meteor.aihw.gov.au/content/index.phtml/. itemId/481386. NEWSLETTER OF ANDROLOGY AUSTRALIA. Australian Centre of Excellen
The Healthy Male NEWSLETTER OF ANDROLOGY AUSTRALIA Australian Centre of Excellence in Male Reproductive Health
CONTENTS 1 Working towards better cancer data collection Developing National Data Set Specifications
2 From the Director 2 Health Spot
Spring 2015
issue 56
Working towards better cancer data collection
Erectile dysfunction and undiagnosed diabetes
3 Focus On Networking for health professionals
5 Professional education Visualising the mechanisms of erection and ejaculation
5 Research round-up Weight loss can help to restore testosterone levels
6 Latest News
Success in recent fundraisers
6 News in brief
Cancer Australia, in partnership with Andrology Australia, has been developing national data set specifications (DSS) for prostate cancer and testicular cancer. A DSS is a defined set of standardised Information and Performance Principal data items that are not mandated Committee—one of several principal for collection but are recommended committees that report to the as best practice. The underlying goal Australian Health Ministers’ Advisory of a DSS is to provide data standards Council—as a recommended national to support a more coordinated and standard for clinical prostate cancer consistent approach to the collection data collection. of data. Over time, the collection and reporting The prostate cancer DSS was of these data will provide more developed in broad consultation with accurate information on national relevant stakeholders and an expert trends in diagnoses, health service working group and is designed to utilisation and clinical care. Ultimately facilitate the collection of clinical this will support improved outcomes data at the point of clinical care. for prostate cancer patients by Key categories of clinical data to be increasing quality and length of life collected include diagnosis, other through enhanced understanding of prognostic characteristics, cancer prostate cancer care. treatment and patient outcomes. To Andrology Australia and Cancer ensure that the DSS was able to be Australia are also developing a DSS for collected in a clinical setting, the testicular cancer, to similarly enhance prostate cancer DSS was pilot tested in the understanding of the cancer care hospitals and cancer treatment centres provided for men with this cancer and involved in prostate cancer diagnosis how their outcomes may be improved. and treatment. The prostate cancer DSS is available online: The prostate cancer DSS has recently meteor.aihw.gov.au/content/index.phtml/ itemId/481386 been endorsed by the National Health
From the Director
The role of the primary and allied health professionals can be very demanding. A professional network can help to provide support for the professional as well as for their patients. In this issue of The Healthy Male, our focus is a bit different from usual—we look at how health professionals (and by extension, their patients) can benefit from developing a strong professional network. By the time you read this, Andrology Australia will be sailing into ‘uncharted waters’ without the steady hand of our experienced CEO Dr Carol Holden on the tiller. It is impossible to summarise here Carol’s impact on
the direction and development of Andrology Australia, and her influence on the wider men’s health landscape in Australia. Suffice it to say that we will greatly miss her knowledge and experience. On behalf of the Advisory Board and the team at Andrology Australia, I thank Carol for excellent management and her commitment to male health. We wish her the very best with her new role.
Professor Rob McLachlan
Dr Carol Holden
Health spot – ED and undiagnosed diabetes
After 15 years at Andrology Australia, our CEO Dr Carol Holden recently announced that she is moving on to a new career challenge.
It has been known for some time that men with diabetes face a higher risk of developing erectile problems (see The Healthy Male no. 29, Summer 2013). Some studies estimate that up to four in five men with diabetes will have erectile dysfunction (ED) at some time in their lives—that’s twice the rate in men without diabetes.
Carol was the first employee of Andrology Australia, appointed by Professor David de Kretser in 2000. Since then she has overseen the expansion and development of the Andrology Australia project in areas of research, professional education, and public awareness. Under her management, Andrology Australia has become a nationally and internationally respected model for the promotion of male health. We thank Carol for all of her great work and wish her well for the future.
