Health Care System Utilization

15.21 Increase the proportion of motorcyclists

HEALTHY PEOPLE 2010
using halmets.
OBJECTIVES RELATED TO MEN'S
15.22 Increase use of helmets by bicyclists.
HEALTH
Violence and Abuse Prevention
Cancer
15.32 Reduce homicides.
3.2 Reduce the lung cancer death rate.
15.33 Reduce physical fighting among adoles-
3.7 Reduce the prostate cancer death rate.
cents.
3.10 Increase the proportion of physician and
15.34 Reduce weapon carrying by adolescents
dentists who counsel their at-risk patients about
on school property.
tobacco use cessation, physical activity, and
Mental Health and Mental Disorders
cancer screening.
Mental Health Status Improvement
Family Planning
18.1 Reduce the suicide rate.
9.6 Increase male involvement in pregnancy
prevention and family planning efforts. Occupational safety and health

Heart Disease and Stroke 20.1 Reduce deaths from work related injuries
Substance Abuse
Heart disease
12.1 Reduce coronary heart disease deaths. Adverse Consequences of Substance

Stroke Use and Abuse

12.7 Reduce stroke deaths. 26.1 Reduce deaths and injuries caused by

Blood pressure alcohol- and drug-related motor vehicle

crashes,
12.8 Reduce the proportion of adults with high
26.2 Reduce drug-induced deaths.
blood pressure.
Substance and Abuse
HIV/A1DS
26.12 Reduce average annual alcohol
13.2 Reduce the number of new AIDS cases
consumption,
among adolescents and adult men who have sex
26.13 Reduce steroid use among adolescents
with men,
13.3 Reduce the number of new A1DS cases Tobacco Use
among females and males who inject drugs. Tobacco Use in Population Groups
13.4 Reduce the number of new AIDS cases 27.1 Reduce tobacco use by adults.
among adolescent and adult men who have sex 27.2 Reduce tobacco use by adolescents,
with men and inject drugs.
Injury and Violence Prevention
Unintentional Injury Prevention
15.15 Reduce deaths caused by motor crashes.1
Patterns of health care utilization by men are cited as un important contributor to

the inferior health status of men. One-third of American men do not have a

checkup every year. Nine million men have not seen a doctor in 5 years (Male

Health Center. 1998a). Men visit doctors 25% less often than women. At the

same time, men account for 66% of the clients admitted emergency rooms

(Men’s Health Network, 1998). Men ten to have fewer contacts with the health

care system, perhaps as a result of psychological and sociological factors such as

a reluctance to admit that they need assistance. This situation is exacerbated by

the fact that the American health care system tends to focus on health from an

illness perspective, with relatively little attention paid to prevention. As a result,

unlike women who have annual gynecological examinations that include

screening for other conditions, men are less likely to enter the health care system

for g physical examination on a routine basis. Moreover, although men come in

contact with many health care professionals in a wide variety of settings, they

have no specialist to whom they can go for their specific care needs.

Strategies to improve men's utilization of preventive health care must target all
ages. Men must establish committed relationship with preventive health care as

early as possible. For men to use preventive health care, programs that present

health prevention as masculine and strengthening must be developed and

implemented.

Health services for men include:-

Ambulatory Care

Of the 860.9 million ambulatory care visits made to physician office, hospital

outpatient departments, and hospital emergency department in 1995. Rates of

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visits to physician offices and hospital outpatient departments than women, but

the visit rates to hospital emergency departments do not diffier by sex.

Hospital Care:-

Hospitalization rates and length of stays in hospitals vary by sex. Hospital

discharge rates, the numbers used to determine usage, from short-stay hospitals

are higher for women (138 per 1,000 women) than for men (96 per 1,000).

When gynecological disorders in women and reproductive disorders in men are

excluded, rates of hospitalization for men are about the same as for women. The

lower rate of discharge and longer, hospital stays may be due to the fact that

when men are hospitalized their conditions are more severe.

Preventive Care:-

Men and women differ in their ability to seek preventive care for the early

diagnosis of health care problems. Unlike women, who seek routine

reproductive health screening, most men do not have routine checkups that

would detect health problems at an early stage. Men are more likely to have

examinations at the insistence of their employers, and they do not perceive that
they need a regular source of care. More often than women, men perceive their

health a very good or excellent and there-fore may not think that they need to be

involved in health promotion activities (clark, 1999). Women are more likely

than men to exhibit stronger health promotion behaviors in terms of blood

pressure checks, dental flossing, diet, smoking, drinking, physical activity,

weight, and hours of sleep. Men tend to view exercise as sufficient to

compensate for unhealthy behaviors such as fatty diets. As a result, men are at

greater risk for several of the top killers such as heart disease, cancer, suicide,

accidents, and violence. Because most of these killers are preventable, changes

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in eating habits, workplace environments, and educational strategies are needed

to improve preventive care for men.

