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8 Tips for promoting men’s health

Here are a few tips that can help ensure the success of men’s health programs.

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Men tend to shy away from clinical medical services and formal health care programs, leaving community-based programs to help fill the gap. But not all programs are created equal. This is according to a study – “Community-based men’s health promotion programs: eight lessons learnt and their caveats”, which was published in the journal Health Promotion International – that shows that the programs that succeed are those that recognize and adapt to the social forces that uniquely affect men.

So for University of British Columbia (UBC) nursing professor John Oliffe, who led the study that reviewed community-based programs in Canada, Australia, New Zealand, UK and the US, there are a few tips that can help ensure the success of men’s health programs.

Recognize the forces that affect men’s health: The UBC research points out that social factors can significantly affect health, including race, culture, socioeconomic status, education and income levels. Dudes Club, a program based in Vancouver’s Downtown Eastside, succeeds because its content is tailored to its largely Indigenous clientele. Events include culturally based activities and elder-led circles, and clients are reporting improved mental, spiritual, physical and emotional well-being as a result.

Physical activity builds connections: Activity-based programs that link to masculine ideals such as problem-solving and physical prowess work well. Men’s Sheds, a program that runs in Australia, Canada and a few other countries, successfully attracts men with woodworking activities, computer tutorials, gardening and informal social events.

Safe spaces help men open up: Many men are reticent to talk about health challenges or talk about personal issues, but programs–like prostate cancer support groups–can expand their comfort zone by creating safe spaces for sharing experiences and discussing sensitive topics.

Knowledge can combat stigma: Many men who are experiencing health challenges like depression or suicidal thoughts lack knowledge about their condition, which further fuels any stigma they may already feel. Community-based programs can promote health literacy and tackle stigma by using simple, non-judgmental language to describe health conditions, Oliffe said.

Men-focused environments work well: No surprise, “men-friendly” community spaces and activities–such as sports events or competitions–work better in recruiting men to health-related programs than strictly clinical programs. Oliffe points to a few examples, including some European soccer clubs, that draw men in to join exercise and healthy eating programs.

A clear vision for the program is a must: Programs must have tangible benefits, clear goals and strong, collaborative leaders. Dads in Gear– developed to assist dads to quit smoking–recruited participants with an offer of free meals and child care. It emphasized the need for participants to actively work for their well-being, and it encouraged the men to independently sustain their healthy practices after completing the program.

Evaluate to perpetuate: Every program should carry out a consistent and formal evaluation process, Oliffe advises. This helps to support future funding efforts and ensures the program is working as well as it should.

Pop-ups’ are OK: And finally, don’t expect to sustain or expand every program, says Oliffe, as some might be best considered “pop-ups”. Once they’ve hit their goal, they can be retired and regarded as the seed for future ideas.

Health & Wellness

Hedonism can lead to happiness

Of course self-control is important, but research on self-regulation should pay just as much attention to hedonism, or short-term pleasure. That’s because new research shows that people’s capacity to experience pleasure or enjoyment contributes at least as much to a happy and satisfied life as successful self-control.

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Relaxing on the sofa or savoring a delicious meal: Enjoying short-term pleasurable activities that don’t lead to long-term goals contributes at least as much to a happy life as self-control, according to new research from the University of Zurich and Radboud University in the Netherlands. The researchers therefore argue for a greater appreciation of hedonism in psychology.

We all set ourselves long-term goals from time to time, such as finally getting into shape, eating less sugar or learning a foreign language. Research has devoted much time to finding out how we can reach these goals more effectively. The prevailing view is that self-control helps us prioritize long-term goals over momentary pleasure and that if you are good at self-control, this will usually result in a happier and more successful life.

“It’s time for a rethink,” says Katharina Bernecker, researcher in motivational psychology at the University of Zurich. “Of course self-control is important, but research on self-regulation should pay just as much attention to hedonism, or short-term pleasure.”

That’s because Bernecker’s new research shows that people’s capacity to experience pleasure or enjoyment contributes at least as much to a happy and satisfied life as successful self-control.

Distraction disrupts pleasure

Bernecker and her colleague Daniela Becker of Radboud University developed a questionnaire to measure respondents’ capacity for hedonism, i.e. their ability to focus on their immediate needs and indulge in and enjoy short-term pleasures. They used the questionnaire to find out whether people differ in their capacity to pursue hedonic goals in a variety of contexts, and whether this ability is related to well-being.

