Shifting paradigms: a social-determinants approach to solving problems in men's health policy and practice

The lack of an evidence base for formulating men's health policies means existing programs and practices for men are influenced by prevailing cultural norms concerning men or habitual health service attitudes towards them. Factors impeding the development of an effective health policy for men include a preoccupation with limited clinical perspectives (an emphasis on the prostate and erectile dysfunction) and a common assumption that all health problems in men are a result of "masculinity" and "men behaving badly". Viewing men's health in terms of gender and health and the socially constructed differences between men and women is important, but does not provide all the perspectives required for meeting men's health needs. A "social determinants of health" approach to men's health would help Australia and Australian medical practitioners move away from policies and practices that perpetuate negative views of men and ignore the complexity of their health problems. The result would be a more evidence-based approach to men's health policy, and the likelihood of improved health outcomes.     

电视传媒的女性视角

女性与媒体有着天然的、不可分割的联系 ,因此麦克汉姆把媒体描述为“人类身体的延伸”。但是 ,女性主义则把媒介权力视为文明时代性别奴役的主要形态。传媒从男性意志出发 ,带着性别歧视的有色眼镜来控制信息载体 ,传播特定的“符号 -意义”体系 ,构成人们对女性的认知概念世界和价值系统 ,并形成对女性认知自我和他者的隐性支配。电视传媒是目前我国受众最乐意接近的媒介之一 ,而女性受众的视听需求与电视传媒审视女性的视角之间存在的偏差也十分明显。为了更好地整合与构建女性主体人格 ,进一步推进男女平等 ,电视媒体审视和表达女性的性别视角必须加以矫正。     

HIV and women in Hawaii: risk and protective factors in HIV/AIDS prevention

Using semi-structured interviews with adults living with or at-risk for HIV and interviews and focus groups with key informants, the present study examined risk for HIV transmission among women living in Hawaii. Key research findings suggest that women in Hawaii are at risk for HIV infection primarily through sexual contact with their male sex partners, including bisexual and injection drug using (IDU) men. A significant factor in women's HIV risk is sex and gender role dynamics in the context of their relationships with men. Recommendations support primary prevention services for HIV-positive men who have sex with men and women, and IDU men who also have sex or share needles with women. Collaborative efforts between health care professionals and HIV/AIDS agencies to integrate gender-specific and culturally appropriate HIV prevention interventions are recommended.     

Men's health research: under researched and under appreciated?

It is well-known that men tend to live longer than women. Despite this, women's health research, as a category of research, is much better recognized than men's health research. The Canadian Institutes of Health Research--Institute of Gender and Health has recognized this issue, and is currently attempting to determine research gaps in men's health research.     

基层计划生育工作中发现的男性生殖健康问题

男性在计划生育或生殖健康工作中应享有同等的权利和义务,可是长期以来在人们心目中总认为生育、节育、不育只是女性的责任,故在政策和服务上更多的是针对女性,而对男性在计划生育的服务经常被忽略。随着国家计划生育项目,特别是近年来生殖健康项目的开展,使男性参与成为项目活动的重要组成部分已成必然。     

Gender, anxiety, and experimental pain sensitivity: an overview

Our objective was to review human experimental studies to see if anxiety had a differential impact on the pain perceptions of men and women. We searched MEDLINE and PsycINFO for studies of anxiety and pain sensitivity in men and women published from 1966 to 2001. Research indicated that women are more sensitive to pain than men, and that anxiety may be partly responsible for the observed differences. Anxiety may also differentially affect men's and women's report of pain. Anxiety may be an important factor when considering sex differences in pain perception and warrants further investigation.     

Gender disparities in treatment for alcohol problems.

OBJECTIVE--To examine women's access to treatment for alcohol problems in terms of the prevalence, characteristics, and treatment-seeking patterns of problem drinkers in a range of alcohol-specific and nonspecialized health care systems. DESIGN--In-person survey. SETTING--A Northern California county. PARTICIPANTS--Consecutive samples of admissions in public alcohol treatment (n = 381), drug treatment (n = 210), mental health treatment (n = 406), emergency health services (n = 2626), primary health clinics (n = 394), and adults in the county general population (n = 3069). PRIMARY OUTCOME MEASURES--Prevalence and relative risk (RR) of problem drinking and rates of alcohol-related treatment episodes. RESULTS--Rates of problem drinking were higher among men than women across all samples. However, after accounting for gender differences in general population rates, women in all of the non-alcohol-specific clinical samples were at greater risk than men for problem drinking (eg, RR = 5.6 for women and RR = 2.1 for men in the mental health sample). Men reported a greater variety in types of services sought in past alcohol-related treatment encounters, but women experienced greater symptom severity. CONCLUSIONS--Female problem drinkers were more likely than male problem drinkers to use non-alcohol-specific health care settings, particularly mental health treatment services, and to report greater symptom severity. Future research on women's access to services for alcohol problems should consider a range of health care systems and gender differences in seeking help.     

