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False beliefs about sexual risk, poor physician-patient communication impede STD screening in young women

A study found that one in four clinicians surveyed will disregard screening guidelines for chlamydia and/or gonorrhea if a patient is asymptomatic.

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Despite record high rates of new cases of sexually transmitted diseases (STDs), young women who are sexually active often don’t talk to their clinicians about sex and STD risk, and many aren’t being tested for infection or disease as guidelines recommend, according to new research from Quest Diagnostics, a provider of diagnostic information services.

The findings from a new survey -“Young Women and STDs: Are Physicians Doing Enough to Empower their Patients and Protect their Health?” – suggest that lack of direct communication between clinicians and patients – and false beliefs about STD risk held by both groups — may contribute to STD prevalence.

The survey examined the perceptions of young women 15-24 years of age, mothers of young women in this age group, and primary care, OB/GYN, and other specialty physicians regarding sexual activity, sexual health, and knowledge of and screening for STDs (also known as sexually transmitted infections or STIs). The results of the 2017 survey were also compared to those of previous research by Quest in 2015 involving similar populations.

Medical guidelines from the Centers for Disease Control and Prevention recommend annual laboratory testing for chlamydia and gonorrhea for all sexually active women under the age of 25. According to the Centers for Disease Control and Prevention (CDC), cases of sexually transmitted disease are at an all-time high, with more than two million cases of chlamydia, gonorrhea and syphilis reported in the United States in 2016. Young adults make up about half of STD cases.

“We know that people often think of STDs as something that happens ‘to others’ and, frequently, health care providers have similar beliefs and don’t view their patients as being at risk,” said Lynn Barclay, president and CEO, American Sexual Health Association. “Testing is crucial in young women because STDs are very common, often without symptoms, and undetected infections like chlamydia can lead to problems including infertility.”

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Among the key findings:

  • Young women may not understand their STD risk: A little more than half of young women (56%) say they are sexually active and of those who are, 56 percent say they have been tested for an STD. Young sexually active women cite “not feeling at risk” (62%) and “being asymptomatic” (55%) as reasons for not testing, although STDs often lack symptoms. Of women who are sexually active, 86 percent and 88 percent said they aren’t at risk for chlamydia or gonorrhea, respectively.
  • Many young women are uncomfortable talking to their clinician about sex and STDs: Fifty-one percent of young women say they don’t want to bring up for discussion the topics of sex or STDs with their clinicians.
  • Young women may fail to be truthful with their clinician: Twenty seven percent of sexually active young women admit they don’t always tell the truth about their sexual history to their clinician. For the youngest sexually active women (15-17 years of age), forty-three percent aren’t always truthful.
  • Women don’t recall having a clinician ask about STD screening: 49 percent of young women claim their clinician has never asked if they want STD testing, and less than one in four sexually active women has asked their healthcare professional for an STD test.

In addition, the survey responses of young women suggest rates of STD screening by clinicians have declined, particularly among those 15-17 years of age. Based on the comparison of responses of sexually active women 15-17 between 2015 and 2017, STD testing by clinicians for chlamydia and gonorrhea has decreased by 9 percent and 11 percent, respectively.

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The survey also found gaps in care by some physicians.

Clinicians may also be uncomfortable discussing STDs, with one in four (24%) primary care physicians agreed with the statement, “I am very uncomfortable discussing STI risk with my female patients.”

One in three primary care physicians rely on symptoms to diagnose an STD: Twenty-seven percent reported that they could accurately diagnose STD patients “based on their symptoms,” even though CDC notes, “STDs do not always cause symptoms, so it is possible to have an infection and not know it.”

Undiagnosed women are much more likely than men to suffer long-term health impacts from STDs, including infertility and pelvic inflammatory disease.
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Also, one in four physicians will disregard screening guidelines if a patient is asymptomatic: Only seventy-four percent of primary care doctors said they would order chlamydia testing of an asymptomatic, sexually active female patient. Only seventy-two percent would order testing for gonorrhea for such an asymptomatic patient.

Annual screening for chlamydia and gonorrhea for men who do not have sex with other men is not currently guideline recommended, although, like women, they may not have symptoms and can unknowingly transmit infection to a partner. Undiagnosed women are much more likely than men to suffer long-term health impacts from STDs, including infertility and pelvic inflammatory disease.