They found that certain people get distracted by intrusive thoughts in moments of relaxation or enjoyment by thinking about activities or tasks that they should be doing instead. “For example, when lying on the couch you might keep thinking of the sport you are not doing,” says Becker. “Those thoughts about conflicting long-term goals undermine the immediate need to relax.” On the other hand, people who can fully enjoy themselves in those situations tend to have a higher sense of well-being in general, not only in the short term, and are less likely to suffer from depression and anxiety, among other things.

More isn’t always better

“The pursuit of hedonic and long-term goals needn’t be in conflict with one another,” says Bernecker. “Our research shows that both are important and can complement each other in achieving well-being and good health. It is important to find the right balance in everyday life.”

People’s capacity to experience pleasure or enjoyment contributes at least as much to a happy and satisfied life as successful self-control.

Unfortunately, simply sitting about more on the sofa, eating more good food and going to the pub with friends more often won’t automatically make for more happiness. “It was always thought that hedonism, as opposed to self-control, was the easier option,” says Bernecker. “But really enjoying one’s hedonic choice isn’t actually that simple for everybody because of those distracting thoughts.”

Conscious planning of downtime

This is currently a topical issue with more people working from home, as the environment where they normally rest is suddenly associated with work. “Thinking of the work you still need to do can lead to more distracting thoughts at home, making you less able to rest,” says Bernecker.

So what can you do to enjoy your downtime more? More research is needed, but the researchers suspect that consciously planning and setting limits to periods of enjoyment could help to separate them more clearly from other activities, allowing pleasure to take place more undisturbed.

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Health & Wellness

Text messaging as the next gen of therapy in mental health

With the COVID-19 pandemic, many people’s schedules have been upended, which may prevent individuals with mental illness from having routine access to a therapist, such as parents who have children at home. Texting can bridge the gap.

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In the US alone, it is estimated that approximately 19 percent of all adults have a diagnosable mental illness. Clinic-based services for mental health may fall short of meeting patient needs for many reasons including limited hours, difficulty accessing care and cost.

In the first randomized controlled trial of its kind, a research team investigated the impact of a texting intervention as an add-on to a mental health treatment program versus one without texting. A text-messaging-based intervention can be a safe, clinically promising and feasible tool to augment care for people with serious mental illness, according to a new study published in Psychiatric Services.

Ninety-one percent of participants found the text-messaging acceptable, 94 percent indicated that it made them feel better and 87 percent said they would recommend it to a friend.

“This study is very exciting because we saw real improvement in those who utilized the text messaging-based intervention on top of normal care. This was true for individuals with some of the most serious forms of mental illness,” explained co-author, William J. Hudenko, a research assistant professor in the department of psychological and brain sciences at Dartmouth, and an adjunct assistant professor of clinical psychology in Dartmouth’s Geisel School of Medicine. “The results are promising, and we anticipate that people with less severe psychopathology may even do better with this type of mobile intervention.”

With the COVID-19 pandemic, many people’s schedules have been upended, which may prevent individuals with mental illness from having routine access to a therapist, such as parents who have children at home.

“Texting can help bridge this gap, by providing a means for mental health services to be continuously delivered. A text-messaging psychotherapy is an excellent match for the current environment, as it provides asynchronous contact with a mental health therapist while increasing the amount of contact that an individual can have,” explained Hudenko.

For the study, the research team examined the impact of text-messaging as an add-on to an assertive community treatment program versus the latter alone. Through an assertive community treatment program, those with serious mental illness have a designated team who helps them with life skills, such as finding a job and housing, managing medications, as well as providing daily, in-person clinic-based services. People with serious mental illness are likely though to experience symptoms each day for which they may need additional therapy.

The study was a three-month pilot, which was assessor blind. There were 49 participants: 62 percent had schizophrenia/schizoaffective disorder, 24 percent had bipolar disorder and 14 percent had depression. Assessments were conducted at baseline, post-trial (three months later) and during a follow-up six months later.

A text-messaging psychotherapy is an excellent match for the current environment, as it provides asynchronous contact with a mental health therapist while increasing the amount of contact that an individual can have.

Licensed mental health clinicians served as the mobile interventionists. They received a standard training program on how to engage effectively and in a personal way with participants. The mobile interventionists were monitored on a weekly basis to ensure that they were adhering to the treatment protocol. Throughout the trial, over 12,000 messages were sent, and every message was encoded, monitored and discussed with a clinician.

The results demonstrated that 95 percent initiated the intervention and texted 69 percent of possible days with an average of four texts per day. On average, participants sent roughly 165 or more text messages and received 158 or more messages. The intervention was found to be safe, as there were zero adverse events reported.

