Placeholder Content Image

Cranberry juice really can help with UTIs – and reduce reliance on antibiotics

<p><em><a href="https://theconversation.com/profiles/christian-moro-121754">Christian Moro</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> and <a href="https://theconversation.com/profiles/charlotte-phelps-1187658">Charlotte Phelps</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a></em></p> <p>Cranberry juice has been <a href="https://www.ncbi.nlm.nih.gov/books/NBK92762/">used medicinally for centuries</a>. Our new research indicates it should be a normal aspect of urinary tract infection (UTI) management today.</p> <p>While some benefits of cranberry compounds for the prevention of UTIs have been suspected for <a href="https://theconversation.com/cranberry-juice-can-prevent-recurrent-utis-but-only-for-some-people-203926">some time</a>, it hasn’t been clear whether the benefits from cranberry juice were simply from drinking <a href="https://bjgp.org/content/70/692/e200">more fluid</a>, or something in the fruit itself.</p> <p>For our <a href="https://www.sciencedirect.com/science/article/pii/S2405456924001226">study</a>, published this week, we combined and collectively assessed 3,091 participants across more than 20 clinical trials.</p> <p>Our analysis indicates that increasing liquids reduces the rate of UTIs compared with no treatment, but cranberry in liquid form is even better at reducing UTIs and antibiotic use.</p> <h2>Are UTIs really that bad?</h2> <p>Urinary tract infections affect more than <a href="https://journals.sagepub.com/doi/pdf/10.1177/1756287219832172">50% of women</a> and <a href="https://bjgpopen.org/content/bjgpoa/5/2/bjgpopen20X101140.full.pdf">20% of men</a> in their lifetime.</p> <p>Most commonly, UTIs are caused from the bug called <em>Escherichia coli</em> (E.coli). This bug lives harmlessly in our <a href="https://www.ncbi.nlm.nih.gov/books/NBK562895/">intestines</a>, but can cause infection in the <a href="http://doi.org/10.33235/anzcj.30.1.4-10">urinary tract</a>. This is why, particularly for women, it is recommended people wipe from front to back after using the toilet.</p> <p>An untreated UTI can move up to the kidneys and cause even more serious illness.</p> <p>Even when not managing infection, many people are anxious about contracting a UTI. Sexually active women, pregnant women and older women may all be at <a href="https://www.ncbi.nlm.nih.gov/books/NBK436013/">increased risk</a>.</p> <h2>Why cranberries?</h2> <p>To cause a UTI, the bacteria need to attach to the wall of the <a href="https://www.nature.com/articles/s41598-023-44916-8">urinary bladder</a>. Increasing fluids helps to flush out bacteria before it attaches (or makes its way up into the bladder).</p> <p>Some beneficial compounds in cranberry, such as <a href="https://www.cochrane.org/CD001321/RENAL_cranberries-preventing-urinary-tract-infections">proanthocyanidins</a> (also called condensed tannins), prevent the bacteria from attaching to the wall itself.</p> <p>While there are treatments, over 90% of the bugs that cause UTIs exhibit some form of <a href="https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance">microbial resistance</a>. This suggests that they are rapidly changing and some cases of UTI might be left <a href="https://www.scientificamerican.com/article/antibiotic-resistant-utis-are-common-and-other-infections-may-soon-be-resistant-too/">untreatable</a>.</p> <h2>What we found</h2> <p>Our analysis <a href="https://www.sciencedirect.com/science/article/pii/S2405456924001226">showed</a> a 54% lower rate of UTIs from cranberry juice consumption compared to no treatment. This means that significantly fewer participants who regularly consumed cranberry juice (most commonly around 200 millilitres each day) reported having a UTI during the periods assessed in the studies we analysed.</p> <p>Cranberry juice was also linked to a 49% lower rate of antibiotic use than placebo liquid and a 59% lower rate than no treatment, based on analysis of indirect and direct effects across six studies. The use of cranberry compounds, whether in drinks or tablet form, also reduced the prevalence of symptoms associated with UTIs.</p> <p>While some studies we included presented conflicts of interest (such as receiving funding from cranberry companies), we took this “high risk of bias” into account when analysing the data.</p> <h2>So, when can cranberry juice help?</h2> <p>We found three main benefits of cranberry juice for UTIs.</p> <p><strong>1. Reduced rates of infections</strong></p> <p>Increasing fluids (for example, drinking more water) reduced the prevalence of UTIs, and taking cranberry compounds (such as tablets) was also beneficial. But the most benefits were identified from increasing fluids and taking cranberry compounds at the same time, such as with cranberry juice.</p> <p><strong>2. Reduced use of antibiotics</strong></p> <p>The data shows cranberry juice lowers the need to use antibiotics by 59%. This was identified as fewer participants in randomised cranberry juice groups required antibiotics.</p> <p>Increasing fluid intake also helped reduce antibiotic use (by 25%). But this was not as useful as increasing fluids at the same time as using cranberry compounds.</p> <p>Cranberry compounds alone (such as tablets without associated increases in fluid intake) did not affect antibiotic use.</p> <p><strong>3. Reducing symptoms</strong></p> <p>Taking cranberry compounds (in any form, liquid or tablet) reduced the symptoms of UTIs, as measured in the overall data, by more than five times.</p> <h2>Take home advice</h2> <p>While cranberry juice cannot treat a UTI, it can certainly be part of UTI management.</p> <p>If you suspect that you have a UTI, see your GP as soon as possible.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/235314/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><a href="https://theconversation.com/profiles/christian-moro-121754"><em>Christian Moro</em></a><em>, Associate Professor of Science &amp; Medicine, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> and <a href="https://theconversation.com/profiles/charlotte-phelps-1187658">Charlotte Phelps</a>, Senior Teaching Fellow, Medical Program, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/cranberry-juice-really-can-help-with-utis-and-reduce-reliance-on-antibiotics-235314">original article</a>.</em></p>

