Where have all the young men gone?A problem here too

Dr. Ranesh Wijesinghe (Colombo South Teaching Hospital)

A recent issue of the American Family Physicians Association (AAFP) in an article under preventive healthcare by Sheri Porter, commenting on the difficulties the doctors experience in getting young people to get their health checkups done regularly for their own good health by detecting any diseases they may have contracted at the early stage poses the question “Where have all these young men gone without coming for these checkups?”

Since we are facing this problem even in Sri Lanka, I thought of referring to that article and quoting from it here in the ‘HealthWatch’ as reading this article might lead at least some of our young people initially to change their attitude others will follow thereafter.

Under preventive healthcare in FP Report Vol. 7, Sheri Porter writes:

Where have all the young men gone? Chances are they’re not in your exam rooms.

The boys that routinely reported for back-to-school checkups and high-school sports physicals probably haven’t set foot in your office since Mom last scheduled an appointment.

Their disappearing act is a national phenomenon. Figures published in AAFP’s ‘2000 Facts about Family Practice’ show a definite dearth of male patients from 18 to 24 years of age.

Is this a worrisome trend - a precursor to a lifetime of doctor ducking? It’s no secret that men are at least 25 per cent less likely than women to visit a doctor and are significantly less likely to have regular physician checkups and obtain preventive screening tests for serious diseases.

Or does the dip in numbers merely reflect the reality that this generally healthy population requires little more than acute care treatment with a dash of healthy lifestyle counselling on the side?

Members weigh in

* “Considering the little we do for men this age, outside of acute care, it’s no wonder that they learn that illness is the only time to see a physician.

Unfortunately, most of the risky behaviours we counsel against are considered by our society to be part of the wild oats men longingly recall when they are older.

Until we have something they view as useful to offer them, men in this age group will continue to be the ‘other person in the room’ when we are taking care of their family members.” Shawn Griffin, MD, of St. Joseph, Mo.

* “Men understand the importance of maintenance on their cars - I tell them to think of their bodies in the same way.

They need regular maintenance exams to make sure they haven’t developed diabetes or high blood pressure and to look for signs of testicular cancer.” Colette Willins, MD, of Westlake, Ohio.

* “I think trying to get young males in for preventive care is a waste of time.

They are generally a healthy lot, and screening for chronic health problems in this group is very low yield.

Young women go in for their Paps annually, in part to gain access to birth control. Young men have no corollary. When young men seek care for acute problems, a few short questions could screen for some problems.

For example, it doesn’t take much time to ask if he smokes. If he does, just give a short message asking him to quit, and add an offer to help when he is ready.” Rob Reneker, MD, of Grandville, Mich.

“In the military, all active duty folks must have a physical examination at least once every five years, which may be enough for this population under discussion.” David Hutcheson-Tipton, MD, Marysville, Wash.

* “I disagree with the idea that these men should seek healthcare on a per needed basis only.

My experience has clearly demonstrated the need for diabetes, hypertension and cholesterol screening on a substantial portion of the Hispanic men in my community whose obesity and family histories often increase their risks of disease.” Sandra Guerra-Cantu, MD, of San Antonio

* “I think a campaign of information about the importance of preventive medical exams is paramount and should be encouraged through employers and on college campuses.

Hereditary diseases such as diabetes and coronary artery disease must be discussed with this age group if we want to start counselling that could delay the onset of the very diseases that their parents and grandparents may already have.” - Viviana Martinez-Bianchi, MD, of Muscatine, Iowa.

* “Any state university that receives federal money should require students to have a complete physical exam prior to enrolment. This should include a review of their immunisations and other healthcare preventive measures.”

Non smokers taking to smoking on the rise in Sri Lanka

A Global Youth Tobacco Survey (GYTS) done by the WHO in 139 countries, indicated the possibility of non-smokers taking to smoking is likely to go up in Sri Lanka.

In a report on this survey prepared by P. W. Gunasekera (Research Coordinator Sri Lanka) it is stated.

Never smokers

“The per cent of never smokers who indicated they were likely to initiate smoking in future was double that of current smokers both boys and girls - suggesting current cigarette smoking may be on the rise in Sri Lanka among adolescents. The comparison of data on this report was based on the years 1999-2003.

The report states: Tobacco use is one of the preventable causes of premature deaths and diseases in the world. WHO attributes over 5 million deaths a year to tobacco use, a figure that is expected to rise to 10 million a year by 2030.

