Malaysian primary care doctors' views on men's health: an unresolved jigsaw puzzle

<p>Abstract</p> <p>Background</p> <p>Men have been noted to utilise health care services less readily then women. Primary care settings provide an opportunity to engage men in health care activities because of close proximity to the target group (men in the community). Understanding attitudes towards men's health among Malaysian primary care doctors is important for the effective delivery of health services to men. We aimed to explore the opinions and attitudes of primary care doctors (PCDs) relating to men's health and help-seeking behaviour.</p> <p>Methods</p> <p>A qualitative approach to explore the opinions of 52 PCDs was employed, using fourteen in-depth interviews and eight focus group discussions in public and private settings. Purposive sampling of PCDs was done to ensure maximum variation in the PCD sample. Interviews were recorded and transcribed verbatim for analysis. Open coding with thematic analysis was used to identify key issues raised in the interview.</p> <p>Results</p> <p>The understanding of the concept of men's health among PCDs was fragmented. Although many PCDs were already managing health conditions relevant and common to men, they were not viewed by PCDs as "men's health". Less attention was paid to men's help-seeking behaviour and their gender roles as a potential determinant of the poor health status of men. There were opposing views about whether men's health should focus on men's <it>overall </it>health or a more focused approach to sexual health. There was also disagreement about whether special attention was warranted for men's health services. Some doctors would prioritise more common conditions such as hypertension, diabetes and hypercholesterolaemia.</p> <p>Conclusions</p> <p>The concept of men's health was new to PCDs in Malaysia. There was wide variation in understanding and opposing attitudes towards men's health among primary care doctors. Creating awareness and having a systematic approach would facilitate PCDs in delivering health service to men.</p

Effects of cagA+ and cagA- strains of Helicobacter pylori on the human gastric mucus layer thickness

Background:  Infection with cytotoxin-associated gene A (cagA) Helicobacter pylori is associated with severe gastric diseases, with contradictory views being expressed concerning the effect of H. pylori on the gastric mucus thickness. The aim of the present study was to differentiate between the effect of cagA+ and cagA– strains on gastric mucus thickness.\ud \ud Methods:  Ninety-nine patients without peptic ulcers who were not on medication were randomly recruited from consecutive endoscopy clinics: six biopsies (five antral, one body) were obtained from each patient. Cryostat sections (18 µm) were cut and stained using the modified periodic acid–Schiff/Alcian blue technique. Mucus thickness was measured using computer-assisted light microscopy. The H. pylori status was assessed by histology, Campylobacter-like organism (CLO)test and culture, and cagA+ status determined by polymerase chain reaction (PCR).\ud \ud Results:  There was no significant difference (P = 0.784) in mean mucus thickness between cagA+ (52.7 ± 1.2 µm, n = 10), cagA– (46.6 ± 1.1 µm, n = 18) or H. pylori-negative patients (51.3 ± 1.1 µm, n = 30). In cagA– patients, mucus thickness was significantly reduced with increased H. pylori colonization density, Spearman (rs) = −0.805, P < 0.0001. In contrast, in cagA+ patients there was a weak positive, but not significant, association between mucus thickness and H. pylori colonization density, rs = 0.333, P = 0.381.\ud \ud Conclusions:  The human gastric mucus thickness is not affected by infection with cagA+ or cagA– strains of H. pylori compared with uninfected. Although a trend of increased mucus thickness with cagA+ infection was observed