Body

Placeholder Content Image

Resistance (exercise) is far from futile: The unheralded benefits of weight training

<p><em><a href="https://theconversation.com/profiles/stuart-phillips-428766">Stuart Phillips</a>, <a href="https://theconversation.com/institutions/mcmaster-university-930">McMaster University</a> </em></p> <p>Everyone can agree that exercise is healthy. Among its many benefits, exercise improves heart and brain function, aids in controlling weight, slows the effects of aging and helps lower the risks of several chronic <a href="https://doi.org/10.1101%2Fcshperspect.a029694">diseases</a>.</p> <p>For too long, though, one way of keeping fit, aerobic exercise, has been perceived as superior to the other, resistance training, for promoting health when, in fact, they are equally valuable, and both can get us to the same goal of overall physical fitness.</p> <p>Aerobic exercise such as running, swimming and cycling is popular because it provides great benefits and with ample <a href="https://doi.org/10.1371/journal.pmed.1001335">scientific evidence</a> to back that up.</p> <p>What has been far less influential to date is that resistance training — whether that’s with dumbbells, weightlifting machines or good old push-ups, lunges and dips — works about as well as aerobic exercise in all the critical areas, including cardiovascular health.</p> <p>Resistance training provides another benefit: building strength and developing power, which become increasingly important as a <a href="https://doi.org/10.1007/s12603-021-1665-8">person ages</a>.</p> <figure><iframe src="https://player.vimeo.com/video/843867756" width="500" height="281" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption><span class="caption">Video about different forms of resistance training explores how all are effective at building strength.</span></figcaption></figure> <p>Building and maintaining muscle strength keeps us springing out of our chairs, maintaining our balance and posture and firing our metabolism, as my colleagues and I explain in a paper recently <a href="https://doi.org/10.1249/FIT.0000000000000916">published</a> by the American College of Sports Medicine.</p> <p>So, if aerobic exercise and resistance training offer roughly equal benefits, how did we end up with so many runners and cyclists compared to weightlifters?</p> <p>It was a combination of timing, marketing and stereotyping.</p> <h2>The rise of aerobics</h2> <p>The preference for aerobic exercise dates back to landmark research from the <a href="https://www.cooperinstitute.org/research/ccls">Cooper Centre Longitudinal Study</a>, which played a pivotal role in establishing the effectiveness of aerobics — Dr. Ken Cooper invented or at least popularized the word with his book <a href="https://www.cooperaerobics.com/About/Aerobics.aspx"><em>Aerobics</em></a>, spurring desk-bound Baby Boomers to take up exercise for its own sake.</p> <p>Meanwhile, resistance training languished, <a href="https://www.cnet.com/health/fitness/does-lifting-weights-make-women-bulky/">especially among women</a>, due to the misguided notion that weightlifting was only for men who aspired to be hyper-muscular. <a href="https://www.britannica.com/biography/Charles-Atlas">Charles Atlas</a>, anyone?</p> <p>Cultural influences solidified the dominance of aerobic exercise in the fitness landscape. In 1977, Jim Fixx made running and jogging popular with <a href="https://en.wikipedia.org/wiki/The_Complete_Book_of_Running"><em>The Complete Book of Running</em></a>. In the 1980s, Jane Fonda’s <a href="https://www.janefonda.com/shop/fitness-videos/jane-fondas-complete-workout/"><em>Complete Workout</em></a> and exercise shows such as <em><a href="https://www.imdb.com/title/tt0268895/">Aerobicize</a></em> and the <em><a href="https://www.imdb.com/title/tt0299431/">20 Minute Workout</a></em> helped solidify the idea that exercise was about raising one’s heart rate.</p> <p>The very word “aerobic,” previously confined to the lexicon of science and medicine, entered popular culture about the same time as leg warmers, tracksuits and sweatbands. It made sense to many that breathing hard and sweating from prolonged, vigorous movement was the best way to benefit from exercising.</p> <p>All the while, resistance training was waiting for its turn in the spotlight.</p> <h2>Recognizing the value of resistance</h2> <p>If aerobics has been the hare, resistance training has been the tortoise. Weight training is now coming up alongside and preparing to overtake its speedy rival, as athletes and everyday people alike recognize the value that was always there.</p> <p>Even in high-level sports training, weightlifting did not become common until the last 20 years. Today, it strengthens the bodies and lengthens the careers of soccer stars, tennis players, golfers <a href="https://doi.org/10.1007/s40279-016-0486-0">and many more</a>.</p> <p>Rising popular interest in resistance training owes a debt to <a href="https://www.livestrong.com/article/545200-the-fall-of-fitness/">CrossFit</a>, which, despite its controversies, has helped break down stereotypes and introduced more people, particularly women, to the practice of lifting weights.</p> <p>It’s important to recognize that resistance training does not invariably lead to bulking up, nor does it demand lifting heavy weights. As our team’s research has shown, lifting lighter weights to the point of failure in multiple sets provides <a href="https://journals.physiology.org/doi/full/10.1152/japplphysiol.00154.2016">equal benefits</a>.</p> <h2>Strength and ageing</h2> <p>The merits of resistance training extend beyond improving muscle strength. It addresses a critical aspect often overlooked in traditional aerobic training: the ability to exert force quickly, or what’s called power. As people age, activities of daily living such as standing up, sitting down and climbing stairs demand <a href="https://doi.org/10.1186/s11556-022-00297-x">strength and power</a> more than cardiovascular endurance.</p> <p>In this way, resistance training can be vital to maintaining overall functionality and independence.</p> <h2>Redefining the fitness narrative</h2> <p>The main idea is not to pit resistance training against aerobic exercise but to recognize that they complement each other. Engaging in both forms of exercise is better than relying on one alone. The <a href="https://doi.org/10.1161/CIR.0000000000001189">American Heart Association</a> recently stated that “…resistance training is a safe and effective approach for improving cardiovascular health in adults with and without cardiovascular disease.”</p> <p>Adopting a nuanced perspective is essential, especially when we guide <a href="https://doi.org/10.1016/j.arr.2021.101368">older individuals</a> who may associate exercise primarily with walking and not realize the limitations imposed by neglecting strength and power training.</p> <p>Resistance training is not a one-size-fits-all endeavour. It encompasses a <a href="https://doi.org/10.1016/j.jshs.2023.06.005">spectrum of activities</a> tailored to individual capabilities.</p> <p>It’s time to redefine the narrative around fitness to make more room for resistance training. It’s not necessary to treat it as a replacement for aerobic exercise but to see it as a vital component of a holistic approach to <a href="https://doi.org/10.1249/ESM.0000000000000001">health and longevity</a>.</p> <p>By shedding stereotypes, demystifying the process and promoting inclusivity, resistance training can become more accessible and appealing to a broader audience, ultimately leading to a new way to perceive and prioritize the benefits of this form of training for <a href="https://doi.org/10.1136/bjsports-2021-105061">health and fitness</a>.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/220269/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/stuart-phillips-428766"><em>Stuart Phillips</em></a><em>, Professor, Kinesiology, Tier 1 Canada Research Chair in Skeletal Muscle Health, <a href="https://theconversation.com/institutions/mcmaster-university-930">McMaster University</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/resistance-exercise-is-far-from-futile-the-unheralded-benefits-of-weight-training-220269">original article</a>.</em></p>