REDUCED BLOOD FLOW The causes of this link between diabetes and ED are known. Diabetes can cause reduced blood flow to the penis or affect the function of blood vessels in the penis, making it more difficult for a man to get or keep an erection. Diabetes can also damage the nerves in the penis and elsewhere in the body. Diabetes is often associated with high blood pressure, high cholesterol, and obesity each of which is a risk factor for erectile dysfunction. UNDIAGNOSED DIABETES In some cases men with erectile dysfunction may have undiagnosed diabetes. Recently published research1 found for the average man between 40 and 59 years of age, the predicted 1. Skeldon, SC. et al. Erectile dysfunction and
undiagnosed diabetes, hypertension, and hypercholesterolemia. Annals of Family Medicine. 2015: 13(4) 331–335.
probability of having undiagnosed diabetes increased from one in 50 for men without erectile dysfunction to one in ten for men with erectile dysfunction. This new information reminds us that erectile dysfunction is an important early warning sign—the ‘canary in the coal mine’—for a range of serious health concerns, particularly in men younger than 60 years of age. It also emphasises that erectile problems should be treated by a doctor as part of an overall health assessment. The good news is that if a blood glucose test ordered by a doctor returns high levels, diabetes treatment can help both the erectile problems and other health problems that are caused by diabetes.
Focus on: Networking for health professionals Primary and allied health professionals working in men’s health often come from diverse backgrounds, such as GPs, nurses, Aboriginal Health Workers, counsellors and diabetes educators, and they may all have a professional interest in men’s health in addition to their recognised professional role. Developing a professional network, whether to support their work in men’s health or another area of interest, can be beneficial both personally and professionally.
What is networking? Networking is about sharing information, ideas, resources and opportunities. Members of a network look to each other for advice, support, careers and training, service pathways, resource/contact sharing, and patient referrals; they create a support system for each other.
As the network grows, it may branch out to include other partner services and regional and state/territory services.
What types of services should I include in my referral network? You may want to include more than just health services in your referral network. Because of the holistic nature of health, services such as counselling and mental health support services, and emergency food and housing may also be relevant.
• Most health professionals and organisations are busy and will not be available all the time so make sure you have as many referral options as possible. When one contact is not accepting referrals and/or has a waiting list, it is essential to have other contacts with similar service or resources as a back-up.
What are the best ways to establish a referral network?
Networking is sometimes done through work colleagues, but it can also be done through more formal meetings. Although it may be difficult for health services when staff are away at meetings, occasionally going to national meetings and conferences can also benefit the health service in the longer term if the health professional is able to bring back new ideas to improve the local service.
How can I maintain my network?
Some key national men’s health meetings include:
Networking is continuous work and it takes time to make professional contacts. Following up and maintaining contacts is essential for building on relationships and maintaining your professional network.
• National Men’s Health Gathering • Australian Men’s Sheds Conference • National Aboriginal and Torres Strait Islander Male Health Convention • National Aboriginal and Torres Strait Islander Male Researcher Gathering—contact Mibbinbah (www.mibbinbah.org) for more information.
It is good to establish a referral network before there is pressure to find the right service or person for a particular patient or client. The following steps may be useful to help with approaching individuals you haven’t met before:
• Do some research on the person or organisation before you call them; writing down what you want to say can help. Why is networking important? • It can be helpful to first approach people that you know or Networking has a range of benefits including: have some connection to. If you don’t know them personally, • Building referral networks: the information and resources it can be useful to mention the name of a mutual friend that become available through networking can help or acquaintance. with patient care so you are more effective in your • Consider whether referrals can be reciprocal between professional role. organisations. If they are, expect that the other service will • Supporting your professional development: advice, guidance want to know about your organisation including community and training opportunities can arise from contacts within needs and what your organisation can similarly offer in your network. terms of information, contacts and ongoing support. • Being approachable, cheerful, confident and straightforward Many health professionals working in regional and remote will all help. It is important that the relationship is settings bear the brunt of challenging situations but do established before any requests are made. not have ready access to support services for their own personal well-being. Networks can also provide support • A phone call or an email is a good way to make an systems beyond the local community, such as access to appointment for a first meeting. professional mentors. • Keep the phone call short, focussed and professional. Tell them the reason you are calling them and ask if they have time to talk—if not, arrange to call back later. How do I start to build a network? • If possible, arrange to meet the person. This gives each A first step in building a referral network is to find out: person the opportunity to present themselves as individuals • What are the community needs? (e.g. talk and listen to local and helps to establish recognition and openness in the community members and find out about their needs, as they working relationship. can be a good source of local knowledge.) • What services already exist, how are they accessed by the How can I keep my referral community and are community needs being met? • Who are the major and minor service providers within the network up to date? local area and the major capital city including the local • Keep a “contact book” of networking contacts and update Primary Health Network? For health professionals working it regularly. with ethnic and cultural communities this would include community-specific services (e.g. Aboriginal or Torres Strait • Follow up services referring patients to you by asking for any Islander-specific services). new leads or referrals. Referrals from other services could be • Who are the key people within these services (including acknowledged in writing (fax/letter or email) at the time you contact details, type of work and availability)? receive the referral, and later to let them know how it went.
