UBC Faculty Research and Publications

Of Boys and Men: The State of the Science on Boys’ and Men’s Health Goldenberg, Larry; Oliffe, John; Tremblay, Yves 2010

You don't seem to have a PDF reader installed, try download the pdf

Item Metadata

Download

Media
[if-you-see-this-DO-NOT-CLICK]
CIHR_IGH_2010_Session2_Audio.mp3 [ 23.44MB ]
CIHR_IGH_2010_Session2_Slides_Goldenberg_1of3.pdf [ 838.72kB ]
CIHR_IGH_2010_Session2_Slides_Oliffe_2of3.pdf [ 1.15MB ]
CIHR_IGH_2010_Session2_Slides_Tremblay_3of3.pdf [ 6.98MB ]
[if-you-see-this-DO-NOT-CLICK]
Metadata
JSON: 1.0132691.json
JSON-LD: 1.0132691+ld.json
RDF/XML (Pretty): 1.0132691.xml
RDF/JSON: 1.0132691+rdf.json
Turtle: 1.0132691+rdf-turtle.txt
N-Triples: 1.0132691+rdf-ntriples.txt
Original Record: 1.0132691 +original-record.json
Full Text
1.0132691.txt
Citation
1.0132691.ris

Full Text

“Men’s Health:  Connecting the Dots” Larry Goldenberg, CM, OBC, MD Vancouver, BC, Canada IGH 2010: Of Boys and Men: The State of the Science on Boys‟ and Mens‟ HealthWHO Madrid Statement, 2002 „to achieve the highest standard of health, health policies have to recognize that women and men, owing to their biological differences and their gender roles, have different needs, obstacles and opportunities‟Healthcare through the Male Lens „Most of what we currently understand about men‟s health is fragmented and diffuse. It is fragmented by the individual disciplinary lenses through which we view men‟s health as epidemiologists, health educators, medical anthropologists, nurses and physicians, psychiatrists, ethnographers, psychologists, public health workers, social workers and sociologists. These individual lenses enable us to deeply understand very specific aspects of men‟s health. However, they also often limit the ways in which we conceptualise and understand men‟s experiences more broadly.‟ Courtenay et al. IJMH, 2002 Global Life Expectancy Stats (2009 est.) Country Men Women Gap Canada 78.3 82.9 3.9 Israel 78.5 82.8 3.7 Afghanistan 43.9 43.8 0.1 Australia 78.9 83.6 4.7 Brazil 68.8 76.1 7.3 UK 77.2 81.6 4.4 Namibia 52.5 53.1 0.6 Singapore 78 81.9 3.9 United States 75.6 80.8 5.2 Russia 61.8 72.6 10.8 Niger 57.8 56 -1.8Health expectancy:  disability and functional dependence-free, life expectancy Potential Years of Life Lost:  number of years lost because of dying at an early age Alternate Health IndicatorsUSA 65.7 63.8 - 67.5 76.4 10.7 Italy 69.5 68.4 - 70.8 80.6 11.1 UK 68.3 66.8 - 69.7 76.8 8.5 Japan 71.2 69.9 - 72.5 79.6 8.4 China 60.9 59.5 - 62.5 70.5 9.7 France 68.5 67.4 - 69.5 78.6 10.2 Germany 67.4 66.0 - 68.7 76.6 9.2 Singapore 66.8 64.3 - 69.0 78.1 11.3 Sweden 70.1 68.7 - 71.6 79.2 9.2 Switzerland 70.4 68.7 - 72.1 79.3 8.8 Health Expectancy at Birth Loss  of Healthy  years International data base (IDB) Estimates 2005 Life ExpectancyThere is a remarkable discrepancy between the health and survival of the sexes: men are physically stronger and have fewer disabilities, but have substantially higher mortality at all ages compared with women “Men: Good health and high mortality” Oksuzyan et al; Aging Clin Exp Res. 2008 “male-female health-survival paradox”A Roadmap to Men’s Health: Current status, research, policy and practice A commissioned population health based report for the Men’s Health Initiative of B.C. January, 2010Life expectancy at birth (BC)What is causing the average life expectancy gap between genders? „a population-level murder mystery‟The Report: A Roadmap for Men‟s Health • Domains of Male health: » Male-specific conditions (e.g. prostate problems, testicular cancer, hypogonadism, ED) » Male-risk conditions (for which being male is a risk factor) Cardiovascular Disease/ Suicide/ Motor Vehicle  Accidents/ Osteoporosis/ Lung Cancer/ HIV • Healthcare database and Systematic academic & gray literature  review concerning key areas of male health • Recommendations: Knowledge Transfer strategy, research, clinical, policyReport Framework: The possible factors contributing to the life expectancy gap • Biological Factors – hormonal, brain structure, other physical differences • Environmental Factors – riskier jobs, less social support • Behavioural Factors – higher risk-taking, avoidance of health care, refusal of preventive lifestyle (exercise, nutrition, etc.) – Traditional masculine role“Having a Y chromosome should not   be seen as possessing a self destruct mechanism” • Blaming the Victim • Undervaluing positive male traits • Alienating men in whom we seek to instill  healthier behaviours Rutz. JMHG, 2004PYLL: Which conditions cause men to die before women? 0 1000 2000 3000 4000 5000 6000 7000 8000 9000 10000 Years of Life Lost by Men minus Years Lost by Women Cardiovascular Diseases Suicide MVA Infectious Diseases Liver Diseases The Big Three: •Cardiovascular    Disease •Suicide •Motor Vehicle AccidentsCardiovascular disease •Strikes men more often and earlier than women •Does estrogen protect the heart? Factors in gender difference: •Poor nutritional habits (high sodium, low fruit & vegetable intake) •Overweight •Poor anger management? Deaths by CVDSuicide •Men carry out suicide 3-4 x more than women/ Highest rate in middle-age Factors in gender difference: •Willingness to use lethal methods •Reluctance to talk about emotional distress or seek help for it •Higher levels of alcohol use •Greater tendency to move quickly from thought to action 0 5 10 15 20 25 30 35 10 -14 15 -19 20 -24 25 -29 30 -34 35 -39 40 -44 45 -49 50 -54 55 -59 60 -64 65 -69 70 -74 75 -79 80 -84 85 -89 90+ Age Group Males Females Deaths by SuicideMotor Vehicle Accidents •High proportion of deaths in the late teens and 20s (= many years of life lost) Factors in gender difference: •High levels of risk-taking (speeding and reckless driving) 0 5 10 15 20 25 30 35 40 1-15 16-20 21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 81-85 86+ Age Group Male Female Deaths from MVAsHealthcare through the Male Lens „Most of what we currently understand about men’s health is fragmented and diffuse. It is fragmented by the individual disciplinary lenses through which we view men‟s health as epidemiologists, health educators, medical anthropologists, nurses and physicians, psychiatrists, ethnographers, psychologists, public health workers, social workers and sociologists. These individual lenses enable us to deeply understand very specific aspects of men‟s health. However, they also often limit the ways in which we conceptualise and understand men‟s experiences more broadly.