Body

Placeholder Content Image

Do you really need antibiotics? Curbing our use helps fight drug-resistant bacteria

<p><em><a href="https://theconversation.com/profiles/minyon-avent-1486987">Minyon Avent</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a>; <a href="https://theconversation.com/profiles/fiona-doukas-1157050">Fiona Doukas</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/kristin-xenos-1491653">Kristin Xenos</a>, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a></em></p> <p>Antibiotic resistance occurs when a microorganism changes and no longer responds to an antibiotic that was previously effective. It’s <a href="https://thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00502-2/fulltext">associated with</a> poorer outcomes, a greater chance of death and higher health-care costs.</p> <p>In Australia, antibiotic resistance means some patients are admitted to hospital because oral antibiotics are <a href="https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance">no longer effective</a> and they need to receive intravenous therapy via a drip.</p> <p>Antibiotic resistance is rising to high levels in certain parts of the world. Some hospitals <a href="https://www.reactgroup.org/news-and-views/news-and-opinions/year-2022/the-impact-of-antibiotic-resistance-on-cancer-treatment-especially-in-low-and-middle-income-countries-and-the-way-forward/">have to consider</a> whether it’s even viable to treat cancers or perform surgery due to the risk of antibiotic-resistant infections.</p> <p>Australia is <a href="https://www.safetyandquality.gov.au/our-work/antimicrobial-resistance/antimicrobial-use-and-resistance-australia-aura/aura-2023-fifth-australian-report-antimicrobial-use-and-resistance-human-health">one of the highest users</a> of antibiotics in the developed world. We need to use this precious resource wisely, or we risk a future where a simple infection could kill you because there isn’t an effective antibiotic.</p> <h2>When should antibiotics not be used?</h2> <p>Antibiotics only work for some infections. They work against bacteria but <a href="https://www.safetyandquality.gov.au/publications-and-resources/resource-library/do-i-really-need-antibiotics">don’t treat</a> infections caused by viruses.</p> <p>Most community acquired infections, even those caused by bacteria, are likely to get better without antibiotics.</p> <p>Taking an antibiotic when you don’t need it won’t make you feel better or recover sooner. But it can increase your chance of side effects like nausea and diarrhoea.</p> <p>Some people think green mucus (or snot) is a sign of bacterial infection, requiring antibiotics. But it’s actually <a href="https://www.safetyandquality.gov.au/sites/default/files/2023-11/aura_2023_do_i_really_need_antibiotics.pdf">a sign</a> your immune system is working to fight your infection.</p> <h2>If you wait, you’ll often get better</h2> <p><a href="https://www.tg.org.au/">Clinical practice guidelines</a> for antibiotic use aim to ensure patients receive antibiotics when appropriate. Yet 40% of GPs say they prescribe antibiotics <a href="https://doi.org/10.1071/HI13019">to meet patient expectations</a>. And <a href="https://pubmed.ncbi.nlm.nih.gov/35973750/">one in five</a> patients expect antibiotics for respiratory infections.</p> <p>It can be difficult for doctors to decide if a patient has a viral respiratory infection or are at an early stage of serious bacterial infection, particularly in children. One option is to “watch and wait” and ask patients to return if there is clinical deterioration.</p> <p>An alternative is to prescribe an antibiotic but advise the patient to not have it dispensed unless specific symptoms occur. This can <a href="https://doi.org/10.1002/14651858.CD004417.pub5">reduce antibiotic use by 50%</a> with no decrease in patient satisfaction, and no increase in complication rates.</p> <h2>Sometimes antibiotics are life-savers</h2> <p>For some people – particularly those with a weakened immune system – a simple infection can become more serious.</p> <p>Patients with life-threatening suspected infections should receive an appropriate antibiotic <a href="https://www.safetyandquality.gov.au/our-work/clinical-care-standards/antimicrobial-stewardship-clinical-care-standard">immediately</a>. This includes serious infections such as <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/bacterial-meningitis#:%7E:text=What%20is%20bacterial%20meningitis%3F,can%20cause%20life%2Dthreatening%20problems.">bacterial meningitis</a> (infection of the membranes surrounding the brain) and <a href="https://clinicalexcellence.qld.gov.au/priority-areas/safety-and-quality/sepsis/adult-sepsis#:%7E:text=Adult%20patients%20with%20sepsis%20also,adult%20emergency%20department%20sepsis%20pathway.">sepsis</a> (which can lead to organ failure and even death).