A glimpse into Singapore’s rainbow community
Singapore may be a cultural melting pot, but – as Tamsin Wu notes after meeting key LGBTQ community leaders – “one thing that the country lags behind is its social attitude towards LGBTQ issues and rights.” Here’s Outrage Magazine’s glimpse of Singapore’s rainbow community.
Singapore is a cultural melting pot as seen from its people, experienced from visiting its different districts and tasted from its myriad of food choices. It exudes a cosmopolitan city bursting with personality.
The first thing I noticed was how strikingly awesome the urban planning and public transportation system were in Singapore. It was definitely light years ahead from the rowdy metropolis environment, massive vehicular traffic and unkempt public transportation dealt with back home. Cleanliness and efficiency were definitely things that Singapore upheld.
One thing that the country lags behind though is its social attitude towards LGBTQ issues and rights. Although Section 377 in the Singapore Penal Code – which criminalizes sex between men – is not really enforced against the gay community, its impact trickles down to, among others, how Singapore’s media industry blatantly prohibits positive depictions of LGBTQ stories and characters, the damaging practice of conversion therapy pushed by some of the religious and conservatives, as well as discrimination in schools and workplaces.
LITERARY REPRESENTATIONS OF LGBTQ
Censorhsip is an issue faced by the Singaporean LGBTQ community. For example, the InfoComm Media Development Authority (IMDA) sets forth media guidelines or policies that make it mandatory for Singapore’s mainstream media to edit out parts of a show – fiction or otherwise – that show LGBTQ personalities in a positive light. At times, it even spreads beyond the periphery of mainstream media, as long as a complaint has been filed regarding homosexual depiction.
Registered Singaporean social worker Yangfa Leow shared to me some instances wherein such censorship was enforced – On TV, there was a time when a portion of Ellen DeGeneres’ talk show was cut out simply because her guest, former US President Obama, complimented her. On live theater, a kissing scene played out by two actors was demanded to be omitted from subsequent running of the shows after an audience member complained that he was caught off-guard by the inclusion of homosexuality in the story. On print, “And Tango Makes Three”, a children’s book based on a true story about two male penguins that adopted and raised a baby penguin, was banned from the National Library Board simply because a parent filed a complaint about it.
Nonetheless, suppression of LGBTQ-related information and stories does not extend its fangs and claws to the Internet and publishing industry. I’ve been able to find out about Singapore’s LGBTQ-related books and organizations through social media and online research. Consequently, aside from reaching out to certain groups advocating for equality, I have scoured out the existence of quality Singaporean queer literature.
I wouldn’t fly out from the country without getting my hands on Cyril Wong’s book, “Let Me Tell You Something About That Night”. It magnificently interweaves fantasy into contemporary Singapore. Without loudly parading itself as an LGBTQ book, since the short stories therein are mainly about human experiences told through alternate worlds or realities, its collection of “strange tales” casually yet beautifully infuses LGBTQ characters here and there. Although simple in its storylines, it makes the reader feel and contemplate about the place of LGBTQ individuals and relationships in society, given the current socio-political landscape for and against the community.
While queer literature doesn’t necessarily fall under the category of activism, having LGBTQ representations in books is still a very useful tool in educating and spreading awareness, as well as empowering the community through words and stories.
COUNSELING AND SUPPORT
One of the groups in Singapore that advocates for LGBTQ rights and helps the LGBTQ community rise up is Oogachaga (OC), a community-based organization that offers professional counseling and support services to LGBTQ individuals, couples and families via hotline, email and WhatsApp, or face-to-face counseling by appointment.
According to Yangfa Leow, executive director of OC, they have established a protocol in screening and training volunteers who would like to contribute their time in providing support services to the LGBTQ community. Applicants are required to go through an interview and a period of classroom and hands-on trainings.
“Some people have observed that this process is quite rigorous, and we see that as a positive thing. There will be applicants who are not selected, or voluntarily withdraw or do not return at various stages of this process. It is only expected that not everyone who wishes to be a volunteer would be a good fit. We want to protect the integrity of the counseling services. One of the key requirements for our hotline, email and WhatsApp counseling volunteers is the need to maintain confidentiality of information and identity. It is also to protect the clients themselves, many of whom may be in vulnerable situations and turn to OC for safety and emotional support. It is also to protect the safety and identities of our volunteers, who give their spare time to support others,” Yangfa said.