“Our findings suggest that discomfort with frank conversations about sexual activity and false beliefs about risk are key barriers to STD testing, and could be driving some of the increase in STD cases of young women,” said Damian P. Alagia, III, MD, FACOG, FACS, medical director of woman’s health, Quest Diagnostics. “Half of all new STD cases are acquired by young people between the ages of 15-24, and one in four sexually active adolescents has a sexually transmitted disease. Our hope in sharing this survey’s findings with clinicians and the general public is that it prompts open dialogue about reproductive health and STD risk, which is absolutely critical to reversing the trajectory of high STD rates in the US.”

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The research was conducted by Aurora Research & Consulting on behalf of Quest Diagnostics in December, 2017. A total of 4,742 study respondents, comprised of 3,414 young women between the ages of 15-24, of whom 1,500 self-identified as sexually active; 1,016 mothers of young women in that age group; and 312 primary care, OB/GYN and specialty physicians were surveyed. Most clinician survey data presented in this report was of responses of 100 primary care physicians. Each respondent completed 15-30 minute online surveys regarding perceptions and knowledge of STDs and chlamydia and gonorrhea testing. Strengths of the research include the large number of respondents and the research’s national scale, while limitations include self-reported data and a lack of direct comparability between study populations. The 2017 research was complemented by results of a survey of similar cohort of patients and healthcare practitioners performed in 2015.

Health & Wellness

Between 16% and 18% of preadolescents have ideas of suicide

Up to 18% of preadolescents have ideas of suicide, with the main risk factors including depressive symptoms, anxiety and compulsive obsessive disorder.

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Up to 18% of preadolescents have ideas of suicide, with the main risk factors including depressive symptoms, anxiety and compulsive obsessive disorder. This is according to “Suicidality in a Community Sample of Early Adolescents: A Three-Phase Follow-Up Study”, done by Voltas, N., Hernández-Martínez, C., Arija, V. and Canals, J.

In the study, the researchers studied a group of 720 boys and 794 girls who studied in 13 schools in Reus. They were monitored during three developmental periods: 10 years old, 11 years old and 13 years old. At the beginning of the study, the students answered a series of psychological tests that were used to detect which of them presented emotional symptoms related to depression, anxiety and obsessive compulsive disorder (OCD). From their responses, two groups were created: one group at risk of emotional problems and a control group.

The disorders were diagnosed with standardised international criteria and the boys and girls were monitored to see how suicidal ideation developed throughout the research period.

The figures were quite stable. During the first period, 16% of the students stated that they had thought about suicide, of whom 33% stated the same one year later. In both the second and the third period, ideas of suicide were expressed by 18% of the students surveyed. The risk of suicide was determined in a personal interview and was present in 12.2% of the children with an average age of 11 years old. Although there were no differences between the sexes, the severity of the suicidal behaviour was greater in boys.

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The researchers also observed what factors predicted suicidal ideation and they found here that there were differences between the sexes.

“In boys it is previous depressive symptoms which determine subsequent suicidal ideation,” says Núria Voltas, one of the researchers involved in the study. In girls, on the other hand, it is a combination of anxiety symptoms, OCD and the family’s socioeconomic situation.

The results of this research, published in the scientific journal Archives of Suicide Studies reveal the factors that can trigger ideas of suicide in this age group. “Our results will enable us to have greater control over this particular aspect and take prevention measures in preadolescents, who are going through a period of considerable vulnerability,” she concludes.

This is a noteworthy study, considering other – and earlier – studies have repeatedly highlighted how members of the LGBTQIA community are greatly affected by suicide. In 2018, for instance, a study from the University of Arizona noted that 50.8% of transmasculine adolescents between the ages of 11 and 19 have attempted suicide at least once, while 41.8% of nonbinary adolescents – those who don’t identify as exclusively male or exclusively female – have attempted suicide.

Still another study – also done in 2018 – that appeared in Pediatrics noted that almost 14% of adolescents reported a previous suicide attempt, with disparities by gender identity in suicide attempts. Female to male adolescents reported the highest rate of attempted suicide (50.8%), followed by adolescents who identified as not exclusively male or female (41.8%).

