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In Europe, syphilis notifications up by 70% since 2010

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

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

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

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

Striking country variations in Europe

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

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

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

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

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

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

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

Decrease among women and congenital syphilis

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

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

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Health & Wellness

Sexual minority adolescents more likely to experience mental health problems

Sexual minorities were around five times more likely to experience high depressive symptoms (54% vs 15%) and self-harm (54% vs 14%). They also had lower life satisfaction (34% vs 10%), lower self-esteem and were more likely to experience all forms of bullying (i.e. peer bullying 27% vs 10%) and victimisation (i.e. sexual assault/harassment 11% vs 3%) .

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New research, published in The Lancet Child and Adolescent Health, found that adolescents from sexual minorities (those attracted to same sex or both sexes) are more likely to experience mental health problems, adverse social environments and negative health outcomes in contrast to their heterosexual counterparts.

The research – entitled ‘Mental health, social adversity & health-related outcomes in sexual minority adolescents: findings from a contemporary national cohort’ – aimed to rectify the lack of contemporary data in Generation Z (people born between 1995 and 2015) regarding the disparity in adverse outcomes faced by sexual minority young people who have grown up in this Century – a time of advances in rights for sexual minorities.

10,000 adolescents

In order to gain a better understanding of these outcomes researchers from the University of Liverpool and University College London analysed information on almost 10,000 adolescents born between 2000-2002 who are taking part in the Millennium Cohort Study (MCS).

The researchers analysed mental health (e.g. depression, self-harm), social (e.g. victimisation, bullying), and health-related outcomes (e.g. weight perception, substance use) in sexual minority (629) versus heterosexual (9256) adolescents at age 14 years. They also estimated the number of co-occurring difficulties in each group.

Findings

The researchers found that sexual minorities were around five times more likely to experience high depressive symptoms (54% vs 15%) and self-harm (54% vs 14%). They also had lower life satisfaction (34% vs 10%), lower self-esteem and were more likely to experience all forms of bullying (i.e. peer bullying 27% vs 10%) and victimisation (i.e. sexual assault/harassment 11% vs 3%) .

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Sexual minorities were also at increased odds of trying cannabis (16% vs 6%) trying alcohol (67% vs 52%), perceiving themselves as overweight (49% vs 33%), and dieting to lose weight (66% vs 44%).

Sexual minorities experienced more negative outcomes at the same time. For example, sexual minorities experienced 1.4 out of 3 mental health difficulties on average whereas heterosexual adolescents experienced 0.4 out of 3 on average. Overall cumulative difficulties experienced were 9·4 out of 28 for sexual minority youth versus 6·2 for heterosexual youth.

Implications

The lead author, Rebekah Amos, said: “Our current study provides much needed population-based estimates indicating pronounced differences in mental health, social, and health-related outcomes between sexual minority and heterosexual adolescents in the UK. We find that sexual minority adolescents are five times more likely to be depressed and self-harm and 2-3 times more likely to be bullied and be victimised, illuminating the scale of current adversities this group of adolescent are facing.”

Dr Praveetha Patalay, study co-author, said: “The study exposes the vast disparities in a range of outcomes between sexual minority and heterosexual young people, highlighting the need for further prevention efforts and intervention at the school, community and policy level to ensure sexual minority adolescents do not face lifelong adverse social, economic and, health outcomes.”

Dr Ross White, clinical psychologist and study co-author, said: “The study findings highlight the need for mental health professionals, teachers, parents and young people to work together to co-create systems of support that will allow young people to flourish irrespective of their sexual orientation. An important aspect of this work will be to foster societal attitudes that celebrate diversity, recognise common humanity and nurture compassion for one-self and others.”

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Rebekah Amos added: “Despite high profile policies such as the legalisation of same sex marriage in 2013 in England, Wales and Scotland and the introduction of sexual orientation as a protected characteristic during these adolescents’ lifetime, the evidence presented here indicates that large inequalities in social and health outcomes still exist for sexual minority adolescents growing up in the 21st Century.”

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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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Health & Wellness

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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Health & Wellness

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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Health & Wellness

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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Health & Wellness

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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