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Beauty for Sale

Cosmetic surgery has become so pervasive, it is now a $4 billion industry, and is said to be growing at a 30% rate per annum. Now that it’s more accepted, where do you head for the next fix?

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The general acceptability of cosmetic surgery helped spawn an industry all its own – medical tourism, which pits the medical practitioners of developed countries, once regarded as the elite bastions of medical expertise, with the developing countries, now also offering highly qualified and well-trained medical professionals using the most advanced in technology.

The story, seeming like an urban myth, even made it to the pages of Asiaweek Magazine: a wealthy Filipino executive in his 60s took his mistress to a plastic surgeon to make her look like his wife when he married her. Unknowingly, the wife went to the same doctor to undergo cosmetic surgery herself, in a bid to keep her husband. After all the nipping and tucking, the wealthy husband left his mistress to return to the surgically rejuvenated wife – but only after undergoing surgery himself, as he started feeling insecure about his own aging appearance.

In a society that is willing to pay the top price for a youthful look, over $160 billion is spent annually worldwide on cosmetic and toiletry products, including deodorants, shampoos and soaps, makeup, lotions, and fragrances. In 2002, Filipinos spent P70 billion for the same, with the figure estimated to reach P89 billion in 2007.

However, more belatedly, cosmetic surgery has become the somewhat simple, yet long-term answer to the pursuit for beauty. Having a hard time losing the gut despite hundreds of sit-ups every day? Opt for abdominal liposuction (price starts at $1,400). There are even muscle implants for the gym body without ever lifting a gym equipment. Losing hair too fast? Consider hair transplant (from $1,500). Insecure about your manhood? Have a penile enlargement and/or lengthening operation (from $450). For women, the vaginal opening can be tightened (from $550) for another “Like a Virgin” experience. Getting edged by younger guys simply because they look better – and, well, younger? Mull over facelift (from $1,000). And, while doing so, you may consider adding a dimple and a cleft chin (from $360) for the Brad Pitt/Alec Baldwin look.

Once derided as vanity medicine, cosmetic surgery has gone a long way, as it is now largely recognized as a legitimate arm of medicine. While it was once only discussed in hushed voices, now anybody who underwent one or more cosmetic surgical procedures actually boasts of having them – men and women alike.

According to former Philippine Medical Association (PMA) president Bu C. Castro, M.D., Ll.B., FPSP, the Philippines is actually a premier destination when it comes to availing of cosmetic surgical procedures, among others. In fact, balikbayans (returning overseas Filipinos) are known to come home to undergo such treatments “Overseas Filipino workers (OFWs), especially those in the entertainment industry, (are among the biggest markets of cosmetic surgery in the Philippines, as it allows them) to level with their competitors, particularly Caucasians, (by giving them similar physical attributes),” he says.

Plastic and reconstructive surgeon Carlos I. Lasa Jr., M.D. agrees. “First, comparing (our costs with) the costs (of medical treatment) where they are working right now, say in London or New York or Japan, where the charges are very high, they can save by coming here,” he says. The balikbayans are also familiar with the Philippine medical system, so they “have more or less this trust in our medical system.” And third, the treatments are merely side trips when they come over to take a vacation, so their visit becomes one trip for everything.

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COMPETITIVE ADVANTAGES

The general acceptability of cosmetic surgery helped spawn an industry all its own – medical tourism, which pits the medical practitioners of developed countries, once regarded as the elite bastions of medical expertise, with the developing countries, now also offering highly qualified and well-trained medical professionals using the most advanced in technology.

“This is a $4 billion industry, which is said to be growing at a 30% rate per annum,” Eddie Uy of rxpinoy.com, the first online community of Filipino doctors and dentists that serves to connect various sectors with the health industry, says. Combined with affiliated industries like tourism, India’s BusinessWorld Magazine estimated that millions of travelers actually spend over $40 billion a year. “We should – and can – break into that.”

