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Transgender veterans as healthy as cisgender veterans, study finds

The study found demographic and economic differences between the two populations. Trans veterans experienced higher rates of poverty and less education and were less likely to be married or partnered compared to cisgender veterans.

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The mental and physical health of transgender veterans is similar to cisgender veterans. The only difference was trans veterans had higher odds of having at least one disability, such as a debility in vision, cognition, mobility, self-care or independent living.

The study, Transgender and Cisgender US Veterans Have Few Health Differences, was published in Health Affairs and co-authored by Janelle Downing, an assistant professor at the University of South Carolina, Kerith J. Conron, Blachford-Cooper distinguished scholar and research director at the Williams Institute at UCLA School of Law, Jody L. Herman, scholar of public policy at the Williams Institute, and John R. Blosnich, research health scientist for the VA Pittsburgh Healthcare System.

The study found demographic and economic differences between the two populations. Trans veterans experienced higher rates of poverty and less education and were less likely to be married or partnered compared to cisgender veterans.

In addition to veterans, researchers examined the health and well-being of trans and cisgender civilians and found transgender civilians were less likely to have health insurance and be employed. They had greater likelihood of not receiving primary care in the past year, delaying care because of cost and having multiple chronic conditions and depression compared to cisgender civilians.

“Disparities in education and poverty have been found to increase the risk of poor health,” said lead author Janelle Downing. “Those may be contributing to the poor health outcomes we observed in transgender civilians, but it was not true for trans veterans. It is possible that the veterans represent a particularly resilient subset of trans people.”

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The study analyzed responses from 517,539 people living in 31 American states and Guam, who participated in the 2014-2016 Behavioral Risk Factor Surveillance System, a nationally representative survey by the Centers for Disease Control and Prevention that collects state-level data on health, risk factors and sociodemographic characteristics of adults in the US.

According to the study, there are an estimated 163,000 transgender veterans in the US. Researchers found that overall, trans people (10.4%) served at similar rates compared to cisgender people (10.1%). However, trans people assigned male at birth were less likely to be veterans and those assigned female at birth were nearly five times more likely to be veterans compared to cisgender people.

But while – in March 2018 – the US Department of Defense issued a memorandum that states an intent to ban trans people with gender dysphoria from joining the military, the study found “no evidence to support the (Donald Trump) administration’s intent to ban trans people from serving in the military,” said study author Jody L. Herman. “On the contrary, the positive and long-term health outcomes of transgender veterans illustrate how well the existing criteria work to determine who is fit for military service.”

Health & Wellness

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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Health & Wellness

Guide to dealing with a new mental health diagnosis

It’s important to remember that mental health is a very wide categorization and not all disorders are the same or even similar.

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It’s estimated that around one-third of use will have to deal with a mental health issue at some point in our lives. But although there are still those who don’t understand fully how mental health works the stigma surrounding such diagnosis is thankfully on the decline.

It’s important to know how to deal with a diagnosis of this kind. It can be very upsetting and confusing, you will no doubt have lots of questions but it can also be a very good time because it means you are suddenly on the course to getting the help you need and this will ensure that you can live your life in a better manner. This is the start of a new phase of your life, and here we will look at some of the ways to start dealing with this situation.

Read Up on Your Diagnosis

Although we are as guilty of anyone of doing this it’s important to remember that mental health is a very wide categorization and not all disorders are the same or even similar. If you take depression as a particular example, even this is a very vague diagnosis and can vary wildly in both its symptoms and its severity. Other conditions such as schizophrenia can exhibit symptoms such as hallucinations, both auditory and visual, delusions of grandeur and you can have all or some of these and they can come and go. So whatever you have it’s good to get an idea of what the symptoms are and what the causes of the condition are as well.

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Look for Support

These days it’s important to know that you don’t need to suffer alone and there are plenty of resources and sources of help. First of all, you will have the doctor or Psychologist who diagnosed you and they should always be your first port of call for support. If you stay on top of your condition and regularly stay in touch with your medical professionals then it can prevent relapses and critical issues, even having to end up being admitted to hospital. But if you do end up having to spend some time in a hospital ward then it’s not the big issue it was in the past. You are suffering from an illness and shouldn’t feel bad for seeking medical help, think about it you wouldn’t berate a cancer sufferer for taking chemotherapy, so mental health treatment should be no different.

