Bisexuality,Minority Stress,and Health

Purpose of Review

Bisexual individuals are at increased risk for negative health outcomes compared to heterosexual individuals and often compared to gay/lesbian individuals as well. The goal of this article is to summarize the current evidence-base on bisexual health disparities, to describe factors that influence them, and to review interventions designed to improve the health of bisexual individuals.

Recent Findings

Based on our review of the literature, we conclude that there is strong evidence that bisexual individuals are at increased risk for mental health and substance use problems. These disparities are evident across dimensions of bisexuality (identity, attraction, and behavior), but there are important nuances to these findings. There is also evidence that bisexual men are at increased risk for sexually transmitted infections (STIs) compared to heterosexual men and that bisexual women are at increased risk for STIs compared to both lesbians and heterosexual women. Although there are numerous causes of these disparities, a leading contributor is stress related to stigma and discrimination. Most of the interventions that have been developed for bisexual individuals are HIV prevention programs for behaviorally bisexual men of color. Despite less attention to mental health and substance use interventions for bisexual individuals, recent developments show promise in their potential application to this population.

Summary

Bisexual individuals are at increased risk for mental health, substance use, and sexual health problems, and this is due, in part, to stigma and discrimination. Future research should continue to examine how different dimensions of bisexuality relate to health disparities and factors that influence them. There is also an urgent need to develop, test, and disseminate interventions to improve the health of bisexual individuals..

     

Internet-Based Interventions for Women’s Sexual Dysfunction

The present paper gives an overview of the methodology and results of the first decade of research into Internet-based interventions for women’s sexual dysfunction. The interventions, retrieved in a literature search, were mostly well grounded on common theoretical models of sexual dysfunction and psychological disorders, and most ingredients of the interventions were theory-informed. Most interventions offered Web-based therapeutic content within a more or less preprogrammed structure. Most of these also offered prescheduled and/or participant-initiated contact with a sexual health care professional. Comparative effect studies showed improvements in sexual functioning as well as relational functioning at the point of termination of the intervention period. Improvements at posttreatment were generally maintained for several months after termination of the active intervention period. The results of this review seem to warrant further development of Internet-based interventions for women’s sexual dysfunctions.     

Epidemiology of adult atopic dermatitis

Atopic dermatitis (AD) is driven by a complex gene–environment interaction. Many of the risk factors and genetic underpinning previously observed for pediatric AD may not apply to adult atopic dermatitis, suggesting that these may largely be different disorders. Whereas AD is classically thought of as a pediatric disease, recent studies have shown high rates of disease in adults as well. Risk factors for persistence of childhood-onset AD, as well as adult-onset AD, are reviewed. Adults with AD are particularly vulnerable to exogenous insults from the outside environment, including climate, ultraviolet exposure, pollution, irritants and pruritogens, and microbes. Finally, adult AD is associated with a substantial health care burden, with increased utilization, direct and indirect costs of care, and lost work productivity.     

Managing cardiovascular disease risk in South Asian kidney transplant recipients

South Asians (SA) are at higher cardiovascular risk than other ethnic groups, and SA kidney transplant recipients (SA KTR) are no exception. SA KTR experience increased major adverse cardiovascular events both early and late post-transplantation. Cardiovascular risk management should therefore begin well before transplantation. SA candidates may require aggressive screening for pre-transplant cardiovascular disease (CVD) due to their ethnicity and comorbidities. Recording SA ethnicity during the pre-transplant evaluation may enable programs to better assess cardiovascular risk, thus allowing for earlier targeted peri- and post-transplant intervention to improve cardiovascular outcomes. Diabetes remains the most prominent post-transplant cardiovascular risk factor in SA KTR. Diabetes also clusters with other metabolic syndrome components including lower high-density lipoprotein cholesterol, higher triglycerides, hypertension, and central obesity in this population. Dyslipidemia, metabolic syndrome, and obesity are all significant CVD risk factors in SA KTR, and contribute to increased insulin resistance. Novel biomarkers such as adiponectin, apolipoprotein B, and lipoprotein (a) may be especially important to study in SA KTR. Focused interventions to improve health behaviors involving diet and exercise may especially benefit SA KTR. However, there are few interventional clinical trials specific to the SA population, and none are specific to SA KTR. In all cases, understanding the nuances of managing SA KTR as a distinct post-transplant group, while still screening for and managing each CVD risk factor individually in all patients may help improve the long-term success of all kidney transplant programs catering to multi-ethnic populations.     

