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Obesity has a greater impact on cardiovascular mortality in younger men than in older men among non-smoking Koreans.

INTRODUCTION: We investigated the effects of age on the relationship between body mass index (BMI) and cardiovascular risk factors and cardiovascular mortality in non-smoking Korean men. METHODS: We performed a prospective cohort study of 246,146 non-smoking Korean men aged 20-69 years at baseline (1992) who were initially without history of cancer or weight change. The associations between BMI and cardiovascular risk factors and mortality during an 9-year follow-up period (2000) were stratified by age group after adjustment for family history, alcohol consumption, exercise habits, and economic status. RESULTS: Calculations of odds ratios (ORs) revealed that younger men (<40 years) with greater BMI (>or=28 kg/m2) were at greater risk of high blood pressure, high blood glucose, and high total cholesterol than older men. The ORs for cardiovascular risk factors associated with greater BMI declined linearly with age. The relative risks for mortality from stroke and from all cardiovascular diseases associated with greater BMI were also higher among younger men and declined linearly with age. CONCLUSIONS: The cardiovascular risk factors and mortality associated with greater BMI were higher among younger than older non-smoking Korean men. These findings indicate that obesity has a greater impact among younger men with respect to premature cardiovascular related deaths.

Adult↗

Comparison of gait of young men and elderly men.

The purpose of this study was to describe and compare the free-speed gait characteristics of healthy young men with those of healthy elderly men. Data collection consisted of high-speed cinematography resulting in synchronized front and side views of 24 healthy male volunteers, 12 between 20 and 32 years of age and 12 between 60 and 74 years of age. Young men were recruited to match the elderly men on the basis of right-leg length. Each subject participated in three filmed trials of free-speed ambulation down a 14-m walkway. The processed film was analyzed for eight gait characteristics. Differences in characteristics between the two groups were examined using a correlated t test (p less than .01). No significant differences were observed between the groups for step and stride length, velocity, ankle range of motion, vertical and horizontal excursions of the center of gravity, and pelvic obliquity; however, the younger men demonstrated a significantly larger stride width than the elderly men (p less than .01). The results suggest that the two populations of healthy adult men have similar gait characteristics.

Adult↗

High prevalence of HIV infection among young men who have sex with men in New York City.

OBJECTIVE: To determine the prevalence of HIV infection and risk behaviors among young men who have sex with men (MSM) aged 15-22 years in New York City. DESIGN: An anonymous cross-sectional survey. METHODS: The 1998 Young Men's Survey in New York City (YMS-NYC), was a multistage probability survey of 541 MSM aged 15-22 years who attend public venues. After identification of venues and their associated high attendance time periods, random samples of venues and time periods were selected on a monthly basis. At each sampling event, potential participants were approached to determine eligibility. Eligible and willing men were interviewed, counselled and had a blood specimen drawn. RESULTS: Between December 1997 and September 1998, 115 sampling events were conducted. Of 612 men enrolled, 541 reported ever having had sex with a male partner. The HIV seroprevalence among the 541 MSM sampled was 12.1%. The HIV seroprevalence was 18.4% among African-Americans, 16.7% among persons of mixed race, 8.8% among Latino individuals and 3.1% among white men. HIV seroprevalence was 5.0% among 15-18 year olds and 16.4% among 19-22 year olds. A total of 65.5% of MSM were susceptible to hepatitis B virus infection (HBV). Almost half (46.1%) of the men reported unprotected anal sex in the previous 6 months and 16.3% reported ever having had an STD. Multiple regression analyses found that being older, of mixed race, black or ever having had an STD was associated with being HIV antibody positive. CONCLUSION: These data identify a large subgroup of MSM in need of effective HIV and HBV primary and secondary prevention programs.

AIDS Serodiagnosis↗

Is 'knowing people with HIV/AIDS' associated with safer sex in men who have sex with men?

