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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

8 Tips for promoting men’s health

Here are a few tips that can help ensure the success of men’s health programs.

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Men tend to shy away from clinical medical services and formal health care programs, leaving community-based programs to help fill the gap. But not all programs are created equal. This is according to a study – “Community-based men’s health promotion programs: eight lessons learnt and their caveats”, which was published in the journal Health Promotion International – that shows that the programs that succeed are those that recognize and adapt to the social forces that uniquely affect men.

So for University of British Columbia (UBC) nursing professor John Oliffe, who led the study that reviewed community-based programs in Canada, Australia, New Zealand, UK and the US, there are a few tips that can help ensure the success of men’s health programs.

Recognize the forces that affect men’s health: The UBC research points out that social factors can significantly affect health, including race, culture, socioeconomic status, education and income levels. Dudes Club, a program based in Vancouver’s Downtown Eastside, succeeds because its content is tailored to its largely Indigenous clientele. Events include culturally based activities and elder-led circles, and clients are reporting improved mental, spiritual, physical and emotional well-being as a result.

Physical activity builds connections: Activity-based programs that link to masculine ideals such as problem-solving and physical prowess work well. Men’s Sheds, a program that runs in Australia, Canada and a few other countries, successfully attracts men with woodworking activities, computer tutorials, gardening and informal social events.

Safe spaces help men open up: Many men are reticent to talk about health challenges or talk about personal issues, but programs–like prostate cancer support groups–can expand their comfort zone by creating safe spaces for sharing experiences and discussing sensitive topics.

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Knowledge can combat stigma: Many men who are experiencing health challenges like depression or suicidal thoughts lack knowledge about their condition, which further fuels any stigma they may already feel. Community-based programs can promote health literacy and tackle stigma by using simple, non-judgmental language to describe health conditions, Oliffe said.

Men-focused environments work well: No surprise, “men-friendly” community spaces and activities–such as sports events or competitions–work better in recruiting men to health-related programs than strictly clinical programs. Oliffe points to a few examples, including some European soccer clubs, that draw men in to join exercise and healthy eating programs.

A clear vision for the program is a must: Programs must have tangible benefits, clear goals and strong, collaborative leaders. Dads in Gear– developed to assist dads to quit smoking–recruited participants with an offer of free meals and child care. It emphasized the need for participants to actively work for their well-being, and it encouraged the men to independently sustain their healthy practices after completing the program.

Evaluate to perpetuate: Every program should carry out a consistent and formal evaluation process, Oliffe advises. This helps to support future funding efforts and ensures the program is working as well as it should.

Pop-ups’ are OK: And finally, don’t expect to sustain or expand every program, says Oliffe, as some might be best considered “pop-ups”. Once they’ve hit their goal, they can be retired and regarded as the seed for future ideas.

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2/3 of parents cite barriers in recognizing youth depression

Teens and preteens are no strangers to depression: 1 in 4 parents say their child knows a peer with depression; 1 in 10 say a child’s peer has committed suicide.

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Telling the difference between a teen’s normal ups and downs and something bigger is among top challenges parents face in identifying youth depression, a new poll suggests.

Though the majority of parents say they are confident they would recognize depression in their middle or high school aged child, two thirds acknowledge barriers to spotting specific signs and symptoms, according to the C.S. Mott Children’s Hospital National Poll on Children’s Health at the University of Michigan in the US.

Forty percent of parents struggle to differentiate between normal mood swings and signs of depression, while 30% say their child is good at hiding feelings.

“In many families, the preteen and teen years bring dramatic changes both in youth behavior and in the dynamic between parents and children,” says poll co-director Sarah Clark. “These transitions can make it particularly challenging to get a read on children’s emotional state and whether there is possible depression.”

Still, a third of parents polled said nothing would interfere with their ability to recognize signs of depression in their child.

“Some parents may be overestimating their ability to recognize depression in the mood and behavior of their own child,” Clark says. “An overconfident parent may fail to pick up on the subtle signals that something is amiss.”

