Third Of Men Research Articles

Gender differentials in the evolution of cigarette smoking habits in a general European adult population from 1993–2003

BackgroundDescribe the recent evolution of cigarette smoking habits by gender in Geneva, where incidence rates of lung cancer have been declining in men but increasing in women.MethodsContinuous cross-sectional surveillance of the general adult (35–74 yrs) population of Geneva, Switzerland for 11 years (1993–2003) using a locally-validated smoking questionnaire, yielding a representative random sample of 12,271 individuals (6,164 men, 6,107 women).ResultsIn both genders, prevalence of current cigarette smoking was stable over the 11-year period, at about one third of men and one quarter of women, even though smoking began at an earlier age in more recent years. Older men were more likely to be former smokers than older women. Younger men, but not women, tended to quit smoking at an earlier age.ConclusionThis continuous (1993–2003) risk factor surveillance system, unique in Europe, shows stable prevalence of smoking in both genders. However, sharp contrasts in age-specific prevalence of never and former smoking and of ages at smoking initiation indicate that smoking continues a long-term decline in men but has still not reached its peak in women.

Robotics in thoracic surgery: Applications and outcomes

doi:10.1016/j.jtcvs.2005.09.007 Robotics has been used in numerous surgical procedures, but with few exceptions, this technologic advance has not been translated into improved outcomes. Many robotic applications have been unveiled as the manifestation a new idea in search of an application. The principal advantages of robotic assistance in surgical intervention are the greater degree of instrumental articulation and motion scaling. However, despite these recognized technical advantages, the demonstration of superior results has been disappointing. A significant clinical application for surgical robotics has been for resection of prostate cancer. In a prospective nonrandomized trial comparing robotic with conventional radical retropubic prostatectomy among 60 patients, Menon and colleaguesr found that the robotic approach significantly reduced intraoperative blood loss and postoperative pain compared with the open approach. Furthermore, although the mean length of stay for patients in the conventional group was 4 days, two thirds of men undergoing robotic prostatectomy were discharged in less than 23 hours. Robotic mitral valve surgery is also gaining acceptance, although there are no randomized studies that demonstrate superiority compared with the conventional approaches. In a recently published prospective series of 38 consecutive patients, Nifong and associates reported no operative deaths, strokes, or conversions to open sternotomy. The average total operative time was less than 5 hours, and the mean length of stay was 4 days. In a recent phase II multicenter trial of robotic mitral valve surgery, total robot, aortic crossclamp, and cardiopulmonary bypass times were 78 minutes, 2.1 hours, and 2.8 hours, respectively. At 1 month of transthoracic echocardiography, only 8% had grade 2 mitral regurgitation. There were no deaths, strokes, or device-related complications. The use of robotics is also being studied in general thoracic surgery, including lobectomy, esophagectomy, and various other procedures, demonstrating safety and feasibility. The study by Park and coworkers in this issue of the Journal describes their experience in developing a standardized approach to robotic lobectomy. As with most thoracic procedures that can be performed robotically, the potential advantages of articulation in 7 degrees and motion stability are probably not fully realized in robotic lobectomy. The growing experience with thoracoscopic lobectomy suggests that the limitations imposed by the thoracoscopic technique, such as port placement and visualization, are easily overcome. However, there are several disadvantage of the robotic system. One important disadvantage is the loss of tactile sense in current systems. Although thoracoscopic lobectomy might alter tactile feedback compared with open thoracotomy, much information is nevertheless communicated to the surgeon’s hands. The significance of this feedback is difficult to quantify, and it is possible that robotic systems will be designed to transmit tactile information in the future. In addition, the instrumentation that is available for use robotically is limited in comparison with the instrumentation available for thoracoscopic or open lobectomy. It is unlikely that the same spectrum of instrumentation will be developed for the robot. Perhaps the superior articulation of the robotic system will compensate for the inferior selection of instrumentation. Also, the time required to assemble the robotic instrumentation is significant, as is the increase in the overall operative time. In this study the median operative time was 218 minutes, and the median room time was 306 minutes. Although the total operative times are likely to decrease with experience, as they have with thoraco-

The overlapping lower urinary tract symptoms of benign prostatic hyperplasia and prostatitis

