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Depression and suicide risk linked to air pollution

Reducing global average exposure to fine particulate matter (PM2.5) air pollution from 44 micrograms per metre cubed (μg/m3) to 25μg/m3 could result in a 15% reduction in depression risk worldwide.

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People exposed to higher levels of air pollution are more likely to experience depression or die by suicide, finds a new analysis led by UCL.

The first systematic review and meta-analysis of evidence connecting air pollution and a range of mental health problems, published in Environmental Health Perspectives, reviewed study data from 16 countries.

The researchers found that, if the relationship with depression reported in some of these studies is causal, then reducing global average exposure to fine particulate matter (PM2.5) air pollution from 44 micrograms per metre cubed (μg/m3) to 25μg/m3 could result in a 15% reduction in depression risk worldwide.

The World Health Organization guidelines recommend that fine particulate matter pollution – small airborne particles that can include dust and soot – should be kept under 10μg/m3.

“We already know that air pollution is bad for people’s health, with numerous physical health risks ranging from heart and lung disease to stroke and a higher risk of dementia,” said the study’s lead author, Dr Isobel Braithwaite (UCL Psychiatry and UCL Institute of Health Informatics). “Here, we’re showing that air pollution could be causing substantial harm to our mental health as well, making the case for cleaning up the air we breathe even more urgent.”

The research team searched for studies that had investigated the association between particulate matter pollution and five different adverse mental health outcomes in adults. They identified 25 studies that fitted their criteria, nine of which were included in the primary analyses.

Five studies looking at long-term particulate matter exposure and depression were included in one meta-analysis. By pooling the results, they found that a 10μg/m3 (microgram per metre cubed) increase in the average level of fine particulate matter (PM2.5) air pollution people were exposed to over long periods was associated with an approximately 10% increase in their odds of depression.

“We found quite consistent results across the studies we reviewed that analysed the relationship between long-term air pollution exposure and depression, even after adjustment for many other factors which could explain the association. The association seems to be similar in magnitude to those that have been found for some physical health impacts of particulate matter, such as all-cause mortality,” Dr Braithwaite said.

Global city PM2.5 levels range from 114 and 97 in Delhi and Dhaka, to 6 in Ottawa and Wellington.

In UK cities, the average particulate matter level that people are exposed to is 12.8μg/m3. The researchers estimate that lowering average air pollution levels to the WHO recommended limit of 10μg/m3 could reduce urban UK residents’ depression risk by roughly 2.5%.

The researchers also found evidence of a connection between short-term changes in coarse particulate air pollution (PM10)* exposure and the number of suicides, from pooling the results of four different studies in a meta-analysis. The risk of suicide appears to be measurably higher on days when PM10 levels have been high over a three-day period than after less polluted periods.

The studies into short-term changes in suicide risk accounted for confounding factors such as weather changes, and day of the week. The relationship is not affected by other neighbourhood or socioeconomic factors given that the comparisons being made are among the same individuals on days with different pollution levels.

The researchers say the evidence was particularly strong for the suicide risk link, but the effect was smaller than for depression (an increase in suicide risk of 2% for each 10μg/m3 increase in the average coarse particulate pollution level over a three-day period).

The researchers say they cannot yet confirm whether air pollution directly causes mental ill health, but say there is evidence to suggest possible causal mechanisms.

“We know that the finest particulates from dirty air can reach the brain via both the bloodstream and the nose, and air pollution has been implicated in increased neuroinflammation, damage to nerve cells and to changes in stress hormone production, which have been linked to poor mental health,” Dr Braithwaite said.

The study’s senior author, Dr Joseph Hayes (UCL Psychiatry and Camden and Islington NHS Foundation Trust), said: “Our findings correspond with other studies that have come out this year, with further evidence in young people and in other mental health conditions. While we cannot yet say that this relationship is causal, the evidence is highly suggestive that air pollution itself increases the risk of adverse mental health outcomes.”

He added: “A lot of what we can do to reduce air pollution can also benefit our mental health in other ways, such as enabling people to cycle or walk rather than drive, and enhancing access to parks, so this adds support to the promotion of active travel and urban green spaces.”