The poll also suggests that the topic of depression is all too familiar for middle and high school students. One in four parents say their child knows a peer or classmate with depression, and 1 in 10 say their child knows a peer or classmate who has died by suicide.

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Indeed, rates of youth suicide continue to rise. Among people ages 10 to 24 years old, the suicide rate climbed 56% between 2007 and 2017, according to the Centers for Disease Control and Prevention.

“Our report reinforces that depression is not an abstract concept for today’s teens and preteens, or their parents,” Clark says.

“This level of familiarity with depression and suicide is consistent with recent statistics showing a dramatic increase in suicide among… youth over the past decade. Rising rates of suicide highlight the importance of recognizing depression in youth.”

Compared to the ratings of their own ability, parents polled were also less confident that their preteens or teens would recognize depression in themselves.

Clark says parents should stay vigilant on spotting any signs of potential depression in kids, which may vary from sadness and isolation to anger, irritability and acting out. Parents might also talk with their preteen or teen about identifying a “go to” adult who can be a trusted source if they are feeling blue, Clark says.

Most parents also believe schools should play a role in identifying potential depression, with seven in 10 supporting depression screening starting in middle school.

“The good news is that parents view schools as a valuable partner in recognizing youth depression,” Clark says.The bad news is that too few schools have adequate resources to screen students for depression, and to offer counseling to students who need it.”

Clark encourages parents to learn whether depression screening is taking place at their child’s school and whether counseling is available for students who screen positive. Given the limited resources in many school districts, parents can be advocates of such efforts by talking to school administrators and school board members about the importance of offering mental health services in schools.

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The Mott Poll report is based on responses from 819 parents with at least one child in middle school, junior high, or high school.

Depression is – of course – an important issue in the LGBTQIA community. One study done in November 2018, for instance, found that half of LGBT people (52%) said they’ve experienced depression in the last year; one in eight LGBT people aged 18-24 (13%) said they’ve attempted to take their own life in the last year; and almost half of trans people (46%) have thought about taking their own life in the last year, 31% of LGB people who aren’t trans said the same.

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First case of sexually transmitted dengue confirmed in Spain

Health authorities confirmed a case of a man spreading dengue through sex. This is a world first for a virus which – until recently – was largely thought to be transmitted only by mosquitos.

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No, getting bitten by mosquitos isn’t the only way you can get dengue.

In Spain, health authorities confirmed a case of a man spreading dengue through sex. This is a world first for a virus which – until recently – was largely thought to be transmitted only by mosquitos.

The case involves a 41-year-old man from Madrid who contracted dengue after having sex with his male partner, who got the virus from a mosquito bite during a trip to Cuba and the Dominican Republic.

When the man’s dengue infection was confirmed in September, it puzzled doctors because he had not traveled to a country where the disease is common. An analysis of the sperm of the two men was carried out and it revealed that not only did they have dengue, but that it was exactly the same virus which circulates in Cuba.

Dengue is transmitted mainly by the Aedes Aegypti mosquito, which grows in number in densely-populated tropical climates, such as the Philippines.

Though it kills 10,000 people a year and infects over 100 million, the disease is fatal only in extreme cases, though symptoms are extremely unpleasant, including high fever, severe headaches and vomiting. It is particularly serious – and deadly – in children.

In the Philippines, the Department of Health reported a total of 271,480 dengue cases from January to August 31 this year, prompting it to declare a national dengue epidemic. As of end-August, an estimated 1,107 people have died of dengue in the country.

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Improved support after self-harm needed to reduce suicide risk

To reduce the high risk of suicide after hospital attendance for self-harm, improved clinical management is needed for all patients – including comprehensive assessment of the patients’ mental state, needs, and risks, as well as implementation of risk reduction strategies, including safety planning.

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Risk of suicide following hospital presentation for self-harm is very high immediately following hospital discharge, emphasising the need for provision of early follow-up care and attention to risk reduction strategies

To reduce the high risk of suicide after hospital attendance for self-harm, improved clinical management is needed for all patients – including comprehensive assessment of the patients’ mental state, needs, and risks, as well as implementation of risk reduction strategies, including safety planning.