What do we know about men's help-seeking and health service use?

Men seek help and use health services less frequently than women do. Men's help-seeking practices and health service use are complex issues involving biological, psychological and sociological considerations. Most discussion on men's help-seeking positions them as reluctant consumers or "behaving badly" with respect to their health. Few studies have explored whether health service providers are equipped to deal with men's health issues appropriately. The current health system appears not to be tailored to meet the health needs of men. Better collaboration is required across disciplines, to further investigate men's health using both qualitative and quantitative research methods.     

Paternal-Fetal Harm and Men’s Moral Duty to Use Contraception: Applying the Principles of Nonmaleficence and Beneficence to Men’s Reproductive Responsibility

Discussions of reproductive responsibility generally draw heavily upon the principles of nonmaleficence and beneficence. However, these principles are typically only applied to women due to the incorrect belief that only women can cause fetal harm. The cultural perception that women are likely to cause fetal and child harm is reflected in numerous social norms, policies, and laws. Conversely, there is little public discussion of men and fetal and child harm, which implies that men do not (or cannot) cause such harm. My goal in this paper is to begin to fill the void in the academic literature about men’s reproductive responsibility by highlighting the health-related, economic, and social harms men can cause to potential fetuses and children and then examining what it would mean to hold them responsible for preventing these harms. Applying the principles of nonmaleficence and beneficence to men, I conclude that men have a moral duty to use contraception if their behavior—past, current, or future—could harm the potential fetuses and children who result from their unprotected sexual behavior.     

女性生殖相关因素对脑卒中影响的研究进展

脑卒中在其流行病学、危险因素等方面存在明显的性别差异,研究证实女性一生中经历的不可逆事件如妊娠、分娩等生殖因素会对女性终生的脑卒中发病风险产生较大影响,国外已对此进行了较全面的研究,并提出将对女性脑卒中风险的干预提前到妊娠期,相比较而言国内临床对此关注偏少。本研究综述了国内外关于女性生殖相关因素与脑卒中的研究,旨在完善医务人员对女性特有危险因素的病史采集,加强生殖相关因素的筛查、治疗及健康宣教,从而降低其终生脑卒中风险;同时或将弥补女性在此方面的防治知识空白,赋予女性及其家属更多的理解及应对自身风险的能力。     

From mortality to morbidity: the challenge of the twenty-first century

Although maternal mortality has been the traditional measure used to evaluate the status of women's health in pregnancy, the Division of Reproductive Health at the Centers for Disease Control and Prevention has expanded beyond its surveillance of pregnancy mortality to explore pregnancy morbidity. Working with a variety of partners, we are looking at several questions. What is pregnancy morbidity, its spectrum and prevalence? What are the most serious complications of pregnancy? Are there differences in the severity of complications between white and black women? What conditions should be monitored and by what methods? Answers to these questions should help us understand why some groups of women experience a greater risk of death from pregnancy, but also help us to enlarge the scope of our concern for the health of women before, during, and after pregnancy.     

Sexual behaviors and reproductive health outcomes: associations with wife abuse in India

