovascular bundle blockage aided by the lidocaine suppository that can reduce sensation in the anal canal. Above the dentate line there is no sensory innervation, resulting in less discomfort of the transrectal probe in the anal canal, especially for the apical biopsies requiring more erect of the probe. The age-related difference in the perception of pain was more conspicuous in the single substance group. No difference was detectable within group 3 (periprostatic nerve block and lidocaine suppository). The reason for including patients with subsequent biopsies was to show that, specifically in group 3, pain reduction was clearly better than that during the previous biopsies. The comment by Dr Salagierski on the general use of local anesthesia can only be supported. In our experience, there are still patients receiving prostate biopsies without any form of analgesia. This must not be carried out today, and is clearly obsolete. In our series, periprostatic injections, particularly around the area of the apex, without a lidocaine suppository were uncomfortable for the majority of the patients. In Hanusch Krankenhaus, Vienna, Austria, every patient undergoing a prostate biopsy receives combination therapy and has excellent outcomes. Even patients who underwent a re-biopsy under the same conditions were not worried. We recommend the combination of a lidocaine suppository and periprostatic nerve block, even in extended biopsies. The use of general anesthesia for prostate biopsies is indicated in perineal and/or saturation biopsies, but cannot be recommended for the large majority of men. Not only because of costs, but also the possible risks of general anesthesia, we believe that any form of sufficient local anesthesia should be recommended for the comfort of the patient and the time schedule of the procedure.

Safety, effectiveness and acceptability of the PrePex device for adult male circumcision in Kenya.

ObjectiveTo assess the safety, effectiveness and acceptability of the PrePex device for adult medical male circumcision (MMC) in routine service delivery in Kenya.MethodsWe enrolled 427 men ages 18–49 at one fixed and two outreach clinics. Procedures were performed by trained clinical officers and nurses. The first 50 enrollees were scheduled for six follow-up visits, and remaining men were followed at Days 7 and 42. We recorded adverse events (AEs) and time to complete healing, and interviewed men about acceptability and pain.ResultsPlacement and removal procedures each averaged between 3 and 4 minutes. Self-reported pain was minimal during placement but was fleetingly intense during removal. The rate of moderate/severe AEs was 5.9% overall (95% confidence interval [CI] 3.8%–8.5%), all of which resolved without sequelae. AEs included 5 device displacements, 2 spontaneous foreskin detachments, and 9 cases of insufficient foreskin removal. Surgical completion of MMC was required for 9 men (2.1%). Among the closely monitored first 50 participants, the probability of complete healing by Day 42 was 0.44 (95% CI 0.30–0.58), and 0.90 by Day 56. A large majority of men was favorable about their MMC procedure and would recommend PrePex to friends and family.ConclusionsThe PrePex device was effective for MMC in Kenya, and well-accepted. The AE rate was higher than reported for surgical procedures there, or in previous PrePex studies. Healing time is longer than following surgical circumcision. Provider experience and clearer counseling on post-placement and post-removal care should lead to lower AE rates.Trial RegistrationClinicalTrials.gov NCT01711411

MP48-08 SAFETY OF TESTOSTERONE THERAPY IN MEN WITH PROSTATE CANCER

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Medical and Non-surgical1 Apr 2014MP48-08 SAFETY OF TESTOSTERONE THERAPY IN MEN WITH PROSTATE CANCER Ravi Kacker, Mariam Hult, William Conners, and Abraham Morgentaler Ravi KackerRavi Kacker More articles by this author , Mariam HultMariam Hult More articles by this author , William ConnersWilliam Conners More articles by this author , and Abraham MorgentalerAbraham Morgentaler More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1482AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Testosterone therapy (TTh) in men with prostate cancer (PCa) remains controversial, and published clinical experience is limited. We report our experience with TTh in various categories of men with PCa. Methods A retrospective chart review identified 135 men (mean age 64 ± 9y) with PCa who started TTh between May 2004 and Janurary 2013 and were followed for at least 6 months. Of these, 33 (24.4%) were on active surveillance (AS), 93 (68.9%) has undergone definitive local treatment for PCa and were without biochemical recurrence at the start of TTh, and 9 (6.7%) were treated with TTh after known biochemical recurrence. Results Of 33 men on AS, 3 men (9.1%) had upgrading on subsequent biopsy and 29 (87.9%) remained on AS over a mean follow-up of 31.2 mo. For 53 (39.3%) men starting TTh after radical prostatectomy, no patients had biochemical disease recurrence (PSA > 0.2ng/dL) over 30 mo of follow-up. Forty (29.6%) patients underwent either brachytherapy or XRT and were followed for an average of 26.7mo. Of these, 2(5%) patients developed PSA 2ng/dL over nadir but had subsequent PSAs below this threshold. Two (5%) men treated with radiotherapy elected for adjuvant HIFU. For the 9 (6.7%) patients with biochemically recurrent disease prior to starting T therapy, PSA continued to rise in 6 men without symptomatic metastatic disease over 28.7 months of follow-up. There were no skeletal-related events, and no deaths from prostate cancer in any group. Overall, 121 (89.6%) men with PCa remained on TTh with most men discontinuing therapy for lack of efficacy or other non-oncologic reasons. Conclusions TTh does not appear to cause higher than expected rates of PCa progression. A large majority of men with PCa treated with TTh will elect to continue treatment indefinitely. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e529-e530 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Ravi Kacker More articles by this author Mariam Hult More articles by this author William Conners More articles by this author Abraham Morgentaler More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Beratung zur erektilen Dysfunktion während stationärer Rehabilitation nach radikaler Prostatektomie

