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Study: stress a factor in teen binge drinking

Minority status contributes to destructive behavior

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binge drinking, gay news, Washington Blade
binge drinking, gay news, Washington Blade

The authors of this study sought to determine if minority stress theory could explain why gay and lesbian adolescents engage in binge drinking more than heterosexual youths.

VANCOUVER, British Columbia β€” Higher rates of binge drinking by lesbian and gay adolescents compared to their heterosexual peers may be due to chronic stress caused by difficult social situations, according to a study presented last weekend at the Pediatric Academic Societies (PAS) annual meeting in Vancouver, British Columbia, Canada.

Research has shown that lesbians and gays experience higher rates of physical and mental health problems. One explanation for these disparities is minority stress. According to this theory, chronic stress due to discrimination, rejection, harassment, concealment of sexual orientation, internalized homophobia and other negative experiences leads to poor health, researchers said in a press release.

The authors of this study sought to determine if minority stress theory could explain why gay and lesbian adolescents engage in binge drinking more than heterosexual youths. To do this, they analyzed responses from 1,232 youths ages 12-18 years who took part in an online survey conducted by OutProud: the National Coalition for LGBT Youth. Sixteen percent of youths identified themselves as lesbian females and 84 percent as gay males.

The survey asked questions about sexual minority experiences and included more than 260 variables. It represents the only known research to explore the relationship between binge drinking and a variety of minority stress experiences, such as homophobia and gay-related victimization, in a large national sample of lesbian and gay adolescents.

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Biden names White House National Monkeypox Response Coordinators

Governors of New York, Illinois, California declare ‘States of Emergency’

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President Joe Biden meets with his national security team on July 1. (Official White House Photo)

The White House announced Tuesday that President Biden has named FEMA’s Robert Fenton as the White House National Monkeypox Response Coordinator and Dr. Demetre Daskalakis as the White House National Monkeypox Response Deputy Coordinator.

The president’s actions come as the governors of New York, Illinois and California have declared ‘States of Emergency’ as the case numbers of global cases of infection also caused World Health Organization’s Director-General Dr. Tedros Adhanom Ghebreyesus to declare the escalating global monkeypox outbreak a Public Health Emergency of International Concern.

The White House notes that Fenton and Daskalakis will lead the Administration’s strategy and operations to combat the current monkeypox outbreak, including equitably increasing the availability of tests, vaccinations and treatments.

Both men have extensive experience in infection disease outbreaks and response. The White House statement laid out their qualifications:

Fenton and Daskalakis combined have over four decades of experience in Federal emergency response and public health leadership, including overseeing the operations and implementation of key components of the Biden Administration’s response to the COVID-19 pandemic, and leading local and Federal public health emergency efforts such as infectious disease control and HIV prevention.

Both played critical roles in making COVID vaccines more accessible for underserved communities and closing the equity gap in adult vaccination rates, through the implementation and execution of FEMA mass vaccination sites in some of the country’s most underserved communities, and working with trusted members of local communities to build vaccine confidence.

Robert Fenton currently serves as Regional Administrator for FEMA Region 9 in the American West, with nearly 50 million people in his area of responsibility. One of the Nation’s most experienced and effective emergency management leaders, Robert Fenton has twice served as Acting Administrator of FEMA and led multiple challenging prevention, response and recovery operations throughout his long and distinguished career, including for natural disasters, disease outbreaks, and complex humanitarian operations. 

Demetre Daskalakis, a leading public health expert, is currently Director of the CDC Division of HIV Prevention. Widely known as a national expert on health issues affecting the LGBGQIA+ communities, his clinical practice has focused on providing care for the underserved LGBTQIA+ communities. He previously oversaw management of infectious diseases for the New York City Department of Health and Mental Hygiene, one of the largest departments in the nation – including in serving as incident commander for the City’s COVID-19 response.

Both the U.S. Secretary of Health and Human Services and the President’s chief medical advisor issued statements applauding Biden’s actions.