</p> <h2>When else might antibiotics be used?</h2> <p>Antibiotics are sometimes used to prevent infections in patients who are undergoing surgery and are at significant risk of infection, such as those undergoing bowel resection. These patients will <a href="https://www.tg.org.au">generally receive</a> a single dose before the procedure.</p> <p>Antibiotics may also <a href="https://www.tg.org.au">be given</a> to patients undergoing chemotherapy for solid organ cancers (of the breast or prostate, for example), if they are at high risk of infection.</p> <p>While most sore throats are caused by a virus and usually resolve on their own, some high risk patients with a bacterial strep A infection which can cause “scarlet fever” are given antibiotics to prevent a more serious infection like <a href="https://www.rhdaustralia.org.au/">acute rheumatic fever</a>.</p> <h2>How long is a course of antibiotics?</h2> <p>The recommended duration of a course of antibiotics depends on the type of infection, the likely cause, where it is in your body and how effective the antibiotics are at killing the bacteria.</p> <p>In the past, courses were largely arbitrary and based on assumptions that antibiotics should be taken for long enough to eliminate the infecting bacteria.</p> <p>More recent research does not support this and shorter courses are <a href="https://www.acpjournals.org/doi/full/10.7326/M19-1509">nearly always as effective as longer ones</a>, particularly for community acquired respiratory infections.</p> <p>For <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736742/">community acquired pneumonia</a>, for example, research shows a three- to five-day course of antibiotics is at least as effective as a seven- to 14-day course.</p> <p>The “take until all finished” approach is no longer recommended, as the longer the antibiotic exposure, the greater the chance the bacteria will develop resistance.</p> <p>However, for infections where it is more difficult to eradicate the bacteria, such as tuberculosis and bone infections, a combination of antibiotics for many months is usually required.</p> <h2>What if your infection is drug-resistant?</h2> <p>You may have an antibiotic-resistant infection if you don’t get better after treatment with standard antibiotics.</p> <p>Your clinician will collect samples for lab testing if they suspect you have antibiotic-resistant infection, based on your travel history (especially if you’ve been hospitalised in a country with high rates of antibiotic resistance) and if you’ve had a recent course of antibiotics that hasn’t cleared your infection.</p> <p>Antibiotic-resistant infections are managed by prescribing broad-spectrum antibiotics. These are like a sledgehammer, wiping out many different species of bacteria. (Narrow-spectrum antibiotics conversely can be thought of as a scalpel, more targeted and only affecting one or two kinds of bacteria.)</p> <p>Broad-spectrum antibiotics are usually more expensive and come with more severe side effects.</p> <h2>What can patients do?</h2> <p>Decisions about antibiotic prescriptions should be made using <a href="https://www.safetyandquality.gov.au/our-work/partnering-consumers/shared-decision-making/decision-support-tools-specific-conditions">shared decision aids</a>, where patients and prescribers discuss the risks and benefits of antibiotics for conditions like a sore throat, middle ear infection or acute bronchitis.</p> <p>Consider asking your doctor questions such as:</p> <ul> <li>do we need to test the cause of my infection?</li> <li>how long should my recovery take?</li> <li>what are the risks and benefits of me taking antibiotics?</li> <li>will the antibiotic affect my regular medicines?</li> <li>how should I take the antibiotic (how often, for how long)?</li> </ul> <p>Other ways to fight antibiotic resistance include:</p> <ul> <li>returning leftover antibiotics to a pharmacy for safe disposal</li> <li>never consuming leftover antibiotics or giving them to anyone else</li> <li>not keeping prescription repeats for antibiotics “in case” you become sick again</li> <li>asking your doctor or pharmacist what you can do to feel better and ease your symptoms rather than asking for antibiotics.</li> </ul> <p><em><a href="https://theconversation.com/profiles/minyon-avent-1486987">Minyon Avent</a>, Antimicrobial Stewardship Pharmacist, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a>; <a href="https://theconversation.com/profiles/fiona-doukas-1157050">Fiona Doukas</a>, PhD candidate, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/kristin-xenos-1491653">Kristin Xenos</a>, Research Assistant, College of Health, Medicine and Wellbeing, School of Biomedical Science and Pharmacy, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/do-you-really-need-antibiotics-curbing-our-use-helps-fight-drug-resistant-bacteria-217920">original article</a>.</em></p>

