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Exploring Primary Care Clinicians' Sexual and Reproductive Health Care Delivery to Male Adolescents and Young Adults.

INTRODUCTION: Despite existing guidance for adolescent sexual and reproductive health (SRH) care, male adolescent SRH care receipt is inadequate. Limited research has explored factors affecting clinicians' provision of SRH care to male adolescents, specifically. METHODS: This mixed-method study with 12 primary care clinicians included a brief survey assessing care delivery practices and confidence, followed by an in-depth interview to explore factors affecting SRH care delivery. RESULTS: Clinicians reported high confidence delivering male adolescent SRH care (mean ± SD: 8.31 ± 1.71 out of 10), but delivered only about half the recommended services (20 items out of 38). Factors influencing care delivery included gaps in education/training, assumptions about male SRH care, and behavioral constraints at various levels. DISCUSSION: Findings underscore the need to strengthen male adolescent SRH care by enhancing provider training, increasing clinic-level supports, and addressing structural barriers. CONCLUSIONS: Findings can inform strategies to improve the quality and comprehensiveness of SRH services for male adolescents in primary care settings.

Humans

Medicine in China.

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China

Characteristics of men most likely to respond to an invitation to be screened.

Some of the characteristics of men, with known risk factors, who were most likely to respond to an invitation to be screened in a national randomized clinical trial to prevent heart disease were determined in 18,872 men, 35-57 years of age, members of the Kaiser Foundation Health Plan of Oregon. Demographic characteristics and risk factor variables (blood pressure, blood cholesterol, and cigarette smoking levels) were abstracted from medical records. The men were ranked high priority or low priority according to level of risk. All age-eligible men in the health plan received at least one invitation to be screened, with high-priority men receiving more invitations. Despite concentrated efforts to bring them in, less than one-half the high-priority men were screened. Participants were older and wealthier than non-participants, and more likely to have more dependents and to routinely use medical services. Whether or not a man received a medical care service within the preceding two years was a powerful discriminating variable in both the univariate and multivariate analyses reported. The findings suggest that health care programs serving a stable population group should give more consideration to screening in routine medical care.

Adult

Therapeutic regimens for anorectal gonococcal infection in males.

Anorectal gonococcal infection is particularly prevalent in women and homosexual men. Although the currently recommended Public Health Service therapeutic regimens for uncomplicated gonorrhea appear to be effective also for anorectal gonorrhea in women, their efficacy for anorectal infection in men has not been adequately evaluated. We report a case of gonococcal proctitis in a homosexual man that did not respond to therapy with ampicillin plus probenecid and tetracycline, but subsequently responded to spectinomycin therapy. Currently available therapeutic regimens for anorectal gonococcal infection in males are reviewed.

Adult

Sex differences in the utilization of health services for psychiatric problems in Saskatchewan.

Comprehensive data on all pscyhiatric patients in Saskatchewan show that women are substantially higher users of health services for psychiatric problems than are men. Women: 1) use up to twice as many services as men in the private sector, but use almost the same number of public sector services; 2) tend to be treated for psychosomatic and neurotic disorders on an outpatient basis; 3) have only a slightly greater chance than men of being hospitalized; and 4) are less likely than men to have organic or addictive diagnoses. These differentials in utilization cannot be explained by age, diagnoses and/or marital status. Sex is the best predictor of utilization. These results are largely consistent with utilization and epidemiological literature. It seems more likely that these sex differences in utilization result from the interaction of biology, sex roles, and the functioning and labelling processes of the health system rather than from any single factor. Combining Andersen's components of health behaviour with Freidson's lay-professional construction of illness continuum yields a possible framework for understanding sex differences in the utilization of psychiatric health services.

Adult

[Experience with detoxification and weaning of heroin addicts by means of acupuncture, gabergic drugs and psychopharmacologic agents in low doses].

UNLABELLED: Presents extensive reports of detoxification and habit loosing trials in 9 male heroine addicts, 19-26 yr. The therapeutic programs were centered on gabergic drugs, low doses tricyclic antidepressants and benzodiazepines, and acupuncture (main points: 8 GB; nasal GB; 1 GB; 3 L; 4 LI; 36 S; 7 H; auricular Shen men) and were continued weekly at the Mental Health Outpatients Service, after discharge from the hospital. RESULTS: 2 Ss, personally checked, abstinent 6 months after their discharge; 4 Ss heard as abstinent and 3 Ss relapsed. Technique, course and times of the therapeutic program seem to be one of the key factors for success.

