Focus On...Rural Health

Men’s Health Issues: Fable, Reality Check and Bright Signs on the Horizon

Robert L. Alt, MD

What is a men’s health issue? According to Davidson and Lloyd, it is “... a disease or condition unique to men, more prevalent in men, more serious among men, for which risk factors are different for men, or for which different interventions are required for men.”1 Why is it important to think in terms of men’s health “issues?” Consider for a moment, the following.



Author Affiliations: Doctor Alt is an Internist at Dean Medical Center’s East Madison Clinic in Madison, WI. In spring, 2002, he was co-chair of and presented at the Primary Care Seminar at St. Marys Hospital entitled “Medicine for Men: The Challenge in Primary Ca

Corresponding Author: Doctor Alt can be reached at alt_robert_l@ssmhc.com.

Editorials

What do men want? Apparently not a check-up

Thomas C. Meyer, MD, WMJ Medical Editor

After his guest editorial on the issue of men’s health (WMJ. 2001;100(3):8-12) we invited Robert Alt, MD, to elaborate on the topic by asking some of his colleagues to prepare a fuller explanation of a few of the problems associated with men’s health in an issue devoted to the theme. He did not disappoint us.


Author Affiliations: Medical Editor for the WMJ

Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800

Key Men’s Health Issues in Public Health – Women Can Help Spread the Word

Peter D. Rumm, MD, MPH; Gale D. Johnson, MPA

During the last decade there has been an increasing focus in public health on women’s health issues. These include: 1) lack of participation in research trials; 2) screening issues with a number of chronic diseases; 3) differences in presentation for a number of diseases; and 4) access issues for young mothers and children. Women suffer a disproportionate amount of diseases such as arthritis, osteoporosis, severe depression and cancers of the direct reproductive tract and breast.1



Author Affiliations: Doctor Rumm is the Chief Medical Officer and State Epidemiologist for Chronic Disease for the Division of Public Health, Department of Health and Family Services (DHFS), Madison, Wis. Ms. Johnson is the Director of the Wisconsin Well Women Program in the

Corresponding Author: Wisconsin Medical Society at 608.442.3800

Original Research

Where the Boys Are Not: A Brief Overview of Male Preventive Health

Robert L. Alt, MD

Excess morbidity and premature mortality in US males is caused, in part, by lack of male participation in preventive health behaviors. Unlike women, who routinely access the health care system for periodic reproductive exams, men between the ages of 15 and 50 rarely seek preventive care services. A chart survey of a sample of female reproductive exams was undertaken to investigate the types of health care services these exams provide. Results indicated that a periodic female reproductive exam often encompasses many elements of a comprehensive history and physical exam, thus serving as an ideal preventive health vehicle, and is reimbursed as such by non-Medicare payers using preventive health codes. In most cases, reproductive issues were a minor portion of the female reproductive exam. It is speculated that males would also benefit from similar periodic, gender-appropriate preventive health exams. Like periodic reproductive exams for women, these “well male exams” would serve as abbreviated comprehensive history and physical exams, and would be reimbursed using the same preventive health codes. A list of age-appropriate preventive health interventions for men is suggested.



Author Affiliations: Doctor Alt is an Internist at the East Madison Clinic of Dean Medical Center in Madison, WI. In Spring, 2002, he was co-chair of and presented at the Primary Care Seminar at St. Marys Hospital entitled “Medicine for Men: the Challenge in Primary Car

Corresponding Author: Doctor Alt can be reached at alt_robert_l@ssmhc.com.