Some helpful strategies include: • Follow up every new contact with an email or phone call. This provides an opportunity to thank the person for taking time to meet and remind them of the gains that can be made from collaboration. This reinforces that it is a two-way relationship. • Use social media as it can be an effective tool to maintain networks, but make sure it is professional and projects the right image online. Ensure that your online activity is consistent with your organisation’s social media policy. • Share information to help build relationships.
What are some tips for networking? There are some things you should be aware of that may help to make your network successful: • • • • •
people respond well to sincere approaches respect other people’s time follow through on promises don’t ‘over-use’ key contact people share network contacts with others as appropriate and with permission • don’t wait to be properly introduced—introduce yourself.
How can I extend my network beyond my work colleagues? It can be useful to make contact with other health professionals with similar interests working in other parts of Australia and around the world. Most professions have professional colleges/societies and/or member organisations that support their members in a variety of ways. Sometimes within these professional groups, there are a number of different special interest groups.
How can I develop my network at meetings and conferences? Attending conferences can be a great way to meet professionals who could become part of your network. Some useful strategies include: • Try to sit with people you don’t know; approaching people who are sitting alone and saying “can I join you?” is a good way of getting to know new people. • The best way to connect with new people is to show interest in them; make the conversation about them and their work. • Attend interactive or workshop sessions, which often involve smaller groups where it is easier to meet others who you may interact with throughout the conference and beyond. • Bring business cards (your own or the health service’s) to give to people you make a connection with. • When you meet new people, be able to briefly and clearly explain what you do. • Follow up with people you make a connection with; send them an email with some information they might find helpful. The role of the primary and allied health professionals can be very demanding—networks provide support for you as well as for your patients. This article is based on information developed for Andrology Australia’s Male Health Education Module for Aboriginal Health Workers (2010). For fact sheets on “Mentoring,” “Getting the most out of conferences,” and “How to make the most of social media at conferences,” go to the Primary Health Care Research & Information Service website: www.phcris.org.au. We thank Dr Christina Haggar (PHCRIS) for her assistance in preparing this article.
Professional education
Visualising the mechanisms of erection and ejaculation
E
RECTILE AND ejaculatory disorders represents some of the common health concerns of adult men of all ages; the high frequency of these disorders is well described in Australia and elsewhere. Appropriate diagnosis and management depends on a doctor’s understanding of the underlying physiology and disease mechanisms, and most importantly their willingness to engage males in discussion about these health concerns in an open and sensitive fashion.
physical structures and neurological and physiological processes involved may be better illustrated through still and moving images. Andrology Australia recently released an animated video Mechanisms of Erection And Ejaculation that describes these structures and processes, and illustrates the timing of events in normal erection and ejaculation.
Normal erection and ejaculation involves a complex orchestra of neural and penile structural elements, neuroendocrine and vascular events, all of which operate in the context of the individual’s sexual attitudes, behaviours and social setting.
We hope that the video will help to improve practitioners’ knowledge of normal erectile function, and provide a context to understand common co-morbidities associated with erectile dysfunction (such as diabetic angiopathy and neuropathy, drug effects, or spinal cord disease) and a basis for good treatment decision-making.
While many of these principles can be described in text-based materials, the
Although intended for a professional audience (particularly medical
students), the video is available for viewing by the general public, and could even be used in medical consultations to explain the causes of ED and the options for treatment. Interested individuals would learn more about their disease, and as a result may be more likely to seek appropriate care, comply with therapy, and make lifestyle choices in order to restore or maintain their sexual function. The video Mechanisms of Erection And Ejaculation can be viewed online at learn.andrologyaustralia.org.