Body

Placeholder Content Image

Drug resistance may make common infections like thrush untreatable

<p><em><a href="https://theconversation.com/profiles/christine-carson-109004">Christine Carson</a>, <a href="https://theconversation.com/institutions/the-university-of-western-australia-1067">The University of Western Australia</a></em></p> <p>We’ve all heard about antibiotic resistance. This happens when bacteria develop strategies to avoid being destroyed by an antibiotic.</p> <p>The consequences of antibiotic resistance mean an antibiotic previously used to cure bacterial infections no longer works effectively because the bacteria have become resistant to the drug. This means it’s getting harder to cure the infections some bacteria cause.</p> <p>But unfortunately, it’s only one part of the problem. The same phenomenon is also happening with other causes of infections in humans: fungi, viruses and parasites.</p> <p>“Antimicrobial resistance” means the drugs used to treat diseases caused by microbes (bugs that cause infection) no longer work. This occurs with antibacterial agents used against bacteria, antifungal agents used against fungi, anti-parasitic agents used against parasites and antiviral agents used against viruses.</p> <p>This means a wide range of previously controllable infections are becoming difficult to treat – and may become untreatable.</p> <h2>Fighting fungi</h2> <p>Fungi are responsible for a range of infections in humans. Tinea, ringworm and vulvovaginal candidiasis (thrush) are some of the more familiar and common superficial fungal infections.</p> <p>There are also life-threatening fungal infections such as aspergillosis, cryptococcosis and invasive fungal bloodstream infections including those caused by <em>Candida albicans</em> and <em>Candida auris</em>.</p> <p>Fungal resistance to antifungal agents is a problem for several reasons.</p> <p>First, the range of antifungal agents available to treat fungal infections is limited, especially compared to the range of antibiotics available to treat bacterial infections. There are only four broad families of antifungal agents, with a small number of drugs in each category. Antifungal resistance further restricts already limited options.</p> <p>Life-threatening fungal infections happen less frequently than life-threatening bacterial infections. But they’re rising in frequency, especially among people whose immune systems are compromised, including by <a href="https://7news.com.au/news/qld/first-heart-transplant-patient-to-die-from-fungal-infection-at-brisbanes-prince-charles-hospital-identified-as-mango-hill-gp-muhammad-hussain-c-12551559">organ transplants</a> and chemotherapy or immunotherapy for cancer. The threat of getting a drug-resistant fungal infection makes all of these health interventions riskier.</p> <p>The greatest <a href="https://www.frontiersin.org/articles/10.3389/fimmu.2017.00735/full">burden of serious fungal disease</a> occurs in places with limited health-care resources available for diagnosing and treating the infections. Even if infections are diagnosed and antifungal treatment is available, antifungal resistance reduces the treatment options that will work.</p> <p>But even in Australia, common fungal infections are impacted by resistance to antifungal agents. Vulvovaginal candidiasis, known as thrush and caused by <em>Candida</em> species and some closely related fungi, is usually reliably treated by a topical antifungal cream, sometimes supplemented with an oral tablet. However, instances of <a href="https://www.theage.com.au/national/victoria/they-can-t-sit-properly-doctors-treat-growing-number-of-women-with-chronic-thrush-20230913-p5e499.html">drug-resistant thrush</a> are increasing, and new treatments are needed.</p> <h2>Targeting viruses</h2> <p>Even <a href="https://theconversation.com/why-are-there-so-many-drugs-to-kill-bacteria-but-so-few-to-tackle-viruses-137480">fewer antivirals</a> are available than antibacterial and antifungal agents.</p> <p>Most antimicrobial treatments work by exploiting differences between the microbe causing the infection and the host (us) experiencing the infection. Since viruses use our cells to replicate and cause their infection, it’s difficult to find antiviral treatments that selectively target the virus without damaging us.</p> <p>With so few antiviral drugs available, any resistance that develops to one of them significantly reduces the treatment options available.</p> <p>Take COVID, for example. Two antiviral medicines are in widespread use to treat this viral infection: Paxlovid (containing nirmatrelvir and ritonavir) and Lagevrio (molnupiravir). So far, SARS-CoV-2, the virus that causes COVID, has not developed significant resistance to either of these <a href="https://www.cidrap.umn.edu/covid-19/low-levels-resistance-paxlovid-seen-sars-cov-2-isolates">treatments</a>.</p> <p>But if SARS-CoV-2 develops resistance to either one of them, it halves the treatment options. Subsequently relying on one would likely lead to its increased use, which may heighten the risk that resistance to the second agent will develop, leaving us with no antiviral agents to treat COVID.</p> <p>The threat of antimicrobial resistance makes our ability to treat serious COVID infections rather precarious.</p> <h2>Stopping parasites</h2> <p>Another group of microbes that cause infections in humans are single-celled microbes such as <em>Plasmodium</em>, <em>Giardia</em>, <em>Leishmania</em>, and <em>Trypanosoma</em>. These microbes are sometimes referred to as parasites, and they are becoming increasingly resistant to the very limited range of anti-parasitic agents used to treat the infections they cause.</p> <p>Several <em>Plasmodium</em> species cause malaria and anti-parasitic drugs have been the cornerstone of malaria treatment for decades. But their usefulness has been significantly reduced by the <a href="https://www.mmv.org/our-work/mmvs-pipeline-antimalarial-drugs/antimalarial-drug-resistance">development of resistance</a>.</p> <p><em>Giardia</em> parasites cause an infection called giardiasis. This can resolve on its own, but it can also cause severe gastrointestinal symptoms such as diarrhea, nausea, and bloating. These microbes have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6207226/">developed resistance</a> to the main treatments and patients infected with drug-resistant parasites can have protracted, unpleasant infections.</p> <h2>Resistance is a natural consequence</h2> <p>Treating infections influences microbes’ evolutionary processes. Exposure to drugs that stop or kill them pushes microbes to either evolve or die. The exposure to antimicrobial agents provokes the evolutionary process, selecting for microbes that are resistant and can survive the exposure.</p> <p>The pressure to evolve, provoked by the antimicrobial treatment, is called “selection pressure”. While most microbes will die, a few will evolve in time to overcome the antimicrobial drugs used against them.</p> <p>The evolutionary process that leads to the emergence of resistance is inevitable. But some things can be done to minimise this and the problems it brings.</p> <p>Limiting the use of antimicrobial agents is one approach. This means reserving antimicrobial agents for when their use is known to be necessary, rather than using them “just in case”.</p> <p>Antimicrobial agents are precious resources, holding at bay many infectious diseases that would otherwise sicken and kill millions. It is imperative we do all we can to preserve the effectiveness of those that remain, and give ourselves more options by working to discover and develop new ones.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/213460/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/christine-carson-109004">Christine Carson</a>, Senior Research Fellow, School of Medicine, <a href="https://theconversation.com/institutions/the-university-of-western-australia-1067">The University of Western Australia</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/drug-resistance-may-make-common-infections-like-thrush-untreatable-213460">original article</a>.</em></p>