Obesidad y psoriasis: naturaleza inflamatoria de la obesidad,relación entre psoriasis y obesidad e implicaciones terapéuticas

Obesity, particularly abdominal obesity, is currently considered a chronic low-grade inflammatory condition that plays an active role in the development of the pathophysiologic phenomena responsible for metabolic syndrome and cardiovascular disease through the secretion of proinflammatory adipokines and cytokines. In recent years clear genetic, pathogenic, and epidemiologic links have been established between psoriasis and obesity, with important implications for health. The relationship between the 2 conditions is probably bidirectional, with obesity predisposing to psoriasis and psoriasis favoring obesity.Obesity also has important implications in the treatment of psoriasis, such as a greater risk of adverse effects with conventional systemic drugs and reduced efficacy and/or increased cost with biologic agents, for which dosage should be adjusted to the patient's weight.     

Considerations for Systemic Treatment of Psoriasis in Obese Patients

Psoriasis is an immune-mediated inflammatory skin disease frequently associated with metabolic disorders, including diabetes, dyslipidaemia and metabolic syndrome. Moreover, a growing number of studies confirm the association between psoriasis and obesity. It has been found that obesity, as measured by body mass index >30 kg/m², can double the risk of incident psoriasis. A positive correlation between different measures of adiposity and the severity of psoriasis has also been reported. Epidemiologic studies have also provided robust evidence confirming the association between obesity and psoriatic arthritis. Genetic, metabolic and environmental factors are all likely to contribute to these associations. Adipose tissue is an active endocrine and paracrine organ that has a key role in lipid and glucose metabolism as well as inflammation. Fat tissue is traditionally distributed into two main compartments with different metabolic characteristics, i.e. the subcutaneous and visceral adipose tissue. Particular attention has been devoted to visceral adiposity because of its contribution to inflammation and atherosclerosis. The association between psoriasis and obesity should be properly considered when choosing a systemic treatment, because it could exert negative effects on metabolic parameters, including liver enzymes, serum lipids and renal function. Obesity may increase the risk of liver and renal toxicity from methotrexate and cyclosporine. Moreover, obesity can compromise the effectiveness of systemic treatments for psoriasis (conventional and biological therapies). Dermatologists are also expected to promote a healthy lifestyle and weight loss for obese patients because they could improve metabolic parameters and responsiveness to psoriasis therapies.     

Neuropsychiatric comorbidity among adolescents with psoriasis

Psoriasis is a common skin disease, typically presenting as a red scaly rash. In mild cases it can be treated with creams, while in patients with so called “moderate to severe psoriasis”, where it is extensive or cannot be controlled with creams only, a systemic treatment, such as pills and phototherapy, is necessary. Psoriasis affects about 2% of adults. It commonly develops in adulthood, but can also be seen in children and adolescents. As might be expected, psoriasis may be physically and emotionally disabling. Growing data suggests that psoriasis patients are at risk of suffering from multiple medical conditions, including mental health disorders (e.g depression) and neurological disorders (e.g migraine). This study, from Israel, aimed to find out whether psoriasis carries a risk of suffering from mental health and neurological disorders, focusing on adolescents, an age group which was previously less studied for these conditions. Data were retrieved from records of recruits evaluated for military service. The study included 1746 and 1366 adolescents (aged 16 to 18) with mild and moderate to severe psoriasis, respectively, and compared them to 884653 healthy adolescents. Differences in the prevalence of the following medical conditions were found between adolescents with moderate to severe psoriasis and healthy adolescents: Overall chronic headaches (8.1% vs. 3.4%), intermediate frequency migraine (4.8% vs. 1.6%), low frequency migraine and non‐migraine headaches (3.4% vs. 1.8%), anxiety (2.1% vs. 0.7%) and social adjustment disabilities (7.5% vs. 4.2%). Interestingly, mild psoriasis was not shown to carry a risk for these conditions. The authors conclude that adolescents with psoriasis, especially those with a moderate to severe disease, are at risk of neurological and mental health disorders. The authors call for physicians’ awareness of these conditions, alongside the need for psychological counselling.     