To investigate the relationship, diagnosis and treatment of the overlapping lower urinary tract symptoms experienced by men diagnosed with benign prostatic hyperplasia and prostatitis. Recent studies have clearly shown that men can suffer from both benign prostatic hyperplasia and prostatitis. Approximately 5-20% of men diagnosed with benign prostatic hyperplasia suffer from prostatitis-like symptoms, while over one third of men diagnosed with benign prostatic hyperplasia have had a diagnosis of prostatitis in the past. Differentiation between these two symptom-based medical conditions can be difficult because of overlapping symptoms, but pain clearly identifies those patients with chronic prostatitis. Treatment for men with co-occurring benign prostatic hyperplasia and prostatitis may include alpha-blockers, 5alpha-reductase inhibitors and phytotherapies (saw palmetto and bee pollen extract), with evidence clearly showing the benefits of alpha-blocker therapy. Benign prostatic hyperplasia and chronic prostatitis are a common cause of lower urinary tract symptoms and frequently co-occur in older men. The best treatment for men with lower urinary tract symptoms associated with both benign prostatic hyperplasia and prostatitis is alpha-blockers.

Long-Term Results of Microwave Thermotherapy for Symptomatic Benign Prostatic Hyperplasia

To study the long-term outcomes of men with moderately severe symptomatic benign prostatic hyperplasia (BPH) who were treated with transurethral microwave thermotherapy (TUMT) with the Dornier Urowave machine. A total of 220 patients (mean age 66.2 years) with clinical BPH, an American Urological Association (AUA) Symptom Score of >or=13, and a peak urinary flow rate (Qmax) of <or=12 mL/sec were enrolled in a multicenter randomized, double-blind, sham-controlled trial. Sham and active treatments were conducted under local anesthesia as an outpatient procedure. Patients were followed up at 1 week and at 1, 3, and 6 months. Patients in the sham-treatment arm who still met the initial enrollment criteria were then offered active treatment. The 6-month interim analysis of the safety and efficacy of this treatment has been previously reported (Urology 1998;51:19). Patients were then followed at 6-month intervals out to 60 months after treatment. At our center, 34 men (mean age 64+/-6 years) continued on the recommended long-term follow-up protocol. Among the 34 men from our center initially entered in the study, 15 completed the entire 5-year follow-up. Four of the men available for follow-up at the 5-year mark were on alpha-blocker medication, and six men had required transurethral surgery for symptom relief. At 5 years, this cohort of patients maintained improvement in AUA Score (from 20.5+/-6.2 to 11.5+/-5.0; P<0.001) and Quality of Life score (from 3.7+/-1.3 to 1.9+/-1.0; P<0.001) but showed no significant improvement in Qmax (8.2+/-1.9 mL/sec to 8.4+/-4.3 mL/sec). At 5 years, 11 of the 15 patients available for review had not required additional therapy. While improvement in voiding symptoms and Quality of Life scores were maintained without the need for adjuvant treatment in approximately one third of men 5 years after TUMT, a significant number had required salvage therapies for symptom relief.

Editorial Commentary

Editorial Commentary

Comparison of Two Physical Activity Questionnaires in Obese Subjects: The NUGENOB Study

Simple instruments are needed to assess habitual physical activity (PA) in obese subjects. In a multicenter European obesity project, we tested whether PA assessments by two questionnaires were correlated and similarly associated to selected obesity-related variables. A total of 757 obese subjects (75% female; age 37.1 [7.9] yr, BMI 35.5 [4.9] kg.m(-2), mean [SD]) completed the Baecke questionnaire (assessing work, sport, and nonsport leisure activity) and the short last 7-d version of the International Physical Activity Questionnaire (IPAQ; assessing vigorous, moderate-intensity, walking activity, and sitting). We assessed percent body fat (bioimpedance), waist circumference, and fasting plasma concentrations of glucose, insulin, leptin, and FFA. Insulin sensitivity was assessed by the HOMA index for insulin resistance (HOMAIR). Using the IPAQ, only about one third of men and women were classified as insufficiently active. Total habitual PA assessments by the Baecke and IPAQ were significantly related (Spearman rho = 0.51 in total sample, P < or = 0.0001, with adjustment for age, gender, and center). Using principal component analysis, we built two uncorrelated indices corresponding to general obesity (determined by high body fat and leptin) and abdominal obesity (determined by high waist circumference and HOMAIR). PA scores from both questionnaires were negatively related to general and abdominal obesity indices, except for abdominal obesity with the IPAQ in men. Total PA assessments by the two questionnaires were found to correlate significantly, and the general pattern of associations of PA with general obesity was similar for the two questionnaires. However, the IPAQ may capture less of the relationships between PA and abdominal obesity than the Baecke, especially in men. Reporting of habitual PA in obese subjects with the IPAQ warrants further evaluation against objective assessment methods.