For men erectile function is essential for quality of life. Besides urine incontinence postsurgical erectile dysfunction (ED) following radical prostatectomy (RPE) represents a significant and prevalent problem. One of the first approaches to this condition should be a consultation performed by professionals in a rehabilitation clinic.A total of 149 patients post RPE participated in this prospective study. All patients were questioned about their understanding of postoperative surgical ED after RPE and if affected they were asked about their own psychological burden as well as their knowledge of possible therapy options. The qualities of presurgical patient information as well as the modules of information pertaining to ED during the rehabilitation were evaluated. Of the patients, 53% expressed that they experienced a considerable burden due to postsurgical ED during their follow-up rehabilitation (AR group) and 70% of the patients during oncological rehabilitation treatment (rehab group). Men who were sexually more active prior to surgery suffered more from postsurgical ED than their less active counterparts. A negative correlation between psychological burden and age was found in the AR group, which however was levelled in the rehab group. Particularly in older patients the burden of ED increases with more time elapsing after the operation. The medical information on ED therapy options provided during the inpatient rehabilitation was considered to be essential by 60% of the men in the AR group and 48% of the patients in the rehab group.Therapeutic possibilities for postsurgical ED following RPE cannot always be given to patients in the preoperative phase or during their stay in the hospital. Since however a large majority of men suffer from postoperative ED following RPE a specialized inpatient urological rehabilitation is suited for a comprehensive consultation.

Disclosure of Incurable Illness to Spouses: Do They Want to Know? A Swedish Population-Based Follow-Up Study

Awareness of the cancer patient's terminal state decreases the risk of psychological morbidity of the bereaved. We wanted to determine whether male spouses of cancer patients who died from their disease had received information that the illness was incurable and to determine their preferences of disclosure. The study included 907 widowers whose wives had died of cancer. In an anonymous questionnaire, we asked whether the widower had received information that his wife's illness was incurable and about his attitudes towards receiving this information. Six hundred ninety-one widowers (76%) participated. Eighty percent of the widowers reported that they were told [corrected] that the wife's cancer was incurable, and 21% reported that they had been informed within 1 week before the patient's death. Although 14% of the widowers did not think the next of kin should be told immediately when the patient's cancer is beyond cure, 39% of the men did not want the patient to be immediately informed. Furthermore, 71% of the men who were never informed about the incurable illness believed that the next of kin should receive that information immediately. Although a large majority of men prefer an immediate disclosure about the incurable stage of their wife's illness, 41% of the husbands received this information during the last week of the patient's life or not at all. These findings indicate that there is room for improvement in the level of communication between health providers and the husbands of women with incurable cancer.

Summary of the Recommendations on Sexual Dysfunctions in Men

There are few published guidelines for the management of sexual dysfunctions in men and women, despite the prevalence and lack of attention to these problems. Disorders of sexual function in men include erectile dysfunction, orgasm/ejaculation disorders, priapism, and Peyronie's disease. To provide evidence-based and expert-opinion consensus guidelines for the clinical management of men's sexual dysfunctions. An International Consultation in collaboration with major urological and sexual medicine societies assembled over 200 multidisciplinary experts from 60 countries into 17 consultation committees. Committee members established the scope and objectives for each chapter. Following intensive review of available data and publications, committees developed evidence-based guidelines in each area. New algorithms and guidelines for assessment and treatment of men's sexual dysfunction were developed. The Oxford system of evidence-based review was systematically applied. Expert opinion was based on systematic grading of the medical literature, in addition to cultural and ethical considerations. Recommendations and guidelines for men's sexual dysfunction are presented. These guidelines were developed as evidence-based, patient-centered, and multidisciplinary in focus. For the clinical assessment and diagnosis of ED, a basic evaluation was recommended for all patients, with optional and specialized testing reserved for special cases. A new treatment algorithm is proposed. This algorithm provides a clinically relevant guideline for managing ED in the large majority of men. New treatment guidelines and algorithms are provided for men's orgasm and ejaculation disorders, including premature ejaculation, retrograde and delayed ejaculation. Finally, expert opinion-based guidelines for the clinical management of priapism and Peyronie's disease are provided. Additional research is needed to validate and extend these guidelines. Nonetheless, this summary encompasses the recommendations concerning men's sexual dysfunctions presented at the 2nd International Consultation on Sexual Medicine in Paris, France, June 28-July 1, 2003.

