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Trauma increases heart disease risk in lesbians, bi women

Women were 30% more likely to suffer from anxiety if they experienced any forms of adulthood trauma and 41% more likely to be depressed if they faced childhood trauma.

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Trauma, including abuse and neglect, is associated with higher cardiovascular disease risk for lesbian and bi women.

This is according to preliminary research presented in Chicago in the US, at the American Heart Association’s Scientific Sessions 2018, a global exchange of the latest advances in cardiovascular science for researchers and clinicians. The research – led by researchers from the Columbia University – showed that sexual minority women with increased severity of childhood, adulthood or lifetime trauma had higher risk for post traumatic stress disorder (PTSD) and a perception of less social support.

For this, the researchers studied 547 sexual minority women. They measured three forms of childhood trauma: physical abuse, sexual abuse and parental neglect; three forms of adult trauma: physical abuse, sexual abuse and intimate partner violence; and lifetime trauma, which was the sum of childhood and adulthood trauma. They analyzed how increasing trauma severity was associated with higher report of several cardiovascular risk factors.

They found that women were 30% more likely to suffer from anxiety if they experienced any forms of adulthood trauma and 41% more likely to be depressed if they faced childhood trauma.

Other findings included:

  • 22% more likely to be depressed if they had experienced more forms of lifetime trauma.
  • 44% more likely to report overeating in the past three months if they experienced increased forms of childhood trauma.
  • 58% more likely to have diabetes if they experienced increasing severity of childhood trauma, and lifetime trauma notably increased their risks of obesity and high blood pressure.

These findings suggest healthcare providers should screen for trauma as a cardiovascular disease risk factor in this population, according to the researchers.

The results were presented at the American Heart Association Scientific Sessions in Chicago.

The research was recognized as the “Cardiovascular Stroke Nursing Best Abstract Award.”

Health & Wellness

Sexual minority men who smoke report worse mental health, more frequent substance use

LGBTQ+ people are more likely to smoke than their cisgender and heterosexual peers to cope with an anti-LGBTQ+ society, inadequate health care access and decades of targeted tobacco marketing. Those social stressors drive the health disparities they face, which are compounded by a lack of LGBTQ-affirming healthcare providers, research shows.

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Cigarette smoking is associated with frequent substance use and poor behavioral and physical health in sexual and gender minority populations, according to Rutgers researchers.

The study, published in the journal Annals of Behavioral Medicine, examined tobacco use by sexual minority men and transgender women to better understand the relationships between smoking, substance use and mental, psychosocial and general health.

The researchers, who are part of the Rutgers School of Public Health’s Center for Health, Identity, Behavior and Prevention Studies, surveyed 665 racially, ethnically and socioeconomically diverse sexual minority men and transgender women, 70 percent of whom reported smoking cigarettes.

They found that smoking was associated with participants’ race/ethnicity, marijuana and alcohol use and mental health. Current smokers were more likely to be white and reported more days of marijuana use in the past month. The study also found that current smoking was associated with more severe anxiety symptoms and more frequent alcohol use.

“Evidence also tells us that smoking is associated with worse mental health and increased substance use, but we don’t know how these conditions are related to each other, exacerbating and mutually reinforcing their effects,” said Perry N. Halkitis, dean of the Rutgers School of Public Health and the study’s senior author.

LGBTQ+ people are more likely to smoke than their cisgender and heterosexual peers to cope with an anti-LGBTQ+ society, inadequate health care access and decades of targeted tobacco marketing. Those social stressors drive the health disparities they face, which are compounded by a lack of LGBTQ-affirming healthcare providers, research shows.

“Our findings underscore the importance of holistic approaches to tobacco treatment that account for psychosocial drivers of substance use and that address the complex relationships between mental health and use of substances like alcohol, tobacco and marijuana,” said Caleb LoSchiavo, a doctoral student at the Rutgers School of Public Health and the study’s first author.

