BACKGROUND AND OBJECTIVE:Evidence suggests that curative treatment for low-risk prostate cancer (LRPC) has no survival benefits over active surveillance (AS); thus, treatment choice becomes a value-sensitive decision. Decision aids (DAs) have the potential to facilitate this process, yet no DA has been tailored to the Australian health care system or population. This study aims to evaluate the impact of an online DA (Navigate) on the uptake of AS, quality of life, and decision-making in Australia. METHODS:This parallel-group, prospective, randomised controlled trial recruited men (from May 2017 to May 2021) from participating cancer centres, via self-referral, or via clinician referral. The inclusion criteria were the following: a recent LRPC diagnosis, no decision on treatment, and clinical suitability for AS. Partners could also enrol. Assessments were undertaken at baseline (before decision) and after baseline (1, 2, and 6 mo). Participants were randomised 1:1 to Navigate (online DA, intervention) or a national prostate cancer website (usual care), stratified by the site/recruitment method. Partners were allocated to the group matching their respective partners. The primary outcome was self-reported uptake of AS for first-line treatment at 1 mo. The secondary outcomes included decision-making preparedness; decisional conflict, regret, and satisfaction; illness communication; and prostate cancer-specific quality of life. Intention-to-treat analyses were conducted. KEY FINDINGS AND LIMITATIONS:Of the 619 patients referred, those eligible (n = 302) were randomised to either Navigate (n = 153) or usual care (n = 149), with no significant between-group differences at baseline. The proportion of men self-reporting AS versus another treatment was 90.6% (Navigate) versus 79.0% (usual care; p = 0.008). Navigate participants also reported greater decision-making preparedness (p < 0.001). Partners were allocated to Navigate (n = 70) or usual care (n = 49); no significant between-group differences were found. Longer-term outcomes were not measured. CONCLUSIONS AND CLINICAL IMPLICATIONS:Providing men with an online DA resulted in higher uptake of AS for LRPC than standard resources and in increased decision-making preparedness. By increasing the uptake of AS, DAs may help reduce treatment-related morbidity. Implementation research assessing the possibility of integrating Navigate into standard care is needed.

ABSTRACTObjectivesFear of cancer recurrence (FCR) is a prevalent unmet need for people affected by cancer, in the context of limited healthcare resources. Stratified‐care models have potential to meet this need, while reducing resource demands. This study aimed to evaluate the feasibility and acceptability of screening procedures and interventions within the Fear‐Less stratified‐care model among those impacted by early‐stage cancer.MethodsPeople affected by breast, head and neck, or gynaecological cancer, who had completed curative treatment, were screened for FCR. Individuals experiencing moderate FCR (scored 13–21 on the Fear of Cancer Recurrence Inventory‐Short Form; FCRI‐SF) were offered a purpose‐developed clinician‐guided self‐management intervention, while those experiencing severe FCR (FCRI‐SF score ≥ 22) were offered individual therapy (ConquerFear). Re‐screening and evaluation measures were completed post‐intervention.ResultsSeventy‐six (70%) of 109 eligible people completed screening, with 53/76 participating in the Fear‐Less model evaluation. Thirty‐nine of 53 participants reported FCR and were referred to an intervention; 30/39 (77%) accepted the referral. Fifteen (83%) of 18 participants completing the self‐management intervention reported reading ≥ 75% of the resource at 5 weeks, with 10/18 (56%) reporting clinically meaningful (≥ 10%) reductions on the FCRI‐SF post‐intervention. Qualitative feedback indicated screening and the stratified‐care received were acceptable.ConclusionsScreening procedures and interventions forming the Fear‐Less model appear feasible and acceptable for identifying and treating FCR among people affected by early‐stage cancer. Although further research is required to evaluate its efficacy, this model has the potential to meet a major unmet need, where psychosocial services are limited amid increased demand.Trial RegistrationThis study was retrospectively registered on the Australian New Zealand Clinical Trials Registry (ACTRN12622000818730) on 10/6/2022.

The study aim was to explore the health and well-being experiences of a cohort of older men (>= 45 years old) in the Southern region of New Zealand (Otago and Southland), and how these experiences corresponded with their expectations of ageing. It was hoped this examination of the lived experiences of older men would enhance our understanding of the enablers and challenges to ageing well for older men. Six focus groups were undertaken (n = 28) at three different locations in New Zealand. Participants ranged in age (45-92 years old) and varied in socioeconomic status. Critical studies of men and masculinities theoretical framework was adopted to underpin the study, with narrative data analyzed using a reflexive thematic approach. Three core themes were identified, including finding purpose in work and life, navigating masculine expectations in the ageing process, concerning challenges associated with social role transition. Each of these core themes incorporates a central organizing concept. Rather than steering older men toward predetermined male social roles, our findings suggest the achievement of ageing well to empower them to have life purpose and engagement should become a new expectation for policymaking.