On the other hand, volunteers with professional qualifications in social work, counseling or psychology are selected to provide face-to-face support, intervention and follow-up on issues.
A hotline call, WhatsApp chat, an email or a counseling session is each counted as a service unit. According to Yangfa, back in 2013, OC served 974 service units. In 2016, the volume of service units reached 1,663 – a 71% increase in 4 years.
“Also, in terms of gender profile, we’re seeing an increase in proportion of service-users who identify as women, transgender or gender diverse – from 31.8% back in 2013 to 40.4% in 2016,” Yangfa added.
When asked about the usual issues tackled, Yangfa said, “In no particular order, the top three presenting issues are sexuality or identity, relationships with partner, family, friends and psychological or mental health – diagnosed or undiagnosed.”
Aside from counseling services, OC also schedules support group sessions and offers training sessions to social service organizations, schools, healthcare institutions and private companies or corporations to talk about LGBTQ issues and how to handle conversations surrounding such matters.
The main struggle that OC encounters is funding. “In August 2016, we were informed by our main, long-term funder that they would cease their support for us. They had been responsible for 80% of our funds for the past 8 years, and it came to a stop. So since then, we have embarked on an ongoing fund-raising drive,” Yangfa said.
Yangfa added that other challenges faced by OC include continuing to stay relevant and reaching out to those segments of the LGBTQ community that may need support, but are not yet being reached.
“For example, those who may not speak English, who may not be able to access our online publicity information, and those who may not be able to access our counseling services for whatever reasons – disability, language ability, stigma, social isolation.”
Yangfa also shared that, despite Christians being a non-dominant religious group in Singapore, they remain to be very vocal and influential in going against equality. There was even an event held called “White Dot” – an anti-LGBTQ offshoot of Singapore’s annual Pride event “Pink Dot” – that was originally headed by an Islamic religious teacher and eventually replicated by a Christian pastor.
Basically, the false notion that “if someone is pro-equality, then s/he cannot be pro-family or pro-society” is at times ridiculously drilled into the conscience of society.
EMBRACING LGBTQ CHRISTIANS
With that being said, however, all is not lost for LGBTQ’s who seek to attend a nonjudgmental, inclusive church environment.
In a country that still breeds animosity towards the LGBTQ’s, the Free Community Church (FCC) in Singapore is a breath of fresh air, especially for those who don’t want to let go of their Christian faith, albeit the off-putting religious bigotry preached by some.
FCC has a weekly cozy Sunday service that is open to everyone who want to join in a religious community feel, sans the abhorrence typically put by fundamentalists against LGBTQ’s and those of other faiths or beliefs. The atmosphere in FCC was light and accommodating. There were the usual leading of worship songs, sharing about the scripture and personal testimonies, as well as the ceremony of bread and wine. Afterwards, everyone was encouraged to spend more time together through lunch already prepared by FCC members.
EMPOWERING THE TRANSGENDER COMMUNITY
But even with the existence of organizations that offer a “safe space” to LGBTQ people, some of them still find themselves alone in battling the painful pangs of discrimination. One example is the dilemma of transgender folks who work in the sex industry to make money. In this case, they face both the stigma society imposes on transgender people and on sex workers. On top of having to deal with discrimination in school and even before entering the workforce, some get disowned by their families. With no one to turn to and no degree or work experience under their belt, they turn to the sex industry just to survive. Even though sex work is legal and regulated in Singapore, transgender sex workers still face the possibility of violence done to them either by a police personnel or the clients.
Nonetheless, June Chua, co-founder of The T Project, has seen positive developments in the attitude of Singapore towards the transgender community. “Society have evolved and being transgender is no longer seen as taboo or a big deal. I do admit educating and raising awareness of the transgender community must still be ongoing but I do see more options and opportunities opening up for the transgender person in terms of employment and acceptance in Singapore.”
The T Project offers shelter to homeless transgender people and enables them to create a better life for themselves. Apart from that, it also coordinates with other social service organizations and does workshops for government institutions, companies and schools to educate them about the transgender community.
“The first thing of how residents come in is by themselves or, alternatively, by referral from other social workers. So the moment they come in we will have to do an admissions interview, tell the residents the do’s and don’ts of living in the shelter, the requirements we expect from them, and to actually manage the expectations of what the shelter can provide. Basically, we don’t provide financial aid, we can connect you to some government agencies who can provide you with that,” explains Eztelle Kaye, shelter manager at The T Project.
