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Hepatitis A outbreaks mostly affecting men who have sex with men, claims WHO

An unusual increase in cases of hepatitis A affecting mainly men who have sex with men (MSM) has been reported particularly by low endemicity countries in the European Region, and in the Americas (Chile and the US).

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Between June 2016 and mid-May 2017, an unusual increase in cases of hepatitis A affecting mainly men who have sex with men (MSM) has been reported particularly by low endemicity countries in the European Region, and in the Americas (Chile and the US).

In the European Region, 15 countries (Austria, Belgium, Denmark, Finland, France, Germany, Ireland, Italy, the Netherlands, Norway, Portugal, Slovenia, Spain, Sweden, and the United Kingdom) reported 1173 cases related to the three distinct multi-country hepatitis A outbreaks as of 16 May 2017.

In Chile, 706 hepatitis A cases were reported at national level as of 5 May 2017. In the US, the New York City Health Department has noted an increase in hepatitis A cases among MSM who did not report international travel.

In low endemicity settings, WHO recommends hepatitis A vaccination for high-risk groups, such as travellers to endemic areas, MSM, people who inject drugs, and chronic liver disease patients.* For MSM the main risk factor is related to sexual transmission, particularly oral-anal sexual contact. Most of the affected countries have routinely recommended hepatitis A vaccine for MSM.

This event is of particular concern from a public health perspective because of the current limited availability of hepatitis A vaccine worldwide.

In this regard, WHO requests countries to report to WHO Regional IHR Contact points any unusual increase in the number of hepatitis A cases among MSM.

WHO risk assessment

Infection with hepatitis A virus is typically acute and self-limiting. Hepatitis A infection does not cause chronic liver disease and is rarely fatal. Some patients may develop more severe symptoms which may last up to a few months. The virus is primarily spread when an uninfected (and unvaccinated) person ingests food or water that is contaminated with the feces of an infected person. The virus can also be transmitted through close physical contact with an infectious person, through dirty hands and through sexual contact.

In low endemicity countries, reported rates of hepatitis A are low. Disease may occur among adolescents and adults in high-risk groups, such as injecting-drug users, MSM, people travelling to areas of high endemicity, and in isolated populations, such as closed religious communities.

So far, no fatalities have been reported in connection with the ongoing outbreaks. It has the potential to spread further to the general population if control measures (vaccination, hygiene, food safety, and safer sex measures) are not implemented.

WHO’s to-do list

  • Countries with low endemicity profile for hepatitis A should routinely offer vaccination to individuals at increased risk of hepatitis A and of a serious complications following infection. The recommended risk groups, among others, include men who have sex with men. Vaccination against hepatitis A should be included as part of a comprehensive package of services to prevent and control of viral hepatitis, including health education and measures for outbreak control.
  • Use of hepatitis A vaccine should be preferred for pre- and post-exposure prophylaxis (e.g. for close contacts of acute cases of hepatitis A).
  • Countries may consider single-dose schedule for hepatitis A vaccination to control outbreaks of hepatitis A, especially when vaccine availability is scarce.
  • Public health messaging should be directed at groups at increased risk of hepatitis A and of serious complications from the infection.
  • Information should include advice on prevention – vaccination, hygiene, food safety and safer sex measures.

*In intermediate endemicity setting, hepatitis A vaccination can be considered for the whole population, while in high endemicity, infections are common, but the disease is uncommon, hence, the vaccine is not recommended.

Health & Wellness

Gender affirmation linked with trans, gender nonbinary youth mental health improvement

Having accessed multiple steps of gender affirmation (social, legal, and medical/surgical) was associated with fewer symptoms of depression and less anxiety. Furthermore, engaging in gender affirmation processes helped youth to develop a sense of pride and positivity about their gender identity and a feeling of being socially accepted.

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Enabling transgender and gender nonbinary youth to access gender affirmation processes is good.

This is according to a study – “Gender Affirmation Is Associated with Transgender and Gender Nonbinary Youth Mental Health Improvement” – done by Anna Martha Vaitses Fontanari, Felipe Vilanova, Maiko Abel Schneider, Itala Chinazzo, Bianca Machado Soll, Karine Schwarz, Maria Inês Rodrigues Lobato, and Angelo Brandelli Costa; and which appeared in LGBT Health.

