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Older LGB people more likely to be sickly, study finds

Lesbian, gay and bisexual (LGB) adults are more likely to be more sickly compared to their heterosexual counterparts. This is according to an American study that particularly noted that LGB older adults have a weakened immune system, and low back or neck pain.

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Lesbian, gay and bisexual (LGB) adults are more likely to be more sickly compared to their heterosexual counterparts. This is according to an American study that particularly noted that LGB older adults have a weakened immune system, and low back or neck pain.

In “Chronic Health Conditions and Key Health Indicators Among Lesbian, Gay, and Bisexual Older US Adults, 2013-2014” published in American Journal of Public Health, Karen I. Fredriksen-Goldsen, Ph.D., Hyun-Jun Kim, Ph.D., Chengshi Shui, Ph.D. and Amanda E. B. Bryan, Ph.D. examined the disparities in chronic conditions and health indicators among LGB adults aged 50 years or older in the US. To do this, they used data from the 2013 and 2014 National Health Interview Survey to compare disparities in chronic conditions, health outcomes and behaviors, health care access, and preventive health care by sexual orientation and gender.

The study found that – aside from LGB older adults having a weakened immune system, and low back or neck pain – sexual minority older women were also more likely than their heterosexual counterparts to report having arthritis, asthma, a heart attack, a stroke, a higher number of chronic conditions, and poor general health. Meanwhile, sexual minority older men were more likely to report having angina pectoris or cancer. Rates of disability and mental distress were similarly higher among LGB older adults.

“At substantial cost to society, many disparities in chronic conditions, disability, and mental distress observed in younger LGB adults persist, whereas others, such as cardiovascular disease risks, present in later life,” the researchers stated. They now recommend that interventions be made to “maximize LGB health”.

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Health & Wellness

Gay and bisexual men have higher rate of skin cancer

Rates of skin cancer were higher among gay and bisexual men compared to heterosexual men, but lower among bisexual women than heterosexual women.

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In the largest study of skin cancer rates among gay, lesbian or bisexual individuals, investigators from Brigham and Women’s Hospital report important differences in skin cancer prevalence among sexual minorities. Rates of skin cancer were higher among gay and bisexual men compared to heterosexual men, but lower among bisexual women than heterosexual women.

These findings, which were possible because of the sexual orientation and gender identity (SOGI) module built into a national system of surveys, have implications for patient education and community outreach initiatives focused on reducing skin cancer risk. They also have implications for the design of future nationwide surveys. Results are published in JAMA Dermatology.

“It’s absolutely critical that we ask about sexual orientation and gender identity in national health surveys; if we never ask the question, we’d never know that these differences exist,” said corresponding author Arash Mostaghimi, MD, MPA, MPH, director of the Dermatology Inpatient Service at the Brigham. “This information helps inform the nation about how to allocate health resources and how to train providers and leaders. When we look at disparities, it may be uncomfortable, but we need to continue to ask these questions to see if we’re getting better or worse at addressing them. Historically, this kind of health variation was hidden, but we now recognize that it’s clinically meaningful.”

Mostaghimi and colleagues leveraged data from the Behavioral Risk Factor Surveillance System (BRFSS), using data collected from annual questionnaires from 2014 to 2018. The Centers for Disease Control (CDC) uses the BRFSS to collect information about risk factors and behaviors among adults. About 450,000 adults are interviewed by telephone by the BRFSS each year. Beginning in 2014, the BRFSS began using the SOGI module to include questions about sexual orientation and gender identity. This module was administered in 37 states.

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Mostaghimi and colleagues compared skin cancer rates among heterosexual men to rates in gay or bisexual men and compared rates among heterosexual women to lesbian or bisexual women. Rates of skin cancer were 8.1 percent among gay men and 8.4 percent among bisexual men, statistically higher than the rate of 6.7 percent among heterosexual men. Skin cancer rates were 5.9 percent among lesbian women and 6.6 percent among heterosexual women, which was not a statistically significant difference. However, the rate of 4.7 percent among bisexual women was statistically significantly lower than heterosexual women.

The authors note that the data are based on self-reported skin cancer diagnoses, which have not been confirmed by a physician. The SOGI module was also only implemented in 37 states, so may not be generalizable to all states.