The results are from an observational study spanning 16 years and including almost 50,000 people from five English hospitals, published in The Lancet Psychiatry journal.

“The peak in risk of suicide which follows immediately after discharge from hospital underscores the need for provision of early and effective follow-up care. Presentation to hospital for self-harm offers an opportunity for intervention, yet people in are often discharged from hospital having not received a formal assessment of their problems and needs, and without specific aftercare arrangements. As specified in national guidance, a comprehensive assessment of the patients’ mental state, needs, and risks is essential to devise an effective plan for their follow-up care,” says study author Dr. Galit Geulayov, Centre for Suicide Research, Department of Psychiatry, University of Oxford, UK.

It has been estimated that every year there are approximately 200,000 presentations to emergency departments in hospitals across England following acts of non-fatal self-harm. Self-harm is associated with increased mortality, especially by suicide. Approximately 50% of individuals who die by suicide have a history of self-harm, with hospital presentation for self-harm often occurring shortly before suicide.

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The new study compared the risk of suicide following hospital presentation for self-harm according to patient characteristics, method of self-harm, and socioeconomic deprivation. It also estimated the incidence of suicide by time after hospital attendance, adjusting for gender, age, previous self-harm, and psychiatric treatment.

The study included 49,783 people aged over 15 years who presented to hospital after non-fatal self-harm a total of 90,614 times between 2000-2013. The authors followed these patients for 16 years (until the end of 2015), and the study included five hospitals (one in Oxford, three in Manchester and one in Derby).

Within the 16 year follow up, 703 out of 49,783 people died by suicide – with the incidence of suicide being 163 per 100,000 people per year.

Around a third of these deaths occurred within a year of the patient attending hospital for non-fatal self-harm (36%, 252/703 deaths), and the study confirmed the high risk of suicide in the first year after presentation to hospital for self-harm (the incidence of suicide in the year following discharge from hospital was 511 suicides per 100,000 people per year – 55.5 times higher than that of the general population).

The authors found that risk was particularly elevated in the first month (the incidence of suicide in the month following discharge from hospital was 1,787 per 100,000 people per year – close to 200 times higher than in the general population) – with 74 out of 703 people in the study dying by suicide within a month.

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The authors note that men were more likely to die by suicide following hospital presentation of self-harm than women, people who attended hospital more than once for non-fatal self-harm were more likely to die by suicide than those with a single presentation, and age was associated with risk (with risk increasing 3% with each year of age).

In addition, those who lived in less deprived areas had a higher risk of death by suicide than those who lived in the most deprived areas, but this contrasts with a large body of evidence and might be explained by higher rates of psychiatric disorders in this group in this study – more research is needed. The authors also note that some forms of self-harm were more strongly linked to subsequent suicide, but advise against including detail of this kind in media reporting.

Suicide is a big issue in the LGBTQIA community. In 2018, for instance, a study found that a total of 37% of trans respondents reported having seriously considered suicide during the past 12 months and 32% had ever attempted a suicide. Offensive treatment during the past three months and lifetime exposure to trans-related violence were significantly associated with suicidality.

A study published in LGBT Health in 2016, meanwhile, emphasized the importance of strengthening family support and acceptance as part of a positive intervention.

The authors of this newer study note that holistic assessment of risk factors is required, and warn that no single characteristic will help predict later suicide.

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“While awareness of characteristics which increase the risk of subsequent suicide can assist as part of this assessment, previous studies indicate that individual factors related to self-harm are a poor means to evaluate the risk of future suicide. These factors need to be considered together, followed by risk reduction strategies, including safety planning, for all patients,” says Professor Hawton, Centre for Suicide Research, Department of Psychiatry, University of Oxford, UK.

The authors note that their study focuses on three cities in England and the findings may not necessarily apply to the whole of the country.