‟ Courtenay et al. IJMH, 2002 MHIBC An “umbrella” initiative, a “brand name” and a “single point of contact” dedicated solely to the pursuit of excellence in male health “Connect the Dots”Men‟s Health: “more than a prostate and penis”The Dots: Foci of excellence Create a network in which experts in diverse fields and communities can communicate, share standards, discuss research opportunities, partner in grant applications and interrelate electronically The “sum of the whole will far exceed the individual parts”The Dots: Education, prevention, early diagnosis and future health outcomes By helping men understand their individual and unique vulnerabilities, they will have the option of modifying their behaviour to prevent future problems and they will see the connection between risk awareness, early diagnosis and better outcomes in managing their eventual illnesses The Dots: Multiple male health issues Linkages between behaviour, lifestyle, diet, activity, environment, workplace, employment opportunities, availability of social services and the various illnesses that impact males predominantly, across all age groups. Linkages between physical illnesses – for example cardiometabolic and erectile function, or testosterone deficiency and depression, bone health, cardiac status or overall mortalityThe Dots: Different regions: geographic and societal The males of various socioeconomic status, races, ethnicities and geographies will have to be connected through a common policy  These dots are diverse and unique but the system needs to adapt to be able to communicate with each and every one in their own way, and address their unique needs The Dots: Male health care sectors The variety of biopsychosocial issues which affect men have different features and requirements when addressed in the greater community, in the acute care institutions or in chronic care facilities. Standards of care and best practices need to be disseminated (developed where absent) within the context of our healthcare system, to connect men‟s health issues as they move through these various health sectors.The Dots: Male health and wellbeing of other groups The approach to community health is not an “either-or‟question, but rather a „both-or neither‟ issue. Men‟s health policies and ultimately improved health outcomes must be connected as a co-equal partner to women‟s health, children‟s health and minority health. Failure to address the health needs of any of these groups impairs the ability to fully serve the othersHealthcare research through the Male Lens „To consider masculinity as dependent on innate biologic factors is to misunderstand the basis of genetics. But to consider masculinity as a purely social construct with no physiologic basis is scientifically dangerous.‟ Treadwell. In: The Making of Masculinities: The New Men‟s Studies; Brod H., ed. (1992) As researchers, educators and healthcare administrators plan the healthcare policies of the future, a male lens must be applied to help to bring the “dots” into focus Disciplines working together To OPTIMIZE Male Health •Women‟s health • Medicine • Nursing • Pharmacy • Social work • Physical therapy • Law, ethics • Public Health • Statistics/epidemiology • Health economics • Computer Science • Digital media production • Marketing /Advertising • etc “Men’s Health:  Connecting the Dots” Larry Goldenberg, CM, OBC, MD Vancouver, BC, Canada IGH 2010: Of Boys and Men: The State of the Science on Boys‟ and Mens‟ HealthWHO Madrid Statement, 2002 „to achieve the highest standard of health, health policies have to recognize that women and men, owing to their biological differences and their gender roles, have different needs, obstacles and opportunities‟Healthcare through the Male Lens „Most of what we currently understand about men‟s health is fragmented and diffuse. It is fragmented by the individual disciplinary lenses through which we view men‟s health as epidemiologists, health educators, medical anthropologists, nurses and physicians, psychiatrists, ethnographers, psychologists, public health workers, social workers and sociologists. These individual lenses enable us to deeply understand very specific aspects of men‟s health. However, they also often limit the ways in which we conceptualise and understand men‟s experiences more broadly.‟ Courtenay et al. IJMH, 2002 Global Life Expectancy Stats (2009 est.) Country Men Women Gap Canada 78.3 82.9 3.9 Israel 78.5 82.8 3.7 Afghanistan 43.9 43.8 0.1 Australia 78.9 83.6 4.7 Brazil 68.8 76.1 7.3 UK 77.2 81.6 4.4 Namibia 52.5 53.1 0.6 Singapore 78 81.9 3.9 United States 75.6 80.8 5.2 Russia 61.8 72.6 10.8 Niger 57.8 56 -1.8Health expectancy:  disability and functional dependence-free, life expectancy Potential Years of Life Lost:  number of years lost because of dying at an early age Alternate Health IndicatorsUSA 65.7 63.8 - 67.5 76.4 10.7 Italy 69.5 68.4 - 70.8 80.6 11.1 UK 68.3 66.8 - 69.7 76.8 8.5 Japan 71.2 69.9 - 72.5 79.6 8.4 China 60.9 59.5 - 62.5 70.5 9.7 France 68.5 67.4 - 69.5 78.6 10.2 Germany 67.4 66.0 - 68.7 76.6 9.2 Singapore 66.8 64.3 - 69.0 78.1 11.3 Sweden 70.1 68.7 - 71.6 79.2 9.2 Switzerland 70.4 68.7 - 72.1 79.3 8.8 Health Expectancy at Birth Loss  of