Specific Male Health Issues

Prostate Cancer

The American Cancer Society lists prostate cancer as the second leading cause

of cancer death in American men after lung cancer (Brock, 1997; Male Health

Center, 1998b). Prorate cancer is most common in men older than 40 and the

risk increases with each decade thereafter (Brock, 1997), Most often; prostate

cancer is asymptomatic until the disease has progressed. Symptoms that may

indicate prostate disease include the following (Male Health Center, J998b):

* Difficulty or pain with urination

* Painful ejaculation

* Blood in urine or semen

Although prostate cancer is the second leading cause of cancer deaths in

American men, how many prostate cancer prevention and awareness campaigns

have you seen? Can the same be said for breast cancer?
Management of the problem:-

Information about the necessity of digital rectal examination beginning at age

40 for all men. With possible earlier intervention for those with signs and

symptom of problems or a positive family history, must be included and

incorporated into health fairs and promotions. Information related to specific

antigen (PSA) blood testing that is used in conjunction with the digital rectal

examination should also be provided. In 1986, the U.S. Food and Drug

Administration approved the PSA test for prostate cancer screening. Many

physicians believe that the subsequent fall in prostate cancer mortality rates can

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be attributed to early diagnosis with PSA testing (Feuer & Merril, 1999). The

importance of the procedure and information regarding signs, symptoms, and the

screening process; should be emphasized in promotions. Nurses should also

include written information for distribution because some men are ill at ease dis-

cussing the procedure and testing in public.

The community health nurse can also organize targeted prostate-specific

screening during winch the men actually have the digital rectal examination and

PSA blood tests. In a study that explored the relationship between attitudes

toward digital rectal examinations and prosrate screening among African Amer-

ican men. The results revealed that fear of the procedure did not prevent men

from participating in the screening (Gelfand, Patzuchowski, Con, & Powell,

1995).

Testicular Cancer

Testicular cancer accounts; for only 1% of all cancers in men (National Cancer

Institute, 1998; Walbrecker, 1995). However, testicular cancer is the most

common form of cancer in men between the ages of 20 and 34 (Brock, Fox,
Gosling, Haney, Kneebone, Nagy, & Qualitza, 1993; Clore, 1993; DHH5,

J995b; National Cancer Institute, 1998; Peate, 1997; Rosella, 1995). It is the

second most common cancer for men between the of 35 and 33 and the third

most common for men between the ages of l5and 19 (National Cancer Institute,

1998). This type of cancer is 4.5 times more common among Caucasian men

than African American men (DHHS, I995b; National Cancer Institute, 1998),

Epidemiological data show an increase in the incidence of testicular

cancer over the past 20 years (Clare, 1993; Koshti-Richman, 1996). As recent as

the early 1980s, testicular cancer was fatal (Brock et al, 1993) for 8 of 10 clients

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(Walbrecker, 1995). But today, because of advances, in chemotherapy and

improved surgical techniques (Brakey. 1994). Testicular cancer is one of the

most curable forms of cancer (Rosella, I994). Testicular cancer has a nearly

100% cure rate with early detection and treatment (Walbrecker, 1995). This

optimistic prognosis with early intervention makes testicular self-examination

(TSE) a critical component of health teaching for young men (Walbrecker,

1995), especially because most cases of testicular cancer are found by the clients

themselves (National Cancer Institute, 1998). Boys should begin TSE around

age 13 and make it a lifelong practice because, although testicular cancer is most

likely to occur before the age of 40, it can occur at any age. In fact, the incidence

rises again after he age of 70 (Brakey, 1994).

High risk group for disease:-

The characteristics that put men at higher risk for testicular cancer include:

Caucasian race, young age, high socio-economic status, or family history, as

well as having a mother who took estrogen during her pregnancy (Kinkade,

1999), Males with undescended testicles or late descending testicles (after age 6)
have a 3 to 17 times higher than average risk for developing testicular cancer

(National Cancer Institute, 1998).

Management:-

Despite this information, the health education literature suggests that most of the

men who are most susceptible to testicular cancer are unaware of the signs and

symptoms of the disease and how to detect them (Rosella, 1994). Research has

indicated that although information has been readily available to young women

regarding breast self-exam (BSE) and the importance of regular Pap smears, the

information related to TSE has not been as widely communicated (Turner 1995).