The local industry has been changing over time, however. According to Uy, although OFWs continue to be the major market of cosmetic procedures, their portal had been receiving inquiries on these procedures from Europeans, particularly from Germany and Denmark. Also, other procedures mainly attract foreign nationals, such as Australians for dentistry, Japanese and Koreans for ophthalmology, and Americans and Europeans for bariatric surgery.

Once derided as vanity medicine, cosmetic surgery has gone a long way, as it is now largely recognized as a legitimate arm of medicine. While it was once only discussed in hushed voices, now anybody who underwent one or more cosmetic surgical procedures actually boasts of having them – men and women alike.

The biggest edge of the Philippines over other countries, particularly in Asia, is its relatively cheap rates for the procedures. For example, breast augmentation could cost up to $5,043 in the US, and at a much lower price of $2,500 in Thailand’s Preecha Aesthetic Institute, but would only cost $2,100 in the Philippines. Similarly, full facelift could cost up to $5,000 in the US, and $4,000 in Thailand, but only $2,500 in the Philippines.

“Among others, there’s an interest in general surgery and cardiovascular surgery because (if they have the surgeries in their home countries) they are sometimes required to co-pay, which they can’t afford, and cosmetic surgery because it is not covered by medical insurance offered to them abroad. So they see (us),” Lasa says. He nonetheless stressed, “The reality is we can’t have fees as high as our counterparts in US and Europe. We also have to have fees that are affordable to the local patients. So when I put up my rates and publish them on the website, it was with due cognizance of the rates in other countries, and of course, the prevailing rates in the Philippines.”

“If you compare the (rates) in peso, (they may look expensive),” Castro says. “But if you go to Singapore, (it’s even more expensive). Even (compared to) Hong Kong, we’re still cheaper when you convert (the rates) to peso. A P150,000 procedure here could cost P250,000 in Hong Kong, and even more in Singapore and Thailand.”

It helps, too, that the standard of living is cheaper in the Philippines by foreign standards. “The Philippines’ highly favorable exchange rate can benefit both local and foreign patients,” Lasa says. With the foreign exchange rate averaging at P56 per $1, the amount brought in by a foreigner visiting the Philippines “can get more for less.”

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Another advantage Lasa sees is that “over Thailand and India, the language barrier is non-existent (in the Philippines) for those who speak English well.”

Dr. Castro, however, believes that the country’s biggest edge is the expertise of the Filipino medical practitioners. “We can be competitive – especially with the skills we have. For example, the medical education in China is only four years, (while) ours is 16 years. So how could you rate their qualifications with ours?” he says.

“And with many of our professionals trained abroad, they don’t mind coming here for their treatments,” adds Lasa.

TAKING WINGS

However, while the Philippine government acknowledges that medical tourism is a potential source of dollar income, there are currently no “nationally palpable efforts done (to advance it), so we’re still off the radar of most Europeans, Americans and other nationals (who are considering availing of medical services outside their home countries),” Lasa says.

Lasa contends that government support will help develop a young industry. “For example, the Indian government (gives certain) incentive to dollar earners,” he says. “We need something like that to really promote (medical tourism in the Philippines). As it is right now, we just (get involved in medical tourism) as part of our regular practices.”

That Philippine government has, in fact, included the medical profession in the expanded value added tax (E-VAT). “The government thinks that by taxing, they can generate more income. Actually, they may be mistaken in that assumption,” Lasa says.

“Necessarily, we’ll have to increase the prices also – we’ll have to throw to the patients the costs of the E-VAT. That’s the problem,” Castro says. “The E-VAT has a negative effect on medical tourism – it will jack up the prices. But it will be costly not only to medical tourism but to local patients, who will primarily bear the burden because of the E-VAT.”

Lasa, however, said that while not necessarily translating to increase in prices, “the implementation of E-VAT will mean a decrease in our net income – it will amount to that.”