Épidémiologie et physiopathologie de la dysfonction érectile

Erectile dysfunction (ED) is a common condition with a significant deleterious effect on the quality of life. The prevalence rate of ED is about 20-45 % and its incidence in western countries has been evaluated from 25 to 30 cases per 1000 person year. Risk factors of ED are ageing, diabetes, and cardiovascular, uro-genital, psychiatric and any chronic diseases. Smoking, hormonal factors and some drugs may be associated with ED. Modifications of risk factors must be initiated before the age of 50 to prevent ED occurrence. Two thirds of men with ED report embarrassment when discussing this problem with a physician and less than 25% ask for medical advice. As a symptom of endothelial dysfunction, ED may be considered a premonitory sign of coronary or peripheral vascular disease and diabetes.

Association of Passive Smoking by Husbands with Prevalence of Stroke among Chinese Women Nonsmokers

Growing evidence suggests that exposure to environmental tobacco smoke may have deleterious cardiovascular effects. Few studies have investigated environmental tobacco smoke exposure in relation to stroke. The authors examined the association between smoking by husbands and stroke prevalence among women nonsmokers in Shanghai, China, where two thirds of men but few women smoke. They analyzed baseline survey data (1997-2000) from a population-based cohort study, the Shanghai Women's Health Study. A total of 60,377 eligible women (aged 40-70 years) were included in the analysis. Information on husbands' smoking status and history of physician-diagnosed stroke was obtained through in-person interviews. Logistic regression was used to compute odds ratios for the associations. There were 526 prevalent cases of stroke reported. The adjusted odds ratios of stroke in women associated with husbands' current smoking of 1-9, 10-19, and > or =20 cigarettes per day were 1.28 (95% confidence interval: 0.92, 1.77), 1.32 (95% confidence interval: 1.01, 1.72), and 1.62 (95% confidence interval: 1.28, 2.05), respectively (p for trend = 0.0002). Prevalence of stroke also increased with increasing duration of husbands' smoking. The authors found that women nonsmokers who lived with husbands who smoked had an elevated prevalence of stroke, and prevalence increased with increasing intensity and duration of husbands' smoking.

Recommendations for Optimal Care of the Fragility Fracture Patient to Reduce the Risk of Future Fracture

Fragility fractures resulting from low trauma events such as a fall from standing height affect up to one half of women and one third of men after age 50 years. These fractures are frequently associated with osteoporosis. History of a fragility fracture is among the strongest risk factors for future fracture. Therefore, optimal care of the patient with a fragility fracture includes not only treatment of the presenting fracture itself but also evaluation and treatment of the underlying cause or causes to prevent future fractures. However, despite the availability of therapeutic agents that reduce fracture risk among osteoporotic patients who have had a fracture, most patients with fragility fractures are not evaluated for osteoporosis or treated adequately to reduce the risk of future fracture. Orthopaedic surgeons are the first and often the only physicians seen by fracture patients. Thus, they have the unique opportunity to serve as primary advocates to ensure that appropriate action is taken to reduce the risk of future fracture.

Bleeding time, stroke and myocardial infarction: the Caerphilly prospective study

The stressed bleeding time is a simple 'global' test of haemostasis, dependent upon platelet function, rheology, thrombosis and intimal function. It could be of considerable value in clinical practice if it were shown to be predictive of vascular disease events. A stressed bleeding time test was done on 1319 men aged 55-69 years in the Caerphilly Cohort Study of Heart Disease, Stroke and Cognitive Decline. The men were followed-up and during the following 7-10 years 155 men had a myocardial infarction (MI) and 72 an ischaemic stroke. The mean bleeding time was 323 (SD 113) s. This was shorter in men who smoked by an average of 45 s, and lengthened in men who took aspirin daily by 40 s. After making statistical adjustments for numerous possible confounding factors, the relative odds (ROs) of an MI within the third of men with the longest bleeding times, compared to the third with the shortest times, was 0.90 (0.40-2.03). For ischaemic stroke, the ROs in the third of men with the longest times were 1.42 (0.39-5.21). The stressed bleeding time does not predict either MI or ischaemic stroke. It has no place in health screening.