The BRFSS survey did not collect information about risk factors for skin cancer, such as UV exposure, Fitzpatrick skin type (a measure of skin color and susceptibility to sun burn), HIV status and more. However, smaller studies have reported higher usage of indoor tanning beds among sexual minority men, a known risk factor for skin cancer.

The CDC recently considered stopping implementation of the SOGI module for future BRFSS surveys, a move Mostaghimi feels would hinder efforts to support this population.

“This is the first time we’ve been able to look nationally at data about skin cancer rates among sexual minorities. Eliminating SOGI would prevent us from better studying this vulnerable population over time to see how rates may change from year to year,” said Mostaghimi. “As a next step, we want to connect with sexual minority communities to help identify the cause of these differences in skin cancer rates. This is work that will need to be done thoughtfully but may help not just sexual minorities but everyone.”

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10+ lifetime sexual partners linked to heightened cancer risk

Those who reported a higher tally of sexual partners were also more likely to smoke, drink frequently, and do more vigorous physical activity on a weekly basis.

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A history of 10 or more lifetime sexual partners is linked to a heightened risk of being diagnosed with cancer, reveals research published online in the journal BMJ Sexual & Reproductive Health.

And among women, a higher number of sexual partners is also linked to heightened odds of reporting a limiting long term condition, the findings indicate.

Few studies have looked at the potential impact of the number of sexual partners on wider health outcomes.

To try and plug this knowledge gap, the researchers drew on information gathered for the English Longitudinal Study of Ageing (ELSA), a nationally representative tracking study of older adults (50+) living in England.

In 2012-13, participants were asked how many sexual partners they had had. Complete data were provided by 5722 of the 7079 people who responded to this question: 2537 men and 3185 women. Responses were categorised as 0-1; 2-4; 5-9; and 10 or more sexual partners.

Participants were also asked to rate their own health and report any long standing condition or infirmity which impinged on routine activity in any way.

Other relevant information obtained included: age; ethnicity; marital status; household income other than a pension; lifestyle (smoking, drinking, physical activity); and presence of depressive symptoms.

The average age of participants was 64, and almost three out of four were married. Some 28.5% of men said they had had 0-1 sexual partners to date; 29% said they had had 2-4; one in five (20%) reported 5-9; while 22% reported 10 or more.

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The equivalent figures for women were: just under 41%; 35.5%; just under 16%; and just under 8%.

In both sexes, a higher number of sexual partners was associated with younger age, single status, and being in the highest or lowest brackets of household wealth.

Those who reported a higher tally of sexual partners were also more likely to smoke, drink frequently, and do more vigorous physical activity on a weekly basis.

When all the data were analysed, a statistically significant association emerged between the number of lifetime sexual partners and risk of a cancer diagnosis among both sexes.

Compared with women who reported 0-1 sexual partners, those who said they had had 10 or more, were 91% more likely to have been diagnosed with cancer.

Among the men, those who reported 2-4 lifetime sexual partners were 57% more likely to have been diagnosed with cancer than were those who reported 0-1. And those who reported 10 or more, were 69% more likely to have been diagnosed with the disease.

While the number of sexual partners was not associated with reported long standing conditions among the men, it was among the women.

Women who reported 5-9 or 10+ lifetime sexual partners were 64% more likely to have a limiting chronic condition than those who said they had had 0-1.

This is an observational study, and as such, can’t establish cause. Nevertheless, the findings chime with those of previous studies, implicating sexually transmitted infections in the development of several types of cancer and hepatitis, suggest the researchers.

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They didn’t obtain information on the specific types of cancer participants reported, but speculate: “…the heightened risk of cancer might be driven by those types known to be associated with [sexually transmitted infections].”

And they suggest that enquiring about the number of sexual partners might complement existing cancer screening programmes by helping to identify those at risk, if further research can establish a causal association between the number of sexual partners and subsequent ill health.

But an explanation for the gender difference in long term condition risk remains “elusive,” they write, especially given that men tend to have more lifetime sexual partners than women, while women are more likely than men to see a doctor when they feel ill, so potentially limiting the associated consequences for their long term health.