A bigger problem bothering the local medical tourism industry is its lack of cohesion. “Aside from the medical, dental, cosmetic and other procedures, medical tourism actually bundles hotel stays, destination tours, concierge services including interpreters, caregivers and tourist guides, and many others” Uy of rxpinoy.com says. “But at the moment, most of these (related) industries and sectors (go it alone).”

Castro recommends the establishment of a national call center for medical tourism, preferably with the assistance of medical staff because they would know what the industry is all about and has to offer. “When prospective clients would call up to ask specific questions, our agents should be able to answer them. Else, they’d ask their questions elsewhere – it could be India, Singapore or Thailand – then end up going there,” he says.

While there are entrepreneurs interested to open services like Singapore’s MNC, a one-stop information center for all medical services offered by the country state, “they want it to be outright business operations, not service-oriented, which increases the prices,” Castro says. “If that happens, then we lose our competitive advantage over our competitors.”

Pinoyrx.com is gearing towards the establishment of a “specific hub for medical tourism” when it recently established http://mtpshow.rxpinoy.com, which lists accredited hospitals, current rates and the credentials of Filipino practitioners. “But beyond that, we would like to cross sell other services in the country – if a person undergoes dental implant that requires for him to stay for up to 10 days in the country, then he has to choose accommodation. While here, he could go on tour. And while touring, he may need other services. rxpinoy.com could help arrange all those,” Uy says.

Dr. Bu Castro believes that the country’s biggest edge is the expertise of the Filipino medical practitioners. “We can be competitive – especially with the skills we have. For example, the medical education in China is only four years, (while) ours is 16 years. So how could you rate their qualifications with ours?” he says.

Another problem the industry is facing is the lack of “related infrastructure,” Lasa says. In Thailand, for example, Bumrungrad Hospital has its own hotel facility, connected by a walkway to the hospital, so families can be close to a family member undergoing treatment. “If local hospitals can afford such facilities, it will definitely help promote our medical tourism,” he says.

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The urgency to address this situation varies, nonetheless, says Castro. “Makati City, for example, has hotels not far from hospitals. It is in other places like Quezon City that problems arise, since they are far from each other,” he says. Already, however, efforts are already done to establish a hospital cum accommodation facility in Subic Bay Metropolitan Area, among others.

The lack of solidity in the industry also poses a problem when it comes to regulating practitioners. “The Philippine law allows all licensed doctors to do any kind of surgery – mainly, this is to allow doctors in provinces to be able to give emergency treatments without worrying about legal consequences,” Lasa says. “This is good for the provinces, but (in cosmopolitan areas) this is problematic.”

While the PMA and other professional associations can regulate medical practitioners, their grasps are limited only to members. “(Medical tourism) is a very good concept,” Castro says. “But it could be subject to abuse with the sprouting of fly-by-night cosmetic centers that we need to control. The government should issue a listing on the qualified and accredited (practitioners). There should be some kind of a regulation to tell the customer that they are also protected.”

At the end of the day, Castro believes it all boils down to marketing. “When you say tourism, marketing is very important,” he says. “And when you say medical tourism, you’re not only marketing the medical services, but the Philippines itself – places to go to, accommodations and services, everything. We should realize that marketing is an indispensable arm of medical tourism.”

GROWING DEMAND

“I think there is a future (for medical tourism in the Philippines),” Lasa says. “Definitely, as long as there is an economic need for people abroad, as long as there is a perceived benefit of coming (here) to have treatments given by competent – let me emphasize competent – practitioners, there will always be people coming here for such reasons, so medical tourism will continue to prosper.”

Uy says that people live longer, “and you need to provide people to look after them (as they age).” “Coupled that with the escalating cost of health care – instead of chasing the expenses, they might as well outsource it,” he says. “With the advent of technology, information has become fluid, so it helps our cause (to promote the Philippine medical tourism). Who knows, this may just avert the brain drain of our medical professionals.”