Permanent or Temporary

It’s also important to remember that not all mental health conditions are permanent, some of them indeed are and you might need to manage them throughout your life. However, you can end up with a reactionary condition that is temporary. This can be a reaction to a stressful life event if this is the case understanding adjustment disorders is very important.

Be Patient

Patience is also a good quality to have. Being diagnosed will a mental health issue can be a long process, and it may have taken a good while to even get to this stage. What you also find is that once you have the diagnosis it can take a lot of trial and error to get the right medication and the correct dose, so bear with it while they take the time to work it out, this is fairly normal.

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Talk to Your Family

Your family is most likely feeling a little apprehensive as well as often in a family setting they are dealing with something like this for the first time. So it leaves your loved ones feeling unable to help and not knowing how they can best be supportive. What can be helpful to them, and to you, is keeping them updated with how things are going, and they will then have more of an idea of what’s going on.

Dealing With Being Misunderstood

Although we mentioned at the start that awareness of mental health issues is much improved from where it has been in the past there is still a great deal of misunderstanding of what certain conditions are all about. If we take schizophrenia as an example, many people still confuse that with split personality syndrome, which in itself is a condition that is disputed as to its existence. Mental health is always a field that is progressing and new conditions and diagnoses are coming around all of the time, if we take gender reassignment, there are still those who wish to try to force individuals into a gender identity they don’t agree with can lead to poor mental health results. 

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Health & Wellness

Having less sex linked to earlier menopause

Women who reported engaging in sexual activity weekly were 28% less likely to have experienced menopause at any given age than women who engaged in sexual activity less than monthly.

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Women who engage in sexual activity weekly or monthly have a lower risk of entering menopause early relative to those who report having some form of sex less than monthly, according to a new UCL study.

The researchers observed that women, who reported engaging in sexual activity weekly, were 28% less likely to have experienced menopause at any given age than women who engaged in sexual activity less than monthly. Sexual activity includes sexual intercourse, oral sex, sexual touching and caressing or self-stimulation.

The research, published in Royal Society Open Science, is based on data from the USA’s Study of Women’s Health Across the Nation (SWAN). It’s the largest, most diverse and most representative longitudinal cohort study available to research aspects of the menopause transition.

First author on the study, PhD candidate Megan Arnot (UCL Anthropology), said: “The findings of our study suggest that if a woman is not having sex, and there is no chance of pregnancy, then the body ‘chooses’ not to invest in ovulation, as it would be pointless. There may be a biological energetic trade-off between investing energy into ovulation and investing elsewhere, such as keeping active by looking after grandchildren.

“The idea that women cease fertility in order to invest more time in their family is known as the Grandmother Hypothesis, which predicts that the menopause originally evolved in humans to reduce reproductive conflict between different generations of females, and allow women to increase their inclusive fitness through investing in their grandchildren.”

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During ovulation, the woman’s immune function is impaired, making the body more susceptible to disease. Given a pregnancy is unlikely due to a lack of sexual activity, then it would not be beneficial to allocate energy to a costly process, especially if there is the option to invest resources into existing kin.

The research is based on data collected from 2,936 women, recruited as the baseline cohort for the SWAN study in 1996/1997.

The mean age at first interview was 45 years old. Non-Hispanic Caucasian women were most represented in the sample (48%), and the majority of women were educated to above a high school level. On average they had two children, were mostly married or in a relationship (78%), and living with their partner (68%).

The women were asked to respond to several questions, including whether they had engaged in sex with their partner in the past six months, the frequency of sex including whether they engaged in sexual intercourse, oral sex, sexual touching or caressing in the last six months and whether they had engaged in self-stimulation in the past six months. The most frequent pattern of sexual activity was weekly (64%).

None of the women had yet entered menopause, but 46% were in early peri-menopause (starting to experience menopause symptoms, such as changes in period cycle and hot flashes) and 54% were pre-menopausal (having regular cycles and showing no symptoms of peri-menopause or menopause).

Interviews were carried out over a ten-year follow-up period, during which 1,324 (45%) of the 2,936 women experienced a natural menopause at an average age of 52.