The obesity syndrome and acanthosis nigricans. Acanthosis nigricans is a common cosmetic problem providing epidemiological clues to the obesity syndrome, the insulin-resistance syndrome, the thrifty metabolism, dyslipidaemia, hypertension and diabetes mellitus type II

Obesity and its consequences are arguably the chief public health problems facing the developed world. Obesity causes many fatal diseases, in particular cerebrovascular and cardiovascular disease. Acanthosis nigricans (AN) is a common cosmetic disability in pigmented ethnic groups. It may present with periorbital darkening or darkening of the neck or knuckles as well as acrochordons (skin tags) around eyelids, neck or axillae. The more classical AN of axillae and groins is less often a cosmetic disability, although it is an important physical sign. AN is very common in pigmented populations throughout the world, irrespective of domicile. It is rare in whites. AN is closely associated with all the features of the insulin-resistance syndrome (IRS), especially obesity. AN and IRS share a similar prevalence and epidemiology. IRS (also known as syndrome X or the deadly quartet) is characterized by insulin resistance (IR) and its associated conditions, including obesity, dyslipidaemia, hypertension and diabetes mellitus (DM) type II. The sequelae of IRS are cardiovascular and cerebrovascular disease. The origins of insulin resistance and its sequel, IRS, are debated. Insulin resistance can result from obesity. Also obesity usually presents before AN, hypertension or DM II. For these reasons it may be more helpful to recognize instead an obesity syndrome. The obesity syndrome is characterized by a genetically determined thrifty metabolism that protects subjects in famine conditions but which, in conditions of plenty, leads to weight gain with all its consequences, including hyperlipidaemia, hypertension, IR with DM II, and, in due course, cerebrovascular and cardiovascular disease. In pigmented races, AN is an important early manifestation of the obesity syndrome. AN helps identify persons at particular risk of developing the obesity syndrome, dyslipidaemia, hypertension and IR with DM II. Recognition of AN, therefore, offers important opportunities for health screening and preventative medicine.     

基层医院对提高未婚流动女性生殖健康知识水平进行干预的效果评价

目的：探索基层医院提高未婚流动女性生殖健康水平的方法并评价临床干预效果。方法：采用类实验研究方法,于2011年3月至2012年9月对在我院诊治的120名未婚流动女性患者用女性生殖健康知识问卷进行调查,通过基线调查了解影响患者生殖健康的各项因素及其健康状况,进一步了解患者的需求及其意愿,运用多种知识对患者的生殖健康问题进行干预,采用知识讲座、发放宣传册和提供对生殖健康咨询服务一系列干预活动,在调查结束后一个月进行统计分析。结果：干预后,未婚流动女性患者的生殖健康知识水平提高了很多,生殖健康知识总分由干预前的（65.50±19.00）分增加到干预后的（88.50±11.00）分（P〈0.05）,其他各种知识得分干预前后均有统计学差异（P〈0.05）;干预后,希望到基层医院接受服务的比例由干预前的6.67%提高到干预后的75.00%（P〈0.05）;干预后,希望向基层医院医生咨询的比例由干预前的13.33%提高到干预后的82.50%（P〈0.05）。结论：基层医院在开展干预活动后,未婚流动女性的避孕节育、经期保健知识和生殖道感染传播疾病及艾滋病的知识掌握方面有了很大程度的提高,同时对于提高基层医院的服务也有了很大的促进作用。     

More than skin deep: atherosclerosis as a systemic manifestation of psoriasis

Psoriasis is highly prevalent and is associated with skin-associated complaints as well as arthritis, depression and a lower quality of life. Recently, it has been demonstrated that not only do patients with psoriasis have an increased prevalence of cardiovascular risk factors, but an increased risk of myocardial infarction, and for those with severe disease, increased mortality. Dermatologists and other health professionals need to be cognizant of this association and ensure that cardiovascular risk factors are evaluated and treated appropriately in those patients with psoriasis. We review the association between psoriasis, atherosclerosis and inflammation, as well as some treatable cardiovascular risk factors that may prove beneficial in reducing a patient's cardiovascular risk.     