OBJECTIVE: To examine the sexually protective role of knowing person(s) with HIV/AIDS (PWHA) by conducting a multidimensional analysis distinguishing the number of PWHA known (by disease status and relationship category) and aspects of the relationship with the closest PWHA (emotional closeness, length of time known, disease status, type of relationship). DESIGN: Cross-sectional study of white, Latino, and African-American men who have sex with men recruited at street locations in West Hollywood, California, in 1997. METHODS: The analyses conducted with linear regression models focused on men (n = 334) who reported that they were seronegative or of unknown serostatus and thus at risk for HIV infection. Unprotected sex was defined as percentage of anal intercourse partners in the past 12 months with whom unprotected anal intercourse (UAI) occurred at least once. RESULTS: The number of PWHA known was not associated with the percentage of UAI partners in multivariate or univariate analyses. Greater emotional closeness to a person who was HIV-positive without AIDS was associated with reduced UAI in multivariate models even after excluding participants whose close PWHA was a lover or sex partner. Younger men (18-25 years) knew fewer PWHA, reported less emotional closeness to a PWHA, and had a higher level of UAI than did older men. CONCLUSIONS: Emotional closeness to a seropositive person without AIDS may be a sexually protective factor. The results suggest the possibility that lower levels of emotional closeness to a PWHA may partially underlie the elevated sexual risk behavior of younger men who have sex with men.

Adolescent↗

HIV, syphilis and heterosexual bridging among Peruvian men who have sex with men.

OBJECTIVES: To determine prevalence of and risk factors associated with HIV and syphilis seropositivity and estimate incidence of HIV infection among Peruvian men who have sex with men (MSM) and characterize behaviors of men who report sex with both men and women ('bridgers'). DESIGN: Cross-sectional study of MSM in Lima, Peru. METHODS: Four-hundred and fifty-one MSM (of whom 442 responded to the question regarding sexual orientation) recruited through street outreach. Each was interviewed and underwent serologic testing for syphilis and HIV, including the less sensitive enzyme immunoassay test to estimate HIV incidence. RESULTS: Overall, HIV and syphilis prevalence were 18.5% and 16.0%, respectively, with highest prevalence among cross-dressers (33.3% and 51.1%, respectively). The estimated overall HIV seroincidence was 11.2% per year (95% confidence interval, 4.8-23.6). Overall, 47.1% of men reported ever having sex with a woman: 78.6% of men self-identifying as heterosexuals, 85.1% of bisexuals, 35.5% of homosexuals, and 12.5% of cross-dressers. Of these, 26.5% were 'bridgers', of whom 55% reported two or more female partners during the last year. 'Bridgers' were less likely to have always used condoms during the past year for vaginal sex (17%) than for insertive anal sex with men (25.5%). CONCLUSIONS: Among MSM in Peru, HIV and syphilis prevalence and HIV incidence were high, especially among cross-dressers. The high prevalence of bisexuality and low rates of consistent condom use, especially with female sexual partners indicates potential HIV transmission into the heterosexual population.

Adolescent↗

Men and their bodies: a comparison of homosexual and heterosexual men.

The study examined influences on body satisfaction, disordered eating, and exercise behavior of a male subculture that places a heightened emphasis on appearance: the homosexual male subculture. Subjects were 71 homosexual and 71 heterosexual men. Relative to heterosexual men, homosexual men showed more body dissatisfaction and considered appearance more central to their sense of self. Also, their exercise was more motivated by a desire to improve attractiveness. Among the homosexual but not the heterosexual group, men who desired to be thinner showed more attitudes and behaviors associated with disordered eating than men who were thinner than their desired size. In contrast, heterosexual but not homosexual men who wished to be heavier had lower self-esteem scores than men who were heavier than or equal to their desired size. The findings support a view that a male subculture that emphasizes appearance may heighten the vulnerability of its members to body dissatisfaction and disordered eating.

Adult↗

Factors associated with testing for hepatitis C in an internet-recruited sample of men who have sex with men.

BACKGROUND: Nearly 4 million individuals in the United States (1.8%) have been infected with hepatitis C virus, yet few are aware of their infection. GOAL: To identify correlates associated with hepatitis C virus testing among a sample of men who have sex with men. STUDY DESIGN: Internet communications were used for solicitation and collection of data, using a 31-question survey. RESULTS: When the study was restricted to men who have sex with men in the United States (n = 381), 95% of the respondents (n = 361) reported at least one risk factor for hepatitis C virus transmission, 39% of these respondents (n = 140) reported having been tested for hepatitis C virus. Testing was associated with a history of nonsexual risk behavior, increased knowledge of the hepatitis C virus, and healthcare provider communication. CONCLUSION: A significant proportion of at-risk respondents had not been tested. Interventions are needed to increase hepatitis C virus knowledge in the community of men who have sex with men, and to encourage providers to communicate about hepatitis to the men in this group who screen as high risk on the basis of their risk behaviors.