Body

Placeholder Content Image

No, antibiotics aren’t always needed. Here’s how GPs can avoid overprescribing

<p><em><a href="https://theconversation.com/profiles/mina-bakhit-826292">Mina Bakhit</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> and <a href="https://theconversation.com/profiles/paul-glasziou-13533">Paul Glasziou</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a></em></p> <p>The growth in antibiotic resistance threatens to return the world to the pre-antibiotic era – with deaths from now-treatable infections, and some elective surgery being restricted because of the risks of infection.</p> <p>Antibiotic resistance is a major problem worldwide and should be the concern of everyone, including you.</p> <p>We need to develop new antibiotics that can fight the resistant bacteria or antibiotics that bacteria would not be quickly resistant to. This is like finding new weapons to help the immune system fight the bacteria.</p> <p>More importantly, we need to use our current antibiotics – our existing weapons against the bacteria – more wisely.</p> <h2>Giving GPs the tools to say no</h2> <p>In 2022, more than <a href="https://www.safetyandquality.gov.au/publications-and-resources/resource-library/aura-2023-fifth-australian-report-antimicrobial-use-and-resistance-human-health">one-third of Australians</a> had least one antibiotic prescription, with <a href="https://www.safetyandquality.gov.au/publications-and-resources/resource-library/analysis-2015-2022-pbs-and-rpbs-antimicrobial-dispensing-data">88%</a> of antibiotics prescribed by GPs.</p> <p>Many people <a href="https://pubmed.ncbi.nlm.nih.gov/28289114/">mistakenly think</a> antibiotics are necessary for treating any infection and that infections won’t improve unless treated with antibiotics. This misconception is found in studies involving patients with various conditions, including respiratory infections and conjunctivitis.</p> <p>In reality, not all infections require antibiotics, and this belief drives patients requesting antibiotics from GPs.</p> <p>Other times, GPs give antibiotics because they think patients want them, even when they might not be necessary. Although, in reality they are <a href="https://pubmed.ncbi.nlm.nih.gov/17148626/">after symptom relief</a>.</p> <p>For GPs, there are ways to target antibiotics for only when they are clearly needed, even with short appointments with patients perceived to want antibiotics. This includes:</p> <ul> <li> <p>using <a href="https://pubmed.ncbi.nlm.nih.gov/32357226/">decision guides</a> or tests to decide if antibiotics are really necessary</p> </li> <li> <p>giving <a href="https://www.safetyandquality.gov.au/our-work/partnering-consumers/shared-decision-making/decision-support-tools-specific-conditions">patients information sheets</a> when antibiotics aren’t needed</p> </li> <li> <p>giving a “<a href="https://pubmed.ncbi.nlm.nih.gov/33910882/">delayed prescription</a>” – only to be used after the patient waits to see if they get better on their own.</p> </li> </ul> <p>All these strategies need some <a href="https://www.nps.org.au/assets/NPS/pdf/NPS-MedicineWise-Economic-evaluation-report-Reducing-Antibiotic-Resistance-2012-17.pdf">training</a> and practice, but they can help GPs prescribe antibiotics more responsibly. GPs can also learn from each other and use tools like <a href="https://pubmed.ncbi.nlm.nih.gov/24474434/">posters</a> as reminders.</p> <p>To help with patients’ expectations, public campaigns have been run periodically to educate people about antibiotics. These campaigns <a href="https://pubmed.ncbi.nlm.nih.gov/35098267/">explain why</a> using antibiotics too much can be harmful and when it’s essential to take them.</p> <h2>Giving doctors feedback on their prescribing</h2> <p>National programs and interventions can help GPs use antibiotics more wisely</p> <p>One successful way they do this is by <a href="https://pubmed.ncbi.nlm.nih.gov/34356788/">giving GPs feedback</a> about how they prescribe antibiotics. This works better when it’s provided by organisations that GPs trust, it happens more than once and clear goals are set for improvement.</p> <p>The NPS (formerly National Prescribing Service) MedicineWise program, for example, had been giving feedback to GPs on how their antibiotic prescriptions compared to others. This reduced the number of antibiotics prescribed.