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Health & Wellness

Visual disturbances in Viagra users

In a new study, Viagra patients suffered numerous visual disturbances, including abnormally dilated pupils, blurred vision, light sensitivity, and color vision disturbances, which included intensely blue colored vision with red/green color blindness.

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Sildenafil is commonly used to treat erectile dysfunction and is generally regarded as safe with limited side effects. However, a recent study in Frontiers in Neurology has highlighted the risk of persistent visual side-effects, such as light sensitivity and color vision impairment, in men who have taken the highest recommended dose of Viagra. While these effects appear to be rare, the research suggests that first-time Viagra users should start with a lower dose before increasing it, if necessary.

Erectile dysfunction can have significant psychological consequences for men who are affected by it, and it can make fulfilling sexual relationships more difficult to achieve. Sildenafil, more commonly known by its trade name Viagra, became available in 1998 as a treatment for erectile dysfunction. It soon became the fastest selling drug in history, demonstrating the phenomenal demand for treatments that enhance sexual performance.

Originally developed as a treatment for high blood pressure, the drug dilates blood vessels and relaxes smooth muscle in the penis, making it easier to achieve and maintain an erection. The effects of the drug normally last 3-5 hours and although side-effects such as headache and blurred vision occasionally occur, they usually disappear relatively quickly.

However, Dr. Cüneyt Karaarslan of the Dünyagöz Adana hospital in Turkey, noticed a pattern in 17 male patients who attended the hospital. In the new study, Karaarslan reports that the patients suffered numerous visual disturbances, including abnormally dilated pupils, blurred vision, light sensitivity, and color vision disturbances, which included intensely blue colored vision with red/green color blindness.

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All 17 patients had taken sildenafil for the first time, and all took the highest recommended dose of 100 mg. None of the men had been prescribed the medication. The visual side-effects began once the drug took effect, and were still present when the men arrived at the clinic 24-48 hours later.

The doctors in the clinic conducted various eye tests and monitored the patients over time to see how their symptoms developed. Fortunately, in all 17 patients the symptoms had cleared up by 21 days later, but this was doubtless a difficult experience for the men involved.

“Many men use non-prescription performance enhancing drugs to help with sexual anxiety and erectile dysfunction,” said Karaarslan. “For the vast majority of men, any side-effects will be temporary and mild. However, I wanted to highlight that persistent eye and vision problems may be encountered for a small number of users.”

So, why were these men susceptible to such long-lived side-effects? It may be possible that a small subsection of the population does not break sildenafil down and eliminate it from the body efficiently, leading to very high concentrations in the blood compared with most users.

These men also took the highest recommended dose of sildenafil on their first time taking the drug. Starting with a lower dose may have meant less severe side-effects. In addition, taking the drug under medical supervision would likely have meant that the men would not have used such a high dose on their first time.

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So, if you are struggling with erectile dysfunction, should you be worried about trying Viagra? In short, no. Such persistent side-effects appear to be very rare. However, it is always best practice to consult your physician first, it may be best not to start at the highest dose, and in case you are particularly sensitive, consider first using the drug under medical supervision.

“Although these drugs, when used under the control of physicians and at the recommended doses, provide very important sexual and mental support, uncontrolled and inappropriate doses should not be used or repeated,” said Karaarslan.

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Health & Wellness

Poor sexual health more common in women than men

Several important at-risk groups may be in danger of being overlooked by current sexual health intervention efforts, so more tailored approaches may be needed, the authors conclude.

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Poor sexual health is more common in women and affects them in more diverse ways than men, according to a UK study – “Latent class analysis of sexual health markers among men and women participating in a British probability sample survey” – published in the open access journal BMC Public Health.

Out of 12,132 men and women included in the study, 17% of men and 47.5% of women reported poor sexual health. Several important at-risk groups may be in danger of being overlooked by current sexual health intervention efforts, so more tailored approaches may be needed, the authors conclude.

To get a better idea of how sexual health varies within the UK population, a team of researchers at the University of Glasgow, UK investigated patterns of sexual health markers, such as sexually transmitted infections (STIs) or sexual function problems, in 12,132 sexually active men and women, aged 16-74 from England, Scotland and Wales, who were interviewed between 2010 and 2012. The data came from the National Survey of Sexual Attitudes and Lifestyles. The authors also examined associations of sexual health with socio-demographic, health and lifestyle characteristics, as well as with satisfaction or distress with a person’s sex life.