Despite global issues re the environment, it is worth noting that the earth may be facing a major crisis, and yet there are some men who do not want to do anything because they are afraid that people may think they are gay. This is according to research published in Sex Roles, which noted that many men opt out from recycling and using cotton bags because they’re afraid of what people may think of them by questioning their… masculinity.

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*The two main types of particulate matter pollution are differentiated by being under 2.5 micrometres in diameter (fine particulate matter, or PM2.5), and between 2.5 and 10 micrometres in diameter (coarse particulate matter, or PM10). Some, like smoke, are visible, while others are too small to be seen by the naked eye. Sources can include road transport, burning of fuels such as for heating or cooking, heavy industry and more.

Health & Wellness

Trans women can safely maintain estrogen treatments during gender affirming surgery

The practice of withholding estrogen prior to gender affirming surgery was not necessary. Most transgender women can now safely remain on their estrogen therapy throughout surgery.

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There was no difference in blood clots when estrogen hormone therapy was maintained during gender affirming surgery.

This is according to a study (titled, “No Venous Thromboembolism Increase Among Transgender Female Patients Remaining on Estrogen for Gender Affirming Surgery”) helmed by John Henry Pang with Aki Kozato from Mount Sinai, and was published in the Journal of Clinical Endocrinology & Metabolism.

Historically, the lack of published data contributed to heterogeneity in the practice of whether doctors and surgeons advised transgender women to withhold their estrogen therapy before surgery. The sudden loss of estrogen in the blood was sometimes very uncomfortable with symptoms that amounted to a sudden, severe menopause.

So the researchers tapped 919 transgender patients who underwent gender affirming surgery at Mount Sinai’s Center for Transgender Medicine and Surgery between November 2015 and August 2019. Notably, including 407 cases of transgender women who underwent primary vaginoplasty surgery.

This study found that the practice of withholding estrogen prior to gender affirming surgery was not necessary. Most transgender women can now safely remain on their estrogen therapy throughout surgery.

The bottom line: This study found that most transgender women can  safely maintain their estrogen hormone treatments during gender affirming surgery.

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Health & Wellness

Bisexual men more prone to eating disorders than gay or straight men – study

80% of bisexual men reported that they “felt fat”, and 77% had a strong desire to lose weight, both figures higher than the 79% and 75% for gay men, respectively.

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Bisexual men are more likely to experience eating disorders than either heterosexual or gay men. This is according to a report from the University of California San Francisco, published in the journal Eating and Weight Disorders.

A handful of studies have actually indicated that gay men are at increased risk for disordered eating, including fasting, excessive exercise and preoccupation with weight and body shape. This newer study, however, suggest that bisexual men are even more susceptible to some unhealthy habits.

For this study, the researchers surveyed over 4,500 LGBTQ adults, and a quarter of the bisexual male participants reported having fasted for more than eight hours to influence their weight or appearance. This is higher when compared to 20% for gay men.

The research also found that 80% of bisexual men reported that they “felt fat”, and 77% had a strong desire to lose weight, both figures higher than the 79% and 75% for gay men, respectively.

Now this is worth stressing: According to study co-author Dr. Jason Nagata, not everyone who diets or feels fat has an eating disorder. “It’s a spectrum — from some amount of concern to a tipping point where it becomes a pathological obsession about body weight and appearance,”Nagata was quoted as saying by NBC News.

For Nagata, several factors may be at play here, including “minority stress” (the concept that the heightened anxiety faced by marginalized groups can manifest as poor mental and physical health outcomes).

“LGBTQ people experience stigma and discrimination, and stressors can definitely lead to disordered eating,” Nagata was also quoted as saying. “For bi men, they’re not just facing stigma from the straight community but from the gay community, as well.”

Of all the respondents, 3.2% of bisexual males were clinically diagnosed with eating disorders (compared to 2.9% of gay men). For heterosexual men, it’s only 0.6%.

For the researchers, there is a need to conduct eating disorder research on various sexual identities independently. This is also to raise awareness on this issue (and how it affects different people of various SOGIESCs).

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Health & Wellness

Timing and intensity of oral sex may affect risk of oropharyngeal cancer

Love giving head? Consider this: Having more than 10 prior oral sex partners was associated with a 4.3-times greater likelihood of having HPV-related oropharyngeal cancer.