</p> <p>However, <a href="https://australianprescriber.tg.org.au/articles/the-end-of-nps-medicinewise.html">NPS no longer exists</a>.</p> <p>In 2017, the Australian health department did something similar by sending <a href="https://behaviouraleconomics.pmc.gov.au/projects/nudge-vs-superbugs-behavioural-economics-trial-reduce-overprescribing-antibiotics">feedback letters</a>, randomly using different formats, to the GPs who prescribed the most antibiotics, showing them how they were prescribing compared to others.</p> <p>The most effective letter, which used pictures to show this comparison, reduced the number of antibiotics GPs prescribed by <a href="https://behaviouraleconomics.pmc.gov.au/sites/default/files/projects/nudge-vs-superbugs-12-months-on-report.pdf">9% in a year</a>.</p> <h2>Clearer rules and regulations</h2> <p>Rules and regulations are crucial in the fight against antibiotic resistance.</p> <p>Before April 2020, many GPs’ computer systems made it easy to get multiple repeat prescriptions for the same condition, which could encourage their overuse.</p> <p>However, in April 2020, the Pharmaceutical Benefits Scheme (PBS) <a href="https://www.pbs.gov.au/pbs/industry/listing/elements/pbac-meetings/psd/2019-08/antibiotic-repeats-on-the-pharmaceutical-benefits-scheme">changed the rules</a> to ensure GPs had to think more carefully about whether patients actually needed repeat antibiotics. This meant the amount of medicine prescribed better matched the days it was needed for.</p> <p>Other regulations or policy targets could include:</p> <ul> <li> <p>ensuring all GPs have access to antibiotic prescribing guidelines, such as <a href="https://www.tg.org.au/">Therapeutic Guidelines</a>, which is well accepted and widely available in Australia</p> </li> <li> <p>ensuring GPs are only prescribing antibiotics when needed. Many of the conditions antibiotics are currently prescribed for (such as sore throat, cough and middle ear infections) are self-limiting, meaning they will get better without antibiotics</p> </li> <li> <p>encouraging GP working with antibiotics manufacturers to align pack sizes to the recommended treatment duration. The recommended first-line treatments for uncomplicated urinary tract infections in non-pregnant women, for example, are either three days of trimethoprim 300 mg per night or five days of nitrofurantoin 100 mg every six hours. However, the packs contain enough for seven days. This can mean patients take it for longer or use leftovers later.</p> </li> </ul> <h2>Australia lags behind Sweden</h2> <p>Australia has some good strategies for antibiotic prescribing, but we have not had a sustained long-term plan to ensure wise use.</p> <p>Although Australian GPs have been doing well in <a href="https://www.safetyandquality.gov.au/our-work/antimicrobial-resistance/antimicrobial-use-and-resistance-australia-surveillance-system/aura-2021">reducing antibiotic prescribing</a> since 2015, <a href="https://pubmed.ncbi.nlm.nih.gov/35098269/">more</a> could be done.</p> <p>In the 1990s, Sweden’s antibiotic use was similar to Australia’s, but is now less than half. For more than two decades, Sweden has had a national strategy that reduces antibiotic use by about <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5677604/">7% annually</a>.</p> <p>It is vital Australia invests in a similar long-term national strategy – to have a centrally funded program, but with regional groups working on the implementation. This could be funded directly by the Commonwealth Department of Health and Ageing, or with earmarked funds via another body such as the Australian Centre for Disease Control.</p> <p>In the meantime, individual GPs can do their part to prescribe antibiotics better, and patients can join the national effort to combat antibiotic resistance by asking their GP: “what would happen if I don’t take an antibiotic?”.</p> <p><em><a href="https://theconversation.com/profiles/mina-bakhit-826292">Mina Bakhit</a>, Assistant Professor of Public Health, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> and <a href="https://theconversation.com/profiles/paul-glasziou-13533">Paul Glasziou</a>, Professor of Medicine, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/no-antibiotics-arent-always-needed-heres-how-gps-can-avoid-overprescribing-213981">original article</a>.</em></p>