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Health & Wellness

Frequent social media use influences depressive symptoms over time among LGBTQ youth

Social media use may foster a positive sense of self and a perception of being valued in a society or community, or it may do the opposite, which can affect adolescents’ psychological well-being. Youth with more negative emotional or psychological symptoms are at higher risk than their peers of developing problematic online engagement patterns in attempts to ease psychological distress, which can lead to problematic usage patterns for some.

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Frequent social media use can impact depressive symptoms over time for LGBTQ youth, according to research from a Washington State University communication professor.

Traci Gillig, an assistant professor in the Edward R. Murrow College of Communication at Washington State University, found that when LGBTQ adolescents attended a social media-free summer camp, they experienced a reduction in depressive symptoms, as outlined in her 2020 research “Longitudinal analysis of depressive symptoms among LGBTQ youth at a social media-free camp”.

According to Gillig, social media use may foster a positive sense of self and a perception of being valued in a society or community, or it may do the opposite, which can affect adolescents’ psychological well-being. Youth with more negative emotional or psychological symptoms are at higher risk than their peers of developing problematic online engagement patterns in attempts to ease psychological distress, which can lead to problematic usage patterns for some.

Previous research reveals that nearly half of youth (42%) report that social media has taken away from in-person, face-to-face time with friends in today’s digital age. Many also report feelings of social exclusion, which is popularly referred to today as the term FOMO (i.e., “fear of missing out”).

In Gillig’s study, LGBTQ youth ages 12-18 were surveyed before and after attending a social media-free summer leadership camp for LGBTQ youth. Survey questions examined the relationship between youth’s social media use prior to camp and changes in their depressive symptoms during the program.

Social media use may foster a positive sense of self and a perception of being valued in a society or community, or it may do the opposite, which can affect adolescents’ psychological well-being.

When examining the role of social media use in changes in depressive symptoms over time, significant findings emerged. Before attending the camp, the average number of hours participants spent using social media each day was about four hours and depressive symptoms among participants was moderate. By the end of the social media-free camp, depressive symptoms lowered by about half.

Youth with the highest levels of pre-camp social media use tended to experience a more “across the board” reduction in depressive symptoms. Gillig believes this can be attributed to the social, affirming camp setting that may have filled a critical need of social interaction for the high-volume social media users.

These findings highlight the positive influence of a “social media break” in a supportive environment on mental health, especially for LGBTQ youth. They also demonstrate the value of face-to-face interactions and how many youth may be unaware of the psychological benefits they could experience by trading social media time for face-to-face interactions in supportive contexts.

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Face-to-face interactions can be even more beneficial for marginalized groups, including LGBTQ adolescents, who may not have access to supportive contacts within their local community. Affirming programming that brings together LGBTQ youth for in-person relationship development, such as camps for LGBTQ individuals, shows promise to improve youth mental health trajectories.

Gillig hopes that other researchers continue to test for relationships between social media use and psychological distress, especially its impact on LGBTQ youth mental health over time. More research is needed to help practitioners make informed recommendations to distressed LGBTQ youth and their parents as to whether the youth may benefit from simply unplugging from social media or from unplugging in the context of LGBTQ-affirming programming.

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Health & Wellness

Prostate cancer: How can we decide when to treat?

Prostate cancer treatment can have significant side-effects such as erectile dysfunction and incontinence, so often avoiding intrusive surgery or radiotherapy can benefit the patient. Nevertheless, being told you have cancer puts great psychological pressure on men to agree to treatment, so understanding just how aggressive the cancer is before deciding on treatment is essential.

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You have been diagnosed with prostate cancer and your doctor gives you the option of not being treated, but of remaining under observation: Is there any objective way you can decide to be treated or not treated? What should you do?

Now using first results from analysis of the world’s biggest Active Surveillance prostate cancer database, the GAP3 consortium has begun to identify which patients are at risk of the disease developing and which patients can continue to safely delay treatment.

As lead researcher, Dr Mieke Van Hemelrijck (King’s College London) says: “Current methods of deciding whether or not to recommend treatment are not reliable. Our analysis shows that we should be able to produce a single global methodology, which will give accurate estimates on how aggressive these cancers are. These will feed directly into the treatment decision, and give men the reassurance they need to decide on treatment”.

Prostate cancer is one of the leading causes of death in men, but many men who discover they have prostate cancer are not in any immediate danger: they have Low Risk Prostate Cancer. Over the past 10 years, an increasing number of these men have been given the option of going on active surveillance, rather than being immediately treated.

