What to do about young men?

This is somewhat out of my normal comfort zone of infections, but a recent review in Pediatrics looks at the subject of health in adolescent boys and young men, and makes some suggestions about activities that might be undertaken to improve their health through screening and other measures.

The paper itself is American, and does not necessarily translate directly to a UK or European setting, but much of it does.  The list of conditions that young men might suffer is quite extensive, and in addition to the various medical conditions there are many other issues such as violence and suicide that while they may differ in degree, are definitely issues for many young men.  The other really interesting issues are those surrounding sexuality and the role of men in society.  This struck me because many of the regular drama programmes in the UK (particularly EastEnders) have a really negative image of men, they all seem to be crooks, emotionally unstable, or generally not very nice.  While this is only drama, the drip, drip, drip effect of negativity may be significant.

One of my jobs here in the College is to run the HIV Course, and the assignment for this includes planning a health education intervention.  A lot of the students decide to target gay men; but when asked how they will access them they only seem to know about gay men in terms of those who go to nightclubs and bars.  Now while many gay men do, I am pretty sure there are many who don't frequent nightclubs and bars, so how best to access them?  The same problem occurs with young men, how do you access them, and when you do what interventions actually work?

Since writing the NICE Fever Guidelines, and being a fully paid up convert to the idea of traffic light tables, maybe one idea might be to do a traffic light for young men.  What characteristics are indicative of low, intermediate and high risk of morbidity?  I know they have limitations, they are either too sensitive or too specific........but they are a start, and they do make people think about what we know, and more importantly what we don't, what is the level of uncertainty and where does it lie?

One particularly fascinating idea is the concept of the positive development approach, where one acknowledges and promotes the young persons strengths and assets rather than problems and weaknesses.  It seems obvious, but actually we don't often do that, indeed the NHS in the UK often referred to as the National Sickness Service rather than the National Health Service.  Then it struck me, promoting strengths and assets, and being positive; wouldn't it be nice if we could do that to everyone?

Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection

This slightly wordy heading refers to Guidelines issued by the WHO this week on treating HIV.  Although really aimed at low and middle-income countries, they contain some useful ideas for everyone.  Apart from the numerous recommendations - the most significant of which is probably starting therapy earlier than is often the case, my take on it is this.

1. Firstly the idea of consolidated guidelines - rather than having different guidelines for pregnancy; children; adolescents; adults etc..... put them all together.  This makes the transitional arrangements clearer and may help to reduce the barriers that different professional groups have working with each other.
2. The same goes for hospital - community care.  This is important because something that more developed health care systems are going to have to get to grips with is the change from HIV being an acute disease ending in sickness and death and with a relatively low prevalence; to a chronic disease with less sickness but higher prevalence as people with HIV survive.  There is probably much that we can learn from middle-income countries about how to provide less intense but equally effective services.
3. Linked to the above is who and how to provide services - do we actually need highly trained doctors and nurses to do all of this?  Yes some people will require that level of expertise, but taking blood; monitoring blood counts.....could this be done in different ways?  One suggestion is to take the principles of the NICE Guidelines for the treatment of fever in children - devise a 'traffic-light' system of signs and symptoms that are associated with low, intermediate and high risk of serious disease.  This needs to be accompanied by high quality 'safety-net' advice but may allow patients to do more of their own monitoring.
4. GRADE as a way of developing recommendations.  This is not the time or place to explain GRADE, apart from to say that GRADE stands for the Grading of Recommendations Assessment, Development and Evaluation, and is a way of grading the quality of evidence and strength of recommendations.  For anyone who is having difficulty getting to grips with GRADE this may help their understanding
5. Which brings me back to the opening point.  Rather than assume as an advanced health system that we know everything; we should learn from how others do things, including countries with fewer resources, because necessity is, as they say, the mother of invention.  If I were to make one major criticism of the UK NHS it is this - sometimes money stifles innovation.