Iron status and hemoglobin level in chronic renal insufficiency.

Much has been written on the important contribution of iron deficiency toward anemia and epoetin resistance among end-stage renal disease (ESRD) patients, but there are few studies of iron status among chronic renal insufficiency (CRI) subjects not yet requiring dialysis. The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) Practice Guidelines recommend maintaining ferritin > or =100 ng/ml and transferrin saturation (TSAT) > or =20% to ensure adequate iron supply for erythropoiesis among patients with chronic kidney disease, whether or not they are dialysis-dependent. Analysis of the nationally representative data from the Third National Health and Nutrition Examination Survey (NHANES III 1988-1994) revealed that only a minority of anemic CRI subjects in the United States met these K/DOQI targets. For example, in the range of creatinine clearance (CrCl) 30 to 50 ml/min, less than one third of men with hemoglobin <12 g/dl and women with hemoglobin <11 g/dl had ferritin > or =100 ng/ml and TSAT > or =20%. In addition, TSAT levels above 20% were independently associated with higher hemoglobin levels. Such data raise the question whether the K/DOQI targets should be reevaluated. It is concluded that ferritin and TSAT targets derived from ESRD studies may not be applicable to subjects with CRI. Further studies are needed to guide optimization of iron status and hemoglobin level in the much larger CRI population.

Best practice policies for male infertility

University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; University of Louisville School of Medicine, Louisville, Kentucky; Baylor College of Medicine, Houston, Texas; Brown University, Providence, Rhode Island; Cleveland Clinic Foundation, Cleveland, Ohio; New York Presbyterian Hospital-Cornell, New York, New York; University of Virginia School of Medicine, Charlottesville, Virginia; Mayo Medical School, Rochester, Minnesota; University of Pennsylvania School of Medicine, York, Pennsylvania; University of California, Davis, Davis, California; and SUNY Health Science Center at Brooklyn, Brooklyn, New York

Predicting cancer following a diagnosis of high-grade prostatic intraepithelial neoplasia on needle biopsy: data on men with more than one follow-up biopsy.

Most studies on the risk of cancer after high-grade prostatic intraepithelial neoplasia (PIN) on biopsy have been small (fewer than 100 men), have not analyzed in detail if histologic features can predict cancer, and have not assessed the risk of cancer with multiple repeat biopsies. We analyzed 245 men in whom the only abnormal finding on the initial biopsy was high-grade PIN and who had at least one follow-up biopsy. Repeat biopsy identified cancer in 32.2% of men. If only one follow-up biopsy had been performed on the 245 men, only 24.5% of men would have been found to have cancer. The only independent histologic predictor of a cancer diagnosis was the number of cores with high-grade PIN; risk of cancer: 30.2% with 1 or 2 cores, 40% with 3 cores, and 75% with >3 cores. The following did not predict cancer: number of high-grade PIN glands, maximum percentage of gland involved by high-grade PIN, nucleolar prominence, percentage of cells with prominent nucleoli, pattern of high-grade PIN (flat, tufting, micropapillary, cribriform), marked pleomorphism, digital rectal examination, transrectal ultrasound findings, family history of prostate cancer, serum prostate specific antigen (PSA) at time of high-grade PIN diagnosis, and rate of change of serum PSA. Eighty-one (33%) men had more than one follow-up biopsy; in these cases the following findings on the original high-grade PIN biopsy predicted cancer: the presence of mitoses, the number of positive cores, predominant micropapillary and cribriform high-grade PIN, and very large prominent nucleoli. Of 81 men with more than one follow-up biopsy, if the first repeat biopsy were benign, high-grade PIN, or atypical, the eventual cancer rate was 10%, 25.9%, and 57.1%, respectively (p = 0.002). Of 15 men with more than two repeat biopsies, only two (13.3%) had cancer. In summary, approximately one third of men with high-grade PIN on biopsy have cancer on follow-up. If cancer is not found on the first two follow-up biopsies, it will unlikely be found. Although clinical findings at the time of diagnosis of high-grade PIN are not useful to predict who might have cancer, histologic findings may help identify who needs additional biopsies.