Writing in a linked comment, Dr. Annette Erlangsen, Danish Research Institute for Suicide Prevention, Denmark, notes that there is a range of treatment options available following presentation of self-harm in emergency departments (including referrals to psychiatric wards after psychosocial assessments, outpatient treatment for patients not under immediate risk of self-harming, and – in some countries – specialized suicide prevention clinics) but many countries send patients home with a referral to their GP or do not refer at all.

She says: “The bottom line is–while the body of evidence of effective intervention is growing, we need to help people who present with self-harm. Operating in such a scenario is challenging but the numbers are clear; we need to ensure that patients receive support immediately when presenting and implement a continuation of care after discharge.”

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Trouble sleeping? Insomnia symptoms linked to increased risk of stroke, heart attack

The results suggest that if we can target people who are having trouble sleeping with behavioral therapies, it’s possible that we could reduce the number of cases of stroke, heart attack and other diseases later down the line.

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People who have trouble sleeping may be more likely to have a stroke, heart attack or other cerebrovascular or cardiovascular diseases, according to a study published in the November 6, 2019, online issue of Neurology, the medical journal of the American Academy of Neurology.

“These results suggest that if we can target people who are having trouble sleeping with behavioral therapies, it’s possible that we could reduce the number of cases of stroke, heart attack and other diseases later down the line,” said study author Liming Li, MD, of Peking University in Beijing, China.

The study involved 487,200 people in China with an average age of 51. Participants had no history of stroke or heart disease at the beginning of the study.

Participants were asked if they had any of three symptoms of insomnia at least three days per week: trouble falling asleep or staying asleep; waking up too early in the morning; or trouble staying focused during the day due to poor sleep. A total of 11 percent of the people had difficulty falling asleep or staying asleep; 10 percent reported waking up too early; and 2 percent had trouble staying focused during the day due to poor sleep. The researchers did not determine if the people met the full definition of insomnia.

The people were then followed for an average of about 10 years. During that time, there were 130,032 cases of stroke, heart attack and other similar diseases.

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People who had all three symptoms of insomnia were 18 percent more likely to develop these diseases than people who did not have any symptoms. The researchers adjusted for other factors that could affect the risk of stroke or heart disease including alcohol use, smoking, and level of physical activity.

People who had trouble falling asleep or staying asleep were 9 percent more likely to develop stroke or heart disease than people who did not have this trouble. Of the 55,127 people who had this symptom, 17,650, or 32 percent, had a stroke or heart disease, compared to 112,382, or 26 percent, of the 432,073 people who did not have this symptom of insomnia.

People who woke up too early in the morning and could not get back to sleep were 7 percent more likely to develop these diseases than people who did not have that problem. And people who reported that they had trouble staying focused during the day due to poor sleep were 13 percent more likely to develop these diseases than people who did not have that symptom.

“The link between insomnia symptoms and these diseases was even stronger in younger adults and people who did not have high blood pressure at the start of the study, so future research should look especially at early detection and interventions aimed at these groups,” Li said.

Li noted that the study does not show cause and effect between the insomnia symptoms and stroke and heart disease. It only shows an association.

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A limitation of the study was that people reported their own symptoms of insomnia, so the information may not have been accurate.

Also, the researchers did not ask participants about having sleep that was not refreshing; this is another common symptom of insomnia.

The question that needs to be asked: How is this relevant particularly to the LGBTQIA community?

Sleep may be fundamental to health, but a study found that lesbian, gay and bisexual adults reported more sleep problems than their heterosexual counterparts. This suggests that sleep difficulties may underlie a number of mental and physical health problems experienced by sexual minorities.

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Study finds normal body weight can hide eating disorder in teens

In 2013, a new category of eating disorder was formally recognized: atypical anorexia nervosa. Individuals with this condition meet all other diagnostic criteria for anorexia nervosa but have a normal body weight.

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Teens and young adults with atypical anorexia nervosa can have normal body weights and still be dangerously ill, according to a new study led by researchers at the Stanford University School of Medicine and the University of California-San Francisco.