Healthy  years International data base (IDB) Estimates 2005 Life ExpectancyThere is a remarkable discrepancy between the health and survival of the sexes: men are physically stronger and have fewer disabilities, but have substantially higher mortality at all ages compared with women “Men: Good health and high mortality” Oksuzyan et al; Aging Clin Exp Res. 2008 “male-female health-survival paradox”A Roadmap to Men’s Health: Current status, research, policy and practice A commissioned population health based report for the Men’s Health Initiative of B.C. January, 2010Life expectancy at birth (BC)What is causing the average life expectancy gap between genders? „a population-level murder mystery‟The Report: A Roadmap for Men‟s Health • Domains of Male health: » Male-specific conditions (e.g. prostate problems, testicular cancer, hypogonadism, ED) » Male-risk conditions (for which being male is a risk factor) Cardiovascular Disease/ Suicide/ Motor Vehicle  Accidents/ Osteoporosis/ Lung Cancer/ HIV • Healthcare database and Systematic academic & gray literature  review concerning key areas of male health • Recommendations: Knowledge Transfer strategy, research, clinical, policyReport Framework: The possible factors contributing to the life expectancy gap • Biological Factors – hormonal, brain structure, other physical differences • Environmental Factors – riskier jobs, less social support • Behavioural Factors – higher risk-taking, avoidance of health care, refusal of preventive lifestyle (exercise, nutrition, etc.) – Traditional masculine role“Having a Y chromosome should not   be seen as possessing a self destruct mechanism” • Blaming the Victim • Undervaluing positive male traits • Alienating men in whom we seek to instill  healthier behaviours Rutz. JMHG, 2004PYLL: Which conditions cause men to die before women? 0 1000 2000 3000 4000 5000 6000 7000 8000 9000 10000 Years of Life Lost by Men minus Years Lost by Women Cardiovascular Diseases Suicide MVA Infectious Diseases Liver Diseases The Big Three: •Cardiovascular    Disease •Suicide •Motor Vehicle AccidentsCardiovascular disease •Strikes men more often and earlier than women •Does estrogen protect the heart? Factors in gender difference: •Poor nutritional habits (high sodium, low fruit & vegetable intake) •Overweight •Poor anger management? Deaths by CVDSuicide •Men carry out suicide 3-4 x more than women/ Highest rate in middle-age Factors in gender difference: •Willingness to use lethal methods •Reluctance to talk about emotional distress or seek help for it •Higher levels of alcohol use •Greater tendency to move quickly from thought to action 0 5 10 15 20 25 30 35 10 -14 15 -19 20 -24 25 -29 30 -34 35 -39 40 -44 45 -49 50 -54 55 -59 60 -64 65 -69 70 -74 75 -79 80 -84 85 -89 90+ Age Group Males Females Deaths by SuicideMotor Vehicle Accidents •High proportion of deaths in the late teens and 20s (= many years of life lost) Factors in gender difference: •High levels of risk-taking (speeding and reckless driving) 0 5 10 15 20 25 30 35 40 1-15 16-20 21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 81-85 86+ Age Group Male Female Deaths from MVAsHealthcare through the Male Lens „Most of what we currently understand about men’s health is fragmented and diffuse. It is fragmented by the individual disciplinary lenses through which we view men‟s health as epidemiologists, health educators, medical anthropologists, nurses and physicians, psychiatrists, ethnographers, psychologists, public health workers, social workers and sociologists. These individual lenses enable us to deeply understand very specific aspects of men‟s health. However, they also often limit the ways in which we conceptualise and understand men‟s experiences more broadly.‟ Courtenay et al. IJMH, 2002 MHIBC An “umbrella” initiative, a “brand name” and a “single point of contact” dedicated solely to the pursuit of excellence in male health “Connect the Dots”Men‟s Health: “more than a prostate and penis”The Dots: Foci of excellence Create a network in which experts in diverse fields and communities can communicate, share standards, discuss research opportunities, partner in grant applications and interrelate electronically The “sum of the whole will far exceed the individual parts”The Dots: Education, prevention, early diagnosis and future health outcomes By helping men understand their individual and unique vulnerabilities, they will have the option of modifying their behaviour to prevent future problems and they will see the connection between risk awareness, early diagnosis and better outcomes in managing their eventual illnesses The Dots: Multiple male health issues Linkages between behaviour, lifestyle, diet, activity, environment, workplace, employment opportunities, availability of social services and the various illnesses that impact males predominantly, across all age groups. Linkages between physical illnesses – for example cardiometabolic and erectile function, or testosterone deficiency and depression, bone health, cardiac status or overall mortalityThe Dots: Different regions: geographic and societal The males of various socioeconomic status, races, ethnicities and geographies will have to be connected through a common policy  These dots are diverse and unique but the system needs to adapt to be able to communicate with each and every one in their own way, and address their unique needs The Dots: Male health care sectors The variety of biopsychosocial issues which affect men have different features and requirements when addressed in the greater community, in the acute care institutions or in chronic care facilities. Standards of care and best practices need to be disseminated (developed where absent) within the context of our healthcare system, to connect men‟s health issues as they move through these various health sectors.The Dots: Male health and wellbeing of other groups The approach to community health is not an “either-or‟question, but rather a „both-or neither‟ issue. Men‟s health policies and ultimately improved health outcomes must be connected as a co-equal partner to women‟s health, children‟s health and minority health. Failure to address the health needs of any of these groups impairs the ability to fully serve the othersHealthcare research through the Male Lens „To consider masculinity as dependent on innate biologic factors is to misunderstand the basis of genetics. But to consider masculinity as a purely social construct with no physiologic basis is scientifically dangerous.