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Nurses are in the best position to provide young men with the information to

learn the self-examination techniques needed for early detection and cure (Peate,

1997). TSE education and screening programs can be set up in high schools and

presented simultaneously with BSE and screening programs. Models can be

used for practicing self-examination with lifelike lumps and abnormalities to

teach young men what they should be looking for. Testicular examination and

TSE education should be part of every routine physical examination for

adolescent and young adult males. Instruction for self-examination of the

testicles are given in Box 33-1

The only way a positive diagnosis of testicular cancer can be made is through

surgical removal (orchiectomy) of the affected testicle for direct examination.

Because testicular cancer occurs most often in men of re-productive age, fertility

is a major concern. Although sperm count may be lowered, a unilateral

orchiectomy usually does not affect sexual function or fertility.

Box 33-1 Testicular Self Examination:

• Self examination should be done once a month after a warm bath or

shower because heat relax scrotum and loosen the skin, making the testes

easier to examine.

• Visually inspect the scrotum for any swelling or change in colour.

• Examine each testicle with both hands by placing the index and middle

finger under the testicle with the thumbs placed on top. Roll the testicle

gently between the fingers and thumb, feeling for any changes such as lumps,

swelling, or painful spots.

• The first sign of testicular cancer is usually a hard, painful lump about the

size of a pea. However, if there are any kinds of changes or abnormalities,

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 immediately notify your health care provider, because only he or she can

make a positive diagnosis.

Many sexual topics are now discussed openly, but erectile dysfunction is still a subject that
.(causes fear and anxiety for many men and women(Male Health Center,1998
Improving both public and professional knowledge and attaining a comfort level in talking
about erectile dysfunction will provide both men and thier sexual partners with an avenue for
.obtaining needed information and effective treatment
?What is Erectile Dysfunction
Erectile Dysfunction is the inability to achieve or maintain a penile erection sufficient for
sexual intercourse. About 15 million American men suffer from erectile dysfunction, and the
incidence increases with age. Approximately 5% of men experience erectile dysfunction by
the age of 40, increasing to between 15% and 25% by the age of 65 ( National Kidney and
Urologic Disease Information Clearinghouse, 1998). Erectile Dysfunction is often assumed
to be a normal part of the aging process, but that assumption is incorrect. Several reports
indicate that most men and women between the ages of 50 and 60 are still interested in
remaining sexually active ( Male Health Cnter, 1998).
Causes
1- Physical causes.
• Diseases
• Surgery
• Medications
• Smoking
2- Psychological causes.
Most cases of erectile dysfunction have a physical cause such as disease, injury, or drug side
effects. Diabetes Mellitus, kidney disease, multiple sclerosis, atherosclerosis, chronic
alcoholis, hypertension, and vascular disease account for approximately 70% of all cases of
erectile dysfunction. Also various kinds of surgeries are also associated with increased
incidence of erectile dysfunction. Such as surgery cause injuries to nerves and arteries near
the penis. . also many common mdications list erectile dysfunction as a side effect including
drugs used to treat hypertension, antihistamines, antidepressents, sedatives, tranquilizers,
appetite suppressants, and pain medications. And smoking has also been shown to have an
adverse effect on erectile dysfunction by increasing the effects of other risk factors such as

8
vascular disease or hypertension . Vasectomy , however has not been associated with
increased risk for erectile dysfunction (NIH,1992).
In 10% to 20% of cases of erectile dysfunction the cause is deemed to be psychological.
Factors such as stress , anxiety, guilt, depression , low self estem, and fear of sexual failure
can cause erectile dysfunction without the presence of any physical problems or can be
secondary reactions to underlying physical causes( National Kidney and Urologic Disease
Information Clearinghouse, 1998) Important facts that should be emphasized when
counseling a man and his sexual partnr about erectile dysfunction include the following
1- Most men experience erectile dysfunction related to stress or alcohol at some
time in thier lives.
2- Past sexual practices, including masturbation, do not cause erectile
dysfunction.
3- Physical disorders can directly affect sexual functioning.
4- An occasional problem with erectile dysfunction dose not mean a chronic
proble will develop.
5- A man can sabotage his ability to have an erection by worrying about it.
Treatment
Treatment varies according to the severity and cause of the dysfunction. Health care providers
start with the least invasive treatment and progress to more invasive treatments until erectile
dysfunction is corrected. Reducing the dosage or eliminating drugs that may be causing
erectile dysfunction is the first step. Psychotherapy and behavior modifications are next.
Vacuum devices, oral drugs, drugs injected into the urethra, and finally surgically implanted
penile devices or vascular surgery are offered as treatment if the problem persists.
In 1998, a new "wonder drug" called silenafil citrate (commonly known as viagra) was
approved by the U.S. food and drug Administration. Viagra is taken 1 hour before sexual
intercourse and works by boosting the effects of nitric oxide, achemical produced by the body
to relax smooth muscle in the pnis and allow increased blood flow during sexual stimulation.
This drug dose not triggr automatic erection as other drugs used to treat erectile dysfunction
do, but rather just allows the man to respond to sexual stimulation. The drug is very succssful
in treating many forms of erectile dysfunction, although some fear the drug may be overused
by middle – aged and older men who may not actually suffer from erectile dysfunction but
just want to "boost"