While arguing that a concerted effort needs to be done in order for the local industry to realize its full potential, “I do not conduct my practice with grandiose visions – I conduct my practice with a simple philosophy: providing excellent patient care on a one-to-one basis. I don’t regard this as a business. I went into this field because I like treating patients on a one-to-one basis. If dadami ang patients ko (the number of my patients grow) because (they were referred to me by satisfied patients) then well and good,” Lasa says. “In the end, it is because of how good we are at our profession that is the driving force of people coming to avail of our services.”

 

Health & Wellness

Gender identity conversion efforts associated with adverse mental health outcomes

Reported exposure to conversion efforts before the age of 10 also was associated with greater lifetime odds of suicide attempts.

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Gender identity conversion efforts to try to change a person’s gender identity to match their sex assigned at birth were associated with increased likelihood of adverse mental health outcomes, including suicide attempts.

This is according to a study helmed by Jack L. Turban, M.D., M.H.S., of the Massachusetts General Hospital, Boston.

The study, tiled “Association Between Recalled Exposure to Gender Identity Conversion Efforts and Psychological Distress and Suicide Attempts Among Transgender Adults”, and which appeared in JAMA Psychiatry, involved nearly 28,000 transgender adults from across the US. This observational study is based on the results of a survey distributed through community outreach to transgender adults in all 50 states, the District of Columbia, some territories and overseas U.S. military bases.

Of 27,715 transgender adults who responded, 19,741 (71.3%) reported having spoken to a secular or religious professional about their gender identity and of these 3,869 (19.6%) reported exposure to gender identity conversion efforts.

That exposure was associated with severe psychological distress during the previous month and prior suicide attempts during their lifetime compared with transgender adults who reported talking about their gender identity with a professional but weren’t exposed to conversion efforts.

Reported exposure to conversion efforts before the age of 10 also was associated with greater lifetime odds of suicide attempts.

Limitations of the study include its inability to determine causation; it didn’t capture conversion efforts by others such as family members; and it’s possible that some adults with worse mental health might have sought conversion therapy.

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The study findings support that gender identity conversion efforts should be avoided in children and adults. Professional organizations, including the American Psychiatric Association, have called conversion therapy for gender identity unethical and ineffective, and some countries have already outlawed the practice.

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Pregnant trans men at risk for depression and lack of care, Rutgers study finds

Older transgender men who become pregnant need better mental health care than female counterparts.

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Transgender men who become pregnant are at increased risk for depression and difficulty getting medical care due to a lack of knowledge among health care providers, a Rutgers study reports.

The study, published in the journal Maturitas, examined health care research on transgender men who become pregnant at or after age 35 to determine their medical and mental health needs.

“Despite the increased visibility of transgender people — there are about 1.4 million who have transitioned in the United States — medical providers are largely unprepared to care for them and most have had limited educational opportunities,” said lead author Justin Brandt, an assistant clinical professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at Rutgers Robert Wood Johnson Medical School.

Transgender men who have transitioned hormonally and are taking testosterone but retain their female reproductive organs have the potential to become pregnant. Since the U.S. medical system has been tracking these patients as female, no data exists on how many transgender men give birth each year, but Brandt said the number is likely higher than people realize. While some plan to become pregnant, the research suggests that unintended pregnancies occur in up to 30 percent of transgender men.

According to the U.S. Transgender Survey, nearly 40 percent of its 28,000 respondents reported attempting suicide — nearly nine times the national average. That risk can be increased in transgender men with the unwanted physical changes resulting from pregnancy, according to Brandt. “The process of transitioning is long and arduous, and pregnancy, which is regarded as a feminine condition, forces these men to almost fully transition back to their sex assigned at birth, which can worsen gender dysphoria,” he said.

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Surveys used to screen pregnant and postpartum females for depression are not designed to assess the impact of pregnancy on gender dysphoria in transgender men.

The study also found that nearly 25 percent of transgender people reported negative health care experiences in the last year. This correlates with the finding that about 44 percent of pregnant transgender men seek medical care outside of traditional care with an obstetrician. Rather, they may seek out non-physician providers, such as nurse midwives, with 17 percent delivering outside of hospitals — a higher rate than with women.

