Screening in Men Professor Ng Chirk Jenn MBBS, MMed (Family - - PowerPoint PPT Presentation

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Screening in Men Professor Ng Chirk Jenn MBBS, MMed (Family - - PowerPoint PPT Presentation

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Evidence-Based Health Screening in Men Professor Ng Chirk Jenn MBBS, MMed (Family Medicine), PhD Department of Primary Care Medicine Faculty of Medicine, University of Malaya First Malaysian Mens Health Conference, 13 -14 August 2018,

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Evidence-Based Health Screening in Men

Professor Ng Chirk Jenn MBBS, MMed (Family Medicine), PhD Department of Primary Care Medicine Faculty of Medicine, University of Malaya

First Malaysian Men’s Health Conference, 13-14 August 2018, University of Malaya

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Poor Men’s Health: Cause

  • Biological

References: Mendelsohn ME, Karas RH. The protective effects of estrogen on the cardiovascular system. The New England journal of medicine. 1999 Jun 10;340(23):1801-11. PubMed PMID: 10362825. Epub 1999/06/11. eng. Power ML, Schulkin J. Sex differences in fat storage, fat metabolism, and the health risks from obesity: possible evolutionary origins. British Journal of Nutrition. 2008;99(05):931-40. Libert C, Dejager L, Pinheiro I. The X chromosome in immune functions: when a chromosome makes the difference. Nature Reviews

  • Immunology. 2010;10(8):594-604.

Sex hormones Visceral fat distributio n Chromosomal immunological disadvantage

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Poor Men’s Health: Cause

  • Behavioural

✓risk-taking behaviour ✓reluctant to engage in health promotion activity ✓have lower health awareness ✓feeling of invulnerability ✓delay or avoid seeking help

References: Addis ME, Mahalik JR. Men, masculinity, and the contexts of help seeking. The American psychologist. 2003 Jan;58(1):5-14. Byrnes JP, Miller DC, Schafer WD. Gender differences in risk taking: A meta-analysis. Psychological bulletin. 1999;125(3):367. Richardson N, Smith JA. National men's health policies in Ireland and Australia: what are the challenges associated with transitioning from development to implementation? Public health. 2011 Jul;125(7):424-32. PubMed PMID: 21726883. Epub 2011/07/06. eng. Banks I. New models for providing men with health care. Journal of Men's Health and Gender. 2004;1(2-3):155-8.

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Male-sensitive In Intervention

  • Systematic review on health promoting interventions targeting men

(Robertson 2008)

  • Holland et al used male personalised letters → increased

screening uptake.

  • Stanton et al used father’s role → increased smoking quit rate.
  • Youl et al used sportsman signed letter → no difference in skin

cancer screening uptake (compared to male sensitive control group)

  • Insufficient evidence supporting the effectiveness of male-

sensitive intervention due to lack of studies.

References: Robertson LM, Douglas F, Ludbrook A, Reid G, van Teijlingen E. What works with men? A systematic review of health promoting interventions targeting men. BMC health services research. 2008;8:141.

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In Intervention to increase screening uptake

Systematic review (Jepson 2000)

  • Interventions to increase screening uptake

➢invitation appointments ➢Letters and phone calls ➢educational home visits ➢opportunistic screening

  • Varying levels of effectiveness.
  • Not tailored to gender and technology is underutilised

References: Jepson R, Clegg A, Forbes C, Lewis R, Sowden A, Kleijnen J. The determinants of screening uptake and interventions for increasing uptake: a systematic review. Health technology assessment (Winchester, England). 2000;4(14):i-vii, 1-133.

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SOCSO Health Screening Programme 2017

  • Uptake rate from 2013-2016
  • Overall: 19.9% (479,666/2,411,027)
  • Male: 15.0% (224,484/1,501,527)
  • Female: 28.1% (255,182/909,500)
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Reasons FOR using BSSK Reasons FOR NOT using BSSK

BSSK is a top down decision = 36.8% (82/219) BSSK helps to facilitate screening = 36.8% (82/219) BSSK is useful to improve the health status of men = 24.7% (55/219 ) Time consuming = 31.6 (73/191) Men refuse to answer = 24.1% (46/191) Too lengthy = 28.3% (54/191)

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  • 1. US

Preventive Services Task Force

  • 2. Malaysian

Consensus Guidelines

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Conclusion

  • Health screening intervention in men:
  • Educational interventions → effective in

improving men's intention to and uptake of screening

  • Studies that used male-sensitive, ICT-based,

video-based interventions are of poor quality

  • Need to conduct larger and more robust

studies

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ScreenMen Health Screening Web App

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Reaching

  • ut to

Men

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Key Messages

  • Screening should start young and be based on the latest

evidence

  • Current screening practices should be reviewed; they must

be gender-sensitive and tailored to the needs of men

  • Innovative approaches, including the use of ICT, can be

considered to improve screening uptake in men

  • Screening should be inclusive – vulnerable populations

should not be neglected

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Acknowledgement

  • Teo Chin Hai

Department of Primary Care Medicine, University of Malaya

  • Dr Tun Firzara

Department of Primary Care Medicine, University of Malaya

  • Professor Alan White

Leeds Beckett University

Email: ngcj@um.edu.my