β€œWe look forward to partnering with Bob Fenton and Demetre Dasklalakis as we work to end the monkeypox outbreak in America,” said HHS Secretary Xavier Becerra. β€œBob’s experience in federal and regional response coordination, and Demetre’s vast knowledge of our public health systems’ strengths and limits will be instrumental as we work to stay ahead of the virus and advance a whole-of-government response.”

β€œBob Fenton and Dr. Daskalakis are proven, effective leaders that will lead a whole of government effort to implement President Biden’s comprehensive monkeypox response strategy with the urgency that this outbreak warrants,” said Dr. Anthony Fauci, Chief Medical Advisor to the President. β€œFrom Bob’s work at FEMA leading COVID-19 mass vaccination efforts and getting vaccines to underserved communities to Demetre’s extensive experience and leadership on health equity and STD and HIV prevention, this team will allow the Biden Administration to further accelerate and strengthen its monkeypox response.”

The Centers for Disease Control and Prevention as of Monday reported that there were 5,811 confirmed cases of the monkeypox virus in the United States.

Statement from GLAAD President and CEO Sarah Kate Ellis:

β€œThe White House appointments today reflect the seriousness of the monkeypox (MPV) outbreak and should be a call for all appropriate federal and state officials to urgently commit necessary resources to educate the public and counter MPV. We must get more vaccines to vulnerable people, especially sexually active gay and bi men, and accelerate all efforts to inform the public to track, test, treat and contain this virus as quickly as possible. Bob Fenton’s experience shows this can be done. Dr. Demetre Daskalakis is a longtime LGBTQ and HIV health advocate whose work will be critical to ensure the federal government responds to the needs of the medical community and the LGBTQ community in equitable ways.”

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With time, the Monkeypox vaccine provides good protection

In clinical trials, recipients who were HIV negative had an 83 percent immune response 28 days after one dose compared to 98 percent with two doses at 42 days.

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A review of academic literature published in the Journal of Internet Medical Research last year determined, when it comes to information about health topics, social media is not the place to turn. (Unless you follow me, of course!) One study found 87 percent of health-related posts contain misinformation. More than 40 percent of posts about vaccines contain incorrect information.   

These findings are, perhaps, not surprising. But they are important to keep in mind as we doom-scroll for information about monkeypox. 

I’ve already seen a number of posts on Twitter claiming to have monkeypox breakthrough infections after vaccination. One author said they developed a monkeypox rash two weeks after vaccination. While this person’s experience was not likely a breakthrough case, the post brings up important questions. How much protection does a person have after being vaccinated and when? And, as some cities move to a one-dose regimen due to vaccine supply, what does research say about the number of doses needed to protect a person?

Monkeypox rashes and lesions can take up to three weeks to develop after exposure to the virus, which means it is possible the Twitter user mentioned above was exposed before vaccination or shortly after. The time following vaccination and when you are exposed to the virus matters in terms of the amount of protection you have. 

Simply put: vaccines do not offer protection immediately after being administered. Remember what we learned when getting our COVID-19 vaccines: no matter which vaccine you received, you were not fully protected until two weeks after the final dose. For the monkeypox vaccine the time to protection is actually longer. Clinical trials indicated it takes up to four weeks for patients to develop strong protection. In fact, two weeks after the first dose, the immune response was just 29 percent! Take extra care during this period to prevent spread.  

Now, what about one dose versus two? With limited monkeypox vaccine supply, cities and states should consider limiting doses to one per person to protect more people.

The U.S. Food and Drug Administration (FDA) approved a vaccine, Jynneos, developed by the U.S. government and Bavarian Nordic in 2019 to protect against both monkeypox and smallpox. The FDA recommended a two dose regimen, four weeks apart. This regimen outperformed an older smallpox vaccine (ACAM2000) for producing an immunological response. The Jynneos vaccine also has fewer side effects and is much safer.