Although data is limited on how transgender men give birth, the review found that 64 percent had vaginal births and 25 percent requested cesarean delivery.

The report also noted that transgender men who requested cesarean deliveries reported feeling uncomfortable with their genitalia being exposed for long periods of time while those who went through labor reported that the process of giving birth vaginally overcame any negative feelings that they had with the female gender that they had been assigned at birth.

“Although Rutgers physicians have not yet had a pregnant transgender male patient, our healthcare professionals are trained and ready,” Brandt said.

The researchers also found that about 51 percent of transgender men breast or chest fed their infants even if they had breast surgery.

Brandt recommended that transgender men planning to conceive should visit their doctor before becoming pregnant to address routine issues, such as folic acid supplementation and screening for genetic disorders, and to be counseled on the risks of advanced-age pregnancy, such as infertility, miscarriage, gestational diabetes and pre-term delivery. Transgender men also likely will need to update health screenings that could have lapsed during transition, such as pap smears and, when indicated for those who have not had chest surgery, mammograms.

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After delivery, Brandt said doctors should address long-acting and reversible methods of contraception if the individual is at risk for unplanned pregnancy. “Transgender men who intend to restart testosterone after delivery may decide to defer contraception since they perceive that their male hormone therapy induces a state of infertility, which is not always the case,” he said.

Co-authors included Amy Patel, Ian Marshall and Gloria A. Bachmann at Rutgers Robert Wood Johnson Medical School.

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Little link found on popper use and dependency; no correlation with mental health or psychological stress

A survey of more than 800 men aged 18 to 35 found little evidence of typical dependency characteristics, including health, social, legal and financial problems, and no correlation between popper use and mental health or psychological stress.

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Young gay and bisexual men are frequent users of alkyl nitrites, or poppers, but few show signs of addiction, risky consumption habits or other psychosocial problems. This is according to ‘Harmless? A hierarchical analysis of poppers use among young gay and bisexual men’, by Dr Daniel Demant and Dr Oscar Oviedo-Trespalacios, and published in Drug and Alcohol Review.

A survey of more than 800 men aged 18 to 35 found little evidence of typical dependency characteristics, including health, social, legal and financial problems, and no correlation between popper use and mental health or psychological stress.

The study is particularly noteworthy considering some efforts to control popper use and distribution – e.g. in Australia. Dr. Daniel Demant, public health researcher at the University of Technology Sydney (UTS), who conducted the study, said that the decision by Australia’s Therapeutic Goods Administration (TGA) to step back from prohibiting poppers is commendable. The TGA, instead, elected to classify them as a Schedule 3 drug, available over the counter in pharmacies from February 2020.

An interim decision by the TGA in 2018 recommended poppers be classed as a prohibited substance, in the same category as methamphetamine and heroin, which would have made “overnight criminals” of the estimated 100,000 plus Australian users.

“What we see with this research is that poppers are a very commonly used drug in the LGBT community, both recently and over their lifetime,” Demant said. “Most of the users are already oppressed or marginalized based on their social identity as gay or bisexual men. This creates a question as to whether there would have been a discriminatory element in banning a substance with such a low risk profile.”

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Demant added that banning a substance that is used by so many people would create a “new class of criminals, basically overnight.”

Currently, poppers are available on prescription from pharmacies, but they are more commonly bought illicitly, in sex-on-premises venues and LGBT bars. A vial containing 25-30mL of the clear, strong-smelling fluid, possibly labelled as “VHS tape cleaner”, “leather cleaner” or “room deodorizer”, sells for up to $50 (or equivalent in countries like the Philippines), despite costing a couple of cents to manufacture.

The new TGA decision to regulate poppers rather than banning them hopefully paves the way for some measure of quality control as well as the removal of the “extreme profit margin” that exists now, Demant said.

Demant said that with poppers becoming a pharmacy-only medicine, safety standards would have to be met and pharmacy staff could provide guidance in cases where poppers might react badly with users’ other medications, particularly Viagra.