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Still another study – also done in 2018 – that appeared in LGBT Health 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. 


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Health & Wellness

FDA warns public on dangers of injectable whitening products like glutathione

The FDA stated that there are numerous side effects on the use of injectable glutathione for skin lightening, including toxic effects on the liver, kidneys, and nervous system.

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It sure took them a while, but the Food and Drug Administration (FDA) has – finally – warned the public on the dangers associated with the use of injectable lightening agents such as glutathione.

In an advisory dated July 5, 2019 – FDA Advisory No. 2019-182 – the FDA noted that “in the Philippines, several health and beauty salons, wellness spa and beauty clinics are offering all kinds of beauty enhancements, services and skin treatments. It is alarming that they also offer services such as intravenous drip or infusion using skin lightening agents including reduced glutathione, vitamin C and other injections.

“To date there are no published clinical trials that have evaluated the use of injectable glutathione for skin lightening. There are also no published guidelines for appropriate dosing regimens and duration of treatment. The FDA has not approved any injectable products for skin lightening. Injectable glutathione is approved by FDA Philippines as an adjunct treatment in cisplatin chemotherapy.”

The FDA stated that there are numerous side effects on the use of injectable glutathione for skin lightening, including toxic effects on the liver, kidneys, and nervous system. “Also of concern is the possibility of Stevens Johnson Syndrome. Injectable glutathione is sometimes paired with intravenous Vitamin C. Vitamin C injection may form kidney stones if the urine is acidic. Large doses of Vitamin C have resulted in hemodialysis in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency.”

Other potential risks include transmission of infectious agents, such as HIV, hepatitis C and B. This is of particular concern when non-medical practitioner administers this treatment or done in a non-sterile facility.
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And given that glutathione affects the production of melanin (the pigment that gives the human skin, hair and eyes their color), “there are (also) theoretical concerns about the long term skin cancer risk.”

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Other potential risks include transmission of infectious agents, such as HIV, hepatitis C and B. This is of particular concern when non-medical practitioner administers this treatment or done in a non-sterile facility.

The FDA is urging people to consult ONLY a board-certified dermatologist, and avoid buying injectable products online and from being lured to a promising effect of medicines as beauty products.

“Seek medical attention immediately if you experience any side effects and report it to FDA at pharmacovigilance@fda.gov.ph or via online reporting through www.fda.gov.ph.” The Center for Drug Regulation and Research may also be reached at (02) 809-5596.

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Health & Wellness

Seeing greenery linked to less intense and frequent cravings

The findings add to evidence that points to the need to protect and invest in green spaces within towns and cities, in order to maximize the public health benefits they may afford.

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Being able to see green spaces from your home is associated with reduced cravings for alcohol, cigarettes and harmful foods, new research has shown.

The study, led by the University of Plymouth, is the first to demonstrate that passive exposure to nearby green space is linked to both lower frequencies and strengths of craving. It builds on previous research suggesting exercising in nature can reduce cravings, by demonstrating the same may be true irrespective of physical activity.

Researchers say the findings add to evidence that points to the need to protect and invest in green spaces within towns and cities, in order to maximize the public health benefits they may afford. They also suggest the causality of this link needs to be investigated further.

The study, published in the journal Health & Place, is the first to investigate the relationship between exposure to natural environments, craving for a range of appetitive substances and the experiencing of negative emotions or feelings.

It involved academics from the University’s School of Psychology, with support from the European Centre for Environment and Human Health at the University of Exeter.

Leanne Martin, who led the research as part of her Master’s degree in Plymouth, said: “It has been known for some time that being outdoors in nature is linked to a person’s wellbeing. But for there to be a similar association with cravings from simply being able to see green spaces adds a new dimension to previous research. This is the first study to explore this idea, and it could have a range of implications for both public health and environmental protection programs in the future.”

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For the research, participants completed an online survey that explored the relationships between various aspects of nature exposure, craving and negative affect.

Among other things, it measured the proportion of green space in an individual’s residential neighborhood, the presence of green views from their home, their access to a garden or allotment; and their frequency of use of public green spaces.

The results showed that having access to a garden or allotment was associated with both lower craving strength and frequency, while residential views incorporating more than 25% greenspace evoked similar responses.