Research round-up
Weight loss can help to restore testosterone levels in ageing men
A
GEING IN men is often accompanied by a decrease in testosterone levels and there has been much discussion recently about the symptoms thought to be linked to low testosterone and whether treatment would be beneficial. On the other hand, some studies have shown that healthy normal weight men can maintain high testosterone levels even into very old age. Identification of factors that can help to maintain testosterone levels in ageing men is therefore important. A paper from the European Male Ageing Study1 describes a follow-up of 3369 men aged 40 to 79 years over a period of 4.3 years. For men who had normal testosterone at baseline, 1. Rastrelli, G, et al. Development and recovery from
secondary hypogonadism in ageing men: Prospective results from the EMAS. J Clin Endocrinol Metab 2015: 100(8): 3172-3182.
sexual symptoms did not appear to change much. This could be due to the increasing prevalence of sexual symptoms as men age, such that a longer follow-up period with greater increases in testosterone may be necessary to see improvements in sexual function.
factors associated with having lower testosterone levels at the end of the study included higher body mass index, greater waist circumference (both measures of obesity) and new or worsening sexual symptoms (mainly decreased sex drive). For men with low testosterone at baseline, those who reduced their weight by five per cent or more during the follow-up period were about twice as likely to have recovered their normal testosterone level by the end of the study. However,
This study supports other research suggesting that lifestyle risk factors and ill-health are the major contributing factors to lower testosterone in ageing men. It also shows that weight loss in overweight men can help to reverse declining testosterone levels, without use of testosterone treatments that may have adverse side-effects. Future studies need to look at whether restoring testosterone levels can improve symptoms, and to separate symptoms due to low testosterone from those due to other aspects of ageing.
In brief
Latest News
Elder Award for Dr Mick Adams
Success in recent fundraisers
Dr Mick Adams, Senior Research Fellow at Australian Indigenous HealthInfoNet and founding member of Andrology Australia’s Aboriginal and Torres Strait Islander Male Health Reference Group, was honoured in June with an Elders award from the Aboriginal and Torres Strait Islander Higher Education Advisory Council. The Elders and Leaders awards form part of the Council’s recognition of individuals or groups who have actively participated in Aboriginal and Torres Strait Islander higher education over a sustained period of time. For much of his 40 year career, Dr Adams has been actively involved in addressing issues associated with the health and well-being of Aboriginal and Torres Strait Islander males. He spent a period of approximately thirteen years attending and studying at academic institutions which laid the foundation for him to lead and promote male issues through advocacy, research, publication and health management.
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W
ITH INCREASED need to expand our activities, Andrology Australia is grateful for all donations and fundraising efforts made by individuals, families, community groups, companies, and other organisations. We thank the following organisations for raising funds for Andrology Australia and helping us to raise awareness of male reproductive health issues. On the return journey from a sixmonth rotation in the Middle East as part of Operation MANITOU, 25 beards were shaved clean on board HMAS Success to raise money for testicular cancer research. Network Ten recently made a donation following the appearance of retired test cricketer and former Andrology Australia Ambassador Merv Hughes on the reality TV show ‘I’m a Celebrity, Get Me Out of Here’.
Each year in May and October, Monash University holds its Global Walk/Run to raise awareness of men’s health issues and to encourage donations to Andrology Australia. We received another donation from Darwin Golf Club following a fundraiser in connection with Men’s Health Week. We also thank all of the individuals and families who have made personal donations over the past year.
To donate visit our website at www.andrologyaustralia.org/donate or call 1300 303 878 and we’ll send you a donation form.
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NEWSLETTER OF ANDROLOGY AUSTRALIA Australian Centre of Excellence in Male Reproductive Health
The Andrology Australia project is supported by funding from the Australian Government under the Health System Capacity Development fund, and is administered by Monash University. Postal Address: Andrology Australia School of Public Health and Preventive Medicine PO Box 315, Prahran, Victoria, Australia, 3181 Street Address: 549 St Kilda Road, Melbourne, Victoria 3004 Telephone: 1300 303 878
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DISCLAIMER: This newsletter is provided as an information service. Information contained in this newsletter is based on current medical evidence but should not take the place of proper medical advice from a qualified health professional. The services of a qualified medical practitioner should be sought before applying the information to particular circumstances.