“The T Project is not just about giving our residents a roof over their heads – it’s about empowering them to be independent and finding a way to have a sustainable life. We wish to educate them and give them the power once they leave the shelter.”
Eztelle met June in the course of volunteering at the Women Care Center, “I was closer to her late sister then, the co-founder of T Project. I met June about 3 years ago when I was working as a volunteer at Women Care Center advocating about more on HIV prevention, STI prevention, how you can actually help and do regular testing. So that’s where I met June. She was the Volunteer Supervisor. From there I’ve connected with June… I believe she saw something in me that’s why she draaaagged~ me here… as the shelter manager,” Eztelle said jokingly.
After deciding to leave her corporate life, she took on the role as shelter manager of The T Project in order to give back to society. “Of course I do miss my days whereby every payday is actually a ‘boutique day’ when I just shop at LV, Prada and such,” Eztelle said with a laugh. “But yeah, I feel I have much more of a sense of job satisfaction and fulfilment because I get the chance to empower the residents here, that they can be more than what they can be if they set their minds to it.”
Asked about the issues faced and rights held by transgender people vis-à-vis sex reassignment surgery (SRS), June said, “To me, the issues and challenges that will arise are not from whether you have underwent SRS or not but how you represent yourself to the public. However, in Singapore after we underwent SRS, we are allowed to legally change our gender marker and are accorded legal rights as a woman under the Woman Chapter Act.”
She shared that they are currently developing a work plan with various programs that would roll out in the later part of the year. “As part of our work plan 2017, we are doing a volunteer recruitment drive on Pink Dot event day itself. Yes, we will start to welcome non-transgender or cis-gender volunteers,” June said smilingly.
“The T project will try to link up the transgender community with employment opportunities. We are also doing a series of TTP (Transgender Talking Point) workshop to empower the transgender and to see what are their needs and wants so that we can support them, hopefully. We are also recruiting 4 The T Project ambassadors to help us in our outreach effort.”
NAVIGATING LGBTQ ACTIVISM IN UNIVERSITIES
“My bubble seems to be one that is generally privileged to some extent, with respect to some other trans people. The trans people I am in contact with have not dropped out of school,” shared Cassandra Thng from the Communications and Media Relations team of the Inter-University LGBT Network – an amazing pool of student bodies that fight together in upholding the well-being of the LGBTQ community in Singapore’s educational institutions, their efforts of which would hopefully reverberate throughout the country.
“Generally, the trans people around me have all been closeted throughout earlier school lives such as primary and secondary school. The earliest I’ve heard of people transitioning within my friends is during Junior College or Poly. Naturally, the gender non-conforming nature of a trans person – such as the increased femininity in a trans girl, or the increased masculinity in a trans guy, or the general lack of non-conformity in a non-binary person – has been something of a sticking point for certain people. For those of us who did not blend as well with our assigned gender roles as others, bullying and mockery definitely were issues that were faced.”
With the intention of fighting LGBTQ discrimination, at least at the level of colleges or universities, 5 student organizations – namely Gender Collective, Kaleidoscope, Out To Care, tFreedom and The G Spot – from different educational institutions came together and founded the Inter-University LGBT Network.
“The Network was born after the leaders from the five founding groups met at a social event organized by Out To Care from Singapore Management University. We found that each group faced similar challenges as the others, and decided to set up the Network so that we can share resources and facilitate collaboration,” shared Daryl Yang, executive director and co-founder of the Network.
Cassandra has observed that the younger generation nowadays cares less about gender identities and sexual orientations that fall outside the “cis-heteronormative patriarchal standards”, and that at times, “it is teachers… who are perpetrators of harsh words and disqualifying beliefs themselves that create less protected and safe-feeling environments for at-risk students”.
She added that, “School environments are also very much shaped by education policy, and one of these policies would include sexuality education. To this day, Focus On The Family (FOTF), a Singaporean splinter from the American-based FOTF anti-LGBT Christian lobby, conducts sexuality education in certain schools. Sexuality education in Singapore in general, and with FOTF in particular, tends to gloss over different sexualities and gender identities in favor of teaching about safe sex, and in FOTF’s case, gender roles and abstinence. While safe sex is an important topic, gender identity and sexualities are also important topics that should be addressed. Many students who are part of those minorities have felt that they were excluded from the conversation and that it would be better to not speak about what they experience to anyone else.”