“We could stop pretending that poppers are sold for anything other than getting people high. And once we do offer it in pharmacies, we would have something made to the highest standards for people to use,” Demant ended.

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LGBT people more likely to develop dementia, according to study

More than 14% of sexual and gender minorities (SGM) reported subjective cognitive decline, significantly higher (p<0.0001) than the 10% rate among cisgender heterosexual participants.

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More than 14% of sexual and gender minorities (SGM) reported subjective cognitive decline, significantly higher (p<0.0001) than the 10% rate among cisgender heterosexual participants. Even after adjusting for factors such as income, age and race, SGM participants were 29% more likely to report subjective cognitive decline (SCD).

This is according to a study presented at the Alzheimer’s Association International Conference (AAIC) 2019 in Los Angeles in the US. The study noted that to date, few studies have investigated the symptoms and disease progression of Alzheimer’s and other dementias in the LGBT community. And so to examine these associations, Jason Flatt, PhD, MPH, assistant professor at the Institute for Health & Aging at the University of California, San Francisco, and colleagues analyzed data from the 2015 Behavioral Risk Factor Surveillance System (BRFSS), a large phone-based survey led by the Centers for Disease Control and Prevention.

The study analyzed data from 44,403 adults aged 45 and older across nine states in the US (Georgia, Hawaii, Illinois, Minnesota, Nevada, Ohio, Virginia, West Virginia and Wisconsin) that participated in the 2015 BRFSS optional modules on the Healthy Brain Initiative, which included subjective cognitive decline and Sexual Orientation and Gender Identity. Roughly three percent of participants (1,253) identified as a sexual or gender minority (SGM). Subjective cognitive decline was defined as self-reported confusion or memory problems that have been getting worse over the past year.

The study – as noted – found higher rates of subjective cognitive decline among LGBT people compared to their cisgender heterosexual counterparts.

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“Given that one in seven adults who identified as a sexual or gender minority reported subjective cognitive decline, it is critical that more opportunities exist for people in these communities to receive regular evaluation for cognitive impairment and Alzheimer’s disease,” Flatt said. “There is also a need for greater education on Alzheimer’s risk, signs and symptoms, and training of health care providers to ensure inclusive and welcoming care for LGBTQ+ populations.”

Flatt added that “while we do not yet know for certain why sexual or gender minority individuals had higher subjective cognitive decline, we believe it may be due to higher rates of depression, inability to work, high stress, and a lack of regular access to healthcare.”

According to Flatt, less than half of SGM adults with SCD in the study talked to their health care provider about it. SGM adults with SCD were also more likely to report that they had to give up day-to-day activities (39% vs. 29%, p=0.003) and needed help with household tasks (44% vs. 35%, p=0.01) than cisgender heterosexual participants. Both groups were similar in terms of talking to their health care provider about their SCD.

LGBT people living with dementia and their caregivers often have difficulty accessing information and support services, which can be especially challenging when memory loss and dementia enter the equation.
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To advance research into Alzheimer’s in the LGBT community, Karen Fredriksen-Goldsen, PhD, professor and director of Healthy Generations Hartford Center of Excellence at the University of Washington, created the “Aging with Pride: Innovations in Dementia Empowerment and Action (IDEA)” study. A multisite study in Seattle, San Francisco and Los Angeles, this is the first federally-funded study on dementia intervention specifically designed for LGBT older adults with dementia and their caregivers.

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The researchers had previously identified unique risk factors of LGBT older adults living with dementia through the first longitudinal study of this population (Aging with Pride: National Health, Aging, and Sexuality/Gender Study). Using longitudinal data with three time points (2014, 2015 and 2016), modifiable factors predicting physical functioning and quality of life (QOL) among LGBT older adults with dementia (n=646) were identified.