Active surveillance means that men continue to be monitored and tested (via PSA levels, biopsy, and other tests), with treatment only starting when the cancer shows signs of developing. The number of men on active surveillance varies from country to country, with up to 80% of men delaying treatment in some countries. However, there are no generally accepted ways of understanding who is at risk, and as many as 38% of men who start active surveillance drop out within five years.

Van Hemelrijck said: “Prostate cancer treatment can have significant side-effects such as erectile dysfunction and incontinence, so often avoiding intrusive surgery or radiotherapy can benefit the patient. Nevertheless, being told you have cancer puts great psychological pressure on men to agree to treatment, so understanding just how aggressive the cancer is before deciding on treatment is essential. At the moment we just don’t have that reassurance”.

Although active surveillance is considered a real step forward in management of low risk prostate cancer, there is surprisingly little agreement on which men will benefit. Doctors consider a range of factors, such as age, PSA score, biopsy details, technical details of the cancer, and so on. But the decision on whether or not to start treatment is still often subjective. Erasmus MC , department of Urology was tasked by Movember to coordinate the development of a global database on Active Surveillance (the GAP3 consortium). Dr Van Hemelrijck worked with a team of researchers from the GAP3 Consortium to develop the world’s most accurate active surveillance nomogram.

The number of men on active surveillance varies from country to country, with up to 80% of men delaying treatment in some countries. However, there are no generally accepted ways of understanding who is at risk, and as many as 38% of men who start active surveillance drop out within five years.

A nomogram is a treatment calculator, similar to an App: you feed in the details and it gives you advice on whether or not to treat. Local nomograms exist, but a global version is needed to be generally applicable. Working with data from the 14,380 patients on the Movember database (the world’s largest), they were able to input data such as age, size and condition of the tumour, PSA, biopsy details, time on active surveillance, genetic factors, etc.

“Not surprisingly, we have found that even accounting for these factors there was still differences in outcomes between participating centers. But this work has shown that it will be possible to produce a nomogram which can guide treatment. Just as importantly, the work shows which additional factors need to be included in the nomogram in future to enable us to eliminate this variation and produce accurate estimates of tumor aggressiveness”.

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Commenting, EAU Adjunct Secretary General Professor Hendrik Van Poppel (University of Leuven, Belgium ) said: “This work shows that it should be possible to develop a global nomogram – in other words, a system which allows us to predict whether active surveillance will be suitable for individual low and intermediate risk prostate cancer patients. This would be an important step forward in terms of the reassurance we can offer patients, and in choosing treatment pathways. The urology community would welcome this, and will be happy to cooperate in taking this project forward”.

This is an independent comment; Professor Van Poppel was not involved in this work.

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Health & Wellness

What has changed in the post-Viagra age?

Scientists report a change in why men seek help for sexual problems, with fewer men complaining about impotence (erectile dysfunction) and premature ejaculation, and more men, especially younger men, complaining about low sexual desire and curvature of the penis (Peyronie’s disease).

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Scientists report a change in why men seek help for sexual problems, with fewer men complaining about impotence (erectile dysfunction) and premature ejaculation, and more men, especially younger men, complaining about low sexual desire and curvature of the penis (Peyronie’s disease).

In a work accepted by the peer-reviewed journal, International Journal of Impotence Research, research leader Dr. Paolo Capogrosso (San Raffaele Hospital, Milan, Italy) said: “Over a 10 year period we have seen a real change in what concerns men when they attend sexual health clinics. This is probably driven by greater openness, and men now accepting that many sexual problems can be treated, rather than being something they don’t want to talk about”.

The success of erectile dysfunction treatments such as Viagra and Cialis, and the availability of new treatments, means that men facing sexual problems have now have treatments for sexual problems which weren’t available a generation ago. Now researchers at San Raffaele Hospital in Milan have studied why men come to sexual health clinics, and how this has changed over a 10-year period.

In what is believed to be the first research of its kind, the scientists questioned 3244 male visitors to the San Raffaele Hospital Sexual Health Clinic in Milan over a 10 year period (2009 to 2019), and classified the main reason for the visit. They found that the number of patients visiting with erectile dysfunction problems increased from 2009 to 2013, then started to decrease.

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There were comparatively few patients complaining of low sex drive or Peyronie’s disease in 2009, but complaints about both of these conditions grow from 2009 to the end of the study. In 2019 men were around 30% more likely to report Peyronie’s disease than in 2009, and around 32% more likely to report low sexual desire.