Sleep disorders and chronic kidney disease

Sleep disorders have a profound and well-documented impact on overall health and quality of life in the general population. In patients with chronic disease, sleep disorders are more prevalent, with an additional morbidity and mortality burden. The complex and dynamic relationship between sleep disorders and chronic kidney disease (CKD) remain relatively little investigated. This article presents an overview of sleep disorders in patients with CKD, with emphasis on relevant pathophysiologic underpinnings and clinical presentations. Evidence-based interventions will be discussed, in the context of individual sleep disorders, namely sleep apnea, insomnia, restless leg syndrome and excessive daytime sleepiness. Limitations of the current knowledge as well as future research directions will be highlighted, with a final discussion of different conceptual frameworks of the relationship between sleep disorders and CKD.     

Bulimia and anorexia nervosa: cutaneous manifestations

Bulimia and anorexia nervosa (BN, AN) are considered psychiatric disorders that have physical complications. Several factors may play a role in the onset of AN and BN, including a familial predisposition to these disorders, as well as individual personality characteristics. Dissatisfaction with body shape and an overwhelming desire to be thin are considered as risk factors for the development of eating disorders. Skin changes are characteristic and are cardinal diagnostic symptoms and pointers to the diagnosis of eating disorders. They are a consequence of starvation and/or malnutrition, self-induced vomiting, drug consumption and concomitant psychiatric illness. A careful examination of the skin can suggest a diagnosis of eating disorder. Cosmetic dermatologists, whose patients are mostly women, have a unique opportunity to detect these signs. This is very important as an early diagnosis will influence prognosis.     

Psychological aspects of obesity

Obesity is a complex condition associated with a host of medical disorders. A common assumption is that obesity must also be related to psychological and emotional complications. Research on the psychosocial aspects of obesity has grown more sophisticated over the years, from purely theoretical papers to cross-sectional comparisons of people with and without obesity to prospective investigations of the temporal sequence of obesity and mood disturbance. These studies have shown that obesity, by itself, does not appear to be systematically associated with psychopathological outcomes. Certain obese individuals, however, are at greater risk of psychiatric disorder, especially depression. The present paper reviews the research findings and presents their clinical implications. Chiefly, treatment providers should not assume that a depressed or otherwise disturbed obese person needs only to lose weight in order to return to psychological health. Significant mood disturbances should be treated equally aggressively, regardless of a patient's weight status.     

Could adult female acne be associated with modern life?

In recent years, the prevalence of adult female acne has increased, but the reason for this increase remains unclear. Acne is one of the most common skin disorders. It can be triggered or worsened by endogenous and exogenous factors, including genetic predisposition, hormone concentrations, diet, smoke and stress; although the interaction with this last factor is not well understood. Modern life presents many stresses including urban noises, socioeconomic pressures and light stimuli. Women are especially affected by stress during daily routine. The recent insertion in the labor market is added to the duties of the mother and wife. Women also have a higher risk of developing psychiatric disorders such as depression and anxiety. Sleep restriction is added to these factors, with several negative consequences on health, including on hormonal secretion and the immune system. This is further complicated by the natural variation in sleep architecture across the menstrual cycle. Recent studies have brought new data about the mechanisms and possible factors involved. This review aims to establish a connection between stress, sleep deprivation and adult female acne.     

Genetics of familial and sporadic melanoma

Like many other cancers, melanoma has a significant genetic basis. However, its genetic pathways may involve multiple genes with probable interactions with sun exposure. Germline mutations in p16 or CDKN2A are found in a significant percentage of relatively rare melanoma families but p16 mutations are uncommon in sporadic tumours. p16 may still be involved by other mechanisms of inactivation; however, it is clear that other melanoma genes remain to be discovered. Family, case-control, twin and sib-pair analyses as well as DNA chip technology may shed some light on genes involved in melanocytic differentiation and skin pigmentation. Recent public health campaigns have not been very successful in changing behaviour regarding tanning, and the relationship between sun exposure and melanoma is very complex. With the understanding of genetic alterations leading to this tumour, follow-up strategies and behavioural interventions may be more specifically designed to target high risk groups.     