Unfortunately, the Jynneos vaccine is in very short supply. Bavarian Nordic, the only manufacturer of the vaccine worldwide, says it can produce 30 million doses of Jynneos annually, meaning with a full regimen less than 15 million patients worldwide will have full protection. That’s why cities like Washington, D.C. and New York have chosen to move to a single-dose regimen. The United Kingdom and some countries in Europe have done the same.  

This approach is the right one. 

In clinical trials, recipients who were HIV negative had an 83 percent immune response 28 days after one dose compared to 98 percent with two doses at 42 days. HIV positive recipients had a 67 percent immune response 28 days after one dose. It was 96 percent 42 days after two doses. 

While that data indicates a two-dose regimen is best, with supplies limited, a one-dose regimen for most people is a reasonable approach. That strategy allows double the group of individuals to be immunized β€” even though there is slightly lower efficacy. A recent article in Science highlighted this important point. Jynneos’ CEO, an immunologist, said one dose of the vaccine conferred a β€œrobust immune response.” 

There is one caveat, however. Based on the clinical trial data, we might need to stick with the original two-dose regimen for people who are immunocompromised or live with HIV (irrespective of immune status).

In the face of what appears to be a public health system in disarray, Americans need to be partners in fighting the virus’ spread. Get vaccinated when available. Individuals who are most at risk should sign up now to receive a vaccine. Second, understand it takes time after receiving the vaccine to develop immunity whether you are HIV positive or not. Understand monkeypox symptoms, the timing of symptoms and how to reduce your risk. And, of course, take care when it comes to social media. Spread truth.

Dr. N. Adam Brown is a practicing emergency medicine physician, founder of a healthcare strategy advisory group ABIG Health, and a professor of practice at the University of North Carolina’s Kenan-Flagler Business School. Previously he served as President of Emergency Medicine and Chief Impact Officer for a leading national medical group. Follow him on Twitter @ERDocBrown.

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World’s first heart transplant between HIV-positive donors performed at NYC hospital

The heart transplant recipient, a woman in her sixties, also received a new kidney during the surgery at a Bronx, New York, hospital.

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World’s first heart transplant between HIV-Positive donor and recipient was successfully performed at Montefiore Health System in New York City.Β 

According to the Montefiore press release, the organ recipient, who suffered from advanced heart failure, went through a four-hour transplant surgery in early spring. She received a kidney transplant at the same time. After recovering at hospital for five weeks, she is seeing her transplant physicians at Montefiore for monitoring.

β€œThanks to significant medical advances, people living with HIV are able to control the disease so well that they can now save the lives of other people living with this condition. This surgery is a milestone in the history of organ donation and offers new hope to people who once had nowhere to turn,” said Ulrich P. Jorde, MD, a cardiologist affiliated with Montefiore and also Professor of Medicine at Einstein.

In 2013, the HIV Organ Policy Equity Act was approved, allowing people living with HIV to donate their organs to other HIV-positive members. However, it took 10 years for heart transplants among the HIV-positive community to become a reality.Β 

According to the data from Montefiore, there are between 60,000 and 100,000 people who could benefit from a new heart across the United States. Studies point out that most HIV-positive people die from end-stage organ diseases or organ failures instead of infections. However, only about 3,800 transplants were performed in 2021.

β€œThis was a complicated case and a true multidisciplinary effort by cardiology, surgery, nephrology, infectious disease, critical care and immunology,” said the patient’s cardiologist, Omar Saeed, also an Assistant Professor of Medicine at Einstein. 

β€œMaking this option available to people living with HIV expands the pool of donors and means more people, with or without HIV, will have quicker access to a lifesaving organ. To say we are proud of what this means for our patients and the medical community at large, is an understatement,” Saeed continued.

HIV-positive patients have not been considered good candidates for organ transplants, due to their short life expectancies. While the federal act went into effect and the United Network for Organ Sharing (UNOS) doesn’t consider HIV a problem for organ transplants, the individual transplant center has the final say in the transplant decision.Β 

There are only 25 centers nationwide eligible to offer the procedure after it met surgical benchmarks and outcomes set by the Organ Procurement and Transplantation Network.

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