Acupuncture Therapy

Stepwise regression of psychosocial problems on global impairment ratings.

Calculated the correlations between the severity ratings for 27 psychosocial problems and global impairment ratings of daily functioning for 109 men and 206 women admitted to the outpatient services of a community mental health center. Controlling for sex and total number of problems rated, a stepwise regression analysis indicated that global impairment estimates were related to problems that represented thought processes, affect, and role functioning. The severity ratings for the thought process problems contributed the most variance (14%) toward the explanation of the global impairment ratings.

Adult

Survey of alcoholism treatment services in Victoria. Relationship of alcoholics drug use to their use of medical facilities.

A cooperative survey of 370 individuals presenting for treatment at nine Victorian alcoholism treatment centres showed that men and women in this population of alcoholics did not differ significantly in indices of their lifetime consumption of alcohol or tobacco per kilogram of body weight, despite considerable difference in their present use of these drugs. Physical disability was associated with extended tobacco consumption both in men and in women. Little relationship existed between use of medical services and the extended use of alcohol, though high present consumption was associated with increased general hospital admissions in men.

Adult

Differences in the provision of mental health services by race.

A study of a newly mandated crisis clinic still shows the signs of a different quality of service offered to Third World clients. Black men in the present study had difficulty in obtaining the most needed and most preferred services. Reasons for the disparity in services appear to be institutional.

Adult

Hospital doctors' career structure and misuse of medical womanpower.

Biological and culturel differences between men and women lead to severe discrimination against women doctors who bear the burdens of pregnancy, child-rearing, and housework. These lead, from equality within medical school and at qualification, to increasing failure to obtain posts commensurate with their innate abilities. Women doctors who temporarily and partially drop out of full-time practice have been studied frequently, but men (who are equally expensive to train) have not, despite their disappearing from National Health Service practice through emigration, death, alcoholism, suicide, or removal from the Medical Register. In a working lifetime of forty years, a woman doctor with an average family is likely to do seven-eighths of the work of a doctor who has not had to carry the primary responsibility of bearing and rearing children. Doctors with dependants are handicapped, and a separate career structure might be set up for them. Supernumerary consultant posts are proposed.

Adult

Radiologic heart volume and subsequent mortality.

In the London Civil Service Health Survey, both p.a. and lateral 100 mm chest films were taken on 12,630 men aged 40 and above. Radiologic heart volume was calculated on a 10 per cent sample and to the sample were added the films of all other subjects from the cohort who had died within 5 years of the survey, or more than 5 years afterwards. Radiologic heart volume could be calculated on 1,390 subjects of whom 233 had died within 5 years, and 47 after 5 years had elapsed. For deaths within the first 5 years there was a stepwise increase in mortality with increasing quintile of heart volume. Radiologic heart volume predicts death from cardiovascular disease both within 5 years of estimation and for deaths occurring more than 5 years after examination.

Adult

Cultural factors affecting the use of family planning services in an Aboriginal community.

The attitudes of the women of an Aboriginal community towards family size, spacing, and planning are briefly reviewed. It is shown that the felt need of the women for a means of control of reproduction and their approval of contraception is not matched by the use of the available family planning services. It is suggested that this gap between attitudes and use is due to the lack of practical recognition by the providers of these services of the indigenous conventions which surround the discussion and management of menstruation, pregnancy, childbirth, and contraception. Several ways in which family planning services could be made more acceptable culturally to both women and men of Aboriginal communities are proposed.

Attitude to Health

Rubella vaccine. Recommendation of the Public Health Service Advisory Committee on Immunization Practices. Center for Disease Control, U.S. Department of Health, Education, and Welfare; Atlanta, Georgia.

Rubella infection may be subclinical or overlooked because of the nonspecificity of its most frequent manifestations. Joint involvement is most frequent in women but can occur in men and children. The most serious complication is induction of fetal anomalies in infected pregnant women. This paper reviews the proper use of live rubella virus vaccine for prophylactive immunization and the postexposure treatment with immune serum globulin for modification or suppression of symptoms.

Centers for Disease Control and Prevention, U.S.