Introduction to men''s mental health

Psychiatry has advanced enormously in the last 100 years, but so has its complexity, which can prove daunting to primary care physicians and even to psychiatrists. Longitudinal studies have frequently adopted narrow, simplistic, or reductionistic and impressionistic approaches that serve to harm rather then help men.

Modern physicians and providers need to be sophisticated, scientific, and broad based in their approaches. The practitioner who wants to understand the intricate problems of men's mental health must be dedicated to gaining knowledge and accumulating clinical experience and wisdom over a lengthy time. Men must be given the time, study and respect they need to function in an ever more complicated world and environment. There is much to be done and many rivers to cross: psychoses in men, mood disorders, attention deficit hyperactivity disorder and its terrible sequellae if left untreated, anxiety disorders that affect the performance and happiness of men, the role of childhood trauma and neglect on the subsequent resiliency and mental health, how men are mistreated in the criminal justice systems, a host of antagonisms and prejudice towards men which deeply affects their self esteem, chronic substance abuse and the issues of self-medication for psychic anguish and the relation to violent behaviors, the workplace and its stresses and inconsistencies, unemployment and its effects on men, the effect of divorce on men and their subsequent enforced isolation from their children, and many others.     

Metabolic risk factors as a connecting link for men''s health issues

According to the World Health Organization (WHO), the estimated life expectancy of men in Russia is 58.9 years, which is 13 years less than that of Russian women. Complications from cardiovascular disease (CVD) account for 37% of the male mortality rate. Of the European countries, Russia seems to hold the lead in the CVD-related death rate among men. This primarily results from both the social and economic situation and from a tardy recognition and correction of risk factors. Currently, about 200 behavioral, biological and environmental risk factors have been identified, but the following six are well recognized as contributing most significantly to the development of CVD: hypertension, hypercholesterolemia, smoking, obesity, alcohol abuse, sedentary lifestyle. Overall, these risk factors all further the progression towards myocardial infarction, as well as towards other non-infectious diseases. Furthermore, these risk factors tend to combine in a single individual. In 1988, G. Reaven, an American endocrinologist, propounded the theory that hypertension, dyslipidemia, and impaired glucose tolerance have a common cause in hyperinsulinemia/insulin resistance, which is a connecting link for all of these disorders.

Recently, papers on the link between the metabolic syndrome (MS), erectile dysfunction (ED) and androgen deficiency have been increasingly published. Thus, low testosterone blood levels, apart from being associated with ED and decreased libido, are also associated with insulin resistance, central obesity, and the impairment of lipid metabolism. Thus, in patients with hypogonadism, compared to individuals with obesity or with normal body weight, a marked, significant, insulin resistance/hyperinsulinemia has been established. However, among men with ED and the MS, in contrast to patients with ED without the MS, their total testosterone levels appear to be four times as low as their free testosterone levels. A step-by-step regression analysis has shown that the metabolic risk factors predominate over other major risk factors of ED progression.

Androgen replacement therapy can be a reasonable first-line treatment for patients with hypogonadism combined with sexual dysfunction and the MS. Clinical studies have demonstrated that long-term testosterone injections improve the metabolic profile, namely by also decreasing triglyceride and LDL cholesterol levels, body weight, waist circumference and glucose metabolism parameters.

Thus, the metabolic risk factors act as a connecting link between the pathogenesis of CVD and androgen deficiency. To prevent complications from these conditions, the development of an interdisciplinary work-up for the comprehensive diagnosis and therapy of the MS, hypogonadism and sexual dysfunction should be considered.     

Polypill and global cardiovascular health strategies

Despite encouraging advances in our knowledge of the prevention and treatment of atherothrombosis, cardiovascular (CV) disease remains the leading cause of death worldwide. The impressive growth of this epidemic during the last decade is due largely to the increasing incidence of CV diseases in low- and middle-income countries (LMICs). The uncontrolled rise in the incidence of risk factors (obesity, hypertension, tobacco, high cholesterol, diabetes) in these countries accounts largely for the increasing incidence of CV diseases. Lifestyle modification and pharmacologic treatment have been very effective in improving the risk profile in those individuals at high risk. In Western countries the impact of all these preventive and therapeutic interventions has been a substantial decline in CV mortality; however, the scenario is quite different in LMICs. Several problems limit the efficacy of secondary prevention strategies: inadequate health policies, poor availability, and lack of affordable medication in LMICs, as well as poor patient adherence to treatment. It has been suggested that along with the promotion of healthy lifestyles, a fixed-dose combination or polypill containing 2 or more drugs addressed to control different risk factors would improve accessibility to treatment, cost, and patient adherence to treatment. This review analyzes the potential role of the polypill strategy in primary and secondary CV prevention.     

Levelling up: prioritisation of global health

European Journal of Orthopaedic Surgery & Traumatology - Trauma has been described as “The forgotten pandemic” (Rossiter in Int Orthop 46:3–11, 2022 ...     

站在亚洲看世界：亚洲视角下脑死亡器官捐献的可持续健康发展

器官短缺是全球移植界面临的共同难题,世界卫生组织呼吁所有国家通过减少疾病负担和扩充符合伦理原则的有效器官来源以实现器官移植的自给自足。在全球范围内,脑死亡器官捐献（DBD）仍是移植器官的主要来源。近几年,包括中国在内的一些亚洲国家积极推动死亡器官捐献事业的发展,这些举措正逐步改变亚洲地区以活体捐献为移植器官主要来源的格局。2020年新型冠状病毒肺炎疫情的暴发放缓了全球器官捐献和移植数量近十年的增长趋势。在疾病负担和移植需求未有显著降低的前提下,我国器官捐献和移植工作在“人民至上,生命至上,坚持动态清零”的疫情防控总方针和相关政策的指引下稳步开展。这一定程度证明了在人民群众医疗诉求和移植需求的持续驱动下,我国已经形成一个有韧性的、有抗压能力的、并具运作惯性且行业赖以生存的器官捐献与移植工作体系。站在中国看亚洲,站在亚洲看世界。本文通过整理全球及亚洲器官捐献与移植相关数据,重点剖析在全球器官移植发展新潮流下亚洲器官捐献和移植整体格局的变化,并结合我国自身发展特征及实践经验,探索脑死亡器官捐献的影响因素,并提出针对性的应对策略,以期为亚洲及我国器官捐献和移植的可持续健康发展提供专业参考。     

Ethical analysis and consideration of health behaviors in organ allocation: focus on tobacco use

Health behaviors are significantly understudied in transplant patients, contributing to significant ethical debate among transplant professionals. Some of these health behaviors (tobacco use and overweight/obesity) are the leading preventable causes of mortality in the US general population and likely have a higher prevalence and impact among transplant populations. For example, tobacco use has been linked to worse graft survival, patient survival, complications, and comorbidities, whereas tobacco cessation has been associated with improved patient and graft survival. Over time, transplant professionals increasingly believe that tobacco use should be a relative contraindication to organ allocation. That belief seems to be strengthened after provider education on pertinent evidence linking tobacco use to medical consequences in both the general and the transplant populations. A core framework for ethical analysis of health behaviors in the context of organ allocation is described, using concepts of utility, justice, and respect for all persons. This framework is designed to help transplant professionals discuss and formulate policy on consideration of health behaviors in the context of organ allocation. More research is needed to advance our knowledge of the impact of health behaviors on transplant patient outcomes.