Varicocèle : traiter ou ne pas traiter ? quand et comment ?

Varicoceles are dilated veins within the spermatic cord and a relatively common occurrence in men. Fortunately, the large majority of men are asymptomatic, however, a proportion of men with varicoceles can suffer from infertility and testosterone deficiency. Sperm and testosterone are produced within the testis, and any alteration to the testicular environment can negatively affect the cells responsible for these processes. The negative impact of varicoceles on testicular function occurs mainly due to increased oxidative stress within the testicular parenchyma which is thought to be caused by scrotal hyperthermia, testicular hypoxia, and blood-testis barrier disruption. Management of varicoceles involves ligation or percutaneous embolization of the dilated veins. Repair of varicoceles can improve semen parameters and fertility, along with serum testosterone concentration. In this review, we discuss the pathophysiology of varicoceles, their impact on testicular function, and management.

Pharmacology (81)

Endocrine consequences of long‐term intrathecal administration of opioids. (University of Antwerp, Edegem, Belgium) J Clin Endocrinol Metab 2000;85:2215–2222.This study involved 73 patients (29 men and 44 women) receiving opioids intrathecally for nonmalignant pain who were enrolled for extensive endocrine investigation. At the time of hormonal determination, the mean duration of opioid treatment was 26.6 ± 16.3 months; the mean daily dose of morphine was 4.8 ± 3.2 mg. The control group consisted of 20 patients (11 men and 9 women) with a comparable pain syndrome, but not treated with opioids. Decreased libido or impotency was present in 23 of 24 men receiving opioids. The serum testosterone level was below 9 nmol/L in 25 of 29 men and was significantly lower than that in the control group (P < 0.001). The free androgen index was below normal in 18 of 29 men and was significantly lower than that in the control group (P < 0.001). The serum LH level was less than 2 U/L in 20 of 29 men and was significantly lower than that in the control group (P < 0.001). Serum FSH was comparable in both groups. Decreased libido was present in 22 of 32 women receiving opioids. All 21 premenopausal females developed either amenorrhea or an irregular menstrual cycle, with ovulation in only 1. Serum LH, estradiol, and progesterone levels were lower in the opioid group. In all 18 postmenopausal females significantly decreased serum LH (P < 0.001) and FSH (P = 0.012) levels were found. The 24‐h urinary free cortisol excretion was below 20 μg/day in 14 of 71 opioid patients and was significantly lower than that in the control group (P = 0.003). The peak cortisol response to insulin‐induced hypoglycemia was below 180 μg/L in 9 of 61 opioid patients and was significantly lower than that in the nonopioid group (P = 0.002). The insulin‐like growth factor I sd score was below −2 sd in 12 of 73 opioid patients and was significantly lower than that in the control group (P = 0.002). The peak GH response to hypoglycemia was below 3 μg/L in 9 of 62 subjects and was significantly lower than that in the control group (P = 0.010). Thyroid function tests and PRL levels were considered normal. No metabolic disturbances were recorded, apart from significantly decreased high‐density lipoprotein cholesterol levels (P = 0.041) and elevated total/high density lipoprotein cholesterol ratio (P = 0.008) in the opioid group compared to the control group. Supplementation with gonadal steroids improved sexual function in most patients. Conclude of all patients receiving intrathecal opioids, the large majority of men and all women developed hypogonadotropic hypogonadism, about 15% developed central hypocorticism, and about 15% developed GH deficiency. These findings suggest that further investigations are required to determine the need for systematic endocrine work‐up in these patients and the necessity for substitutive therapy.

Endocrine consequences of long-term intrathecal administration of opioids.