Little is known about how New Zealand men understand their health and wellbeing as they age and what are the determinants of their healthy ageing. Contiguous and exploratory sequential mixed methods study were conducted with the collection of both focus group and survey data. Methodologically, this abductive process was incorporated within an intersectional framework, providing a comprehensive picture of healthy aging in men across life stages and socioeconomic statuses. Integrated results revealed that for respondents the most significant factors influencing their healthy aging were, life engagement purpose, substance misuse, and masculinity norms. This article contributes to mixed methods research by providing practical applications of incorporating the intersectional model to enhance rigor in designing, conducting, and interpreting mixed methods research.

OBJECTIVE:Fear of cancer recurrence (FCR) is highly prevalent among cancer survivors, but irregularly identified in practice. Single-item FCR measures suitable for integration into broader psychosocial screening are needed. This study evaluated the validity of a revised version of the original FCR-1 (FCR-1r) and screening performance alongside the Edmonton Symptom Assessment System - Revised (ESAS-r) anxiety item. METHODS:The FCR-1r was adapted from the FCR-1 and modelled on the ESAS-r. Associations between FCR-1r and FCR Inventory-Short Form (FCRI-SF) scores determined concurrent validity. Relationships of FCR-1r scores with variables related (e.g., anxiety, intrusive thoughts) and unrelated (e.g., employment/marital status) to FCR determined convergent and divergent validity respectively. A Receiver-Operating Characteristic analysis examined screening performance and cut-offs for the FCR-1r and ESAS-r anxiety item. RESULTS:107 participants were recruited in two studies (Study 1, July-October 2021, n = 54; Study 2: November 2021-May 2022, n = 53). The FCR-1r demonstrated concurrent validity against the FCRI-SF (r = 0.83, p < 0.0001) and convergent validity versus the Generalised Anxiety Disorder-7 (r = 0.63, p < 0.0001) and Impact of Event Scale-Revised Intrusion subscale (r = 0.55, p < 0.0001). It did not correlate with unrelated variables (e.g., employment/marital status), indicating divergent validity. An FCR-1r cut-off ≥5/10 had 95% sensitivity and 77% specificity for detecting clinical FCR (area under the curve (AUC) = 0.91, 95% CI 0.85-0.97, p < 0.0001); ESAS-r anxiety cut-off ≥4 had 91% sensitivity and 82% specificity (AUC = 0.87, 95% CI 0.77-0.98, p < 0.0001). CONCLUSIONS:The FCR-1r is a valid and accurate tool for FCR screening. Further evaluation of the screening performance of the FCR-1r versus the ESAS-r anxiety item in routine care is needed.

Abstract Objectives To develop an online treatment decision aid (OTDA) to assist patients with low‐risk prostate cancer (LRPC) and their partners in making treatment decisions. Patients and methods Navigate, an OTDA for LRPC, was rigorously co‐designed by patients with a confirmed diagnosis or at risk of LRPC and their partners, clinicians, researchers and website designers/developers. A theoretical model guided the development process. A mixed methods approach was used incorporating (1) evidence for essential design elements for OTDAs; (2) evidence for treatment options for LRPC; (3) an iterative co‐design process involving stakeholder workshops and prototype review; and (4) expert rating using the International Patient Decision Aid Standards (IPDAS). Three co‐design workshops with potential users (n = 12) and research and web‐design team members (n = 10) were conducted. Results from each workshop informed OTDA modifications to the OTDA for testing in the subsequent workshop. Clinician (n = 6) and consumer (n = 9) feedback on usability and content on the penultimate version was collected. Results The initial workshops identified key content and design features that were incorporated into the draft OTDA, re‐workshopped and incorporated into the penultimate OTDA. Expert feedback on usability and content was also incorporated into the final OTDA. The final OTDA was deemed comprehensive, clear and appropriate and met all IPDAS criteria. Conclusion Navigate is an interactive and acceptable OTDA for Australian men with LRPC designed by men for men using a co‐design methodology. The effectiveness of Navigate in assisting patient decision‐making is currently being assessed in a randomised controlled trial with patients with LRPC and their partners.