Adolescent↗

The HIV epidemic among older men who have sex with men.

The authors present HIV prevalence and risk behavior data for urban men who have sex with men (MSM) aged 50 years or older. Data are based on a probability sample of MSM conducted in 1997 (n = 2881 total; 507 older MSM) in New York, Los Angeles, Chicago, and San Francisco. The authors determined HIV status through self-report and biologic measures. Risk behavior was assessed through self-report. The authors found that HIV prevalence was 19% (95% CI: 14, 25) for men in their 50s and 3% (95% CI: 1, 10) for men in their 60s. No men in their 70s were HIV-positive. Prevalence was at high levels for older blacks (30%), MSM who are injection drug users (21%), moderately heavy drug users (35%), and less closeted men (21%). High-risk sex between serodiscordant partners was relatively constant (4%-5%) across age groups older than 30 years of age and decreased among MSM in their 70s. Current levels of HIV among older urban MSM in the United States are very high, particularly among those in their 50s. High mortality rates among MSM with AIDS up to 1996 (before highly active antiretroviral therapy [HAART]) would account for the lower levels among men in their 60s and 70s. Because of HAART, we would expect HIV levels to increase in these age groups. Given high levels of risk behavior among MSM through the sixth decade of life, the authors would expect an older MSM epidemic of substantially larger proportion than that observed in the 1980s and 1990s.

Age Factors↗

High HIV prevalence and risk behaviors in men who have sex with men in Chennai, India.

OBJECTIVE: To estimate HIV and sexually transmitted disease (STD) prevalence and behavioral risk characteristics of men who have sex with men (MSM) in Chennai, India. METHODS: A cross-sectional population-based random sample survey was conducted in 2001. Randomly selected residents of 30 slums in Chennai were interviewed for behavioral risk factors through face-to-face interviews. Sera and urine were examined for syphilis, HIV-1, gonorrhea, and chlamydia. Logistic regression analyses were used to assess associations between MSM status and HIV infection and to identify risk characteristics of MSM. RESULTS: Of 774 men, 46 reported (5.9%) sex with other men. MSM were more likely to be seropositive for HIV (odds ratio [OR] = 8.57; 95% confidence interval [CI]: 1.83, 40.23) and were more likely to have a history of STD (OR = 2.66; 95% CI: 1.18, 6.02) than non-MSM. Men who used illicit drugs in past 3 months (adjusted odds ratio [AOR] = 4.01; 95% CI: 1.92, 8.41), ever exchanged money for sex (AOR = 3.93; 95% CI: 1.97, 7.84), or were ever tested for HIV (AOR = 3.72; 95% CI: 1.34, 10.34) were significantly more likely to report sex with men. CONCLUSIONS: MSM in Chennai slums are at high risk for HIV. HIV prevention strategies aimed at changing unsafe drug and sexual practices should target the general population of men, with specific attention to areas with high rates of MSM.

Adolescent↗

A comparison of on-line and off-line sexual risk in men who have sex with men: an event-based on-line survey.

OBJECTIVE: To assess whether men who have sex with men (MSM) are more likely to report unprotected anal intercourse (UAI) with partners met on-line compared with those met off-line. METHODS: A total of 6122 individuals consented to participate in an anonymous behavioral survey on-line. This event-based analysis is limited to the 1683 men from the United States and Canada who had sex in the 3 months before the study and reported that their last sexual encounter included a new or casual male partner or partners. Prevalence and predictors of UAI were analyzed separately for the 386 men reporting more than 1 partner (multiple) and the 1297 men reporting only 1 (single) partner in their last encounter. RESULTS: Of the 1683 MSM recruited on-line, 51% met their partner(s) in their last sexual encounter on-line and 23% reported UAI. No difference in risk for UAI was found for partners met on-line versus off-line in the bivariate or multivariate analyses. In a multivariate analysis of men with multiple-partner encounters, UAI was significantly associated with being HIV-seropositive (adjusted odds ratio [OR] = 2.87; P = 0.02) in a model that included age; education; whether partners were met on-line or off-line; and use of crystal methamphetamine, sildenafil, or alcohol before sex. Using the same model, significant predictors of UAI in men reporting a single-partner encounter were use of crystal methamphetamine (adjusted OR = 5.67; P = 0.001) and no college degree (adjusted OR = 1.63; P = 0.01). CONCLUSIONS: MSM recruited on-line who reported a new or casual sex partner(s) in the prior 3 months are at considerable risk of HIV or other sexually transmitted infections, but they are equally likely to report UAI whether sex partners were met on-line or off-line. The Internet may be an ideal venue for reaching high-risk MSM.