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By modelling the relationship between sexual frequency and the age of natural menopause, women of any age who had sex weekly had a hazard ratio of 0.72, whereas women of any age who had sex monthly had a hazard ratio of 0.81.

This provided a likelihood whereby women of any age who had sex weekly were 28% less likely to experience the menopause compared to those who had sex less than monthly. Likewise, those who had sex monthly were 19% less likely to experience menopause at any given age compared to those who had sex less than monthly.

The researchers controlled for characteristics including oestrogen level, education, BMI, race, smoking habits, age at first occurrence of menstruation, age at first interview and overall health.

The study also tested whether living with a male partner affected menopause as a proxy to test whether exposure to male pheromones delayed menopause. The researchers found no correlation, regardless of whether the male was present in the household or not. Last author, Professor Ruth Mace (UCL Anthropology), added: “The menopause is, of course, an inevitability for women, and there is no behavioural intervention that will prevent reproductive cessation. Nonetheless, these results are an initial indication that menopause timing may be adaptive in response to the likelihood of becoming pregnant.”

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Health & Wellness

Transgender students face higher levels of substance abuse

This misuse of drugs by transgender individuals is thought not to be anything to do with their non-gender conformity but with the discrimination that they, as transgender individuals, face on a daily basis.

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A study by The Journal of School Health has found transgender students to be 2.5 times more likely to try and use drugs such as methamphetamines and cocaine than their non-transgender peers. Transgender students were also found to be twice as likely to misuse prescription medication than other students their age. 

This misuse of drugs by transgender individuals is thought not to be anything to do with their non-gender conformity but with the discrimination that they, as transgender individuals, face on a daily basis, with stigma being one of the primary drivers of transgender mental health issues across the world. 

In the US more than 50% of transgender individuals report suffering from depression or anxiety and LGBTQ individuals are also 7 times more likely to consider death by suicide than heterosexual gender-conforming individuals. 

At home, 19% of transgender individuals have experienced domestic violence as a result of their gender nonconformity and at work, more than 50% of transgender individuals have experienced discrimination. 

With so much stigma at home, on the street and in the workplace it’s no wonder that some transgender individuals are turning to narcotics as a way to numb the pain and escape their realities. 

Dr. Pedro, a scientist who helped conduct the drug use study has said “When it comes to transgender teens, it’s the transphobia that impacts [their use of drugs], not being transgender. In order to reduce the likelihood of a kid to resort to drugs as a means to cope, there has to be some sort of social support mechanism,” 

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Evidence from initiatives in the US supports the idea that better support systems and less stigmatizing communities can have a positive impact on the mental health of transgender individuals. Simply providing transgender individuals with appropriate toilet facilities was found to reduce the likelihood of transgender teens committing suicide by a staggering 45% and the introduction of same-sex marriage saw a huge drop in suicide attempts by 134,000.

So what else can be done to help support transgender individuals and reduce their need to rely on narcotics?

The evidence provided by initiatives in the US proves that removing the stigma surrounding being transgender is key to reducing suicide rates and improving transgender mental health but this won’t happen overnight. We need to see an introduction of more support systems for transgender people in the form of support groups and access to counseling and we need to provide transgender people with access to inpatient drug rehab centers if they have already fallen too far. 

To remove stigma in the community, schools and governors need to focus on transgender awareness and education, helping friends, families, and co-workers to understand what it means to be transgender and how they can help to ease the weight that their loved one, friend or colleague is carrying. Education also needs to start far earlier and be taught in schools to help students grow up into compassionate individuals with a wider understanding of the LGBTQ community and the challenges it faces. 

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Hidden sexual-arousal disorder can compromise mental health

It’s important that people know of this medical condition and that it is primarily a neurological problem, not a psychiatric one.

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Persistent genital arousal disorder (PGAD)–which is almost exclusively experienced by females and characterized by spontaneous and unwanted sexual arousal unrelated to desire–can compromise individuals’ mental health and well-being and severely damage relationships with partners. Results from a new study by investigators at Massachusetts General Hospital (MGH) indicate that PGAD can be caused by altered firing of nerves that carry sensations from the genitalia or by damage to the lowest parts of the spinal cord. The study also found that neurological treatments benefit many patients.