A definition is required for men’s health that captures current thinking around men and their health and well-being globally. A new definition of men’s health should reflect greater complexity than that has existed in previously accepted, over-simplistic definitions of what constitutes “men’s health.” In addition, the most com-monly used definitions in the field that originated from the westernised countries of the Global North do not seem to be inclusive of the heterogeneity among a significant proportion of the world’s population. Definitions are important as they help drive academic endeavour, practice and policy; they also help shape organisations working in men’s health and, as such, they need to be as broad as possible. This paper outlines the limitationsand conceptual concerns in the current definitions and argues for a more inclusive definition.

Now that the UK Government has announced a women's health strategy, it is time for a national strategy on men's health too. This must recognise it as a whole life‐course issue impacting on every stage of men and boys’ lives, and include action on the social determinants that lead to such excessive inequalities between different men.

Coronary artery disease (CAD) is the single leading cause of death in Europe and the most common form of cardiovascular disease. Little is known about awareness in the European population. A cross-sectional telephone survey of 2609 individuals from six European countries was conducted to gather information on perceptions of CAD, risk factors, preventive measures, knowledge of heart attack symptoms and ability to seek emergency medical care. Level of awareness was compared according to gender, age, socioeconomic status (SES) and educational level. Women were approximately five times less likely than men to consider heart disease as a main health issue or leading cause of death (OR = 0.224, 95% CI: 0.178–0.280, OR = 0.196, 95% CI: 0.171–0.226). Additionally, women were significantly less likely to have ever had a cardiovascular screening test (OR = 0.515, 95% CI: 0.459–0.578). Only 16.3% of men and 15.3% of women were able to spontaneously identify the main symptoms of a heart attack. Almost half of the sample failed to state that they would call emergency services in case of a cardiac event. Significant differences according to age, SES and education were found for many indicators amongst both men and women. Development of a European strategy targeting improved awareness of CAD and reduced gender and social inequalities within the European population is warranted.

Background Fear of cancer recurrence (FCR) is a significant unmet need amongst cancer survivors and is consistently associated with psychological distress and impaired quality of life. Psychological interventions for FCR, such as ConquerFear, have demonstrated efficacy in reducing FCR and improving emotional wellbeing. Unfortunately, there are barriers to the uptake of evidence-based FCR treatments in clinical practice. A stepped-care FCR treatment model may overcome these barriers and has demonstrated potential in people with advanced melanoma. This study aims to evaluate the acceptability, feasibility, and impact of a stepped-care FCR treatment model ( Fear-Less ) in people with other cancer types, who have completed treatment with curative intent. Methods Sixty people with early-stage cancer (defined as individuals who have received treatment with curative intent and with no metastatic disease) will be screened for FCR using the Fear of Cancer Recurrence Inventory—Short Form (FCRI-SF). Individuals reporting moderate FCR (FCRI-SF between 13 and 21) will be offered a clinician-guided self-management resource; those reporting high FCR (FCRI-SF ≥ 22) will be offered individual therapy according to the ConquerFear protocol. Participants will complete purpose-built evaluation surveys assessing their FCR screening and intervention experiences. Clinicians will also complete a survey regarding their experiences of the treatment model. Fear-Less will be evaluated in terms of (1) acceptability (i.e., patient and clinician experience), (2) feasibility (i.e., referral uptake, treatment adherence, and time taken to screen and deliver interventions), and (3) impact (i.e., pre- to post-intervention FCR changes). Discussion The Fear-Less stepped-care model is a novel framework for screening FCR and stratifying survivors to the appropriate level of treatment. Our study will provide an indication of whether Fear-Less is a feasible and acceptable FCR model of care amongst survivors with early-stage disease and inform further investigations of this model. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR); ACTRN12622000818730 .

Background: Globally, there has been a growing awareness of the health challenges faced by men. The current public health agenda in Aotearoa New Zealand (NZ) does not specifically address the needs of men. The aim of this scoping review was to capture the major health issues facing men in NZ and particularly to identify the knowledge gaps in the understanding of men’s health within the NZ context. This was achieved by presenting key data on their health status and systematically mapping research in NZ related to men’s health; international data are also referenced for context as relevant. Method: A search and screening of the literature were conducted using Ovid, Web of Science and Scopus databases from January 1996 to July 2021, with advice from a medical librarian. Search terms included “men’s/male’s health” and “men’s/male’s health NZ.” An environmental scan of international literature was also carried out and information from the Ministry of Health and Statistics NZ was obtained to provide context of the status of research on men’s health in NZ. Main Findings: In keeping with international literature, the major health issues for men in NZ are life-limiting diseases including cancer and cardiovascular disease, the spread of overweight and obesity, issues with masculinity and help-seeking behaviours, unhealthy lifestyles, mental health issues and poor health literacy. The main areas of research related to men’s health from the NZ literature were highlighted. Discussion: Men’s health remains an under-recognised issue in NZ. If we are to address current inequities in health for men, clinicians, researchers and relevant agencies need to pay more attention to men’s health issues and take up the challenge to highlight and promote men’s health status in NZ.