LGBT older adults living with dementia were significantly more likely to live alone (nearly 60%), not be partnered or married (65%), not have children (72%), and not have a caregiver (59%), when compared to older non-LGBT adults living with dementia. Previous experiences of discrimination and victimization (b=-0.19, p<.001) were negatively associated with QOL among LGBT older adults living with dementia. Socializing with friends or family (b=1.11, p<.05) was positively associated with QOL, and physical activity (b = 0.26, p<.001) were associated with better physical functioning.

Also as reported at AAIC 2019, “Aging with Pride: IDEA” includes a tailored approach in which trained coaches identify and modify challenging behaviors that are adversely affecting older adults living with dementia and their caregivers, either of whom are LGBT. The coaches delivered an individualized program of exercise, and behavioral and coping strategies designed to improve physical function, independence and QOL.

The exercise intervention is a low-impact physical exercise program including nine one-hour sessions over six weeks designed to improve physical functioning and maintain independence. The behavior and coping strategies include: techniques for working with LGBT-specific trauma, identity management and disclosure of their LGBT identities to providers and others, plus support engagement in the LGBT community and dementia services. Testing of the intervention is now underway and will be delivered to 225 pairs of LGBT older adults living with dementia and their caregivers.

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“Given their lifetime experiences of victimization, discrimination and bias, many LGBT older adults forgo seeking needed medical care,” said Fredriksen-Goldsen. “LGBT people living with dementia and their caregivers often have difficulty accessing information and support services, which can be especially challenging when memory loss and dementia enter the equation.”

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Psychotherapy should be first-line treatment for depression in young people, trial finds

If antidepressants have a role, they have more of a role in people at the older end of the age range. The take-home message from the study is that the first-line treatment for young people with depression should be psychotherapy.

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Young people seeking support for depression should be offered psychotherapy as the first line of treatment, a clinical trial by researchers at Orygen, the National Centre of Excellence in Youth Mental Health, has found.

Associate Professor Christopher Davey, head of mood disorder research at Orygen, said the clinical trial results emphasised the importance of a multi-faceted approach to treating depression in young people.

“The results suggest that we should really be focusing on providing good quality psychotherapy, such as cognitive behavioural therapy, to young people and keeping medication as the second line of treatment,” Associate Professor Davey said.

Psychotherapy refers to a range of psychological therapies provided by a counsellor, psychologist or psychiatrist. Cognitive behavioural therapy is the most common psychotherapy for treating depression in young people.

The randomized, double blind, placebo-controlled clinical trial involved 153 young people aged 15-25 who had been diagnosed with depression and were being treated at youth mental health services in north-west Melbourne. All trial participants received cognitive behavior therapy for 12 weeks coupled with either the common antidepressant fluoxetine or a placebo medication.

The trial results have been published in The Lancet Psychiatry.

Associate Professor Davey said at the end of treatment there were no significant differences in symptom improvement between the two groups, suggesting that the addition of fluoxetine did not affect the participants’ mental health outcomes.

However, this does not suggest that antidepressants should not be used in treating depression.

“Antidepressants can be very useful for some people,” Associate Professor Davey said. “Anyone considering the role of antidepressants in their treatment should discuss this with their doctor or clinician.

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“Our study found some evidence to suggest that if antidepressants have a role, they have more of a role in people at the older end of our age range. The take-home message from the study is that the first-line treatment for young people with depression should be psychotherapy.”

This is of particular interest to members of the LGBTQIA community because 41% of non-binary people said they harmed themselves in the last year compared to 20% of LGBT women and 12% of GBT men. One in six LGBT people (16%) said they drank alcohol almost every day over the last year.


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Health & Wellness

In Europe, syphilis notifications up by 70% since 2010

Syphilis diagnoses were consistently higher among men, with rates doubling from 6.1 per 100,000 in 2010 to 12.1 in 2017. Between 2007 and 2017, close to two-thirds (62%) were reported among men who have sex with men. Heterosexual men contributed 23% of cases and women 15%.