The study also measured physical activity undertaken within the same time frame that cravings were assessed, showing the reduced craving occurred irrespective of physical activity level.

Dr Sabine Pahl, Associate Professor (Reader) in Psychology, added: “Craving contributes to a variety of health-damaging behaviors such as smoking, excessive drinking and unhealthy eating. In turn, these can contribute to some of the greatest global health challenges of our time, including cancer, obesity and diabetes. Showing that lower craving is linked to more exposure to green spaces is a promising first step. Future research should investigate if and how green spaces can be used to help people withstand problematic cravings, enabling them to better manage cessation attempts in the future.”

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Health & Wellness

Alcohol causes significant harm to those other than the drinker

Some 21% of women and 23% of men experienced harm because of someone else’s drinking in the last 12 months. These harms include: threats or harassment, ruined property or vandalism, physical aggression, harms related to driving, or financial or family problems.

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Each year, one in five adults – estimated to reach 53 million people in the US alone – experience harm because of someone else’s drinking. This is according to “Alcohol’s secondhand harms in the United States: New data on prevalence and risk factors”, research done by Nayak, M. B. Patterson, D. Wilsnack, S. C. Karriker-Jaffe, K. J. and Greenfield, T. K., and which appeared in the Journal of Studies on Alcohol and Drugs.

This is why, according to the researchers, similar to how policymakers addressed the effects of secondhand smoke, society also needs to combat the secondhand effects of drinking because alcohol’s harm to others is “a significant public health issue.”

To conduct the study, researchers led by Nayak of the Alcohol Research Group, a program of the Public Health Institute in Oakland, California, analyzed data from two telephone surveys conducted in 2015 – the National Alcohol’s Harm to Others Survey and the National Alcohol Survey. The current research, funded by the National Institute on Alcohol Abuse and Alcoholism, looked at data from 8,750 respondents age 18 and older and provides support for alcohol control policies, such as taxation and pricing to reduce alcohol’s harm to persons other than the drinker.

According to the study, some 21% of women and 23% of men, an estimated 53 million adults, experienced harm because of someone else’s drinking in the last 12 months. These harms include: threats or harassment, ruined property or vandalism, physical aggression, harms related to driving, or financial or family problems. The most common harm was threats or harassment, reported by 16% of survey respondents.

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The specific types of harm experienced differed by gender. Women were more likely to report financial and family problems, whereas ruined property, vandalism, and physical aggression were more likely to be reported by men.

The researchers also cited additional factors, including age and the person’s own drinking. For instance, people younger than age 25 had a higher risk of experiencing harm from someone else’s drinking.

Also, almost half of men and women who themselves were heavy drinkers said they had been harmed by someone else’s drinking. Even people who drank but not heavily were at two to three times the risk of harassment, threats, and driving-related harm compared with abstainers. Heavy drinking was defined as drinking five or more drinks at a time for men or four or more drinks for women at least monthly.

It is worth noting that members of sexual minority sectors have higher rates of polysubstance use/abuse.

“[T]he freedom to drink alcohol must be counter-balanced by the freedom from being afflicted by others’ drinking in ways manifested by homicide, alcohol-related sexual assault, car crashes, domestic abuse, lost household wages, and child neglect,” wrote Timothy Naimi, M.D., M.P.H., of the Boston Medical Center in an accompanying commentary.

Naimi advocates for increased taxes on alcoholic beverages, noting that there is strong evidence that increased alcohol taxes decrease excessive drinking and reduce the harms to people other than the drinker.

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Nayak – the research’s lead author – agreed. “Control policies, such as alcohol pricing, taxation, reduced availability, and restricting advertising, may be the most effective ways to reduce not only alcohol consumption but also alcohol’s harm to persons other than the drinker,” she said.

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Health & Wellness

Sexual minority women more likely to engage in high-intensity binge drinking

Sexual minority women, whether defined on the basis of sexual attraction, behavior, or identity, were more likely than sexual majority women to engage in high-intensity binge drinking.

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Sexual minority women, whether defined on the basis of sexual attraction, behavior, or identity, were more likely than sexual majority women to engage in high-intensity binge drinking. This is according to a study done by Jessica N. Fish and published in LGBT Health.