Proteolytic enzymes: potential allergens for the skin and respiratory tract?

Proteolytic enzymes of animal, bacterial, mould or plant origin are used in many industrial processes, e.g. in the detergent, food and pharmaceutical industries as well as in medicine. The allergenic potency of these enzymes should not be underestimated, for they cause, in particular, IgE-mediated respiratory allergies. The risk of sensitization to enzymes due to inhalation as a result of occupational exposure is very high (up to 50%), and therapeutic applications are also not without risk. Therefore, the utmost care should be taken in the production and handling of pulverized enzymes and their inhalation should be avoided. Papain and Bromelain are used as tenderizers of meat and to clarify beer. Therefore, these enzymes are also potential ingestive allergens and may represent an unrecognized cause of an allergic reaction following a meal. As contact allergens the enzymes play a minor role; biodetergents in particular present no increased risk of skin damage for the user.     

The dermatological consequences of obesity

Obesity is emerging as a global epidemic with at least 300 million people thought to be obese worldwide. This has implications for health professionals including dermatologists. Recent interest has focused on the role of obesity in psoriasis, but obesity is implicated in many dermatoses. Perhaps most worrying is emerging data which suggest that obesity may constitute a risk factor for the development of skin cancer. Its rising incidence ensures that obesity‐related skin disease will represent an increasing proportion of dermatologists’ work load. In this article, we review dermatoses associated with obesity and review the epidemiology and treatment for obesity.     

Heart disease in psoriasis

Psoriasis has been traditionally viewed as an inflammatory skin disorder of unknown origin. Recent advances in the immunopathogenesis and genetics of psoriasis have broadened our understanding of psoriasis. Psoriasis is now considered a systemic inflammatory condition analogous to other inflammatory immune disorders. Patients with other immune disorders, such as systemic lupus erythematosus or rheumatoid arthritis, are known to be at increased risk of heart disease. Similarly, patients with psoriasis may carry an excess risk of heart disease, which would represent an important previously unrecognized cause of morbidity and mortality. This review summarizes the current evidence for an increased cardiovascular risk in patients with psoriasis and outlines deficits in our knowledge in this area.     

Tanning beds, skin cancer, and vitamin D: an examination of the scientific evidence and public health implications

Indoor tanning has become increasingly popular over the past decades, despite evidence of an increased risk of melanoma and, possibly, nonmelanoma skin cancer. Tanning bed proponents cite the health benefits of vitamin D to support indoor tanning, including concerns that reduced vitamin D levels or certain vitamin D receptor polymorphisms may be associated with increased incidence of various cancers, including cutaneous melanoma. However, most tanning devices primarily emit ultraviolet A, which is relatively ineffective in stimulating vitamin D synthesis. Health benefits can be fully dissociated from the ultraviolet exposure risks with vitamin D supplementation, although optimal levels remain to be established. Indoor tanning represents an avoidable risk factor for skin cancer, and education of the general public as well as the enactment and stricter enforcement of indoor tanning legislation are a public health imperative.     

Diabetes and Sexual Function

Diabetes mellitus (DM) is a global health issue and a major risk factor for sexual dysfunction. Diabetic patients are at an increased risk for erectile dysfunction (ED), ejaculatory disorders, and hypogonadism. ED in these patients results from a multitude of pathophysiological mechanisms that culminate in vascular, neurogenic, and myogenic damage. Furthermore, these patients are often difficult to treat with current pharmacologic therapies. Ejaculatory disorders can be problematic, often requiring invasive modalities for those patients who wish to procreate. Finally, hypogonadism remains a topic of great debate in the diabetic population and general population alike. Its relation to the development of low sexual drive and even DM, itself, requires further investigation. Overall, the complex pathophysiology of this condition makes it difficult to develop clinical treatments tailored specifically for diabetic patients. As our understanding of diabetic ED progresses, the development of novel and effective treatment strategies will evolve.