Aside from student social events, the Network provides support by initiating studies and projects that aim to study LGBTQ-related issues faced by the student community, in order to raise awareness and recommend necessary revisions to existing university policies and frameworks, as well as to create an environment wherein LGBTQ students feel safe and empowered.
According to Xin Yee Teo, the Network’s Social Media Manager, Singapore universities have anti-discrimination and anti-harassment policies that cover gender and sexual orientation. “However, procedure for seeking recourse via these policies remains unclear, and we are currently conducting a research project on this.”
Xin Yee further shared about the current projects of the Network, “For instance, the Harassment & Non-Discrimination Policy Research Project aims to find out how harassment is experienced by LGBTQ+ undergraduates in Singapore’s universities. It also seeks to find out if universities are equipped with the necessary resources like counsellors and student support groups to serve individuals who have been targeted for their gender or sexual orientation. Another ongoing project is the S377A Commemorative Project, which aims to analyze how the rhetoric surrounding S377A has evolved over the past 10 years since the repeal campaign in 2007, as well as its impact on LGBT discourse in Singapore. The end result of this project would be a moving exhibition across universities in the month of October, so as to coincide with the 10 year anniversary of the parliamentary debate. We also have various support projects – such as Youth Resource Development Project and Campus Support Project – which aims to provide help and support to LGBTQ+ youth in Singapore, as well as outreach projects which aims to provide inclusive platforms for networking and community-building.”
One challenge faced by some LGBTQ student orgs is being officially recognized by the university, including the difficulty in setting up a group and organizing events, due to the stigma that may still be lingering “usually from more religiously conservative corners of the university”, as Daryl puts it.
“Nonetheless, people are generally respectful and it is rare to find cases of serious verbal, physical or emotional bullying based on someone’s sexual or gender identity. We have noticed encouraging shifts in attitudes towards LGBT issues in our universities since our Network was established. For instance, there are now talks at other universities or colleges to set up similar support groups, initiated by both students and faculty. There is also greater visibility of LGBT identities in the arts scene at our universities as well, most recently with groups from both NUS and Yale-NUS staging theatre performances featuring gay and transgender narratives.”
CARRYING ON THE FIGHT
Despite all the bad news concerning discrimination, it is good to know that the LGBTQ movement is still roaring proudly in Asia’s Lion City.
Heartening indeed to see that the progressive Singaporean youth is currently being active in the advocacy alongside LGBTQ-related organizations in order to raise and strengthen equality. It is hoped that the fight would continue on and fortify until Singapore reaches a place in time wherein its strength of diversity and multiculturalism includes that of human sexuality and gender expression.
One in five contract STI from somebody they met on a dating app
85% of 18-24 year olds have used dating apps. Unfortunately, of 2,000 respondents, 18% said they had caught an STI from someone they had met online.
The sexual health risks for young adults are increasing through the use of dating websites and apps.
This is according to an original research by Zava, which found that 85% of 18-24 year olds have used dating apps. Unfortunately, of 2,000 respondents, 18% said they had caught an STI from someone they had met online, with chlamydia being the most common STI, with 10% of 18-24 year-olds catching the infection as a result of a meeting arranged through a dating app.
Interestingly, the rise in STIs like chlamydia and gonorrhea ought to be linked to lower levels of sexual health education; but as per Zava’s research, the opposite is true, with almost two thirds saying they feel informed about STIs.
The study also noted that young adults in rural areas are more likely to have been diagnosed with an STI as a result of their online activity than those in urban areas. Also, people who identify as gay are also more likely to have contracted an STI, with a third of young gay people testing positive for a sexually transmitted infections after meeting a partner online.
38% of people with an STI found out about the infection by noticing the symptoms, particularly for common STIs like chlamydia and gonorrhea rather than being told by the person they caught it from. Healthcare professionals suggest this could be partly due to the practice of people deleting the profiles of their previous partners, so they can’t always inform them if they are diagnosed with an infection later on.
As an FYI: The most popular dating app among the respondents was Tinder, with 70% having used it, way ahead of Bumble (6%), Grindr (4%), Happn (2%) and Hinge (1%).
In terms of STI testing, it seems that for young people, the decision to get tested isn’t related to public service advertising. Only 5% of the general population and 12% of people who identify as gay reported that public service advertisements were their primary reason for getting tested. Overall, people who identify as gay or bisexual are more likely to get tested for STIs (34% and 33% respectively) than their straight counterparts (28%).