The study recommends further research examining the social determinants of disparities in substance use among marginalized populations and how interpersonal and systemic stressors contribute to poorer physical and mental health for minority populations.

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Health & Wellness

Love hormone also forms important link between stress and digestive problems

Oxytocin, an anti-stress hormone, is released from the hypothalamus in the brain which acts to counteract the effects of stress. For a long time, the actions of oxytocin were believed to occur due to its release into the blood with only minor effects on the nerves within the brain that regulate gastrointestinal functions.

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New research published in The Journal of Physiology shows that oxytocin, known as the love hormone, plays an important role in stress’ disruption of digestion such as bloating, discomfort, nausea and diarrhea.  

Stress disrupts gastrointestinal functions and causes a delay in gastric emptying (how quickly food leaves the stomach). This delay in gastric emptying causes bloating, discomfort, and nausea and accelerates colon transit, which causes diarrhea.  

Oxytocin, an anti-stress hormone, is released from the hypothalamus in the brain which acts to counteract the effects of stress. For a long time, the actions of oxytocin were believed to occur due to its release into the blood with only minor effects on the nerves within the brain that regulate gastrointestinal functions.  

The study used new ways to manipulate the neurons and nerves (neurocircuits) that oxytocin released from the hypothalamus acts upon and measured the effects on the response of gastric emptying to stress. They have shown that, contrary to previous assumptions, these oxytocin circuits play a major role in the response of the stomach to stress.  

Activation of these oxytocin circuits reversed the delay in gastric emptying that occurs normally in response to stress, by increasing muscle contractions (motility) of the stomach, while inhibition of these neurocircuits prevented adaptation to stress.  

The new research, conducted at Penn State University- College of Medicine and was sponsored by a grant from the National Institute of Health, USA, employed cutting-edge tools that allow selective manipulation of the circuits that receive hypothalamic oxytocin inputs together with simultaneous measurements of gastric emptying and motility in response to stress.  

The authors used a rat model of different types of stress – acute stress, appropriate adaptation to stress, and inappropriate adaptation to stress. The authors infected the neurons controlling the oxytocin nerves and neurocircuits with novel viruses that allowed them to be activated or inhibited and measured muscle activity in the stomach, as well as gastric emptying (the time for food to leave the stomach).  

The researchers have shown that these oxytocin neural circuits play a major role in the gastric response to stress loads. Indeed, their activation reversed the delayed gastric emptying observed following acute or chronic responses to stress, thus increasing both gastric tone and motility. Conversely, inhibition of these neurocircuits prevented adaptation to stress thus delaying gastric emptying and decreasing gastric tone.   

These data indicate that oxytocin influences directly the neural pathways involved in the stress response and plays a major role in the gastric response to stressors. ​ 

The ability to respond appropriately to stress is important for normal physiology functions. Inappropriate responses to stress, or the inability to adapt to stress, triggers and worsens the symptoms of many gastrointestinal disorders including delayed gastric emptying and accelerated colon transit.  

Previous studies have shown that the nerves and neurocircuits that regulate the function of gastric muscle and emptying respond to stress by changing their activity and responses.  

In order to identify targets for more effective treatments of disordered gastric responses to stress, it is important to first understand how stress normally affects the functions of the stomach. Their study provided new information about the role that oxytocin plays in controlling these nerves and circuits during stress and may identify new targets for drug development. 

Commenting on the study R Alberto Travagli said: “Women are more vulnerable to stress and stress-related pathologies, such as anxiety and depression, and report a higher prevalence in gastrointestinal disorders. Our previous studies showed that vagal neural circuits are organized differently in males versus females. We are now finalizing a series of studies that investigate the role and the mechanisms through which oxytocin modulates gastric functions in stressed females. This will help to develop targeted therapies to provide relief for women with gastrointestinal disorders.”