CONTEXT: Wife abuse has been associated with a variety of health concerns. Associations between abuse and reproductive health in India are not well known. OBJECTIVE: To examine relationships between men's reports of wife abuse and reproductive health issues in northern India. DESIGN: Structured face-to-face interviews were conducted as part of the male reproductive health supplement of the PERFORM System of Indicators Survey, a systematic multistage survey conducted in 1995-1996. SETTING: The northern state of Uttar Pradesh, one of the least developed states in India. PARTICIPANTS: A total of 6632 married men aged 15 to 65 years who lived with their wives and completed all survey questions for the study variables reported here. MAIN MEASURES: Physically and sexually abusive behaviors toward wives, sexual activities outside marriage, sexually transmitted disease (STD) symptoms, contraception use, unplanned pregnancies, and sociodemographic characteristics. RESULTS: Fifty-four percent of men reported not abusing their wives, while 17% reported physically but not sexually abusing their wives, 22% reported sexual abuse without physical force, and 7% reported sexual abuse with physical force. Abuse was more common among men who had extramarital sex (for sexual abuse using force: odds ratio [OR], 6.22; 95% confidence interval [CI], 3.98-9.72). Similarly, men who had STD symptoms were more likely to abuse their wives (with current symptoms: OR, 2.43; 95% CI, 1.73-3.42). Unplanned pregnancies were significantly more common among wives of abusive men, especially sexually abusive men who used force (OR, 2.62; 95% CI, 1.91-3.60). CONCLUSIONS: Wife abuse appears to be fairly common in northern India. Our findings that abusive men were more likely to engage in extramarital sex and have STD symptoms suggest that these men may be acquiring STDs from their extramarital relationships, thereby placing their wives at risk for STD acquisition, sometimes via sexual abuse. These abusive sexual behaviors also may result in an elevated rate of unplanned pregnancies.     

Health service needs of women with reproductive tract infections in selected areas of China

Objective To provide insight into the psychosocial factors underlying the utilisation of health services by women with reproductive tract infection (RTI) symptoms.Methods A cross- sectional study, adopting Aday and Andersen’s Social Behaviour Model, was conducted between 1998 and 1999 in Chinese Hebei province and Beijing. A total of 864 eligible married women (age 21 to 60 years) were face to face interviewed. Results The percentage of self- reported symptoms of RTIs in urban and rural women was 35. 6 and 46. 8, respectively; the proportion of women with RTIs who utilised health services was 27. 5% and 26. 7%, respectively. Compared to urban women, rural women had less knowledge on RTIs and more traditional beliefs, and were more satisfied with local health services. The results of logistic regression analysis showed that the common factor influencing health service utilisation in women with RTIs was current experience of RTIs. Knowledge about self- medication, perceived social stigma attached to RTIs, prior experience of RTIs, family income and perceived severity of RTIs were also predictors of utilisation of health services in rural women with RTIs. Satisfaction with health providers, information received from health providers, prior experience of RTIs, occupation and medical care coverage were predictors of utilisation of health services in urban women with RTIs. Conclusion The prevalence of RTIs is high, but the rate of seeking health services is low. There is a great need for emphasizing culturally acceptable reproductive health education in different places to improve women’s ability for self- care. Regular medical check- ups for women are also important. It is necessary to improve the quality of health service, complete the reform of health insurance and alleviate women’s social stigma related to RTIs, giving women social and moral support.     

东莞市流动青年生殖健康情况及影响因素分析

目的对东莞市流动青年的生殖健康状况进行调查,以探讨流动青年生殖健康服务最佳途径模式,更好地为流动人口的避孕节育服务。方法采用分层随机抽样的方式,通过对流动青年进行封闭自填式问卷调查以收集定量资料,掌握流动青年人群的基本人口学特征和生殖健康知识了解情况等。结果流动青年获得药具最多的途径为药店（95．5％）;只有24．77％的流动青年在第一次性行为时采取了避孕措施,且女性多于男性;39．91％的男青年性伴侣I〉2个,这一数值女性为16．29％;79．84％的流动青年主要通过看电视了解生殖健康知识;在希望得到的服务上男女有别,男青年最希望得到的服务是派发宣传资料（82．29％）,女青年则希望得到免费咨询（68．33％）。结论数据显示,被调查的流动青年具有明显的“三低”特征（就业职位低、经济收入低、知识水平低）,避孕套在流动青年中的使用情况不理想,性行为存在不安全因素,生殖健康状况也不容乐观,有巨大的避孕知识需求,且男女有别。怎样在流动青年中推广避孕套使用知识和性知识,提高他们的健康水平,是我们计划生育服务人员的不断追求,值得后续研究。     

年龄和性别与冠状动脉钙化、狭窄的相关性分析

目的：探讨年龄和性别与冠状动脉钙化（CAC）及冠状动脉狭窄的相关关系，以及年龄和性别对CAC诊断冠心病（CHD）的影响。方法：记录591例可疑CHD患者临床相关指标，对所有入选患者行冠状动脉造影，分析年龄和性别与冠状动脉钙化、狭窄的相关关系。站果：CAC总检出率为43．82％，其中男性和女性患者CAC检出率分别为42．32％和49．14％，差异无统计学意义。60岁以下男性患者CAC检出率高于女性，但60岁以上女性钙化检出率已超过男性。检出冠脉狭窄患者433例，占入选患者总数的73．27％，其中男性和女性患者狭窄检出率分别为76．84％和58．62％，差异有统计学意义（P〈0．05）。各年龄组的狭窄检出率男性均高于女性，但60岁以上女性狭窄检出率迅速增高。结论：年龄和性别对冠状动脉钙化诊断冠心病的价值有很大影响，临床上评价冠状动脉钙化对冠心病的诊断时必须充分考虑年龄和性别因素。     