Commenting on the findings, Dr Kathryn Basford of Zava, said: “Both gonorrhoea and chlamydia are bacterial infections that can have serious health consequences if they remain untreated. Prevention is much better than treatment, so we advise all young adults meeting people online to use a barrier contraceptive like condoms, femidoms, or dental dams. Not only can barrier contraceptives prevent unwanted pregnancies, unlike other forms of contraception they also reduce the risk of contracting an STI.”
How tech is shaking up the retail investing scene
Investors can check the price of stocks whenever they like, read associated stories, access balance sheets, and generally have all of the tools at their disposal to work out whether a company is a good buy. It’s fair to say that tech is shaking up the retail investing scene in more ways than one.
Retail investors used to have to make a stark choice. Either they bought and sold equities through a broker – somebody who would buy shares in companies on their behalf – or they’d pile all their capital into a mutual fund and wait. Without the internet, investors usually had to wait for their statements in the mail before they found out about the performance of their investments. It wasn’t always good news.
Technology has changed all that. Retail investors now have information that is nearly as good as top hedge funds. Investors can check the price of stocks whenever they like, read associated stories, access balance sheets, and generally have all of the tools at their disposal to work out whether a company is a good buy. It’s fair to say that tech is shaking up the retail investing scene in more ways than one.
It was only a matter of time before somebody applied new artificial intelligence software to the retail investing scene. In the past, retail investors had to do their research if they wanted to understand how markets worked. Investing is a technical discipline, as well as an art, and an understanding of key terms is essential. But robo advisors take some of the edge off the otherwise steep learning curve. People new to finance can quickly get up to speed with all the relevant concepts and jargon. Robo advisors can give information about complicated investment plans, 401(k)s and many other things.
Retail investors can also put their faith in machines too if they see fit. The world’s first AI-powered investment ETF launched last year. The ETF is a collection of funds managed by a computer based on all available data. The software takes data from the market to predict which firms will perform best over a 12-month horizon. So far, the software hasn’t convincingly beaten the market, but it’s early days.
In the past, if you wanted to buy shares in a company, you had to physically visit your broker, give the order, and then get them to buy the shares on the open market. Things have moved on a lot since then. Thanks to smartphones, the average investor can now just fire up an app on their phone, place an order, and take ownership of shares on the same day. Apps are usually linked to major trading houses, so be careful which you choose
High-Frequency Trading Products
The market is continually looking for new ways to create profit opportunities. A controversial method of doing this is the so-called high-frequency trading where an automated trading system makes dozens of trades per second. High-frequency trading is shaking up the retail investment scene because it is changing the strategy that regular traders should use.
Retail investors can either invest in funds that take advantage of automated, rapid trading or they can adopt a value-investing approach, ignoring all the short term fluctuations in the market. The good news is that there are now products that cater to both. Some funds use high-frequency trading, while others attempt to follow companies with value potential.
Trans hormone therapy less risky than birth control pills, according to studies
A study suggests that hormone therapy for transgender people increases the risk of blood clots less than birth control pills and does not increase the risk of cardiovascular disease at all.
Studies published in the Men’s Health Issue of AACC’s journal Clinical Chemistry suggest that hormone therapy for transgender people increases the risk of blood clots less than birth control pills and does not increase the risk of cardiovascular disease at all. These preliminary results could help more transgender individuals to access essential hormone therapy by increasing physician comfort with prescribing it.
Major medical associations agree that transgender individuals need to be able to express their gender in ways with which they feel comfortable and that this is the most effective treatment for psychological distress caused by incongruence between sex assigned at birth and gender.
For many transgender individuals, expressing their gender involves physically changing their body through medical steps such as taking hormone therapy.
However, transgender patients often experience difficulty getting hormone therapy prescriptions, to the point that one in four transgender women have to resort to illegally obtaining cross-sex hormones. Part of this is because existing research on transgender hormone therapy is limited and conflicting, which has led to some physicians denying patients this treatment out of concern that it could significantly increase the risk of health problems such as blood clots and cardiovascular disease.
A team of researchers led by Dina N. Greene, PhD, of the University of Washington in Seattle in the US estimated that in transgender women prescribed estrogen, blood clots only occur at a rate of 2.3 per 1,000 person-years. While this is higher than the estimated incidence rate of blood clots in the general population (1.0-1.8 per 1,000 person-years), it is less than the estimated rate in premenopausal women taking oral contraceptives (3.5 per 1,000 person-years), which means that it is an acceptable level of risk.