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Human papillomavirus (HPV) can infect the mouth and throat to cause cancers of the oropharynx.

This is according to a study published in CANCER, a peer-reviewed journal of the American Cancer Society, which has found that having more than 10 prior oral sex partners was associated with a 4.3-times greater likelihood of having HPV-related oropharyngeal cancer. The study also shows that having oral sex at a younger age and more partners in a shorter time period (oral sex intensity) were associated with higher likelihoods of having HPV-related cancer of the mouth and throat.

Previous studies have shown that performing oral sex is a strong risk factor for HPV-related oropharyngeal cancer. To examine how behavior related to oral sex may affect risk, Virginia Drake, MD, of Johns Hopkins University, and her colleagues asked 163 individuals with and 345 without HPV-related oropharyngeal cancer to complete a behavioral survey.

In addition to timing and intensity of oral sex, individuals who had older sexual partners when they were young, and those with partners who had extramarital sex were more likely to have HPV-related oropharyngeal cancer.

“Our study builds on previous research to demonstrate that it is not only the number of oral sexual partners, but also other factors not previously appreciated that contribute to the risk of exposure to HPV orally and subsequent HPV-related oropharyngeal cancer,” said Dr. Drake. “As the incidence of HPV-related oropharyngeal cancer continues to rise… our study offers a contemporary evaluation of risk factors for this disease. We have uncovered additional nuances of how and why some people may develop this cancer, which may help identify those at greater risk.”

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Health & Wellness

Sexual, gender minority youths more likely to have obesity, binge eating disorder

Findings suggest that weight and eating disorder disparities observed in SGM adolescents/adults may emerge in childhood. As such, “clinicians should consider assessing eating- and health-related behaviors among SGM youths.”

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Sexual and gender minorities (SGM) youths were more likely to have obesity and full-threshold or subthreshold binge eating disorder. This is according to research – “Obesity and Eating Disorder Disparities Among Sexual and Gender Minority Youth” by Natasha A. Schvey, PhD; Arielle T. Pearlman, BA; David A. Klein, MD, MPH; et al -published in JAMA Pediatrics.

SGM are those who identify as lesbian, gay, bisexual and/or transgender, or whose sexual orientation and/or gender identity/expression do not conform to societal conventions.

For this study, the researchers noted that as it is, “obesity and eating disorders in youth are prevalent, are associated with medical and psychosocial consequences, and may persist into adulthood. Therefore, identifying subgroups of youth vulnerable to one or both conditions is critical.”

For them, one group that may be at risk for obesity and disordered eating is SGM.

In total, 11,852 participants were considered (aged 9-10 years), derived from the Adolescent Brain Cognitive Development Study. The mean age was 9.91, and 5,672 (47.9%) of the total number were female. The sample comprised 1.6% (n = 190) probable sexual (n = 151) and/or gender minority (n = 58) youths, of whom 24.7% (n = 47) responded yes and 75.3% (n = 143) responded maybe to the SGM queries.

The researchers found that one in six youths (1,987 [16.8%]) had obesity and 10.2% (n = 1,188) had a full-threshold (86 [0.7%]) and/or subthreshold (1103 [9.4%]) eating disorder.

They also reported that adjusting for covariates, SGM youths were more likely to have obesity (odds ratio, 1.64; 95% CI, 1.09-2.48) and full-threshold or subthreshold binge eating disorder (odds ratio, 3.49; 95% CI, 1.39-8.76).

SGM and non-SGM youths did not differ in the likelihood of full-threshold or subthreshold anorexia nervosa or bulimia nervosa. The same pattern of results remained when limiting SGM youths to those responding yes to the SGM items, although significance for the likelihood of obesity was attenuated.

For the researchers, the findings suggest that weight and eating disorder disparities observed in SGM adolescents/adults may emerge in childhood. As such, “clinicians should consider assessing eating- and health-related behaviors among SGM youths.”

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Health & Wellness

Sexual dysfunction hits some women harder than others as they age

Factors other than use of hormone therapy, such as higher importance of sex, positive attitudes toward sex, satisfaction with one’s partner, and fewer genitourinary symptoms associated with menopause appear to be protective and are linked to better sexual function across the menopause transition.