The research is the largest, most comprehensive assessment to date of normal-weight adolescents with atypical anorexia.

Traditionally, individuals had to be below 85% of their ideal body weight to receive a diagnosis of anorexia nervosa, a disorder characterized by restrictive eating, over-exercising, distorted body image and intense fear of weight gain. But in 2013, a new category of eating disorder was formally recognized: atypical anorexia nervosa. Individuals with this condition meet all other diagnostic criteria for anorexia nervosa but have a normal body weight.

“This group of patients is underrecognized and undertreated,” said the study’s senior author, Neville Golden, MD, professor of pediatrics at the Stanford School of Medicine. “Our study showed that they can be just as sick medically and psychologically as anorexia nervosa patients who are underweight.”

The study, publishing online Nov. 5 in Pediatrics, shows that large, rapid weight loss is the best predictor of medical and psychological problems in patients with atypical anorexia, not their body weight at diagnosis. Dangerously low heart rate and blood pressure, as well as serious electrolyte imbalances and psychological problems, are common in patients with atypical anorexia whose weight is within a normal range, the study found.

The study’s lead author is registered dietitian Andrea Garber, PhD, adjunct professor of pediatrics at UCSF.

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“The bigger context is that, over the past 30 years, the prevalence of adolescent obesity has quadrupled, and teens are being told to lose weight without being given tools to do so in a healthy way,” Golden said. Obese teens who adopt unhealthy behaviors — such as severe food restriction and extreme exercise — may initially be praised for weight loss or told not to worry about eating-disorder concerns because they aren’t underweight.

“By the time they get to see us, they’ve lost a tremendous amount of weight, their vital signs are unstable and they need to be hospitalized,” Golden said.

The study compared 50 patients with atypical anorexia nervosa with 66 patients who met traditional diagnostic criteria, including being underweight. Participants were 12-24 years old, and 91% were female. All participants received eating-disorder treatment as part of the study, the results of which will be reported in a future publication.

Before developing an eating disorder, patients with atypical anorexia had higher weight-to-height ratios than typical patients. During their illness, patients in both groups lost the same amount of weight, an average of 30 pounds over 15.9 months. The two groups had equally poor vital signs, including low heart rate and low electrolytes. Cessation of menstruation, a side effect of the disease, was equally common in the two groups. Some members of both groups also had very low blood pressure, although this was more common in the patients with typical anorexia. Atypical patients had worse psychological symptoms, on average.

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The researchers used statistical modeling to determine which factors best predicted illness severity. The amount, speed and duration of weight loss were linked with worse illness; body weight at the time of diagnosis was not, they found.

More research is needed to identify what constitutes healthy weight for adolescents recovering from atypical anorexia nervosa, Golden said.

“If a patient was obese, the goal is not to have them regain all the lost weight,” Golden said, adding that a mixture of metabolic, hormonal and psychological measures may be needed to define a healthy weight instead.

“If someone gains a bit of weight, regains menses, and is doing well socially, emotionally and cognitively, that might indicate that they are in a place of recovery,” he said.

Other Stanford co-authors on the study are Cynthia Kapphahn, MD, clinical professor of pediatrics; research coordinators Anna Kreiter and Kristina Saffran; and clinical dietitian Allyson Sy. Scientists at UCSF, UCLA and the University of Chicago also contributed to the study.

Weight issues also affect the LGBTQIA community, with 44% to 70% of LGBTQ teens reported weight-based teasing from family members, 41% to 57% reported weight-based teasing from peers, and as many as 44% reported weight-based teasing from both family members and peers.

Meanwhile, specific to the gay community, a study found that Grindr, the most popular dating app for gay, bisexual, two-spirit and queer men, had a negative effect on men’s body image, especially when it came to weight. The study also found that apart from weight stigma, body dissatisfaction stemmed from sexual objectification and appearance comparison. With three out of four gay men reported to have used Grindr, this issue affects a big chunk of the gay population.

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