Osteoporosis in Men

Neil Binkley, MD; Diane Krueger, BS, CCRC

Osteoporosis is often considered a disease of women. However, the lifetime risk of osteoporotic fracture in men is as high as 1 in 4. Furthermore, approximately 30% of hip fractures occur in males. Additionally, morbidity and mortality following osteoporotic fractures appears to be greater in men than women. Thus, it is appropriate that increased attention be paid to this problem in men. Recently, indications for bone mass measurement in men have been published. They include prior low trauma fracture, hypogonadism, and corticosteroid treatment, among others. Additionally, a consensus recommendation that osteoporosis be diagnosed at a T-score of -2.5 or below will soon be published. In men presenting with low bone mass or osteoporotic fractures, secondary causes of bone loss will be found in up to two thirds. The most common secondary causes are cortico-steroid use, alcohol abuse, hypogonadism, and idiopathic hypercalciuria. Thus, laboratory evaluation is indicated in osteoporotic men. Finally pharmacologic agents to treat osteoporosis have recently been approved in men. This review highlights current understanding of epidemiology, pathophysiology, diagnosis, and treatment of osteoporosis in men.



Author Affiliations: Authors are with the University of Wisconsin-Madison, Osteoporosis Clinical Center and Research Program and Institute on Aging. Doctor Binkley is an Assistant Professor in Geriatrics and Endocrinology. Ms. Krueger is Program Manager.

Corresponding Author: Address correspondence to Neil Binkley, MD, Suite 100, 2870 University Ave, Madison, WI 53705; 608.265.6410; nbinkley@facstaff.wisc.edu.

Sexually Transmitted Diseases in Wisconsin Men

Barry C. Fox, MD

Trends in reported sexually transmitted diseases in Wisconsin men mimic the trends in national reporting. Chlamydia trachomatis, Neiserria gonorrheae, and Herpes simplex virus are the most frequently reported conditions. Newer diagnostic techniques based on the amplification of DNA for Neiserria gonorrheae and Chlamydia trachomatis provide health care providers with a more reliable and rapid diagnosis. In the current health care environment, reporting of sexually transmitted diseases among men occurs at a lower frequency than among women. Screening programs for Wisconsin men outside of the traditional setting are few. The most common sexually transmitted diseases are reviewed, with emphasis on newer developments. New treatment guidelines have been issued by the Center for Disease Control and Prevention (2002). Wisconsin health care providers can assist in the appropriate reporting of sexually transmitted diseases to the Wisconsin Division of Public Health.



Author Affiliations: Doctor Fox is with the Division of Infectious Diseases, Department of Medicine, University of Wisconsin Hospitals and Clinics.

Corresponding Author: Address correspondence to Barry C. Fox, MD, H4/572 CSC, 600 Highland Ave, Madison, WI 53792; e-mail:bcfox@ facstaff.wisc.edu.

The Challenge of Raising Emotionally Healthy Boys

Ronald J. May, PhD

Men’s health problems are rooted in early socialization, which inhibits self-care and help-seeking behavior. This article explores the impact of male socialization, as well as developmental challenges that undermine the health of boys and male adolescents. Maladaptive coping strategies used by young males are outlined. The author describes what young males need for maintaining emotional connections with themselves and others. Practical strategies are offered for how physicians may promote the emotional health of today’s boys and male adolescents.



Author Affiliations: Dr. May is a licensed psychologist in private practice at The Psychology Center in Madison, Wis. He also serves as the supervising psychologist at Aspen Family Counseling in Portage, Wis. For the past eight years, Dr. May has taught “The Psychology

Corresponding Author: Please address correspondence to the Wisconsin Medical Society to 608.442.800

Your Practice

Enhancing men’s urologic health

Philip M. Farrell, MD, PhD

When I was in medical school, my class was led to believe (misled, actually) that certain major health problems—such as stroke and heart disease—mainly affected men, not women. We now know that this is not the case; these pervasive diseases afflict women almost as frequently as they do men. With this understanding and with the great attention that has been given to breast cancer and osteoporosis, the field of women’s health has blossomed. And largely in response to that development, special attention now has turned to health issues that uniquely pertain to men—such as several aspects of urology. At UW Medical School we are building on a deep and broad foundation in urology to enhance men’s health by further strengthening our urology programs.



Author Affiliations: Doctor Farrell is Dean, University of Wisconsin Medical School, and Vice Chancellor for Medical Affairs at UW-Madison.


Corresponding Author: Please address correspondence to the Wisconsin Medial Society at 608.442.3800