The study aimed to evaluate the impact of each domain of gender affirmation (social, legal, and medical/surgical) on the mental health of transgender and gender nonbinary youth. To do this, 350 transgender boys, transgender girls, and gender nonbinary Brazilian youth, aged from 16 to 24 years old, were asked to answer an online survey.

Among the 350 participants, a total of 149 (42.64%) youth identified as transgender boys, 85 (24.28%) identified as transgender girls, and 116 (33.14%) identified as gender nonbinary youth. The mean age was 18.61 (95% confidence interval 18.34–18.88) years. Having accessed multiple steps of gender affirmation (social, legal, and medical/surgical) was associated with fewer symptoms of depression and less anxiety. Furthermore, engaging in gender affirmation processes helped youth to develop a sense of pride and positivity about their gender identity and a feeling of being socially accepted.

“Enabling transgender and gender nonbinary youth to access gender affirmation processes more easily should be considered as a strategy to reduce depression and anxiety symptoms, as well as to improve gender positivity,” the researchers stated.

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Bullying is common factor in LGBTQ youth suicides, Yale study finds

Death records of LGBTQ youth who died by suicide were substantially more likely to mention bullying as a factor than their non-LGBTQ peers.

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Researchers at the Yale School of Public Health have found that death records of LGBTQ youth who died by suicide were substantially more likely to mention bullying as a factor than their non-LGBTQ peers. The researchers reviewed nearly 10,000 death records of youth ages 10 to 19 who died by suicide in the United States from 2003 to 2017.

The findings are published in the current issue of JAMA Pediatrics.

While LGBTQ youth are more likely to be bullied and to report suicidal thoughts and behaviors than non-LGBTQ youth, this is believed to be the first study showing that bullying is a more common precursor to suicide among LGBTQ youth than among their peers.

“We expected that bullying might be a more common factor, but we were surprised by the size of the disparity,” said lead author Kirsty Clark, a postdoctoral fellow at Yale School of Public Health. “These findings strongly suggest that additional steps need to be taken to protect LGBTQ youth — and others — against the insidious threat of bullying.”

Death records from LGBTQ youths were about five times more likely to mention bullying than non-LGBTQ youths’ death records, the study found. Among 10- to 13-year-olds, over two-thirds of LGBTQ youths’ death records mentioned that they had been bullied.

Bullying is a major public health problem among youth, and it is especially pronounced among LGBTQ youth, said the researchers. Clark and her co-authors used data from the National Violent Death Reporting System, a Centers for Disease Control and Prevention (CDC)-led database that collects information on violent deaths, including suicides, from death certificates, law enforcement reports, and medical examiner and coroner records.

Death records in the database include narrative summaries from law enforcement reports and medical examiner and coroner records regarding the details of the youth’s suicide as reported by family or friends, the youth’s diary, social media posts, and text or email messages, as well as any suicide note. Clark and her team searched these narratives for words and phrases that suggested whether the individual was LGBTQ. They followed a similar process to identify death records mentioning bullying.

“Bullies attack the core foundation of adolescent well-being,” said John Pachankis, the Susan Dwight Bliss Associate Professor of Public Health at the Yale School of Public Health and study co-author. “By showing that bullying is also associated with life itself for LGBTQ youth, this study urgently calls for interventions that foster safety, belonging and esteem for all young people.”

Other authors on the study include Anthony J. Maiolatesi, doctoral student at Yale School of Public Health, and Susan Cochran, professor at UCLA Fielding School of Public Health.

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Health & Wellness

Impact of children’s loneliness today could manifest in depression for years to come

Young people who are lonely might be as much as three times more likely to develop depression in the future, and that the impact of loneliness on mental health could last for at least 9 years.

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Children and adolescents are likely to experience high rates of depression and anxiety long after current lockdown and social isolation ends and clinical services need to be prepared for a future spike in demand, according to the authors of a new rapid review into the long-term mental health effects of lockdown.

The research, which draws on over 60 pre-existing, peer-reviewed studies into topics spanning isolation, loneliness and mental health for young people aged 4 – 21, is published in the Journal of the American Academy of Child and Adolescent Psychiatry.

According to the review, young people who are lonely might be as much as three times more likely to develop depression in the future, and that the impact of loneliness on mental health could last for at least 9 years.