In order to determine this, Greene’s team performed a systematic review of all studies that have included the incidence rate of blood clots in transgender women receiving estrogen therapy, identifying 12 that were most relevant. The researchers then used meta-analysis to combine the results of these 12 studies and calculate a risk estimate that is based on all available evidence to date.
“Documenting the risks associated with hormone treatment may allow for prescribers to feel more comfortable with prescribing practices, allowing for better overall management of transgender people,” said Greene. “Our data support the risk of thrombotic events in transgender women taking estrogen therapy being roughly comparable to the risk of thrombotic risks associated with oral contraceptives in premenopausal women. Given the widespread use of oral contraception, this level of risk appears to be broadly accepted.”
In a second study, a team of researchers led by Guy G.R. T’Sjoen, MD, PhD, also conducted a systematic review of all studies that measured risk factors for cardiovascular disease in transgender people taking hormone therapy. The researchers identified 77 relevant studies in this area and found that the majority of them report no increase in cardiovascular disease in either transgender men or women after 10 years of hormone therapy. The studies that did indicate a higher cardiovascular disease risk for transgender women in particular mainly involved patients using ethinyl estradiol, a now obsolete estrogen agent, and are therefore no longer valid.
T’Sjoen’s team does state that their results are not conclusive due to the small sample sizes and relatively short duration of the studies in this area (and Greene’s team included a similar caveat for their work). However, it is important to look at Greene and T’Sjoen’s studies in the context of transgender research as a whole. The field only began to receive National Institutes of Health funding in 2017 and is also lagging due to the fact that transgender patients often aren’t identified in medical databases that provide data for research. In light of this, these studies are significant not only because they suggest that transgender hormone therapy is safe, but also because they underscore the need for longer-term, large scale studies involving this underserved population.
Sexual, gender minority patients report greater comfort when SOGI’s collected via nonverbal self-report
Registrar form collection is the optimal patient-centered approach to collecting sexual orientation and gender identity information in the emergency department.
Sexual or gender minority patients reported greater comfort and improved communication when SOGI was collected via nonverbal self-report.
This is according to “Assessment of Patient-Centered Approaches to Collect Sexual Orientation and Gender Identity Information in the Emergency Department”, a study done by Adil Haider, MD, MPH; Rachel R. Adler, ScD; Eric Schneider, PhD; et al and publisher din JAMA Network Open.
For this study, the researchers wanted to identify the optimal patient-centered approach to collecting sexual orientation and gender identity information in the emergency department (ED).
So they tapped four EDs on the east coast of the US that sequentially tested two different sexual orientation and gender identity (SOGI) collection approaches between February 2016 and March 2017.
A total of 540 enrolled patients were analyzed; the mean age was 36.4 years and 66.5% of those who identified their gender were female.
In particular, two SOGI collection approaches were tested: nurse verbal collection during the clinical encounter vs nonverbal collection during patient registration. The ED physicians, physician assistants, nurses, and registrars received education and training on sexual or gender minority health disparities and terminology prior to and throughout the intervention period.
Multivariable ordered logistic regression was used to assess whether either SOGI collection method was associated with higher patient satisfaction with their ED experience. Eligible adults older than 18 years who identified as a sexual or gender minority (SGM) were enrolled and then matched 1 to 1 by age (aged ≥5 years) and illness severity (Emergency Severity Index score ±1) to patients who identified as heterosexual and cisgender (non-SGM), and to patients whose SOGI information was missing (blank field). Patients who identified as SGM, non-SGM, or had a blank field were invited to complete surveys about their ED visit. Data analysis was conducted from April 2017 to November 2017.
The study found that sexual or gender minority patients had significantly better Communication Climate Assessment Toolkit scores with nonverbal registrar form collection compared with nurse verbal collection (mean [SD], 95.6 [11.9] vs 89.5 [20.5]; P = .03). No significant differences between the 2 approaches were found among non-SGM patients (mean [SD], 91.8 [18.9] vs 93.2 [13.6]; P = .59) or those with a blank field (92.7 [15.9] vs 93.6 [14.7]; P = .70). After adjusting for age, race, illness severity, and site, SGM patients had 2.57 (95% CI, 1.13-5.82) increased odds of a better Communication Climate Assessment Toolkit score category during form collection compared with verbal collection.
In a gist (and to emphasize): Registrar form collection is the optimal patient-centered approach to collecting sexual orientation and gender identity information in the emergency department.