The main reason for the shift had been the decline in communicable diseases in the younger age groups, but this positive change has been accompanied by a growth in non-communicable diseases (NCDs). A key feature of the majority of the health challenges facing men is that they are mostly preventable, with lifestyles and risk-taking principal factors. The low growth in the younger population is more marked in some areas of the world than others, with Eastern European countries and others such as Japan seeing a drop in birth rates to below sustainable growth levels. Healthy life expectancy (HALE), gives the number of years the population is expected to live in good health as opposed to the total years lived. Male excess of premature mortality is seen from conception onwards, with most intrauterine fetal deaths occurring with a male embryo, as a result of genetic malformation.

Background: The Breakfast Club is a peer review group consisting of registrars and early career psychiatrists (ECPs) with interest in academic psychiatry in Brisbane, Queensland. The Club meets every 2 months for breakfast. At each meeting, we invite a ‘Pancake Prince’ or ‘Princess’ – an established academic psychiatrist – as a guest of honour to share his or her wisdom and foster intergenerational transmission of the research culture. Objectives: This is an update to the last year’s symposium. We aim to showcase the diverse research that is being conducted by members of the Breakfast Club. Methods: Six members of the Breakfast Club will present their research. The symposium will be chaired by Associate Professor John Allan (Pancake Prince) and Doctor Catherine Franklin (Pancake Princess). There will be an interactive discussion with the audience about how research can be incorporated into clinical practice throughout the symposium. Findings: Members of the Breakfast Club are involved in a wide range of research using many different research methods. Some topics are service related (e.g. setting up a new service model) while others are clinically orientated (e.g. physical activity in a rehabilitation setting). We will also discuss the challenges and difficulties associated with conducting clinical research in the public mental health services. Conclusions: The Breakfast Club continues to be successful in fostering research culture and mutual learning among registrars, ECPs and established academic psychiatrists in Brisbane, Queensland. We believe that a similar approach can be successful in many other areas of Australasia.

Epidemics and pandemics, like COVID-19, are not gender neutral. Much of the current work on gender, sex, and COVID-19, however, has seemed implicitly or explicitly to be attempting to demonstrate that either men or women have been hardest hit, treating differences between women and men as though it is not important to understand how each group is affected by the virus. This approach often leaves out the effect on gender and sexual minorities entirely. Believing that a more nuanced approach is needed now and for the future, we brought together a group of gender experts to answer the question: how are people of different genders impacted by COVID-19 and why? Individuals working in women’s, men’s, and LGBTQ health and wellbeing wrote sections to lay out the different ways that women, men, and gender and sexual minorities are affected by COVID-19. We demonstrate that there is not one group “most affected,” but that many groups are affected, and we need to move beyond a zero-sum game and engage in ways to mutually identify and support marginalized groups.

An amendment to this paper has been published and can be accessed via the original article.

Scaling digital health tools with machine learning will require more than just investment in IT infrastructure, it requires capacity within government to support the tools.

The scale of the issue is immense; across America as of the 21st May 2020 nearly 38 million have filed jobless claims. Suicide is a devastating event that has wide implications for the families, friends, and all associated with the victim. Suicide is recognised as a serious public health issue, claiming the lives of nearly 800,000 people globally, of which 75% are men, with 13.5 male suicides per 100,000 population and 7.7 per 100,000 for females. Suicide rates vary considerably across the world, with the highest levels being found in low- and middle-income countries (79%) and over half are occur before the age of 45 years. Schizophrenia when coupled with comorbid depression has a marked effect on suicidal behaviour – especially for first episode psychosis, with the effect lasting up to 10 years. Higher levels of suicide are found in gay and bisexual men and in transgender men.

The World Health Organisation has produced a men's health report and strategy for the 53 countries of the European region. There has been a long debate about men's help-seeking behaviour with conflicting messages from the literature and research. Men's usage of health services across the lifespan reflects these changing patterns of need. Boys younger than 18 year have similar if not greater access to services than girls. The gap in usage was only partially explained by reproductive health consultations in women; when the analysis also took into account two conditions commonly associated with women and men consultation rates came closer to parity. Men are also less likely to seek help with regard to the common mental health conditions. A systematic review and meta-analysis of the role mobile devices in doctors-patient communication found in the majority of cases they were only being used for appointment reminders, medication adherence, disease control, and test-result notification.