The studies highlight an association between loneliness and an increased risk of mental health problems for young people. There is also evidence that duration of loneliness may be more important than the intensity of loneliness in increasing the risk of future depression among young people.

This, say the authors, should act as a warning to policymakers of the expected rise in demand for mental health services from young people and young adults in the years to come – both here in the UK and around the world.

Dr Maria Loades, clinical psychologist from the Department of Psychology at the University of Bath who led the work, explained: “From our analysis, it is clear there are strong associations between loneliness and depression in young people, both in the immediate and the longer-term. We know this effect can sometimes be lagged, meaning it can take up to 10 years to really understand the scale of the mental health impact the covid-19 crisis has created.”

For teachers and policymakers currently preparing for a phased re-start of schools in the UK, scheduled from today, Monday 1 June, Dr Loades suggests the research could have important implications for how this process is managed too.

She adds: “There is evidence that it’s the duration of loneliness as opposed to the intensity which seems to have the biggest impact on depression rates in young people. This means that returning to some degree of normality as soon as possible is of course important. However, how this process is managed matters when it comes to shaping young people’s feelings and experiences about this period.

“For our youngest and their return to school from this week, we need to prioritise the importance of play in helping them to reconnect with friends and adjust following this intense period of isolation.”

Members of the review team were also involved in a recent open letter to UK Education Secretary, Gavin Williamson MP, focusing on support for children’s social and emotional wellbeing during and after lockdown.

In their letter they suggested that:

  • The easing of lockdown restrictions should be done in a way that provides all children with the time and opportunity to play with peers, in and outside of school, and even while social distancing measures remain in place;
  • Schools should be appropriately resourced and given clear guidance on how to support children’s emotional wellbeing during the transition period as schools reopen and that play – rather than academic progress – should be the priority during this time;
  • The social and emotional benefits of play and interaction with peers must be clearly communicated, alongside guidance on the objective risks to children.

Acknowledging the trade-offs that need to be struck in terms of restarting the economy and reducing educational disparities, their letter to the Education Secretary concludes: ‘Poor emotional health in children leads to long term mental health problems, poorer educational attainment and has a considerable economic burden.’

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Health & Wellness

Binge drinkers beware, ‘Drunkorexia’ is calling

Excess alcohol consumption combined with restrictive and disordered eating patterns is extremely dangerous and can dramatically increase the risk of developing serious physical and psychological consequences, including hypoglycaemia, liver cirrhosis, nutritional deficits, brain and heart damage, memory lapses, blackouts, depression and cognitive deficits.

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Mojito, appletini or a simple glass of fizz – they may take the edge off a busy day, but if you find yourself bingeing on more than a few, you could be putting your physical and mental health at risk according new research at the University of South Australia.

Examining the drinking patterns of 479 female Australian university students aged 18-24 years, the world-first empirical study explored the underlying belief patterns than can contribute to “Drunkorexia” – a damaging and dangerous behavior where disordered patterns of eating are used to offset negative effects of consuming excess alcohol, such as gaining weight.

Concerningly, researchers found that a staggering 82.7 per cent of female university students surveyed had engaged in “Drunkorexic” behaviors over the past three months. And, more than 28 per cent were regularly and purposely skipping meals, consuming low-calorie or sugar-free alcoholic beverages, purging or exercising after drinking to help reduce ingested calories from alcohol, at least 25 per cent of the time.

Clinical psychologist and lead UniSA researcher Alycia Powell-Jones says the prevalence of Drunkorexic behaviours among Australian female university students is concerning.

“Due to their age and stage of development, young adults are more likely to engage in risk-taking behaviors, which can include drinking excess alcohol,” Powell-Jones says. “Excess alcohol consumption combined with restrictive and disordered eating patterns is extremely dangerous and can dramatically increase the risk of developing serious physical and psychological consequences, including hypoglycaemia, liver cirrhosis, nutritional deficits, brain and heart damage, memory lapses, blackouts, depression and cognitive deficits.”

She added that “certainly, many of us have drunk too much alcohol at some point in time, and we know just by how we feel the next day, that this is not good for us, but when nearly a third of young female uni students are intentionally cutting back on food purely to offset alcohol calories; it’s a serious health concern.”

The harmful use of alcohol is a global issue, with excess consumption causing millions of deaths, including many thousands of young lives.