“Our interventional study assessing two potential methods to collect SOGI in the ED found that SGM patients reported significantly higher satisfaction with their experience in the ED with registrar nonverbal collection compared with nurse verbal collection,” the researchers stated. “In other words, SGM patients preferred a standardized collection process where all patients could report SOGI along with other demographical information vs being asked by a nurse during a clinical encounter. Non-SGM patients and those without reported SOGI information were no less satisfied with form collection compared with verbal collection.”
Non-heterosexual adolescents more vulnerable to depressive symptoms from 10 years old
Gay, lesbian, bisexual and questioning youth are more likely to experience depressive symptoms from as young as age 10 and these symptoms persist at least into their early 20s.
Depressive symptoms are more common among sexual minority youth than heterosexual youth at age 10, develop faster during adolescence, and continue into young adulthood (even if they start to decline from age 18).
This is according to “Depression and self-harm from adolescence to young adulthood in sexual minorities compared with heterosexuals in the UK: a population-based cohort study”, an observational study that followed almost 5,000 young people from 10 to 21 years of age in the UK. Published in The Lancet Child & Adolescent Health, it was authored by Madeleine Irish, MSc; Francesca Solmi, PhD; Becky Mars, PhD; Michael King, PhD; Glyn Lewis, PhD; Rebecca M Pearson, PhD; et al.
Previous research found that annually, in the UK alone between 2001 and 2014, on average across 10- to 19-year-olds, around 37 per 10,000 girls and 12 per 10,000 boys were treated for self-harm.
The findings suggest that sexual minority youth and are four times more likely to report recent self-harm at ages 16 and 21 years than their heterosexual peers, and are at higher risk of depressive symptoms from as young as 10 years old.
“We’ve known for some time that sexual minority youth have worse mental health outcomes, and it’s quite concerning that we’ve found this trend starts as early as 10 years old, and worsens throughout adolescence,” said the study’s senior author, Lewis.
To make for a robust sample of LGBQ youth, all participants who were not exclusively heterosexual were grouped into the same ‘sexual minority’ category, including 625 people (13%) who had described themselves as homosexual, bisexual, mainly homosexual, mainly heterosexual, unsure or not attracted to either sex.
The participants responded to questions about depressive symptoms seven times from age 10 to 21, and at 16 and 21 were asked if they had attempted to hurt themselves in the past year.
Depressive symptoms increased throughout adolescence in both groups but the increase was greater for sexual minority youth, who already were more likely to report depressive symptoms from age 10. Self-harm was more common among non-heterosexuals at both 16 and 21.
At age 18 years, the LGBQ adolescents were twice as likely to fulfil the criteria for a clinical diagnosis of depression.
Mental health outcomes were worse for each of the sexual minority groups compared to heterosexuals.
The researchers said that there may be numerous factors likely involved here.
“As these differences emerge so early, we suspect that a sense of feeling different might affect mental health before children can even articulate that difference. As they progress through adolescence, a range of stressors could be involved, such as discrimination, stigmatization, feelings of loneliness, social isolation, shame or fear or rejection, including at home or at school,” said the study’s first author, Irish.
The findings suggest that clinicians who encounter young people, whether in primary or secondary care, sexual health services, the emergency department, or as school nurses, should be mindful about sexuality in considering the wider context for depressive symptoms or self-harm.
“Clinicians should use language and questions that reflect openness about sexuality, and not assume heterosexuality, and they should be aware that a young person who identifies as not exclusively heterosexual may have struggled with mental health problems from early in development,” said co-author Pitman.
The fact we found mental health disparities at such a young age suggests that early interventions may be useful to prevent and treat such mental health challenges, Lewis said.
“Despite changes to public perceptions and attitudes in recent years, gay, lesbian and bisexual youth remain at increased risk of long-term mental health problems – addressing this inequality should be a research, policy, clinical and public mental health priority,” Lewis ended.
7 Tips to control your acid reflux
Acid reflux, unlike many other medical conditions, can be almost completely preventable – that is if you do the right thing. The following steps will help you reduce your symptoms of acid reflux.
Gastroesophageal Reflux Disease (GERD) commonly known as acid reflux or heartburn is a very common digestive disease. It happens when acid from the stomach escapes into the esophagus, the aftereffect is felt as heartburns, pain, and inflammation.