Management of Peyronie's disease - a review.

Peyronie's disease is an uncommon condition involving middle-aged men and probably resulting from penile trauma. The injury causes an inflammation in the tunica and ultimately scarring and penile curvature develop. It may also occur due to nonspecific inflammation. The use of medications such as β-blockers can sometimes result in Peyronie's disease. In Peyronie's disease, the normal elastic tissue of the tunica is replaced by scar tissue. The penile plaque, or scar tissue in this condition, is not elastic but hard and will not stretch with erection. The side that does not stretch results in penile curvature to the side of the scar. One third of men with Peyronie's disease have painful erections. A low percentage of men with Peyronie's disease develop erectile dysfunction. Because inflammation is initially associated with the scar tissue, some amount of discomfort occurs during erection. Most patients with early stage Peyronie's disease can continue to function sexually with the curvature in the penis. Others with a severe penile deformity will have difficulty in sexual intercourse. Literature regarding the effectiveness of conservative therapy in the early phase with pain and inflammation is limited, with only modest and at times anecdotal benefits. The commonly used agents include 400 units of vitamin E (vitamin E promotes healing and prevents scarring), ibuprofen (anti-inflammatory) and Colchicine (useful for pain during erection). Fexofenadine is recently being used in the early phase of Peyronie's disease for its anti-inflammatory effect. Radiation and ultrasound are not usually very helpful. When the disease process stops, there is usually some residual distortion of the penis but the majority of patients are able to have satisfactory sexual intercourse. However, if there is severe penile distortion interfering with intercourse, surgery is indicated. Surgical techniques for Peyronie's disease include tightening or plication (Nesbit's tuck) of the penis opposite the curvature to produce straightening. This usually results in some small loss of length. The other type of surgery consists of incision of the plaque or scar tissue and patching with a vein (saphenous vein graft) or dermal graft. Laser therapy is occasionally used. A penile prosthesis is the treatment of choice in patients with Peyronie's disease and erectile dysfunction.

Prevalence of morbidity and multimorbidity in elderly male populations and their impact on 10-year all-cause mortality: The FINE study (Finland, Italy, Netherlands, Elderly)

Older males are known to carry, more likely than younger people, one or more chronic diseases with an expected impact on mortality. This study was aimed at identifying the relationship of prevalent chronic diseases in elderly populations of different countries with all-cause mortality. Men aged 65–84 from defined areas were enrolled in Finland ( N=716), the Netherlands ( N=887) and Italy ( N=682). They were survivors of cohorts studied for 25 years within the Seven Countries Study. Major chronic diseases were diagnosed at entry. Ten-year follow-up for mortality was completed. Entry prevalence of selected chronic diseases was higher in Finland (56%) than in Italy (51%) and the Netherlands (44%). Ten-year age-adjusted death rates from all causes were higher in Finland (565 per 1000) and lower in the Netherlands (478 per 1000) and Italy (445 per 1000). The absolute risk of death related to chronic disease was high in the three countries, but was higher in Finland than in the Netherlands and Italy. The most lethal condition was stroke, with 10-year death rates of 806 per 1000 in Finland and 707 and 729 per 1000 in the Netherlands and Italy, respectively. The relative risk of all-cause mortality for a set of seven chronic diseases (coronary heart disease, heart failure, claudicatio intermittens, cerebrovascular accidents, diabetes, COPD and cancer) adjusted by age, other diseases and cohort was less than two for each condition, except cerebrovascular accidents in the Netherlands (RR 2.20). In general, relative risk was higher in Finland, intermediate in the Netherlands and lower in Italy, where only cerebrovascular accidents, intermittent claudication, diabetes and the presence of any chronic condition had a significant relative risk. About one third of men had one chronic disease, and between 10% and 15% had two diseases. The coexistence of any two or three chronic conditions was associated with a relative risk of 2 or more in Finland and the Netherlands and less than 2 in Italy. In these elderly men prevalent morbidity and comorbidity was relatively common and it explained a large proportion of excess in all-cause mortality in 10 years of follow-up.