In Australia for instance, one in six people consume alcohol at dangerous levels, placing them at lifetime risk of an alcohol-related disease or injury. The combination of excessive alcohol intake with restrictive eating behaviors to offset calories can result in a highly toxic cocktail for this population.

The study was undertaken in two stages. The first measured the prevalence of self-reported, compensative and restrictive activities in relation to their alcohol consumption.

The second stage identified participants’ Early Maladaptive Schemes (EMS) – or thought patterns – finding that that the subset of schemas most predictive of Drunkorexia were ‘insufficient self-control’, ’emotional deprivation’ and ‘social isolation’.

Powell-Jones says identifying the early maladaptive schemas linked to Drunkorexia is key to understanding the harmful condition.

These are deeply held and pervasive themes regarding oneself and one’s relationship with others, that can develop in childhood and then can influence all areas of life, often in dysfunctional ways. Early maladaptive schemas can also be influenced by cultural and social norms.

Drunkorexic behaviour appears to be motivated by two key social norms for young adults – consuming alcohol and thinness.

“This study has provided preliminary insight into better understanding why young female adults make these decisions to engage in ‘Drunkorexic’ behaviors,” Powell-Jones says. “Not only may it be a coping strategy to manage social anxieties through becoming accepted and fitting in with peer group or cultural expectations, but it also shows a reliance on avoidant coping strategies.”

It is recommended for clinicians, educators, parents and friends to be aware of the factors that motivate young women to engage in this harmful and dangerous behavior, including cultural norms, beliefs that drive self-worth, a sense of belonging, and interpersonal connectedness.

“By being connected, researchers and clinicians can develop appropriate clinical interventions and support for vulnerable young people within the youth mental health sector,” Powell-Jones says.

Worth highlighting: Alcoholism is a big issue in the LGBTQIA community.

A 2017 study found that bisexual people had higher odds of engaging in alcohol use behaviors when compared with people from the sexual majority. This study also found that bullying mediated sexual minority status and alcohol use more particularly among bisexual females.

Still in 2017, another study noted higher levels of alcohol use among men who have sex with men (MSM), which is closely associated with intimate partner violence (IPV). The same study found that over half of MSM experienced IPV, and just under half of MSM perpetrating IPV themselves, including physical, sexual, emotional or HIV-related IPV.

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Health & Wellness

Greater availability of non-alcoholic drinks may reduce alcohol consumption

The findings suggest that interventions to encourage healthier food and drink choices may be most effective when changing the relative availability of healthier and less-healthy options.

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People are more likely to opt for non-alcoholic drinks if there are more of them available than alcoholic drinks, according to a study published in the open access journal BMC Public Health.

A team of researchers at the NIHR Bristol Biomedical Research Centre, and the Universities of Bristol and Cambridge, UK found that when presented with eight drink options, participants were 48% more likely to choose a non-alcoholic drink when the proportion of non-alcoholic drink options increased from four (50%) to six (75%). When the proportion of non-alcoholic drink options decreased from four to two (25%), participants were 46% less likely to choose a non-alcoholic drink.

Dr Anna Blackwell, the corresponding author said: “Alcohol consumption is among the top five risk factors for disease globally. Previous research has shown that increasing the availability of healthier food options can increase their selection and consumption relative to less healthy food. To our knowledge, this is the first study to demonstrate that increasing the availability of non-alcoholic drinks, relative to alcoholic drinks in an online scenario, can increase their selection.”

Participants in the study completed an online task in which they were presented with a selection of alcoholic beer, non-alcoholic beer and soft-drinks. The drink selections included four alcoholic and four non-alcoholic drinks, six alcoholic and two non-alcoholic drinks or two alcoholic and six non-alcoholic drinks. 808 UK residents with an average age of 38 years who regularly consumed alcohol participated in the study.

When presented with mostly non-alcoholic drinks, 49% of participants selected a non-alcoholic drink, compared to 26% of participants who selected a non-alcoholic drink when presented with mostly alcoholic drinks. These results were consistent regardless of the time participants had to make their decision, indicating that the findings were not dependent on the amount of time and attention participants were able to devote to their drink choice. The findings suggest that interventions to encourage healthier food and drink choices may be most effective when changing the relative availability of healthier and less-healthy options.