Intrathecal administration of opioids is a very efficient tool in the long-term control of intractable nonmalignant pain. However, despite the well known role of opioids in endocrine regulation, few data are available about possible effects on hypothalamic-pituitary function during this treatment. Seventy-three patients (29 men and 44 women; mean age, 49.2 +/- 11.7 yr) receiving opioids intrathecally for nonmalignant pain were enrolled for extensive endocrine investigation. At the time of hormonal determination, the mean duration of opioid treatment was 26.6 +/- 16.3 months; the mean daily dose of morphine was 4.8 +/- 3.2 mg. The control group consisted of 20 patients (11 men and 9 women; mean age, 54.2 +/- 14.0 yr) with a comparable pain syndrome but not treated with opioids. Decreased libido or impotency was present in 23 of 24 men receiving opioids. The serum testosterone level was below 9 nmol/L in 25 of 29 men and was significantly lower than that in the control group (P < 0.001). The free androgen index was below normal in 18 of 29 men and was significantly lower than that in the control group (P < 0.001). The serum LH level was less than 2 U/L in 20 of 29 men and was significantly lower than that in the control group (P < 0.001). Serum FSH was comparable in both groups. Decreased libido was present in 22 of 32 women receiving opioids. All 21 premenopausal females developed either amenorrhea or an irregular menstrual cycle, with ovulation in only 1. Serum LH, estradiol, and progesterone levels were lower in the opioid group. In all 18 postmenopausal females significantly decreased serum LH (P < 0.001) and FSH (P = 0.012) levels were found. The 24-h urinary free cortisol excretion was below 20 microg/day in 14 of 71 opioid patients and was significantly lower than that in the control group (P = 0.003). The peak cortisol response to insulin-induced hypoglycemia was below 180 microg/L in 9 of 61 opioid patients and was significantly lower than that in the nonopioid group (P = 0.002). The insulin-like growth factor I SD score was below -2 SD in 12 of 73 opioid patients and was significantly lower than that in the control group (P = 0.002). The peak GH response to hypoglycemia was below 3 microg/L in 9 of 62 subjects and was significantly lower than that in the control group (P = 0.010). Thyroid function tests and PRL levels were considered normal. No metabolic disturbances were recorded, apart from significantly decreased high density lipoprotein cholesterol levels (P = 0.041) and elevated total/high density lipoprotein cholesterol ratio (P = 0.008) in the opioid group compared to the control group. Supplementation with gonadal steroids improved sexual function in most patients. In conclusion, of all patients receiving intrathecal opioids, the large majority of men and all women developed hypogonadotropic hypogonadism, about 15% developed central hypocorticism, and about 15% developed GH deficiency. These findings suggest that further investigations are required to determine the need for systematic endocrine work-up in these patients and the necessity for substitutive therapy.

Ethics and society: A survey of semen donation: phase II — the view of the donors

This report presents the findings of phase II of the survey of semen donation commissioned by the Human Fertilization and Embryology Authority (HFEA), the purpose of which was to obtain information about the motivations and attitudes of semen donors in comparison with a matched group of non-donors. A total of 14 centres licensed by the HFEA to conduct donor insemination participated in the investigation. At each centre, all men who attended for their first or second appointment between 1st November 1993 and 31st January 1994 were asked to complete a questionnaire about the factors which prompted them to attend the centre and about their knowledge of, and attitudes towards, semen donation. In spite of the recommendation by the HFEA that attempts should be made to recruit as semen donors older men in stable relationships who already have children of their own and who wish to donate for altruistic reasons, it remains the case that the large majority of men in the UK who donate semen are young single students who are largely motivated by payment. Views on oocyte donation of women who had never donated oocytes were also obtained, and compared with views on semen donation of a matched group of men who had never donated semen.

Symptomatic response to therapy of men with gonococcal urethritis: do all need posttreatment cultures?

Because the large majority of men with gonorrhea respond to antimicrobial therapy with the rapid disappearance of signs and symptoms, it was hypothesized that a symptomatic response to therapy would predict successful treatment. The records of 4897 men with gonorrhea, of whom 183 (3.7%) were treatment failures on days 3-7 after treatment were studied, and the clinical response to therapy with microbiologic outcome was correlated. Before therapy, 4662 men (95.2%) had dysuria and/or urethral discharge. Of the 582 men who remained symptomatic, 103 (17.7%) had a positive culture after treatment, as compared with only 78 (1.9%) of 4080 men who became asymptomatic (P less than .01). The conclusion was that men who are initially symptomatic and become asymptomatic after therapy have a small chance (one of 50) of being infected at the posttreatment visit. However, because of its very large size, this group contributed almost one-half of all treatment failures (78 of 183; 42.6%).

Hyperactive Boys and Their Brothers

Twenty men, who had conformed to diagnostic criteria for the hyperactive child syndrome 20 to 25 years ago, and their brothers were interviewed. A large majority of men who were hyperactive had completed high school, and each was steadily employed and self-supporting. Half of the men who were hyperactive continued to show a number of symptoms of hyperactivity. Nearly half had problems of a psychiatric nature and despite normal intelligence quota scores and levels of education, these men had not achieved a socioeconomic status equal to that of their brothers or their fathers. Our findings suggest that emotional problems in everyday living may result from the persistance of symptoms of hyperactivity and that most social and psychiatric consequences of the disorder relate to its presence in childhood as well as to its persistance in adulthood.