Adolescent↗

Decreased spinal and femoral neck volumetric bone mineral density (BMD) in men with primary osteoporosis and their first-degree male relatives: familial effect on BMD in men.

OBJECTIVE: Low bone mass may be caused by a reduction in the amount of bone or density of bone or both. The purpose of this study was to examine differences in bone volume and volumetric bone mineral density (vBMD) in men with primary osteoporosis and their first-degree male relatives (FDMR). DESIGN: We used dual-energy X-ray absorptiometry (DXA) to measure areal density, then calculated bone volume and volumetric density in 121 men with primary osteoporosis, 73 FDMR and 66 normal men. We used regression methods adjusting for age, height and weight to determine deficits in bone volume and vBMD at the spine and femoral neck between men with spinal fractures due to primary osteoporosis, FDMR and normal men. RESULTS: Men with osteoporosis had a tendency to smaller bone volume in the spine and femoral neck (P = 0.08 and P = 0.09, respectively) and lower volumetric bone density at the spine (by about 50%) and femoral neck (by about 30%) compared with healthy controls (P < 0.0001). FDMR had no deficit in bone volume but did have lower volumetric density at the spine (by 10.2%) compared with healthy controls (P < 0.0001). CONCLUSIONS: A deficit in bone mineral accrual may underlie the pathogenesis of primary osteoporosis in men, resulting in low vBMD. This is likely to be determined by genetic factors, although shared common environmental factors may also be important.

Absorptiometry, Photon↗

Sexual function of men ages 40 to 79 years: the Olmsted County Study of Urinary Symptoms and Health Status Among Men.

OBJECTIVES: Knowledge of male sexual function is somewhat limited because of a lack of current population-based data. This study provides information on sexual function and satisfaction in a population-based sample of men. METHODS: Men aged 40 to 79 years (n = 2115) were selected randomly from the Olmsted County population for the baseline component of a prospective cohort study (the Olmsted County Study of Urinary Symptoms and Health Status Among Men) during 1989-1990. The men completed a self-administered questionnaire that included questions about sexual concerns, performance, satisfaction, drive, and erectile dysfunction. RESULTS: For all five sexual parameters queried, the prevalence of problems and dysfunction increased with age. A comparison of men aged 70 to 79 years with men aged 40 to 49 years suggested that older men were more worried about sexual function (46.6% vs 24.9%), had worsened performance compared with a year ago (30.1% vs 10.4%), expressed extreme dissatisfaction with sexual performance (10.7% vs 1.7%), had absent sexual drive (25.9% vs 0.6%), and reported complete erectile dysfunction when sexually stimulated (27.4% vs 0.3%). Logistic regression analyses suggested that sexual dissatisfaction was significantly associated with erectile dysfunction, decreased libido, and the interaction between erectile dysfunction and libido, but not age. CONCLUSIONS: These population-based cross-sectional data corroborate the previously reported age-related decrease in sexual function. The age-related increase in dissatisfaction could, however, be accounted for primarily by the age-related increase in erectile dysfunction, decreased libido, and the interaction between erectile dysfunction and decreased libido.

Adult↗

Psychosexual factors that differentiate men with inhibited ejaculation from men with no dysfunction or another sexual dysfunction.