The condition is noticed when the barrier between the stomach and the esophagus becomes impaired, causing the acid and food in the stomach to flow back into the esophagus. If not treated over time, the reflux of stomach acid into the esophagus through the lower esophageal sphincter can result in a more serious condition including throat cancer.
Acid reflux, unlike many other medical conditions, can be almost completely preventable – that is if you do the right thing. Acid reflux can cause sore throats and hoarseness and may literally leave a bad taste in your mouth. The following steps will help you reduce your symptoms of acid reflux.
1. Avoid Going to Bed After a Meal
Sleeping immediately after a meal one sure way to trigger acid reflux. Why? When you lie down (horizontally that is), you create a somewhat level field for the stomach acid and all that you’ve eaten to move freely into the esophagus. However, when you sit or stand, gravity help keeps the stomach acid in the stomach, where it belongs.
To prevent this, eat your meals at least two to three hours before lying down. This will give food time to digest and get out of your stomach. Furthermore, by this time, the acid level would have also gone down.
2. Get to Know Your Triggers and Run from Them
For every person living with acid reflux, there are certain foods which trigger this condition. Onions, peppermint, chocolate, beverages with caffeine, citrus fruits or juice, tomatoes, high-fat and spicy foods are some known culprits. The list of triggers is relative, as what can cause an explosive heartburn for one may just be digested normally in another.
To help with this, we advise that you get a list of foods and how you react with them. You can rank the heartburn effect you feel after eating them using a scale of 1 to 5 or 1 to 10 or even 20. The lower numbers on the list should represent the foods that leave mild heartburn symptoms.
It may take quite some time to get a comprehensive list when you finally do, it becomes easier to control your heartburn.
3. Reduce Your Mealtime Portions
Eating smaller meal portions is also another way of controlling acid reflux. When you overstuff your stomach, you give acid in the stomach no space – looking for where to stay, they move into the esophagus. If you cannot manage the small meals three times a day, you can eat up to four or five times a day. Just don’t overstuff your stomach.
4. Eat a Little Bit Slower
Even if it is not your thing, you may need to consider eating more slowly to control your acid reflux. By slowing down your eating you will end up with less food in your stomach at any one time. It takes time for the chemical messengers in our stomach to let the brain know we’re getting full. Give those messengers time to work, and your body will better tell you when you’ve had enough.
If you are a vigorous eater, you can mix food with conversation to spend more time on each meal. As a final resort, you can begin eating with your non-dominant hand. Unless you are ambidextrous or created to eat with both hands, this can be an easy way to slow down.
5. If You Do, Stop Smoking and Drink Moderately
While these are habits some consider cool and normal, they would worsen your heartburn. Cigarettes contain nicotine which will weaken the esophageal sphincter – the muscle saddled with the responsibility of controlling the opening between your esophagus and your stomach. When it’s closed, it keeps acid and other things in your stomach from going back up.
While alcohol may be a great way of blowing off steam after a stressful day, we recommend exercising, walking, meditation, stretching, or deep breathing instead of turning to the bottles. Alcohol increases the production of stomach acid and also relaxes the lower esophageal sphincter (LES), allowing stomach contents to reflux back up into the esophagus.
Taking alcohol may not leave the same effect on everyone. If some people, a bottle is more than enough to trigger reflux, others may be able to tolerate two, maybe three before the symptoms surface. The important thing is that you know how much you can take before reflux, and stick to it.
6. Use Medication
There are great medications to help with your acid reflux. First are antacids which will typically work very quickly on heartburn – but for a short period of time. Mylanta, Rolaids, and Tums, are common Antacids. Next up are H2 blockers. These group of drugs will work for a longer period of time, usually up to 12 hours. Cimetidine, Famotidine, nizatidine, and ranitidine.
Finally, we have proton pump inhibitors, and Omeprazole is one of the most popular of these. Omeprazole works by reducing the amount of acid that your stomach produces and so helps to reduce the symptoms associated with acid reflux. Omeprazole is an effective and established medicine for the treatment of acid reflux.
As a part of your medication, your doctor may advise that you drop some weight. Many experts believe that extra belly fat increases pressure on the stomach, forcing food and acid back up through the esophagus. Please, do this only after your doctor has recommended.
7. Sleep on an Inclined Plane
To put it simply, elevate your bed – the bedposts to be exact. By raising your bedpost up to six or eight inches, you give gravity the chance to keep gastric acid down in your stomach. Avoid using pillows as this can put your head at an angle that can put more pressure on your stomach and make your heartburn worse.