‟ Treadwell. In: The Making of Masculinities: The New Men‟s Studies; Brod H., ed. (1992) As researchers, educators and healthcare administrators plan the healthcare policies of the future, a male lens must be applied to help to bring the “dots” into focus Disciplines working together To OPTIMIZE Male Health •Women‟s health • Medicine • Nursing • Pharmacy • Social work • Physical therapy • Law, ethics • Public Health • Statistics/epidemiology • Health economics • Computer Science • Digital media production • Marketing /Advertising • etc Tripartite of Men’s Health John Oliffe www.menshealthresearch.ubc.caEmpirical Contact with a medical doctor in the past 12 months Age group Sex 2003 2005 2007 2008 2009 12 to 19 years Both sexes 2,399,902 2,390,533 2,308,198 2,304,228 2,400,612 Males 1,173,808 1,156,858 1,133,857 1,096,382 1,166,734 Females 1,226,094 1,233,675 1,174,340 1,207,846 1,233,878 20 to 34 years Both sexes 4,829,612 4,948,305 4,869,051 4,894,620 4,962,943 Males 2,091,499 2,155,245 2,076,110 2,049,592 2,153,220 Females 2,738,113 2,793,059 2,792,941 2,845,028 2,809,723 35 to 44 years Both sexes 4,140,171 3,970,641 3,741,000 3,758,592 3,727,471 Males 1,917,921 1,847,321 1,692,523 1,710,997 1,647,264 Females 2,222,250 2,123,320 2,048,477 2,047,595 2,080,207 45 to 64 years Both sexes 6,508,160 6,959,436 7,277,365 7,536,442 7,741,789 Males 3,065,358 3,281,669 3,387,953 3,534,245 3,645,819 Females 3,442,802 3,677,767 3,889,412 4,002,198 4,095,970 65 years and over Both sexes 3,386,429 3,501,277 3,701,323 3,806,446 3,994,830 Males 1,474,771 1,552,035 1,660,115 1,722,686 1,815,230 Females 1,911,657 1,949,242 2,041,208 2,083,760 2,179,601 Age group 12–19 years 20–34 years 35–44 years 45–64 years > 65 years 2009 Men 68.3 64.1 68.4 79.5 92.7 2009 Women 76.1 85.1 86.8 87.8 92.3Good Will Bumping TheoreticalGender relationsMethodologicalThank you John.oliffe@ubc.ca www.menshealthresearch.ubc.ca “Men’s Health:  Connecting the Dots” Larry Goldenberg, CM, OBC, MD Vancouver, BC, Canada IGH 2010: Of Boys and Men: The State of the Science on Boys‟ and Mens‟ HealthWHO Madrid Statement, 2002 „to achieve the highest standard of health, health policies have to recognize that women and men, owing to their biological differences and their gender roles, have different needs, obstacles and opportunities‟Healthcare through the Male Lens „Most of what we currently understand about men‟s health is fragmented and diffuse. It is fragmented by the individual disciplinary lenses through which we view men‟s health as epidemiologists, health educators, medical anthropologists, nurses and physicians, psychiatrists, ethnographers, psychologists, public health workers, social workers and sociologists. These individual lenses enable us to deeply understand very specific aspects of men‟s health. However, they also often limit the ways in which we conceptualise and understand men‟s experiences more broadly.‟ Courtenay et al. IJMH, 2002 Global Life Expectancy Stats (2009 est.) Country Men Women Gap Canada 78.3 82.9 3.9 Israel 78.5 82.8 3.7 Afghanistan 43.9 43.8 0.1 Australia 78.9 83.6 4.7 Brazil 68.8 76.1 7.3 UK 77.2 81.6 4.4 Namibia 52.5 53.1 0.6 Singapore 78 81.9 3.9 United States 75.6 80.8 5.2 Russia 61.8 72.6 10.8 Niger 57.8 56 -1.8Health expectancy:  disability and functional dependence-free, life expectancy Potential Years of Life Lost:  number of years lost because of dying at an early age Alternate Health IndicatorsUSA 65.7 63.8 - 67.5 76.4 10.7 Italy 69.5 68.4 - 70.8 80.6 11.1 UK 68.3 66.8 - 69.7 76.8 8.5 Japan 71.2 69.9 - 72.5 79.6 8.4 China 60.9 59.5 - 62.5 70.5 9.7 France 68.5 67.4 - 69.5 78.6 10.2 Germany 67.4 66.0 - 68.7 76.6 9.2 Singapore 66.8 64.3 - 69.0 78.1 11.3 Sweden 70.1 68.7 - 71.6 79.2 9.2 Switzerland 70.4 68.7 - 72.1 79.3 8.8 Health Expectancy at Birth Loss  of Healthy  years International data base (IDB) Estimates 2005 Life ExpectancyThere is a remarkable discrepancy between the health and survival of the sexes: men are physically stronger and have fewer disabilities, but have substantially higher mortality at all ages compared with women “Men: Good health and high mortality” Oksuzyan et al; Aging Clin Exp Res. 2008 “male-female health-survival paradox”A Roadmap to Men’s Health: Current status, research, policy and practice A commissioned population health based report for the Men’s Health Initiative of B.C. January, 2010Life expectancy at birth (BC)What is causing the average life expectancy gap between genders? „a population-level murder mystery‟The Report: A Roadmap for Men‟s Health • Domains of Male health: » Male-specific conditions (e.g. prostate problems, testicular cancer, hypogonadism, ED) » Male-risk conditions (for which being male is a risk factor) Cardiovascular Disease/ Suicide/ Motor Vehicle  Accidents/ Osteoporosis/ Lung Cancer/ HIV • Healthcare database and Systematic academic & gray literature  review concerning key areas of male health • Recommendations: Knowledge Transfer strategy, research, clinical, policyReport Framework: The possible factors contributing to the life expectancy gap • Biological Factors – hormonal, brain structure, other physical differences • Environmental Factors – riskier jobs, less social support • Behavioural Factors – higher risk-taking, avoidance of health care, refusal of preventive lifestyle (exercise, nutrition, etc.) – Traditional masculine role“Having a Y chromosome should not   be seen as possessing a self destruct mechanism” • Blaming the Victim • Undervaluing positive male traits • Alienating men in whom we seek to instill  healthier behaviours Rutz. JMHG, 2004PYLL: Which conditions cause men to die before women? 