AIM: Inhibited or retarded ejaculation (IE) is an uncommon male sexual dysfunction that may result in a lack of sexual fulfillment for both the man and his partner. In this study, we attempted to identify factors that differentiate men with IE from sexually functional controls or from men with other sexual dysfunctions and to specify whether such factors predict self-reported sexual arousal during psychophysiological assessment. METHODS: Each patient underwent psychophysiological assessment and a structured clinical interview based on a standardized questionnaire that included demographic information, psychosexual and medical history, and assessment of current sexual, erectile, and ejaculatory function, including relationship quality and characteristics. RESULTS: Men with IE resemble men with other dysfunctions but are differentiated from controls, in their lower level of relationship satisfaction, greater level of distress, and higher level of health-related problems. Men with IE were further characterized by lower levels of self-reported subjective sexual arousal, despite exhibiting strong penile response during psychophysiological testing and reporting high quality erections across a variety of situations. Also notable, however, were the many factors on which men with IE did not differ from controls. CONCLUSIONS: Taken together, this research helps specify directions for future investigations of men with IE.

Adult↗

Antioxidant state and mortality from coronary heart disease in Lithuanian and Swedish men: concomitant cross sectional study of men aged 50.

OBJECTIVE: To investigate possible risk factors and mechanisms behind the four times higher and diverging mortality from coronary heart disease in Lithuanian compared with Swedish middle aged men. DESIGN: Concomitant cross sectional comparison of randomly selected 50 year old men without serious acute or chronic disease. Methods and equipment were identical or highly standardised between the centres. SETTING: Linköping (Sweden) and Vilnius (Lithuania). SUBJECTS: 101 and 109 men aged 50 in Linköping and Vilnius respectively. MAIN OUTCOME MEASURES: Anthropometric data, blood pressure, smoking, plasma lipid and lipoprotein concentrations, susceptibility of low density lipoprotein to oxidation, and plasma concentrations of fat soluble antioxidant vitamins. RESULTS: Systolic blood pressure was higher (141 v 133 mm Hg, P < 0.01), smoking habits were similar, and plasma total cholesterol (5.10 v 5.49 mmol/l, P < 0.01) and low density lipoprotein cholesterol (3.30 v 3.68 mmol/l, P < 0.01) lower in men from Vilnius compared with those from Linköping. Triglyceride, high density lipoprotein cholesterol, and Lp(a) lipoprotein concentrations did not differ between the two groups. The resistance of low density lipoprotein to oxidation was lower in the men from Vilnius; lag phase was 67.6 v 79.5 minutes (P < 0.001). Also lower in the men from Vilnius were mean plasma concentrations of lipid soluble antioxidant vitamins (beta carotene 377 v 510 nmol/l, P < 0.01; lycopene 327 v 615 nmol/l, P < 0.001; and lipid adjusted gamma tocopherol 0.25 v 0.46 mumol/mmol, P < 0.001. alpha Tocopherol concentration did not differ). Regression analysis showed that the lag phase was still significantly shorter by 10 minutes in men from Vilnius when the influence of other known factors was taken into account. CONCLUSIONS: The high mortality from coronary heart disease in Lithuania is not caused by traditional risk factors alone. Mechanisms related to antioxidant state may be important.

Antioxidants↗

Coping with unfair treatment at work--what is the relationship between coping and hypertension in middle-aged men and Women? An epidemiological study of working men and women in Stockholm (the WOLF study).

BACKGROUND: An important hypothesis in psychosomatic medicine is that exposure to psychosocial factors that arouse anger may accelerate the onset of hypertension, particularly if the subject is not allowed to show anger or to deal constructively with the factor that evoked it. For working men and women, being treated in an unfair way at work may be crucial. The present study was designed to answer the question whether the pattern of coping - primarily directed towards the aggressor (open) or directed inwards or towards others (covert) - is associated with hypertension among working men and women. STUDY GROUP: Five thousand seven hundred and twenty working men and women aged 15-64 participated in the study. The participation rate was 76%. METHODS: The coping pattern was studied by means of a Swedish version of a self-administered questionnaire that was originally introduced by Harburg et al. RESULTS: Significant results were confined to the age group 45-54. All analyses were adjusted for age and body mass index. Smoking habits and social class had no effect on the relationships. Low scores (lowest quartile) for open coping tended to be associated with an elevated prevalence ratio (PR) of hypertension both among men (PR 1.3, 95% confidence interval, CI, 0.9-1.7) and women (PR 1.4, 95% CI 1.0-2.0). High scores for covert coping (highest quartile) were associated with an elevated PR of hypertension among men (PR 1.6, 95% CI 1.2-2.2) but not in women. If the analysis was confined to cases without medication, the relationship between a high level of covert coping and high blood pressure was still significant for men. For women, however, no significant findings were made after this operation. Accordingly, the relationship between a low level of open coping and hypertension in women was confined to women with medication. Coping patterns were correlated with psychosocial work environment factors, in particular decision latitude. CONCLUSION: In men, covert coping was associated with prevalence of hypertension. In women, there tended to be a relationship between low scores for open coping and hypertension.