Alison Parkes, who led the study at the MRC/CSO Social and Public Health Sciences Unit said: “‘Sexual health’ is an umbrella term that covers several different health risks, such as STIs, unplanned pregnancy, sexual function problems and sexual coercion. A greater understanding of how these risks are patterned across the population is needed to improve the targeting and delivery of sexual health programmes.”

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Based on markers of sexual health that were most common in different groups of people, the authors identified sexual health classes, four of which were common to both men and women; Good Sexual Health (83% of men, 52% of women), Wary Risk-takers (4% of men, 2% of women), Unwary Risk-takers (4% of men, 7% of women), and Sexual Function Problems (9% of men, 7% of women). Two additional sexual health classed were identified in women only; a Low Sexual Interest class which included 29% of women and a Highly Vulnerable class, reporting a range of adverse experiences across all markers of sexual health, which included 2% of women.

Highly Vulnerable women were more likely to report an abortion than all other female sexual health classes except unwary risk takers, and most likely to report STIs. They were also the most likely to report sexual coercion. Risk of sexual coercion was found to be low in all male sexual health classes. Among men, only those in the Sexual Function Problem class were more likely to perceive low satisfaction / high distress with their sex lives than those in Good Sexual Health. By contrast, all female poor sexual health classes were more likely to perceive low satisfaction / high distress.

Parkes said: “We identified several groups who are not well served by current sexual health intervention efforts: men and women disregarding STI risks, women with a low interest in sex feeling distressed or dissatisfied with their sex lives, and women with multiple sexual health problems. These groups had distinctive socio-demographic profiles, and may benefit from new tailored programs.

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“However, we also noticed that poor sexual health groups had certain characteristics in common. They were generally more likely to have started having sex before the age of 16; and to experience depression, alcohol or drug use. Knowledge of these comorbidities may inform interventions designed to improve sexual health across different vulnerable populations.”

The authors caution that the observational nature of the study does not allow for assumptions about cause and effect. Causal mechanisms underlying associations such as between substance use and sexual health are likely to be complex and bidirectional.

Parkes said: “At a time when financial pressures are being felt by sexual health services across Britain, it may be advisable to prioritize interventions with the most widespread benefits. Our study identified widely-shared characteristics of different groups at risk of poor sexual health. Targeting these lifestyle and health factors could mitigate a broad spectrum of sexual health problems.”

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Health & Wellness

Pornography is not a ‘public health crisis’, say researchers

“The movement to declare pornography a public health crisis is rooted in an ideology that is antithetical to many core values of public health promotion and is a political stunt, not reflective of best available evidence.”

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Existing evidence suggests pornography may negatively affect some individuals, but it does not qualify as a public health crisis, and calling it one could cause harm.

Researchers from the Boston University School of Public Health (BUSPH) have written an editorial in the American Journal of Public Health special February issue arguing against the claim that pornography is a public health crisis, and explaining why such a claim actually endangers the health of the public.

“The movement to declare pornography a public health crisis is rooted in an ideology that is antithetical to many core values of public health promotion and is a political stunt, not reflective of best available evidence,” write Dr. Kimberly M. Nelson and Dr. Emily F. Rothman, both faculty in the Department of Community Health Sciences at BUSPH.

While 17 U.S. states have introduced nonbinding resolutions declaring pornography a public health crisis, the authors write that pornography does not fulfill the public health field’s definition of one. Pornography use has increased steadily over time rather than spiking or reaching a tipping point; it does not “directly or imminently” lead to death, disease, property destruction, or population displacement; and it does not overwhelm local health systems.

Instead, Nelson and Rothman write, the existing evidence suggests that there may be negative health consequences for some people who use pornography, no substantial consequences for the majority, and even positive effects for some (for example, through safer sexual behaviors such as solo masturbation). Motivating people to use less extreme pornography, and less frequently, are reasonable harm reduction goals, the authors write, instead of trying to end all use. Increasing pornography literacy would also be useful, they write; Dr. Rothman and colleagues outline their pornography literacy program for Boston area adolescents in a paper in the same journal issue.