0 1000 2000 3000 4000 5000 6000 7000 8000 9000 10000 Years of Life Lost by Men minus Years Lost by Women Cardiovascular Diseases Suicide MVA Infectious Diseases Liver Diseases The Big Three: •Cardiovascular    Disease •Suicide •Motor Vehicle AccidentsCardiovascular disease •Strikes men more often and earlier than women •Does estrogen protect the heart? Factors in gender difference: •Poor nutritional habits (high sodium, low fruit & vegetable intake) •Overweight •Poor anger management? Deaths by CVDSuicide •Men carry out suicide 3-4 x more than women/ Highest rate in middle-age Factors in gender difference: •Willingness to use lethal methods •Reluctance to talk about emotional distress or seek help for it •Higher levels of alcohol use •Greater tendency to move quickly from thought to action 0 5 10 15 20 25 30 35 10 -14 15 -19 20 -24 25 -29 30 -34 35 -39 40 -44 45 -49 50 -54 55 -59 60 -64 65 -69 70 -74 75 -79 80 -84 85 -89 90+ Age Group Males Females Deaths by SuicideMotor Vehicle Accidents •High proportion of deaths in the late teens and 20s (= many years of life lost) Factors in gender difference: •High levels of risk-taking (speeding and reckless driving) 0 5 10 15 20 25 30 35 40 1-15 16-20 21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 81-85 86+ Age Group Male Female Deaths from MVAsHealthcare through the Male Lens „Most of what we currently understand about men’s health is fragmented and diffuse. It is fragmented by the individual disciplinary lenses through which we view men‟s health as epidemiologists, health educators, medical anthropologists, nurses and physicians, psychiatrists, ethnographers, psychologists, public health workers, social workers and sociologists. These individual lenses enable us to deeply understand very specific aspects of men‟s health. However, they also often limit the ways in which we conceptualise and understand men‟s experiences more broadly.‟ Courtenay et al. IJMH, 2002 MHIBC An “umbrella” initiative, a “brand name” and a “single point of contact” dedicated solely to the pursuit of excellence in male health “Connect the Dots”Men‟s Health: “more than a prostate and penis”The Dots: Foci of excellence Create a network in which experts in diverse fields and communities can communicate, share standards, discuss research opportunities, partner in grant applications and interrelate electronically The “sum of the whole will far exceed the individual parts”The Dots: Education, prevention, early diagnosis and future health outcomes By helping men understand their individual and unique vulnerabilities, they will have the option of modifying their behaviour to prevent future problems and they will see the connection between risk awareness, early diagnosis and better outcomes in managing their eventual illnesses The Dots: Multiple male health issues Linkages between behaviour, lifestyle, diet, activity, environment, workplace, employment opportunities, availability of social services and the various illnesses that impact males predominantly, across all age groups. Linkages between physical illnesses – for example cardiometabolic and erectile function, or testosterone deficiency and depression, bone health, cardiac status or overall mortalityThe Dots: Different regions: geographic and societal The males of various socioeconomic status, races, ethnicities and geographies will have to be connected through a common policy  These dots are diverse and unique but the system needs to adapt to be able to communicate with each and every one in their own way, and address their unique needs The Dots: Male health care sectors The variety of biopsychosocial issues which affect men have different features and requirements when addressed in the greater community, in the acute care institutions or in chronic care facilities. Standards of care and best practices need to be disseminated (developed where absent) within the context of our healthcare system, to connect men‟s health issues as they move through these various health sectors.The Dots: Male health and wellbeing of other groups The approach to community health is not an “either-or‟question, but rather a „both-or neither‟ issue. Men‟s health policies and ultimately improved health outcomes must be connected as a co-equal partner to women‟s health, children‟s health and minority health. Failure to address the health needs of any of these groups impairs the ability to fully serve the othersHealthcare research through the Male Lens „To consider masculinity as dependent on innate biologic factors is to misunderstand the basis of genetics. But to consider masculinity as a purely social construct with no physiologic basis is scientifically dangerous.