Perspectives in Public Health

Research has led to effective treatment regimes for erectile dysfunction (ED). Convincing evidence links vascular risk factors (hypertension, diabetes mellitus, hyperlipidaemia and smoking) with ED. This association is not surprising since the corpus cavernosum is a modified vascular tissue. This review presents a brief account of the aetiology, diagnosis and treatment of ED. There is a need to raise awareness of this condition and to make appropriate treatment available to patients.

Testicular cancer is a rare condition, accounting for approximately 1-1.5% of all cancers in men. It is the most common cancer affecting men in their 20s and 30s. Little is known about the exact cause of this disease, although numerous risk factors have been recognised.

Treatment of testicular cancer has been extremely successful, with impressive cure rates reported. This is due to the excellent tumour response to chemotherapy and radiotherapy, and also to the diagnosis and follow-up regimes.

Prostate cancer is the second most common cancer affecting men in Europe and the USA. The incidence of prostate cancer has risen by 60-75% in the Western world in the last 15 years. One in twelve men over the age of 60 develop prostate cancer and this figure is expected to rise to three in twelve in the next 20 years. Early prostate cancer often does not cause symptoms. However, patients may present with lower urinary tract symptoms (LUTS) and therefore, such patients should be investigated. Effective treatment in the form of surgery and radiotherapy is available for individuals with localised disease, and the effectiveness of different combination therapy is being assessed to improve the outcome further.

Approximately 20% of the patients have metastatic disease on presentation. The mainstay of treatment for these patients is androgen ablation therapy; however patients on this regime eventually relapse and develop an androgen independent tumour. This aggressive stage of the disease carries a high morbidity and mortality. At present the treatment for such hormone refractory prostate cancer is inadequate and the desperate search for alternative forms of therapy continues.

Benign prostatic hyperplasia (BPH) is a common condition, which increases with increasing age. Although not a life-threatening condition, BPH can significantly affect quality of life. BPH manifests clinically with lower urinary tract symptoms (LUTS) and may be associated with sexual dysfunction. As many as 60% of men aged 60 years have some degree of clinical BPH. With the projected increases in the distribution of people over the age of 60, BPH is set to become an even greater problem in men’s health.

Bladder cancer is the fifth most common malignancy in Europe and the fourth most common malignancy in the United States.¹ It affects one in 4000 people and accounts for 5% of all diagnosed cancers. The peak incidence is in the fifth and seventh decade.

There is a strong association between smoking and bladder cancer. Smokers have a fourfold higher incidence of developing bladder cancer than the general population.²

The disease has a spectrum of clinical severity varying from superficial bladder cancer to muscle invasive or metastatic disease which carries a poor prognosis. Currently the superficial form of the disease is managed by endoscopic resection of the tumour, often followed by the instillation into the bladder of cytotoxic agents. Due to the tendency of bladder cancer to recur repeated cystoscopies and resections are often required. Because of this, one of the main thrusts of research is to find a way of preventing the progression from superficial disease to muscle invasive and metastatic bladder cancer.

Non-regular, non-cohabiting relationships and condom neglect are known to fuel the HIV/AIDS epidemic in Africa. Reproductive health needs of the men, the major decision-makers in this community, have been grossly neglected in this regard. This exploratory, community-based study assessed condom use among married men when with commercial sex workers (CSWs) and abstinent behaviour when their wives were unavailable for sex. (A CSW is one known to receive payment for sex.)

Out of the 3,178 married respondents, 1,755 (55.2%) had ever used condoms. Of this number, 1,296 (73.8%) resided in urban locations while 459 (26.2%) resided in rural areas. Of these men, 137 had used CSWs in the six months prior to the study. Only 63 (46%) of these had used a condom at the last visit. Young age (<30 years) was the only predictor of condom use when with CSWs (p=0.03). Predictors of abstinence behaviour when the wife was unavailable for sex included: primary and secondary education, young age of the wife, low occupational status and monogamy.

National HIV/AIDS control programmes should address men’s risk-taking behaviour, empowering women to negotiate condom use and reduce long abstinence periods.

Continued efforts should be made to reach sex workers and to make condoms much more widely available, acceptable and affordable, especially in rural areas.

This paper describes the development of a community mental health project in a local football stadium.

Funded for three years by the Laureus Foundation’s ‘Sport for Good’ initiative, the project provides mental health promotion and mental health awareness input targeted initially at young men, a group who are often very difficult to engage in this type work.

Using group interventions and utilising football as a metaphor, the project helps young men address issues around depression, self-esteem and inclusion, and addresses the subject of suicide which remains the second biggest cause of death in young men in Britain.

The paper describes the development of the project, the structure of the groups and the evaluation of the first two groups to complete the process.

The work takes place in the Moss Rose stadium, home of Macclesfield Town, a team in the English Football League.