农村少数民族已婚育龄男性生殖健康现状及影响因素探析

目的调查农村少数民族已婚育龄男性生殖健康水平，探索其影响因素。方法在贵州省镇宁、三都、玉屏和务川4个少数民族自治县8个乡，随机问卷调查布依族、水族、仡佬族、侗族20—49岁农村已婚少数民族男性280名，数据分析处理采用SPSS11．5分析软件。结果有效问卷267份，对避孕方法的了解以绝育为主，对性病传播途径正确掌握情况较差，生殖健康综合知识平均得分为16．96（5～27）。自报经诊断的生殖系统疾病患病率34．5％。近1年来的性生活频率为2．82±2．67次／周（0～20次／周），对性生活满意的占73．4％。多因素分析结果提示，民族、受教育程度、参加生殖健康培训和生殖健康知识来源是农村少数民族已婚育龄男性生殖健康的影响因素。结论农村少数民族已婚育龄男性生殖健康水平较低，各民族间不同的风俗观念影响着他们的生殖健康水平。需多方合作、采取少数民族群众易于接受的形式，通过开展宣传教育等多种形式的干预活动，以增强少数民族男性生殖健康意识和提高生殖健康水平。     

农村已婚育龄妇女避孕方法满意度分析

目的　了解目前农村已婚育龄妇女对可逆性避孕措施的满意度 ,并分析其影响因素。方法　采用整群抽样的方法对我国 4个地区 8个乡镇 30个行政村的 2 0～ 4 9岁已婚未绝育妇女进行结构式问卷调查。结果　已婚育龄妇女对所用避孕方法的总体满意度高 (98.8% )。育龄妇女的年龄、当前采用的避孕方法、该避孕方法的获得途径、该避孕方法的决定主体、生殖道感染状况、计划生育综合知识得分 ,以及人流次数会影响育龄妇女对现用避孕方法的满意度。结论　避孕方法知情选择是提高育龄妇女对现用避孕方法满意度的重要途径。普查普治生殖道感染 ,推广RTI干预工程 ,提高女性生殖健康状况 ,有利于提高女性对避孕方法的满意度。继续完善和发展计划生育网络 ,为育龄妇女提供方便、快捷和高质量的计划生育 /生殖健康服务是计划生育优质服务推广的平台保证     

中国已婚育龄妇女性生活频度及其影响因素分析

目的 了解我国已婚育龄妇女的性生活频度,探讨影响性生活频度的影响,为提高妇女生殖健康水平提供科学依据。方法 利用1997年全国人口与生殖健康调查资料,对我国已婚育龄妇女的性生活频度及其影响因素进行了分析。结果 月性生活频度中位数为4次,90％的可信限为1－12次。户口性质、民族、年龄、婚龄、是否定期参加妇科检查、怀孕史、流产史、性生活满意度、性生活中妇女的地位等影响性生活的频度。结论 性生活频度不仅受到人口学特征和生理因素的影响,而且受到性观念和性态度等因素的影响。     

Sexual dysfunction in the United States: prevalence and predictors

CONTEXT: While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men. OBJECTIVE: To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders. DESIGN: Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults. PARTICIPANTS: A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. MAIN OUTCOME MEASURES: Risk of experiencing sexual dysfunction as well as negative concomitant outcomes. RESULTS: Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall well-being. CONCLUSIONS: The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.     

Science and advocacy as partners: the Office of Research on Women's Health in the 1990s

The federal government's investment in research related to sex/gender differences in health and disease has resulted in better understanding of the health of women and men and holds promise for improved health. By working together, advocates for women's health and the scientific community have expanded the focus of women's health research and created new opportunities in science. The Office of Research on Women's Health has assessed and identified progress and needs in women's health in its Agenda for Research on Women's Health for the 21st Century and will continue to collaborate with the advocacy and scientific communities to keep women's health research a high national priority that is responsive to changing public health needs.