‟ Treadwell. In: The Making of Masculinities: The New Men‟s Studies; Brod H., ed. (1992) As researchers, educators and healthcare administrators plan the healthcare policies of the future, a male lens must be applied to help to bring the “dots” into focus Disciplines working together To OPTIMIZE Male Health •Women‟s health • Medicine • Nursing • Pharmacy • Social work • Physical therapy • Law, ethics • Public Health • Statistics/epidemiology • Health economics • Computer Science • Digital media production • Marketing /Advertising • etc Tripartite of Men’s Health John Oliffe www.menshealthresearch.ubc.caEmpirical Contact with a medical doctor in the past 12 months Age group Sex 2003 2005 2007 2008 2009 12 to 19 years Both sexes 2,399,902 2,390,533 2,308,198 2,304,228 2,400,612 Males 1,173,808 1,156,858 1,133,857 1,096,382 1,166,734 Females 1,226,094 1,233,675 1,174,340 1,207,846 1,233,878 20 to 34 years Both sexes 4,829,612 4,948,305 4,869,051 4,894,620 4,962,943 Males 2,091,499 2,155,245 2,076,110 2,049,592 2,153,220 Females 2,738,113 2,793,059 2,792,941 2,845,028 2,809,723 35 to 44 years Both sexes 4,140,171 3,970,641 3,741,000 3,758,592 3,727,471 Males 1,917,921 1,847,321 1,692,523 1,710,997 1,647,264 Females 2,222,250 2,123,320 2,048,477 2,047,595 2,080,207 45 to 64 years Both sexes 6,508,160 6,959,436 7,277,365 7,536,442 7,741,789 Males 3,065,358 3,281,669 3,387,953 3,534,245 3,645,819 Females 3,442,802 3,677,767 3,889,412 4,002,198 4,095,970 65 years and over Both sexes 3,386,429 3,501,277 3,701,323 3,806,446 3,994,830 Males 1,474,771 1,552,035 1,660,115 1,722,686 1,815,230 Females 1,911,657 1,949,242 2,041,208 2,083,760 2,179,601 Age group 12–19 years 20–34 years 35–44 years 45–64 years > 65 years 2009 Men 68.3 64.1 68.4 79.5 92.7 2009 Women 76.1 85.1 86.8 87.8 92.3Good Will Bumping TheoreticalGender relationsMethodologicalThank you John.oliffe@ubc.ca www.menshealthresearch.ubc.ca Dr Yves Tremblay Professeur Titulaire Ü Département d’Obstétrique et de Gynécologie / U. Laval ÜAxis in Reproduction and Child Health, Development and Well-Being  at the CRCHUL ÜResearch Center in Reproductive Biology 10th Anniversary of CIHR-IGHMajor Interest since the beginning of my PhD: The Steroid Action in Peripheral Tissues Pulmonary Development Research Context: Steroid Action in Lung DevelopmentSteroids: ANDROGENS, Estrogens, Glucocorticoids, and Mineralocorticoids in the Mechanism of Fetal Lung Development and Lung Maturation: How a Sex-Based Approach has been successful to understand the role of androgens and this for the benefit of premature infants Clinical Context: Respiratory Distress Syndrome of the Neonate, Bronchopulmonary Dysplasia and more generally  the consequences to be born alive with immature lungs. Respiratory Distress Syndrome of the Neonate ̇ The one links with a deficiency in the surge of surfactant synthesis that affects Ü1- infants who were born premature and Ü2- Boys who are at higher risk (1.62:1 Statistic  Canada, 2008)General Information ÜLate in gestation, the last pulmonary system of the lung matures allowing for the transition from water to air environment. - This process requires the maturation of the specialized cells and the finality results in the production/secretion of the SURFACTANT by the alveolar Type II cells. ÜA deficiency in this production of surfactant is related to the Respiratory Distress Syndrome (RDS) of the neonatesGeneral Information ÜThis production of surfactant does not occur at the same period of pregnancy for male and female fetuses. The production of surfactant by male is DELAYED and this temporal delay is NORMAL - at comparable developmental time points, sex influences lung maturation, i.e., males exibits delayed development  of the lung and BOYS represent ~65% (1.62 male:1 female) of all RDS cases reported in North America SUMMARIZE ÜThe risk of RDS increases in newborn infant with: 1- PREMATURITY(Extremely-low-birth-weight infant, before 28w); 2- SEX-MALEEtiology of the Sex-Difference in RDS Ü To which factor(s) RDS is linked: To the presence of ANDROGENS in  MALE lung. ÜThe ANDROGENS are responsible for the DELAY in lung maturation in male vs female babies.Summarize ÜThe literature is clear and presents RDS as being the result of  a SEXUAL DIMORPHISM and the cause is THE PRESENCE  OF ANDROGENS in male lung.What are the clinical avenues Ü Antenatal glucocorticoid administration to mothers at high risk to deliver prematurely was introduced in 1972 to accelerate- enhance fetal lung maturation and surfactant-dependent processes.  Ü At birth: Pulmonary surfactant replacement  therapy assisted by  new mechanical ventilation strategies that include oxygenation protocol and inhalation of nitric oxide to reduce lung injurySummarize Therapeutic Action Ü While actual therapies have resulted in SIGNIFICANT improvements in mortality rates in micro-preemies, SEX DIFFERENCES in survival persist and the poorer prognosis for the male is still present.Why the difference male-female persists Because actual therapies exert SIMILAR effects on lung development in BOTH SEXES and thus keep the delay unchanged and keep the male production of surfactant delayed compared to the female.̇How to track this sex difference: the first reflexe is that only the male lung are exposed to androgens since only boys produce androgens during the fetal life if we refer to the testicular differentiation. But Testis differentiation occurs earlier. 14Fibroblasts Epitheliales Type II (Alveolar) Paracrine Factors Surfactant + Mechanism Androgens: - Glucocorticoids: +3Η−Δ4 0 5 10 15 20 25 30 35 40 45 50 Δ4 T DHT 3α,17β-diol Androsterone %  o f  r e c o v e r e d  r a d i o a c t i v i t y Provost et al., Endocrinology (2000) 141, 2786 A-549 cells (h,epithelial and male) Similar amount  3α,17β-diol and androsterone Androgens synthesisFibroblastic Cell Age stage (2) Sex (3) 17β-HSD-2 / 5α-reductase Cell lines origin (1) activity ratio (4) LL24 L 5 years M 0.2 CCD-34Sk (5) S N (2,5w) F 0.2 Hs 389(B).Lu L F (16w) F 0.4 Hs 907.Lu L N (7w) F 0.4 FHs 738Lu L F (sd trim) M 2.4 CCD-34Lu (5) L N (2,5w) F 2.9 CCD-32Lu L N (1m) M 3.1 IMR-90 L F (16w) F 4.4 MRC-5 L F (14w) M 4.9 (1) lung (L), skin (S) (2) fetal (F), new born (N), week (w), month (m), second trimester (sd trim) (3) male (M), female (F) (4) Tritiated testosterone and androstenedione were respectively used for measurement of 17β-HSD-2 and 5α-reductase activities (5) These two cell lines were isolated from the same subject Inactivating activity of androgens in human fibroblast cell lines WEAK OR HIGH Provost et al JCEM 2002, 83 3883FIBROBLASTTYPE II EPITHELIAL CELL BLOOD VESSEL T T T T T androgen receptor Low Inactivating Activity T androgen receptor High Inactivating Activity Δ4 Δ4 Δ4 TΔ4 Δ4 Δ4 T Provost et al Endocrinology 2000 ; J. Clin. Endocrinol. Metab 2002 A549 and Fibroblasts Protection against androgen seems to be related to the inactivating activity19 From these in vitro results: One major question? 