Anna Blackwell said: “Many licensed venues already offer several non-alcoholic options but these are often stored out of direct sight, for example in low-level fridges behind the bar. Our results indicate that making these non-alcoholic products more visible to customers may influence them to make healthier choices. The market for alcohol-free beer, wine and spirit alternatives is small but growing and improving the selection and promotion of non-alcoholic drinks in this way could provide an opportunity for licensed venues to reduce alcohol consumption without losing revenue.”

The authors caution that as the study measured hypothetical drink selection online, results may differ in real-world settings. Further studies are needed to determine how the relative availability of non-alcoholic and alcoholic drinks impacts the purchasing and consumption of alcohol in real life.

Alcoholism is a big issue in the LGBTQIA community.

In 2017, a study found that bisexual people had higher odds of engaging in alcohol use behaviors when compared with people from the sexual majority. This study also found that bullying mediated sexual minority status and alcohol use more particularly among bisexual females.

Still in 2017, another study noted higher levels of alcohol use among men who have sex with men (MSM), which is closely associated with intimate partner violence (IPV). The same study found that over half of MSM experienced IPV, and just under half of MSM perpetrating IPV themselves, including physical, sexual, emotional or HIV-related IPV.

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Health & Wellness

Study finds more severe eating disorders among LGBT individuals

Delays in accessing treatment are especially widespread for transgender and nonbinary individuals with eating disorders. Some of the causes include delayed diagnosis by providers who fail to assess non-cisgender female patients for disordered eating, as well as limited access to trans-affirming treatment options.

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A study published in the International Journal of Eating Disorders finds that eating disorder patients who identify as LGBT have more severe eating disorder symptoms, higher rates of trauma history, and longer delays between diagnosis and treatment than heterosexual, cisgender patients.

“While we know there is a higher prevalence of eating disorders among LGBTQ folks, particularly trans and non-binary folks (with rates estimated to be anywhere from 40% to 70%), our field is in its infancy with researching this health disparity, so I believe research like ours is especially important” said clinical psychologist Jennifer Henretty PhD, CEDS, one of the study’s co-authors who serves as the Executive Director of Clinical Outcomes for Discovery Behavioral Health, Center For Discovery.

Eating disorders are a serious mental health concern: At least 30 million people—of all ages, sexual orientations, and gender-identities—experience an eating disorder in the US alone, and every 62 minutes at least one person dies as a direct result of an eating disorder. In fact, eating disorders have the highest mortality rate of any mental illness.

The most common eating disorders are binge eating disorder, where people regularly eat a large amount in a short period of time; bulimia nervosa, where people regularly eat a large amount in a short period of time and then try to offset the food using harmful behaviors (like vomiting); and anorexia nervosa, where people regularly eat too little due to a fear of gaining weight and thus are malnourished.

The causes of eating disorders are not clear but both biological and environmental factors are thought to play a role. Eating disorders typically begin in adolescence but it appears that the rate of the disorder may be on the rise in middle-aged and even older adults.

The peer-reviewed academic study analyzed data from 2,818 individuals treated in residential (RTC), partial hospitalization (PHP), and/or intensive outpatient (IOP) levels-of-care at a large eating disorder treatment organization; 471 (17%) of the participants identified as LGBT. The facilities were operated by Center for Discovery, a US healthcare provider specializing in the treatment of eating disorders.

Research shows that individuals who identify as lesbian, gay, bisexual, transgender, or other non-heterosexual/non-cisgender identities have significantly higher rates of mental and physical health conditions compared to their heterosexual, cisgender peers.

“LGBT individuals are more likely to experience housing and employment discrimination, and to struggle with multiple mental health challenges related to minority stress; this perfect storm of barriers means eating behaviors are often overlooked,” said Vaughn Darst, RD, who serves as Operations Advisor for Discovery Behavioral Health, Center For Discovery and who also discussed in a TedX talk the complex issue at the intersection of gender, body image, food and identity.

The study found a full 12-month delay in treatment for LGBT patients compared to non-LGBT patients.

“Delays in accessing treatment are especially widespread for transgender and nonbinary individuals with eating disorders. Some of the causes include delayed diagnosis by providers who fail to assess non-cisgender female patients for disordered eating, as well as limited access to trans-affirming treatment options, particularly at the residential level of care” said Darst.

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