Prostate cancer: demographic and behavioral correlates of stage at diagnosis among blacks and whites in North Carolina

Objectives. Although stage at diagnosis is one of the most important predictors of survival from prostate cancer, demographic factors, screening practices, and knowledge and beliefs associated with stage at diagnosis have not been well documented, particularly by race. Methods. We conducted telephone interviews with 117 black and 114 white men diagnosed with prostate cancer to identify the demographic factors, healthcare-seeking behaviors, and prostate cancer-related knowledge, attitudes, and practices associated with stage. The sample was stratified by stage at diagnosis and was composed of men 50 to 74 years old who resided in a contiguous 63-county region in North Carolina and who were diagnosed at 1 of 16 participating hospitals. Results. Among blacks, stage was inversely correlated with income ( P = 0.04) and health insurance status ( P ≤ 0.001); among whites, stage was not associated with income or health insurance status, but approached significance with marital status ( P = 0.06). Awareness of prostate cancer before diagnosis tended to decline with advancing stage among black men ( P = 0.07), but was high for all stages (greater than 93%) among whites. Report of a prostate-specific antigen screen was inversely correlated with stage among black men ( P = 0.01); a trend was observed among whites but was not significant ( P = 0.20). Knowledge of prostate cancer risk factors was not significantly associated with stage for blacks or whites. Less than one third of men in each race and stage group knew that black men are at increased risk of prostate cancer. Conclusions. Demographic and other factors vary with stage and should be considered when designing and targeting interventions to reduce late diagnosis of prostate cancer.

Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study.

STUDY OBJECTIVE: To determine the prevalence of varicose veins and chronic venous insufficiency (CVI) in the general population. DESIGN: Cross sectional survey. SETTING: City of Edinburgh. PARTICIPANTS: Men and women...

Emerging tobacco hazards in China: 1. Retrospective proportional mortality study of one million deaths

Objective: To assess the hazards at an early phase of the growing epidemic of deaths from tobacco in China.Design: Smoking habits before 1980 (obtained from family or other informants) of...

Chest pain is an unreliable measure of ischemia in men and women during PTCA

To investigate the differences between men and women in ischemia-induced pain, the amount of ST-segment deviation (the "ST deviation score"), and the relation between pain intensity and ST deviation score. Retrospective, comparative descriptive. Cardiac catheterization laboratory of a large, urban, university-affiliated medical center with full cardiac services. Adults who underwent percutaneous transluminal coronary angioplasty (PTCA) and had electrocardiographic (ECG) evidence of myocardial ischemia during balloon inflation. Continuous 12-lead ECGs were recorded during balloon inflation in patients undergoing PTCA. Patients rated pain on a scale of 0 to 10. The total ST deviation score equaled baseline ECG ST minus maximal ST deviation; absolute deviations were totaled. Frequencies, measures of central tendency, or chi-square or t tests were used for data analysis with significance established at p < 0.05. There were no difference in the degree of chest pain between men and women during balloon inflation, nor was ST deviation score associated with pain in either gender. Pain intensity did not correlate with total ST deviation in men (r = 0.02) or women (r = -0.07). In this study, pain was a poor indicator of ischemia in both sexes during PTCA, and the degree of pain did not correlate with the magnitude of ST deviation. More than one third of men and more than one fourth of women experienced no chest pain during balloon inflation. Clinicians should consider continuous ST-segment monitoring and patient symptoms to monitor accurately for ischemia.

Osteoporosis. Frequency, consequences, and risk factors.

More than half of all women and about one third of men will experience osteoporotic fractures during their lives. Although no symptoms occur prior to fracture, bone mineral density and other risk factors can be used to identify high-risk patients, and because effective interventions exist, many of these fractures are now preventable. The proportion of people who are affected, the mortality and morbidity resulting from osteoporotic fractures, and the major known risk factors are discussed. Greater attention should be given to measuring bone mineral density and identifying other risk factors to quantitate the degree of fracture risk among patients (with or without a history of previous fractures), because the consequences of fractures often are severe, and no symptoms other than fractures are associated with disease progression.