The amount of men complaining of premature ejaculation dropped by around 6% over the 10-year period. The average age of first attendance at the clinical also dropped, from a mean of 61 to 53 years.

“Erectile dysfunction is still the main reason for attending the clinic, but this number is dropping, whereas around 35% of men attending the clinic now complain of Peyronie’s disease, and that number has shown steady growth,” said Dr. Capogrosso. “Our patients are also getting younger, which may reflect a generational change in attitude to sexual problems”.

Dr. Capogrosso continued: “We need to be clear about what these figures mean. They do not indicate any change in the prevalence of these conditions, what they show is why men came to the clinic. In other words, it shows what they are concerned about. The changes probably also reflect the availability of treatments; as treatments for sexual conditions have become available over the last few years, men are less likely to suffer in silence”.

These are results from a single centre, so they need to be confirmed by more inclusive studies. “Nevertheless there seems to be a growing awareness of conditions such as Peyronie’s disease, with articles appearing in the popular press. In addition, we know that the awareness of this condition is increasing in the USA and elsewhere, so this may be a general trend,” said Dr. Capogrosso.

Erectile dysfunction is still the main reason for attending the clinic, but this number is dropping, whereas around 35% of men attending the clinic now complain of Peyronie’s disease, and that number has shown steady growth.

Commenting on this study, Dr. Mikkel Fode, associate professor of urology at University of Copenhagen, and who’s not involved in the work, said that although these data are somewhat preliminary as they stem from single institution, they are interesting because “they allow us to formulate several hypothesis. For example the drop in men presenting with erectile dysfunction may mean that family physicians are becoming more comfortable addressing this issue and that the patients are never referred to specialized centers. Likewise the simultaneous drop in age at presentation and increase in Peyronie’s disease and low sex drive could indicate that both men and their partners are becoming more mindful to optimizing their sex lives. I will be very interesting to see if these trends are also present in other centers around the world.”

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Intimate partner violence, history of childhood abuse worsen trauma symptoms for new moms

A study found that new experiences of sexual, emotional and physical abuse at the hands of a romantic partner 18 months after childbirth are associated with increasing symptoms of trauma such as anxiety, depression, self-harm and sleep disorders.

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A study assessed the interaction of new and old relationship traumas among women three to 18 months after the birth of their child – one of the most challenging periods of their lives. The study found that new experiences of sexual, emotional and physical abuse at the hands of a romantic partner during this period are associated with increasing symptoms of trauma such as anxiety, depression, self-harm and sleep disorders. It also found that having experienced abuse in childhood appears to worsen the impact of current abuse on those symptoms.

Published in the Journal of Traumatic Stress, the research points to postnatal medical screenings as a potential point of intervention, giving health practitioners the opportunity to help young mothers recognize the signs of abuse and take steps to protect themselves and their children from harm.

The research suggests that recent episodes of relationship trauma can exacerbate a woman’s mental health problems above and beyond symptoms tied to childhood experiences of maltreatment, the researchers said. It also indicates that interventions at this time of life may help alleviate a woman’s symptoms, despite her personal history.

Studies have shown that intimate partner violence sometimes increases after parents bring a newborn into the home, said Patricia Cintora, a graduate student in the neuroscience program at the University of Illinois at Urbana-Champaign who led the research with U. of I. psychology professor Heidemarie Kaiser Laurent.

Women who experienced childhood maltreatment also tended to report higher levels of traumatic stress in response to recent episodes of IPV.

“In addition to the physical changes of pregnancy, there are a lot of emotional, social and economic changes that come along with parenthood that may cause stress or magnify prior stressors that feed into intimate partner violence,” Cintora said. “Rather than focusing on specific categories of abuse that fall under the umbrella of IPV, we decided to look at the total number of experiences and severity.”

The researchers followed 85 low-income women after the birth of a child. The women checked in at three, six, 12 and 18 months postpartum. They answered questions from standardized checklists designed to determine their trauma symptoms, history of childhood maltreatment and exposure to – or perpetuation of – intimate partner violence.

“We found that the higher their scores for experiencing intimate partner violence, the more symptoms they reported,” Cintora said. “We also saw that relative changes in their experience over time also had an important effect on their symptoms.”

Women who experienced childhood maltreatment also tended to report higher levels of traumatic stress in response to recent episodes of IPV, she said.

“This work is important because it highlights both the harms of worsening postpartum relationship dynamics – even before they reach clinically recognized abuse thresholds – and the opportunity to beneficially impact women’s health during this critical time,” Laurent said.

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