1- How to explain that the fibroblasts derived from female can inactivate androgens if only male can produce them? Do the lung from female can make androgens.In vivo MODEL ÜMouse ÜMouse is a model where androgens and sex are etiologic factors recognized for RDS. Ü Mouse lung contains the same androgen-expressing genes as  in human ÜGlucocorticoid receptors are expressed by the fetal lung tissues. ÜBalb/c; inbred F-1 strain, genetically similar; less individual variations Experimental  Design Ü Balb/c were mated in our animal core facility Ü Pregnant mice were sacrificed at GD 15, 16, 17, 18 (during the gestational period where expression of the Surfactant Protein-C an indicator of lung maturity is increased; Term GD21) Ü Fetuses were sexed (expression of Uty and Sry in the male) Ü Fetal lungs were collected (one pool / sex / pregnant mother) Ü Isolation of total RNA Ü Real time PCR ̇ Transcriptional analysis of androgen-metabolizing enzyme genes ̇ SP-C ̇ Expression were normalized with several housekeeping mRNAs known to be not constant during that period (SDHA, TBP, YWHAZ, GAPDH, HPRT-1)0 10 8 6 4 2 14 12 18 16 20 22 66Pregnant female # 70 71 72 77 10 28 78 79 80 7 8 19 20 34 44 3 6 14 31 60 Gestation Time (day) 15,5 16,5 17,5 18,5 1 7 ß - H S D  t y p e  2 - m R N A  l e v e l s / 1 7 ß - H S D  t y p e  5 - m R N A  l e v e l s ̇ Ratio Androgen inactivation / Androgen Synthesis > 2,F ~ 1 Provost et al AJRCCM 2004 170, 296Maturation FIBROBLASTSPT-II Before GD17 T T GD 17 Paracrine factors Reprogrammation + Ratio type 2 / type 5 favors the inactivation , no binding on AR Ratio type 2 /type 5 = 1 Maturation process ends HIGH Inactivatio n Surfactant Hypothesis T ΔA Ratio ~1 Maturation goes on M F No PFsFrom in vivo study we conclude that this capacity of the fetal lung to maintain an androgen-dependent pressure was unexpected and new. It is present in male and female. Provost et al 2004 Am J. Respir Crit Care Med 170:296-304This capacity of the lung to produce androgens with the emergence of the mature surfactant-producing cells acts as a signal to indicate these are mature and are ready to produce surfactant suggesting that androgen play a role in cell reprogramming. Provost et al 2004 Am J. Respir Crit Care Med 170:296ACTU-MATCH ! JEUDI 28 OCTOBRE 2010The extreme prematury is still a question of general interest and is still a delicate question. During the last months we are  working in the development of an integrate project trying to capture more generally  how the Sex Differences and Gender Influences the  fate of Premature Infants.Question How to address such a delicate question of a  birth at the limit of the viability in term of medical action, ie the decision to begin and /or to maintain medical assistance to maintain life (ressuscitation) or to stop or do nothingGENDER DIFFERENCES AND PREMATURE INFANTS: A Novel Integrative Approach to Evaluate the Impact of the Fetal Sex on Clinical PracticeÜBy developing NOVEL INTEGRATIVE APPROACHES to evaluate the IMPACT OF THE FETAL SEX ON CLINICAL PERINATAL PRACTICE. This means MORE PARTICIPATING DISCIPLINES to evaluate more precisely how fetal sex impact on pulmonary morbidity when a mother is a higher risk of premature delivery or generally when neonatal complications are predictable. GOAL of MUST ̇ Promote uni-/ multi-/ and trans/-disciplinar  researches to document the question of how the fetal sex should impact on critical medical situations in case of premature infants with the objective to elaborate new evidence- based guidelines in perinatalogy and public policy.- MUST groups professors from 3 Faculties and two Universities asking ONE question using several approaches WHERE THE FETAL SEX AND THE FATE OF BABIES BORN EXTREME PREMATURE IS CENTRAL, RDS, BPD - Sectors are: biomedical, clinical, public health, and bioethicist - Biomedical (Molecular physiology and endocrinology; tool:  molecular biology - Clinical (Ob, Neo, Epidemiology) and Populational approaches - To disseminate, to translate and transfer, and put existing and new knowledges into action for the benefit of these infants we set up a Web-based  discussion forum at http://www.fmed.ulaval.ca/prema/33 On-Going Activities 1- We have created the Web-Based Plateform 2- The First round of Discussion forum with up- date knowledge in Biomedical, Obstetrical, Pediatric, Ethic, Epidemiology, Psychologic have been published in an Ebook (http://www.fmed.ulaval.ca/prema/) 3- Focus Group with several practioners is on- going. 4- Follow-up of children with recruitment of infants at 5 years-old is on-going. We expect 200 infants in Montréal and QuébecAcknowledgements Le lab: Dr Pierre R. Provost,  Res Assistant (1993- ) Dr Tommy Seaborn, PDF (2005-2007) Dr Eva Bresson  PDF(2008- 04/2009) Marc Simard, student PhD (2004- ) Éric Boucher, student PhD  (2006- ) Julie-Alexandra Moulin, student MSc (2005-2007) Julie Plante, MSc (2002- 2005) Mélissa Côté, student MSc (2006- 2008 Nouvelles (2008- ): Marie-Christine Gérard Hudon Audrey Devillers, Geneviève Cormier Collaborators: Members of the MUST Group as well as other to different  ways Support: CHUQ and JJL Foundations, Lung Association from Québec, NSERC, CHIR, INSTITUTE OF GENDER AND HEALTH who has believed into this novel approach MS et EB are supported by a Ph.D. studentship award from the FRSQ-Réseau Santé Respiratoire. And STIRRHS, TS et EB were supported by