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What is the harm of calling pornography a public health crisis? Nelson and Rothman argue that this mischaracterization can lead to unwarranted policy or funding shifts, rather than saving the power to mobilize the public health workforce for real crises. “Moreover, pathologizing any form of sexual behavior, including pornography use, has the potential to restrict sexual freedom and to stigmatize, which is antithetical to public health,” they write.

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When caregivers need care

Caregivers provide tremendous benefits for their loved ones, yet they may be at risk for lacking access to needed services which puts their health in jeopardy.

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People who regularly care for or assist a family member or friend with a health problem or disability are more likely to neglect their own health, particularly by not having insurance or putting off necessary health services due to cost.

This is according to “Healthcare Coverage and Utilization Among Caregivers in the United States: Findings from the 2015 Behavioral Risk Factor Surveillance System” by Jamie L. Tingey, MS, Jeremiah Lum, MS, Whitney Morean, MS, Rebecca Franklin, MS, and Jacob A. Bentley, PhD; and which was published in Rehabilitation Psychology

“Caregivers provide tremendous benefits for their loved ones, yet they may be at risk for lacking access to needed services which puts their health in jeopardy,” said Bentley of Seattle Pacific University, co-author of the study. “We found that caregivers were more likely not to have health care coverage or forgo needed medical appointments and services. They were also at an increased risk for experiencing depression in their lifetime as compared with non-caregivers.”

The study focused solely on people who provided care to family and friends, not professional caregivers.

More than 43 million adults in the US (alone) function as caregivers each year, according to 2015 data from the National Alliance for Caregiving and AARP cited in the study.

“Informal caregiving provides enormous economic value to our society because if we were to replace informal caregiving with formal, paid caregiving services, it could cost the country upwards of $600 billion in wages for home health aides,” said Bentley. “Despite the economic benefits for society and valuable assistance provided to care recipients, attention must also be given to caregivers’ own financial, physical and emotional challenges.”

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The study used data from more than 24,000 people who participated in the 2015 Behavioral Risk Factor Surveillance System annual phone survey conducted by the US Centers for Disease Control and Prevention. Most participants were white women under 65 earning between $10,000 and $70,000 per year. Half were employed, half were unemployed or retired.

Participants reported that they had provided regular care or assistance to a family member or friend with a health problem or disability within the 30 days prior to the survey. More than half of the participants provided care for up to eight hours a week, typically doing household tasks such as cleaning, managing money or preparing meals. The vast majority indicated that they did not need support services, such as support groups or individual counseling, suggesting a need for additional research into alternative support services that are prioritized by caregivers, according to Bentley.

Participants were also asked if they had health insurance, if there was a time within the 12 months before the survey that they did not see a doctor because of the cost and if they had ever been diagnosed with a depressive disorder by a health care provider.

“Caregivers had a 26% higher risk of not having health care coverage, compared with non-caregivers, and they were at a significantly higher risk, a 59% additional risk, for not going to the doctor or getting a necessary health service due to cost, ” said Bentley.

Further, one-fourth of the caregivers reported that they had been diagnosed with a depressive disorder by a health care provider at some point during their lives, representing a 36% increased risk over non-caregivers, according to the study.

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“Also, nearly 30% reported experiencing at least one limitation to daily activities because of physical, mental or emotional problems,” said Bentley.

Bentley and his colleagues believe that some of these disparities may be due to financial barriers experienced by caregivers. Previous research has indicated that their duties may interfere with their ability to seek employment outside of the home or advance their careers due to the need for flexible schedules to accommodate their caregiving responsibilities, he said.

“While we expected caregivers to be more at risk in these areas, we were concerned to learn of the extent of these risks and barriers to health care access encountered by caregivers,” said Bentley. “Given the scope of difficulties acquiring health care coverage and utilizing needed services in this large national sample, we believe our findings warrant additional research and likely the development of low-cost and accessible services that meet the multifaceted needs of caregivers.”

“At a broader level, these findings can serve as evidence for policymakers focused on public health agendas because they have the power to develop policies aimed at reducing financial burdens and heath care service gaps among caregivers who are vital not only to those in our communities who need care, but also to our overall health care economy,” he said.

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