Seventy per cent of these deaths will occur in developing countries. Globally one person dies every 6.5 seconds of a tobacco related disease and tobacco consumption on the increase.

Given the current pattern of tobacco use globally, it is estimated that 250 million children and adolescents who are alive today will die prematurely because of tobacco, most of them in the developing countries.

Global Youth Tobacco Survey (GYTS)

In order to combat the rapid spread of the tobacco epidemic among adolescent age children and to help countries all over the world to plan and implement policies and programmes to control youth tobacco use, the Tobacco Free Initiative of WHO in collaboration with the Office on Smoking and Health (OSH), Centers for Disease Control (CDC) USA, developed the GYTS.

The GYTS uses a common methodology, core questionnaire, and consistent data processing for all countries.

GYTS is a school-based survey conducted among students studying in grades corresponding to ages 13-15 years. In Sri Lanka this included grades 8-10 in government and private schools.

GYTS has been conducted in 139 countries and has been repeated at least once in 31 countries across all six WHO regions. GYTS includes data on prevalence of cigarettes and other tobacco use, perception and attitudes concerning tobacco use as well as information on access, availability and price, exposure to environment tobacco smoke (ETS), school curriculum, media and advertising, and cessation.

Data from the GYTS can be used to help countries develop, implement and evaluate comprehensive tobacco control programmes.

Methodology and Survey Administration

The 1999 and 2003 Sri Lankan GYTS were school based surveys of students attending grades 8-10 corresponding to the age group 13 to 15, using a standardised methodology. (4) Both surveys were conducted with an anonymous, self-administered close ended questionnaire.

The questionnaire had 55 core questions and was pilot tested before it was administered in 1999; the same questionnaire was used in 2003.

In 1999 as well as in 2003, a two-stage cluster sample design was used to produce representative data for the entire country. At the first stage schools were selected with probability proportional to enrolment size.

At the second stage, classes were randomly selected and all students in selected classes were eligible to participate.

In 1999, the school response rate was 85.7 per cent, the students response rate was 89.0 per cent and the overall response rate was 76.4 per cent (school * student). A total of 2,896 students participated in the 1999 survey.

In 2003, the school response rate was 100%, the student response rate was 79.1 per cent and the overall response rate was 79.1 per cent. For the 2003 survey, 1,845 students participated.

The GYTS was administered during one class period, i.e. second period of the day, and the procedures were designed to protect student privacy by assuring that their participation was anonymous and voluntary.

Before the surveys were administered concurrence of the education authorities, directorate, school heads and the parents of participating students were obtained.

The per cent of students who had ever-smoked cigarettes significantly decreased between 1999 and 2003 (12.1 per cent and 6.3 per cent, respectively) (Table 1). Boys were significantly less likely to have ever smoked cigarettes in 2003 than in 1999 (9.2 per cent and 17.7 per cent, respectively).

In both 1999 and 2003, boys were significantly more likely than girls to have ever smoked cigarettes. Current use of cigarettes and other tobacco products (i.e. beedis, cigars, and white cigars) did not change, significantly between 1999 and 2003 (Table 1).

However, use of other tobacco products was significantly higher than cigarette smoking in 1999 and 2003.

This difference held for girls in both years and for boys in 2003.

Estrogen therapy may cut heart risks: study

Estrogen may reduce one heart disease threat among postmenopausal women in their 50s, although the therapy increases chances of blood clots and stroke, a study out Wednesday said.

The study found lower levels of calcified plaque in the coronary arteries of women who had their uteruses removed and used estrogen therapy to relieve menopause symptoms such as hot flashes. Coronary artery calcification is one factor leading to heart attack.

But the study’s senior author warned that the finding should not be interpreted to mean that estrogen should be used to prevent heart disease.

“Heart disease is complex, and the effect of estrogen on one risk factor does not adequately predict the risk of having a heart attack,” said Marcia Stefanick, professor of medicine at the Stanford Prevention Research Center.

“But this study offers some reassurance for women of menopausal age that it’s not unsafe, in terms of the risk of heart attack, to take estrogen, at least for a few years,” she said.

Stefanick also warned that hormone therapy still carried other health risks such as the increased likelihood of blood clots and stroke.

The study, published in the June 21 issue of the New England Journal of Medicine, was a follow-up to a the US-funded Women’s Health Initiative (WHI), the largest study of postmenopausal women.

AFP