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The number of syphilis cases has been consistently going up across Europe since 2010, mostly affecting men who have sex with men living in urban areas. In 2017, notification rates reached an all-time high in the EU/EEA countries with more than 33 000 reported cases. An in-depth ECDC study describes the factors behind this increase and outlines the evidence-based options for public health control of syphilis, including case finding and management as well as educational activities.

Overall, more than 260 000 confirmed syphilis cases were reported from 30 EU/EEA countries between 2007 and 2017. While annual notifications decreased slightly between 2007 and 2010 (from almost 20 000 to a low of some 19 000 cases), they continuously rose to more than 33 000 cases in 2017. An all-time high since the start of ECDC surveillance recording.

This trend results from notification data of the 23 countries with comprehensive surveillance systems reporting consistently between 2007 and 2017. The rate dropped to a low of 4.2 per 100 000 persons in 2010, before reaching an EU/EEA peak of 7.1 per 100 000 population in 2017 – an increase of 70% compared with the notification rate in 2010. This means that for the first time since the early 2000s, the EU/EEA countries report more syphilis than HIV cases.

Striking country variations in Europe

Between 2010 and 2017, 15 countries reported an increase in the notification rate of more than 15%. However, this varied greatly among countries with rates more than doubling in five countries: Iceland (876%), Ireland (224%), the United Kingdom (153%), Germany (144%) and Malta (123%). On the other hand, Estonia and Romania reported a drop of 50% or more over the same period.

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During this period, syphilis diagnoses were consistently higher among men, with rates doubling from 6.1 per 100 000 in 2010 to 12.1 in 2017. Between 2007 and 2017, close to two-thirds (62%, 94 015 of the 152 233 cases where sexual orientation was known) were reported among men who have sex with men. Heterosexual men contributed 23% of cases and women 15%. The proportion of cases diagnosed among men who have sex with men ranged from below 20% in Latvia, Lithuania and Romania to more than 80% in France, Germany, Ireland, the Netherlands, Sweden and the United Kingdom.

The ECDC study looked at more than 60 studies reporting on rising syphilis trends in high-income countries since the early 2000s.

“There is a clear relationship between sexual risk behaviour and the risk of syphilis and other sexually transmitted diseases”, states Andrew Amato-Gauci, Head of the ECDC programme on HIV, STI and viral hepatitis. “The increases in syphilis infections that we see across Europe, as well as other countries around the world, are a result of several factors such as people having sex without condoms and multiple sexual partners combined with a reduced fear of acquiring HIV”, Amato continues. “To reverse this trend, we need to encourage people to use condoms consistently with new and casual partners. Regular tests for syphilis and other sexually transmitted infections should also be part of the parcel, especially if there has been a risk of infection.”

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In addition, response measures should be informed by sound epidemiological data and targeted towards affected population groups taking into account the main determinants of transmission.

The response to syphilis outbreaks or programmatic control should include a combination of:

  • case finding, including screening of at-risk groups, partner notification and surveillance activities,
  • case management with appropriate treatment following diagnosis,
  • educational activities directed at the general population, those at-risk of syphilis infection, and at healthcare providers.

Decrease among women and congenital syphilis

Congenital syphilis rates in the EU/EEA have been decreasing since 2005. During this time, rates of syphilis among women have decreased consistently in the EU/EEA, particularly in eastern Europe. This contributed to the reduction of the risk of mother-to-child transmission of syphilis in Europe that is in contrast to increasing congenital syphilis rates in many other parts of the western world. Despite this, underreporting of congenital syphilis is likely in several Member States of the EU/EEA and there is some concern regarding increasing syphilis rates among women in some western EU/EEA countries. Effective national antenatal screening programmes together with interventions to control syphilis transmission among heterosexual populations are key in order to sustain the low rates of congenital syphilis.

The diagnosis and treatment of syphilis are both accessible and cost effective. Left untreated, syphilis infection can lead to severe complications and also facilitates transmission of HIV infection. Untreated syphilis during pregnancy can severely compromise pregnancy outcomes, leading to foetal loss, stillbirth or congenital syphilis in the newborn.

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