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Health & Wellness

Notable percentage of trans men who have sex with men never got tested for HIV, bacterial and viral STIs

When considering screening for HIV and sexually transmitted infections (STIs), transgender men who have sex with men (TMSM) represent an understudied population. A study found that a notable percentage of TMSM had never tested for HIV and bacterial and viral STIs.

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When considering screening for HIV and sexually transmitted infections (STIs), transgender men who have sex with men (TMSM) represent an understudied population. A study found that a notable percentage of TMSM had never tested for HIV and bacterial and viral STIs.

In “Sociodemographic and behavioural factors associated with testing for HIV and STIs in a US nationwide sample of transgender men who have sex with men” – done by Nadav Antebi-Gruszka, Ali J. Talan, Sari L. Reisner and Jonathon Rendina, and published in BMJ Journals – researchers tried to examine HIV and STI testing prevalence among TMSM along with the factors associated with testing in a diverse sample of TMSM. They used data from a cross-sectional online convenience sample of 192 TMSM, analyzed using multivariable binary logistic regression models to examine the association between sociodemographic and behavioral factors and lifetime testing for HIV, bacterial STIs and viral STIs, as well as past year testing for HIV.

The researchers found that more than two-thirds of TMSM reported lifetime testing for HIV (71.4%), bacterial STIs (66.7%), and viral STIs (70.8%), and 60.9% had received HIV testing in the past year. Engaging in condomless anal sex with a casual partner whose HIV status is different or unknown and having fewer than two casual partners in the past six months were related to lower odds of lifetime HIV, bacterial STI, viral STI and past year HIV testing.

Being younger in age was related to lower probability of testing for HIV, bacterial STIs and viral STIs.

The domiciles of the TMSM also affected their health-seeking behaviors. In this study, those residing in the South of the US were less likely to be tested for HIV and viral STIs in their lifetime, and for HIV in the past year.

Finally, lower odds of lifetime testing for viral STIs was found among TMSM who reported no drug use in the past six months.

According to the researchers, these findings indicate that a notable percentage of TMSM had never tested for HIV and bacterial and viral STIs, though at rates only somewhat lower than among cisgender MSM despite similar patterns of risk behavior.

They recommend for “efforts to increase HIV/STI testing among TMSM, especially among those who engage in condomless anal sex.”

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People with anorexia and body dysmorphic disorder show brain similarities, differences

Eating disorders and body dysmorphic disorder are more than simply choosing to eat or not eat or not liking how you look. These are brain abnormalities, and how we treat those brain abnormalities could be with psychotherapy, or psychiatric medications, but brain changes need to happen in order to address these disorders.

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A new UCLA study shows partially overlapping patterns of brain function in people with anorexia nervosa and those with body dysmorphic disorder, a related psychiatric condition characterized by misperception that particular physical characteristics are defective.

The study, published in the peer-reviewed journal Brain Imaging and Behavior, found that abnormalities in brain function are related to severity of symptoms in both disorders, and may be useful in developing new treatment methods.

The results reinforce the understanding that eating disorders and body dysmorphic disorder are more than simply choosing to eat or not eat or not liking how you look. “These are brain abnormalities, and how we treat those brain abnormalities could be with psychotherapy, or psychiatric medications, but brain changes need to happen in order to address these disorders,” says Dr. Wesley Kerr, neurology resident and biostatistics researcher at UCLA.

For the study, the researchers recruited 64 female participants: 20 with anorexia nervosa, 23 with body dysmorphic disorder, and 21 healthy controls. Patients with anorexia nervosa have a distorted body image and an intense fear of gaining weight, leading them to eat very little. Body dysmorphic disorder (BDD) is characterized by obsessions with a particular body part or a perceived flaw rather than with weight.

Eating disorders and body dysmorphic disorder are more than simply choosing to eat or not eat or not liking how you look.

Participants were shown images of male and female bodies while researchers observed their brain activity via MRI. Three types of images were used: normal photos, “low spatial frequency” (LSF) images, which had details blurred out, and “high spatial frequency” (HSF) images, in which the edges and details were accentuated.