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Sexual dysfunction often accompanies the menopause transition. Yet, not all women experience it the same. A study identified the determinants that affect a woman’s risk of sexual dysfunction and sought to determine the effectiveness of hormone therapy in decreasing that risk and modifying sexual behavior.

The study – “Sexual behaviors and function during menopausal transition–does menopausal hormone therapy play a role?” – was published in Menopause, the journal of The North American Menopause Society (NAMS).

Although hot flashes easily rank as the most common symptom of menopause, the transition is often accompanied by other issues, including changes that affect a woman’s libido, sexual satisfaction, and overall sexual behavior. Because hormone therapy is the most-effective treatment option to help women manage menopause symptoms, it was the focus of a new study designed to determine why some women experience greater sexual dysfunction than others.

The study involving more than 200 women aged 45 to 55 years found that women with secondary and higher education and a greater number of lifetime sexual partners were less likely to experience sexual dysfunction. In contrast, women with more anxious behaviors during sexual activity and those with more severe menopause symptoms were more at risk for sexual dysfunction.

Hormone therapy was not found to mitigate the risk for sexual dysfunction, nor did it play a major role in determining sexual behaviors. However, women using hormone therapy typically had higher body esteem during sexual activities; better sexual function in all domains, except for desire/interest; better quality of relationships; and fewer sexual complaints (other than arousal problems) than those women who do not. Of importance to helping maintain a woman’s sexual function were positive sexual experiences, attitudes about sex, body image, and relationship intimacy.

“These results are consistent with the findings of prior studies and emphasize that factors other than use of hormone therapy, such as higher importance of sex, positive attitudes toward sex, satisfaction with one’s partner, and fewer genitourinary symptoms associated with menopause appear to be protective and are linked to better sexual function across the menopause transition,” says Dr. Stephanie Faubion, NAMS medical director.

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Health & Wellness

LGB adults less likely to take cholesterol-lowering meds

Lesbian, gay and bisexual (LGB) adults who could benefit from cholesterol-lowering medicine to prevent heart disease are less likely than non-LGB adults to take them.

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Lesbian, gay and bisexual (LGB) adults who could benefit from cholesterol-lowering medicine to prevent heart disease are less likely than non-LGB adults to take them.

This is according to new research – “Statin Use for Atherosclerotic Cardiovascular Disease Prevention Among Sexual Minority Adults” – written by Yi Guo, Christopher W. Wheldon, Hui Shao, Carl J. Pepine, Eileen M. Handberg, Elizabeth A. Shenkman, and Jiang Bian, and which appeared in the Journal of the American Heart Association.

As it is, sexual minorities – including LGB individuals – are at increased risk for cardiovascular disease. This can be attributed to elevated rates of health risk factors, including smoking and having obesity.

For this study, the researchers conducted a cross‐sectional online survey about statin use in adults ≥40 years of age between September and December 2019 using Facebook advertising. In total, 1,531 people responded to targeted Facebook ads.

The researchers calculated the prevalence of statin use by age, sexual orientation, and statin benefit populations. They used multivariable logistic regression to examine whether statin use differed by sexual orientation, adjusting for covariates.

Analysis showed that less than 21% of LGB adults were taking statins, compared to 44% of their non-LGB peers.

“We observed a significantly lower rate of statin use in the LGB versus non‐LGB respondents (20.8% versus 43.8%; P<0.001) in the primary prevention population,” the researchers reported.

In a news release, study author Yi Guo – an assistant professor of health outcomes and biomedical informatics at the University of Florida College of Medicine in Gainesville – said that “there could be many reasons for the difference we observed… LGB individuals may not go to the doctor as often, which leads to lower chances of being recommended statins for cardiovascular disease prevention.”

But looking at the use of statins among people who already had cardiovascular disease, there was no disparity between LGB and non-LGB adults.

For Guo, members of the LGB population may be less aware of the protective effect of statins.

For the researchers, the “results emphasize the urgent need for tailored, evidence‐based cardiovascular disease prevention programs that aim to promote statin use, and thus healthy aging, in the LGB population.”

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