Role of The Community Health Nurse

9
Provide accurate and easily understandable innformation and to encourage the man and his
sex partener to talk openly and comfortably about the problem.
Including the man's sex partner in the discussion acknowledges his or her importance in the
relationship.
Many persons whose partners are important blame themselves for the problem . the partner
may also feel hurt and angery because the male has withdrawn physically and emotionally. It
is important for the nurse to be sensitive to the needs of clients whose values or sexual
orientation may be different from the nurse. Not all partners of male clients will be thier
wives. In fact, some of the sex partners of male clients may also be male. Whatever the
relationship of the partners, all couples should be treated with dignity and respect.
Cardiovascular Disease
Cardiovascular disease is the single greatest cause of death in men. Approximately 1 in 3
male deaths is related to cardiovascular disease. Similarly, more than one-third of men dying
between the ages of 45 and 65 die of a heart attack. Cardiovascular disease is caused by the
accumulation of fatty deposits within the artery wall that causes stiffness and reduced blood
flow. When the brain interprets reduced blood flow as low blood pressure, it sends a singal to
the heart to compensate. The heart works faster with less rest and increases the pressure on
each contraction. Normal blood pressure for men range from 120/70 to 150/80 depending on
age . with severe hardening of the arteries blood pressure may increase to 200/100 mmhg .
Although there are many explanations for higher cardiovascular disease rates among men than
women, research points to two major factors:-
1- Men's diets have higher ratios of saturated to polyunsaturated fat, which
contributes to cardiovascular disease.
2- Men's sociocultural environments lead to higher levels of stress which
contributes to cardiovascular disease.
Cardiovascular disease and hypertension can often be prevented by changes in behavior,
including stopping smoking, increasing activity, and improving diet . community health
nurses can design educational programs that target men to promote behavior changes that
reduce the risk of cardiovascular disease. These recommendations may include the
following:-
• Losing weight
• Reducing salt intake
• Quitting smoing
• Eating foods rich in natural sources of fiber and antioxidant vitamins

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 • Exercising
• Relaxing
In addition, consumption of moderate amounts of alcohol and sexual activity are associated
with reduced riss of cardiovascular disease.
Selected At- Risk Populations
Men with HIV/AIDS
According to the Centers for Disease Control and Prevention (CDC,1998) AIDS had become
a leading cause of death in the U.S.for men between the ages of 25 and 44.
With the introduction of new medications in recent years, AIDS –related death rates have
steadily declined, but the incidence of incidence of new HIV cases contiues to rise
(CDC,1998) . AIDS has historically been viewed in the United States as a disease targeting a
specific population- homosexual men. High –risk behaviors such as alcohol and drug use and
unprotected sex with numerous partners, continue to put heterosexual men at risk .
heterosexual transmission rates continue to escalate, especially in the African American and
Hispanic communities, where 41% of all new reported cases are found (CDC,1997).

Community Health Nursing Roles

The community health nurse assumes a wide range of duties and resposibilities while
providing health care to men. A typical week could include hundreds of miles traveled,
diverse teaching methods and strategies, and numerous new encounters. Community health
nursing roles may include client advocate , educator, and facilitator.

1- Client Advocate
As a client advocate, the role of the community health nurse includes interfacing with health
care providers and health care agencies to support the best care for the client. A proper
assessment must be made to determine whether alternative medications could have been
prescribed. With the permission of the client, the nurse can contact the appropriate health care
provider and discuss the client's options with a nonthreatening and nonjudgmental stance to
allow for future interactions. Any new information must be shared with the client.
2- Educator
The role of a health educator for men can often be challenging .education can occur in any
setting from the stockyard to the corporate boardroom.
3- Facilitator

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The comunity health nurse as facilitator brings various peoplr and groups together to talk
about issues and needs. The most significant facilitator role involves helping people and
groups of different views to reach a compromise so that they can find a common ground to
solve problems and bring about positive changes to alleviate a specific community health
problem.

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