Functional MRI is a brain imaging technique that detects the blood flow within the brain, allowing researchers to see which parts of the brain are active while a person is doing various tasks. It can also be used to understand what brain regions’ activities are in sync with each other; that is, “connected.”

Each of the women performed a “matching” task while inside the MRI scanner. On the top of the screen, the person would see an image of a body, and would have to choose the matching body from two images shown on the bottom of the screen.

While viewing the images that differed from those of healthy individuals, people with anorexia nervosa and those with BDD showed patterns of activity and connectivity in visual and parietal brain networks. These abnormalities in activity were different in BDD and anorexia nervosa, whereas the connectivity abnormalities were largely similar. The more severe the symptoms, the more pronounced the pattern of brain activity and connectivity when the images were viewed, particularly for the LSF images. Further, connectivity and activity abnormalities were associated with how the participants judged the appearance and body weight of the individuals in the photos.

What the researchers saw indicated that while the brains of patients with anorexia nervosa and those with BDD abnormally process images with high, low, or normal levels of detail, the abnormalities for low level of detail, that is “low spatial frequency” images, have the most direct relationships to symptom severity and body perception. The results may help researchers understand the underlying neurobiology that leads to the characteristic body image distortions in both cases.

“This gives us a clearer picture of neurological basis for what is one disorder, what is the other, and what characteristics they share,” said Dr. Jamie Feusner, senior author and professor of psychiatry and biobehavioral sciences at the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA.

A next step for the research will be to see whether, with existing psychotherapy and medication treatments, the brain activity in patients begins to normalize, or else changes in a different way to compensate for underlying abnormalities.

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Health & Wellness

Why ‘one day at a time’ works for recovering alcoholics

“One day at a time” is a mantra for recovering alcoholics, for whom each day without a drink builds the strength to go on to the next. A new brain imaging study by Yale researchers shows why the approach works.

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“One day at a time” is a mantra for recovering alcoholics, for whom each day without a drink builds the strength to go on to the next. A new brain imaging study by Yale researchers shows why the approach works.

Imaging scans of those diagnosed with alcohol use disorder (AUD) taken one day to two weeks after their last drink reveal associated disruptions of activity between the ventromedial prefrontal cortex and striatum, a brain network linked to decision making. The more recent the last drink, the more severe the disruption, and the more likely the alcoholics will resume heavy drinking and jeopardize their treatment and recovery, researchers report in the American Journal of Psychiatry.

However, the researchers also found that the severity of disruption between these brain regions diminishes gradually the longer AUD subjects abstain from alcohol.

“For people with AUD, the brain takes a long time to normalize, and each day is going to be a struggle,” said Rajita Sinha, the Foundations Fund Professor of Psychiatry and professor in the Child Study Center, professor of neuroscience and senior author of the study. “For these people, it really is ‘one day at a time.'”

The imaging studies can help reveal who is most at risk of relapse and underscore the importance of extensive early treatment for those in their early days of sobriety, Sinha said.

“When people are struggling, it is not enough for them to say, ‘Okay, I didn’t drink today so I’m good now’,” Sinha said. “It doesn’t work that way.”

The study also suggests it may be possible to develop medications specifically to help those with the greatest brain disruptions during their early days of alcohol treatment. For instance, Sinha and Yale colleagues are currently investigating whether existing high blood pressure medication can help reduce disruptions in the prefrontal-striatal network and improve chances of long-term abstinence in AUD patients.

Former Yale postdoctoral researcher Sarah K. Blaine, now at Auburn University, is lead author of the study.

Alcoholism is a big issue in the LGBTQIA community.

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

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Hormone therapy may be cause of porphyria in trans women

High levels of estrogen associated with hormone therapy changes, along with risk factors such as smoking, may lead to porphyria cutanea tarda (PCT) in transgender women.

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High levels of estrogen associated with hormone therapy changes, along with risk factors such as smoking, may lead to porphyria cutanea tarda (PCT) in transgender women.

