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Should sexuality come into prostate cancer?

Prostate cancer poses as significant a risk to men as breast cancer does to women. But while there’s endless information about breast cancer, prostate cancer seems much more of a medical black hole.

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While it often falls under the radar, prostate cancer is a severe problem for men. In fact, 1 in 7 men will receive this diagnosis at some point. With statistics like that, prostate cancer poses as significant a risk to men as breast cancer does to women. While there’s endless information about breast cancer, prostate cancer seems much more of a medical black hole.

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Of course, things are progressing. Studies, such as the VCaP prostate tests, help develop understanding. You can head to sites like herabiolabs.com for details on this study and others, all of which help towards developing treatments. Indeed, the future looks set to get better as our knowledge grows.

But, despite these studies, there are still areas in which we need to develop understanding. As can be seen from articles like this one found at health.usnews.com, gay men who receive a diagnosis of prostate cancer find a surprising lack of information about the future they face. Most notably, healthcare practitioners fail to even ask sexual orientation. The argument is that who you’re attracted to has little standing on an illness such as cancer. But, that isn’t quite the reality.

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Of course, there’s no distinct difference in statistics between gay and straight men being diagnosed. Cancer can happen to anyone. But, gay men certainly face challenges unique to their sexual orientation. Worse, there’s no guidelines or information out there to help them through. And, with healthcare practitioners not even taking sexuality into account, the road becomes even rockier.

On top of this, many gay men who receive a diagnosis of prostate cancer report feeling isolated, even within the gay community. Unlike with a diagnosis of HIV, where everyone pulls together, a prostate diagnosis leaves you out in the cold. The gay community itself merely hasn’t considered the impact of this illness. So, gay men who do suffer are often left with no one to turn to.

But, how does this illness impact gay men? For the most part, this issue comes from the way treatment affects sexual performance. Of course, this can be an issue for anyone. But, for a gay man, the implications are that bit more damaging. For one, many treatments can result in weaker erections, which are more problematic for gay men because of harder penetration. Plus, if surgery is conducted to remove the prostate, there can be problems with ejaculation. Not to mention the obvious issues faced by those who receive during intercourse. As well as experiencing discomfort before treatment, there’s the ongoing issue of removing the primary source of pleasure.

What needs to be done differently? For the most part, we just need to open the floor for conversations like these. It seems that, though sexual orientation doesn’t immediately impact the condition, healthcare providers still need to ask about it. This way, they can talk through personal worries, and help prepare the patient adequately for what they can expect after treatment. In short; doing away with this silence will go a long way.

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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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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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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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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Study finds normal body weight can hide eating disorder in teens

In 2013, a new category of eating disorder was formally recognized: atypical anorexia nervosa. Individuals with this condition meet all other diagnostic criteria for anorexia nervosa but have a normal body weight.

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Teens and young adults with atypical anorexia nervosa can have normal body weights and still be dangerously ill, according to a new study led by researchers at the Stanford University School of Medicine and the University of California-San Francisco.

The research is the largest, most comprehensive assessment to date of normal-weight adolescents with atypical anorexia.

Traditionally, individuals had to be below 85% of their ideal body weight to receive a diagnosis of anorexia nervosa, a disorder characterized by restrictive eating, over-exercising, distorted body image and intense fear of weight gain. But in 2013, a new category of eating disorder was formally recognized: atypical anorexia nervosa. Individuals with this condition meet all other diagnostic criteria for anorexia nervosa but have a normal body weight.

“This group of patients is underrecognized and undertreated,” said the study’s senior author, Neville Golden, MD, professor of pediatrics at the Stanford School of Medicine. “Our study showed that they can be just as sick medically and psychologically as anorexia nervosa patients who are underweight.”

The study, publishing online Nov. 5 in Pediatrics, shows that large, rapid weight loss is the best predictor of medical and psychological problems in patients with atypical anorexia, not their body weight at diagnosis. Dangerously low heart rate and blood pressure, as well as serious electrolyte imbalances and psychological problems, are common in patients with atypical anorexia whose weight is within a normal range, the study found.

The study’s lead author is registered dietitian Andrea Garber, PhD, adjunct professor of pediatrics at UCSF.

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“The bigger context is that, over the past 30 years, the prevalence of adolescent obesity has quadrupled, and teens are being told to lose weight without being given tools to do so in a healthy way,” Golden said. Obese teens who adopt unhealthy behaviors — such as severe food restriction and extreme exercise — may initially be praised for weight loss or told not to worry about eating-disorder concerns because they aren’t underweight.

“By the time they get to see us, they’ve lost a tremendous amount of weight, their vital signs are unstable and they need to be hospitalized,” Golden said.

The study compared 50 patients with atypical anorexia nervosa with 66 patients who met traditional diagnostic criteria, including being underweight. Participants were 12-24 years old, and 91% were female. All participants received eating-disorder treatment as part of the study, the results of which will be reported in a future publication.

Before developing an eating disorder, patients with atypical anorexia had higher weight-to-height ratios than typical patients. During their illness, patients in both groups lost the same amount of weight, an average of 30 pounds over 15.9 months. The two groups had equally poor vital signs, including low heart rate and low electrolytes. Cessation of menstruation, a side effect of the disease, was equally common in the two groups. Some members of both groups also had very low blood pressure, although this was more common in the patients with typical anorexia. Atypical patients had worse psychological symptoms, on average.

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The researchers used statistical modeling to determine which factors best predicted illness severity. The amount, speed and duration of weight loss were linked with worse illness; body weight at the time of diagnosis was not, they found.

More research is needed to identify what constitutes healthy weight for adolescents recovering from atypical anorexia nervosa, Golden said.

“If a patient was obese, the goal is not to have them regain all the lost weight,” Golden said, adding that a mixture of metabolic, hormonal and psychological measures may be needed to define a healthy weight instead.

“If someone gains a bit of weight, regains menses, and is doing well socially, emotionally and cognitively, that might indicate that they are in a place of recovery,” he said.

Other Stanford co-authors on the study are Cynthia Kapphahn, MD, clinical professor of pediatrics; research coordinators Anna Kreiter and Kristina Saffran; and clinical dietitian Allyson Sy. Scientists at UCSF, UCLA and the University of Chicago also contributed to the study.

Weight issues also affect the LGBTQIA community, with 44% to 70% of LGBTQ teens reported weight-based teasing from family members, 41% to 57% reported weight-based teasing from peers, and as many as 44% reported weight-based teasing from both family members and peers.

Meanwhile, specific to the gay community, a study found that Grindr, the most popular dating app for gay, bisexual, two-spirit and queer men, had a negative effect on men’s body image, especially when it came to weight. The study also found that apart from weight stigma, body dissatisfaction stemmed from sexual objectification and appearance comparison. With three out of four gay men reported to have used Grindr, this issue affects a big chunk of the gay population.

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