“It’s important that people know of this medical condition and that it is primarily a neurological problem, not a psychiatric one,” said senior author Bruce Price, MD, an MGH Department of Neurology investigator who is also chief of Neurology at McLean Hospital. “Many affected women are silent and undercover–it’s in no way a fun condition, and it is difficult for patients to address their symptoms with their doctors, who have typically never heard of PGAD.” The problem can be especially troubling for adolescents, causing confusion, shame, and fear.

The study, published in PAIN Reports, included 10 females whose PGAD symptoms began between ages 11 to 70 years. Although the study involved only a small number of patients, it’s still one of the first to carefully examine PGAD in a thorough and scientific manner.

Spinal nerve-root cysts were detected in four patients and generalized sensory nerve damage (neuropathy) in two. One patient with symptoms since childhood was born with a small defect in her lowest spinal cord, one had a lumbosacral herniated disc in the lower back, and another developed short-lived PGAD when she abruptly stopped a prescribed antidepressant medication.

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All psychiatric and gynecological treatments were ineffective, and injecting local anesthetics had no lasting benefit. In contrast, neurological treatments–such as cyst removal and treating nerve damage–were effective in 80% of patients.

“Physicians need to be aware of PGAD and inquire about it when patients experience other pelvic pain or urological symptoms that often accompany PGAD,” said first author Anne Louise Oaklander, MD, PhD, an investigator in the Department of Neurology at MGH. “It’s treatable, but the treatment depends on the cause. By identifying some common causes–and localizing them to specific regions of the sacral nervous system–our study provides direction on how to help patients and to guide future research.”

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Health & Wellness

Women with single dose of HPV vaccine gain similar protection as multiple doses

While results of the paper showed that a single dose may be as effective as the currently recommended two- or three-dose series, it’s too early for people to rely on a single dose of the vaccine for protection.

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A new study revealed that one dose of the HPV vaccine may prevent infection from the potential cancer-causing virus, according to research published in JAMA Network Open from The University of Texas Health Science Center at Houston (UTHealth).

According to the Centers for Disease Control (CDC), 34,800 new cancer diagnoses are linked to human papillomavirus (HPV) annually. The virus is thought to account for more than 90% of all cervical and anal cancers, more than 60% of all penile cancers, and approximately 70% of all oral cancers.

While results of the paper showed that a single dose may be as effective as the currently recommended two- or three-dose series, it’s too early for people to rely on a single dose of the vaccine for protection, according to senior author Ashish A. Deshmukh, PhD, MPH, an assistant professor at UTHealth School of Public Health.

Although the study participants included only women, the CDC recommends a two-dose regimen for all children starting the series before age 15 or a three-dose regimen if the series is started between ages 16 to 26.
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“HPV vaccine coverage is less than 10% globally because of poor vaccine uptake rates in many resource-limited countries. Ensuring boys and girls receive their first dose is a big challenge in several countries and a majority of adolescents are not able to complete the recommended series due to a lack of intensive infrastructure needed to administer two or three doses,” Deshmukh said. “If ongoing clinical trials provide evidence regarding sustained benefits of a one-dose regimen, then implications of single-dose strategy could be substantial for reducing the burden of these cancers globally.”

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Although the study participants included only women, the CDC recommends a two-dose regimen for all children starting the series before age 15 or a three-dose regimen if the series is started between ages 16 to 26. The latest generation of HPV vaccine can protect against nearly 90% of cancer-causing HPV infections. Yet, current vaccinations rates are less than ideal – half of people in the U.S. are not vaccinated against this common sexually transmitted infection.

“The current HPV vaccine dosing regimen can be cumbersome for people to understand. If one dose is proven effective in trials, the vaccine regimen will be simplified. This will help improve the coverage rate among adolescents that are currently below the Healthy People 2020 goal and possibly will also increase the momentum of uptake in the newly approved age group,” said lead author Kalyani Sonawane, PhD, who is an assistant professor at UTHealth School of Public Health.

Michael D. Swartz, PhD, of UTHealth co-authored the study, along with Alan G. Nyitray, PhD, of the Medical College of Wisconsin; and Gizem S. Nemutlu, PhD, and Jagpreet Chhatwal, PhD, from Harvard Medical School.

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