CIHR/Wyeth R&D awardsThank youSTEROIDS GENDER DIFFERENCES AND PREMATURE INFANTS: A Novel Integrative Approach to Evaluate the Impact of the Fetal Sex on Clinical Practice N-Principal Investigator: Dr Yves Tremblay  I    I l I t r ti r  t l t  t  I t f t  t l   li i l r ti  - ri i l I ti t r: r  r l CLINICIANS: HEALTH POPULATION : BASIC SCIENTISTS : FORUM’S PARTICIPANTS:STEROIDS GENDER DIFFERENCES AND PREMATURE INFANTS: A Novel Integrative Approach to Evaluate the Impact of the Fetal Sex on Clinical Practice NPI: Dr Yves Tremblay  I    I l I t r ti r  t l t  t  I t f t  t l   li i l r ti  I: r  r l CLINICIANS: PIs: Bruno Piedboeuf, (neo) Emmanuel Bujold, (Ob) Francine Lefebvre, (neo) Project: To document sex differences  in long term neurobehavioral development while taking into account neonatal complications and health related difficulties (5 years). Project: To question the impact of fetal sex on counselling provided by clinicians. We are using small Focus-Group across Canada with obstetricians and neonatalogist separately: Québec, McGill, Montréal, Sherbrooke, BC, Edmonton HEALTH POPULATION: BASIC SCIENTISTS: FORUM’S PARTICIPANTS:STEROIDS GENDER DIFFERENCES AND PREMATURE INFANTS: A Novel Integrative Approach to Evaluate the Impact of the Fetal Sex on Clinical Practice: NPI: Dr Yves Tremblay  I    I l I t r ti r  t l t  t  I t f t  t l   li i l r ti : I: r  r l CLINICIANS: HEALTH POPULATION: BASIC SCIENTISTS: Yves Tremblay, (PhD) Guy Poirier (PhD) Pierre Provost (PhD) Project: To use advanced biomedical technologies to document, at the molecular level, the effect of biological sex on lung development and maturation: genomic,  proteomic and metabolomic approaches FORUM’S PARTICIPANTS:STEROIDS GENDER DIFFERENCES AND PREMATURE INFANTS: A Novel Integrative Approach to Evaluate the Impact of the Fetal Sex on Clinical Practice: NPI: Dr Yves Tremblay  I    I l I t r ti r  t l t  t  I t f t  t l   li i l r ti : I: r  r l CLINICIANS: HEALTH POPULATION: PI: Gina Muckle (psychosocial) Project: To also document, through access to a population-based cohort (QLSD) of infants born at term, whether the risk of difficulties at school entry for premature infants is similar to that found in the normal population. BASIC SCIENTISTS: FORUM’S PARTICIPANTS:STEROIDS GENDER DIFFERENCES AND PREMATURE INFANTS: A Novel Integrative Approach to Evaluate the Impact of the Fetal Sex on Clinical Practice: NPI: Dr Yves Tremblay  I    I l I t r ti r  t l t  t  I t f t  t l   li i l r ti : I: r  r l CLINICIANS: HEALTH POPULATION: BASIC SCIENTISTS: FORUM’S PARTICIPANTS: PIs  Raymond Lambert, Yves Tremblay: Coll: Anne-Marie gagné (psychologist) Ginette Mantha (PrémaQuébec) Mireille Carpentier (Éthique UQAR) Jean-Pierre Rogel (Journalist and KT) Caroline Chapraude (Jurist) Stéphanie Roberge (Epidemiology) To translate existing and new knowledge into realizations for premature infants, we set up a transdisciplinary research-analysis using Web- based discussion forum.  Using precise questions, participants evaluate how knowledge gained from research can be integrated to formulate transdisciplinary  advice.STEROIDS GENDER DIFFERENCES AND PREMATURE INFANTS: A Novel Integrative Approach to Evaluate the Impact of the Fetal Sex on Clinical Practice: NPI: Dr Yves Tremblay  I    I l I t r ti r  t l t  t  I t f t  t l   li i l r ti : I: r  r l CLINICIANS: HEALTH POPULATION: BASIC SCIENTISTS: FORUM’S PARTICIPANTS:STEROIDS GENDER DIFFERENCES AND PREMATURE INFANTS: A Novel Integrative Approach to Evaluate the Impact of the Fetal Sex on Clinical Practice: NPI: Dr Yves Tremblay  I    I l I t r ti r  t l t  t  I t f t  t l   li i l r ti : I: r  r l CLINICIANS: HEALTH POPULATION: BASIC SCIENTISTS: FORUM’S PARTICIPANTS:STEROIDS GENDER DIFFERENCES AND PREMATURE INFANTS: A Novel Integrative Approach to Evaluate the Impact of the Fetal Sex on Clinical Practice NPI: Dr Yves Tremblay  I    I l I t r ti r  t l t  t  I t f t  t l   li i l r ti I: r  r l CLINICIANS: HEALTH POPULATION: BASIC SCIENTISTS: FORUM’S PARTICIPANTS:To develop new research approach/project in a near future Ethic; law; economic prospective related to the cost to be born prematurely for the person himself but also for Society. NEXTYES HOW ?̇ How to follow-up on the sex difference. There is one way, that consist to target genes under the regulation of androgen early in gestation  (microarray) ̇ These studies are undergoing and we succeeded to identify cascade that are androgen-dependent. ̇ In parallel to the studies on the androgens we also showed that the fetal lung can also act as an adrenals, in that it can produce glucocorticoids and that this production also presents a sex difference (MANY FETUSES DO NOT RESPOND TO ANTENATAL GLUCOCORTICOID EVEN WITH OPTIMAL REGIMEN (Timing)) ̇We also identify genes that are involved in the lipid synthesis or transport and therefore could regulate surfactant production. These are also expressed with sex-differences 46̇ In short androgens exert two distinct roles ̇- One is deleterious and probably uccur as a consequence of the gonad differentiation ̇One is good and occurs in both sexe and is involved in the fibroblasts reprogrammation. ̇This is great but for the purpose of today these data cannot explain the sex difference. 47

Cite

Citation Scheme:

    

Usage Statistics

Country Views Downloads
United States 15 0
Canada 7 1
Indonesia 2 0
Netherlands 1 2
Malaysia 1 0
Australia 1 0
France 1 0
City Views Downloads
Durham 5 0
Richmond 5 1
Unknown 4 24
University Park 2 0
Atlanta 2 0
Québec 2 0
Ashburn 2 0
Columbus 1 0
Mountain View 1 0
Melbourne 1 0
Waverly 1 0
Maitland 1 0
Shah Alam 1 0

{[{ mDataHeader[type] }]} {[{ month[type] }]} {[{ tData[type] }]}
Download Stats

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
http://iiif.library.ubc.ca/presentation/dsp.52383.1-0132691/manifest

Comment

Related Items