This is according to a case study, whose findings add to the increasing body of evidence highlighting the higher risk of skin problems in trans women on long-term hormone therapy.

The case study, “Porphyria cutanea tarda unmasked by supratherapeutic estrogen during gender-affirming hormone therapy”, was published in the journal JAAD Case Reports.

PCT – which is the most common form of porphyria – is caused by a deficiency in the uroporphyrinogen decarboxylase enzyme, which leads to the buildup of porphyrins in the skin, making it extremely sensitive to sunlight.

There are various factors contributing to PCT, including genetic mutations and environmental factors. Some of the factors associated with the disease include: excessive iron levels in the liver, alcohol consumption, smoking, estrogen, hepatitis C, HIV infections, as well as mutations in the HFE gene.

Because of the link of high estrogen levels associated with hormone therapy and PCT, the researchers in the case study suggest for physicians to “recognize the potential risk for PCT in this patient population and consider hormone therapy adjustments, without undermining its importance in affirming gender identity”.

For many members of the trans community, hormone therapy helps affirm their gender identity, potentially easing gender dysphoria (or extreme discomfort caused by a discrepancy between a person’s sex at birth and their gender identity). This, therefore, could help improve quality of life.

But such therapy can also lead to unwanted skin-related side effects, including acne, changes in hair distribution or density, and skin darkening.

In trans women in particular, hormone therapy involves higher estrogen doses than those used for other indications. This is a cause of concern due to risk for conditions associated with estrogen exposure, including PCT.

Physicians should “recognize the potential risk for PCT in this patient population and consider hormone therapy adjustments, without undermining its importance in affirming gender identity”.

The researchers – Stephanie Jackson Collision, Jaroslaw Jedrych and Alaina James – particularly reported on the case of a 55-year-old trans woman who developed PCT following a change in hormone therapy that led to estrogen levels above the therapeutic range (supratherapeutic).

This woman was admitted to the hospital with a three-month history of burning pain, itching, and recurrent blisters on her hands and forearms after exposure to sunlight.

Though she had no personal or family history of liver disease, iron abnormalities, or blistering eruptions, the woman was a smoker and reported drinking two beers a day.

While she had been taking oral estradiol (the most active form of estrogen) daily for the past 23 years, her hormone therapy changed one month before symptom onset. To better control gender dysphoria, she began a trial of oral progesterone (100 mg/day), the other main female hormone, and increased her daily estradiol dose from 2 mg to 4 mg.

Analyses revealed supratherapeutic total estrogen levels (1945 picograms/mL; therapeutic range: 600-1000 picograms/mL), high levels of porphyrins in the blood and urine, and a mutation in the HFE gene.

Overall, the evidence pointed to PCT, likely induced by a combination of supratherapeutic estrogen and other known risk factors, such as tobacco and alcohol use, and HFE mutations.

Attending physicians recommended she stopped taking oral progesterone and temporarily interrupt estrogen therapy, followed by a dose reduction. The woman was also advised to quit smoking, lower her alcohol consumption, and avoid sun exposure.

Clinical remission was achieved within five months without reductions in tobacco or alcohol use. At that time, the woman was reintroduced to hormone therapy with skin patches of 0.025 mg estradiol twice weekly, without PCT recurrence.

For many members of the trans community, hormone therapy helps affirm their gender identity, potentially easing gender dysphoria (or extreme discomfort caused by a discrepancy between a person’s sex at birth and their gender identity).

“The current lack of clear evidence-based hormone therapy (HT) treatment algorithms and barriers to HT access foster therapeutic inconsistency and hormone level fluctuations, which increase the risk of PCT and other cutaneous side effects of HT in transgender females,” the researchers wrote. “It is important to recognize the potential risk for PCT in this growing demographic and consider a multifaceted treatment approach that includes HT adjustment as a therapeutic option, while being mindful of its important role in affirming gender identity.”

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