Adaptation, Psychological↗

Serum sialic acid, a reputed cardiovascular risk factor, is elevated in South Asian men compared to European men.

Serum total sialic acid (TSA) has recently been reported as a cardiovascular risk factor, but whether there are racial differences is not known. One hundred and twenty-four healthy young subjects (62 women and 62 men) were studied. Their age was 20.7 [0.9] years and they were matched for body mass index (BMI). Sixty-eight were of South Asian origin (37 women and 31 men) and 56 (25 women and 31 men) were European. Mean (SD) serum TSA was significantly higher in the South Asian men than the age-matched European men (74.3 [12.3] mg/dL versus 68.2 [13.0] mg/dL, P = 0.0198). In addition, serum TSA was significantly higher in South Asian women compared with European men (71.6 [8.9] mg/dL versus 68.2 [13.0] mg/dL, P = 0.0352). Finally, serum TSA was significantly higher in European women compared with European men (76.0 [13.1] mg/dL versus 69.2 [13.0] mg/dL, P = 0.008). We conclude that serum TSA may be worth measuring in different racial groups and also may be useful to assess individuals at risk of cardiovascular disease. Large prospective studies may help to explain why serum TSA is a reputed cardiovascular risk factor and shows racial differences.

Adult↗

Coronary heart disease mortality among men aged 35-44 years by prefecture in Japan in 1995-1999 compared with that among white men aged 35-44 by state in the United States in 1995-1998: vital statistics data in recent birth cohort.

The levels of risk factors for coronary heart disease (CHD) in men in the post World War II (WWII) birth cohort are almost similar between Japan and the USA, except for the considerably higher prevalence of cigarette smoking in Japan and the much higher prevalence of obesity in the USA. The present study evaluated the CHD mortality among men in the post WWII birth cohort by prefecture in Japan in 1995-1999 and then compared the data with those for white men in different states in the USA. There was a greater than 2-fold difference in CHD mortality among men aged 35-44 by prefecture in Japan: 5.3/100,000 in Kumamoto vs 12.6/100,000 in Tochigi. CHD mortality among men aged 35-44 in the top 3 prefectures in Japan is about half that of white men in the USA and is similar to that of white men in the lowest 3 states. The much lower CHD mortality in Japan does not appear to be caused by differences in the classification of causes of death and the results suggest that there may be strong and important protective factors that reduce the risk of CHD in Japan.

Adult↗

A study to assess the prevalence of chronic testicular pain in post-vasectomy men compared to non-vasectomised men.

OBJECTIVE: To assess the prevalence of chronic post-vasectomy testicular pain (CPTP) compared to the prevalence of chronic testicular pain in a control population of non-vasectomised men. METHODS: A retrospective postal study of 198 men who had a vasectomy more than 3 years previously at the Palatine Centre to determine the incidence of CPTP, of whom 101 (51%) replied (mean age 40.4 years, range 29-54 years, mean time since vasectomy 46.5 months). A control group of 102 men (mean age 40.2 years, range 28-55 years) who had not had a vasectomy were obtained via patients attending the community family planning clinics or associated general practitioner (GP) services in the same geographical area. RESULTS: Occasional non-troublesome discomfort was reported by 37/101 of the post-vasectomy men compared to 21/102 of the control group. Occasional discomfort which was a nuisance was felt by 10/101 of the post-vasectomy group compared with 3/102 of the control group, and 6/101 in the post-vasectomy group reported pain severe enough to seek medical advice compared to only 2/102 controls. None of the post-vasectomy men regretted having had the operation. CONCLUSIONS: Only 6% of cases (compared to 2% of controls) experienced pain severe enough to seek medical advice in the 3-4-year post-operative period. However, there was a significant difference in the prevalence of occasional testicular discomfort between post-vasectomy men and controls. Mostly these pains were not regarded as troublesome, however men attending for vasectomy counselling should be informed of the possibility of this morbidity.

Adult↗