The study, “Sexual Orientation-Related Disparities in High-Intensity Binge Drinking: Findings from a Nationally Representative Sample“, eyed to assess sexual orientation differences in high-intensity binge drinking using (American) nationally representative data.

Data used were from the National Epidemiologic Survey on Alcohol and Related Conditions III (N = 36,309), a nationally representative sample of US adults collected in 2012–2013. Sex-stratified adjusted logistic regression models were used to test sexual orientation differences in the prevalence of standard (4+ for women and 5+ for men) and high-intensity binge drinking (8+ and 12+ for women; 10+ and 15+ for men) across three dimensions of sexual orientation: sexual attraction, sexual behavior, and sexual identity.

As per the researcher (and as stated): “Sexual minority women, whether defined on the basis of sexual attraction, behavior, or identity, were more likely than sexual majority women to engage in high-intensity binge drinking at two (adjusted odds ratios [aORs] ranging from 1.52 to 2.90) and three (aORs ranging from 1.61 to 3.27) times the standard cutoff for women (4+).”

Sexual minority men, depending on sexual orientation dimension, were equally or less likely than sexual majority men to engage in high-intensity binge drinking.

The results suggest that differences in alcohol-related risk among sexual minority individuals vary depending on sex and sexual orientation dimension.

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LGBT-identifying females are at increased risk of substance use in early adolescence

The odds of substance use among females who identify as sexual minorities – an umbrella term for those who identify with any sexual identity other than heterosexual or who report same-sex attraction or behavior – is 400% higher than their heterosexual female peers.

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Females who identify as sexual minorities face an increased risk of substance use that shows up as early as age 13, suggesting early adolescence is a critical period for prevention and intervention efforts, a new study from Oregon State University has found.

The odds of substance use among females who identify as sexual minorities – an umbrella term for those who identify with any sexual identity other than heterosexual or who report same-sex attraction or behavior – is 400% higher than their heterosexual female peers.

“We saw this striking difference in substance use at age 13 and there was rapid increase in the rate of cigarette and alcohol use from there,” said Sarah Dermody, an assistant professor in the School of Psychological Science in OSU’s College of Liberal Arts and the study’s lead author. “That tells us we need to find ways to intervene as early as possible to help prevent substance use in this population.”

The findings were published recently in the Journal of LGBT Youth. Co-authors are James McGinley of McGinley Statistical Consulting and director of behavioral analytics at the Vector Psychometric Group; Kristen Eckstrand, a physician at the University of Pittsburgh Medical Center; and Michael P. Marshal of the University of Pittsburgh.

Among youth, alcohol, marijuana and nicotine are the three most commonly used drugs. That is a concern because youth who use those substances are at risk of negative health and social outcomes, including addiction and poor cognitive, social and academic function.

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Past research has shown that sexual minority youth reported nearly three times more substance use than heterosexual youth. The disparity may be due in part to stress from discrimination, violence and victimization rooted in their sexual minority status, Dermody said.

The pattern of increased substance use for youth who identify as sexual minorities is magnified significantly for females. In the new study, researchers hoped to gain better understanding of how substance use rates develop over time for this group in particular, Dermody said.

Using data from about 2,200 participants in the Pittsburgh Girls Study, a large, longitudinal study of the lives of urban girls, researchers examined substance use among females over time from age 13 to 20, comparing those who identified as heterosexual to those identifying as lesbian/gay or bisexual.

They looked at when disparities in use between heterosexual and sexual minority identifying females began to emerge; rates of change over time for both groups; and how rates change as the girls approach young adulthood.

The researchers found that disparities in substance use between heterosexual and sexual minority girls were already present at age 13. The difference in use between heterosexual and sexual minority girls persisted and increased as they entered their 20s.

The findings suggest that early prevention and intervention efforts may be needed to reduce initial use and slow the escalation of substance use among the population. Such efforts could also help decrease substance use disparities over time, Dermody said.

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“It’s already a risky and vulnerable period for youths’ social development, and it’s also a vulnerable time for brain development,” Dermody said.

It’s also important to remember that within the population of youths who identify as sexual minorities, there are many youths who are not using any substances at all, or who are not using them as heavily, Dermody said.

“This is a subgroup that we are concerned about,” she said. “In future research, it would useful to explore how individual youths’ experiences influence where they fall on the spectrum of substance use.”

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