Caring

Placeholder Content Image

The rise and fall of antibiotics. What would a post-antibiotic world look like?

<p><em><a href="https://theconversation.com/profiles/allen-cheng-94997">Allen Cheng</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a></em></p> <p> </p> <p>These days, we don’t think much about being able to access a course of antibiotics to head off an infection. But that wasn’t always the case – antibiotics have been available for less than a century.</p> <p>Before that, patients would die of relatively trivial infections that became more serious. Some serious infections, such as those involving the heart valves, were <a href="https://pubmed.ncbi.nlm.nih.gov/20173297/">inevitably</a> fatal.</p> <p>Other serious infections, such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070694/">tuberculosis</a>, weren’t always fatal. Up to a <a href="https://www.biorxiv.org/content/10.1101/729426v1.full.pdf">half</a> of people died within a year with the most severe forms, but some people recovered without treatment and the remainder had ongoing chronic infection that slowly ate away at the body over many years.</p> <p>Once we had antibiotics, the outcomes for these infections were much better.</p> <h2>Life (and death) before antibiotics</h2> <p>You’ve probably heard of Alexander Fleming’s accidental <a href="https://www.acs.org/education/whatischemistry/landmarks/flemingpenicillin.html">discovery of penicillin</a>, when fungal spores landed on a plate with bacteria left over a long weekend in 1928.</p> <p>But the <a href="https://www.ox.ac.uk/news/science-blog/penicillin-oxford-story">first patient</a> to receive penicillin was an instructive example of the impact of treatment. In 1941, Constable Albert Alexander had an infected scratch on his face that had become infected.</p> <p>He was hospitalised but despite various treatments, the infection progressed to involve his head. This required removing one of his eyes.</p> <p>Howard Florey, the Australian pharmacologist then working in Oxford, was concerned penicillin could be toxic in humans. Therefore, he felt it was only ethical to give this new drug to a patient in a desperate condition.</p> <p>Constable Alexander was given the available dose of penicillin. Within the first day, his condition had started to improve.</p> <p>But back then, penicillin was difficult to produce. One way of extending the limited supply was to “recycle” penicillin that was excreted in the patient’s urine. Despite this, supplies ran out by the fifth day of Alexander’s treatment.</p> <p>Without further treatment, the infection again took hold. Constable Alexander eventually died a month later.</p> <p>We now face a world where we are potentially running out of antibiotics – not because of difficulties manufacturing them, but because they’re losing their effectiveness.</p> <h2>What do we use antibiotics for?</h2> <p>We currently use antibiotics in humans and animals for a variety of reasons. Antibiotics reduce the duration of illness and the chance of death from infection. They also prevent infections in people who are at high risk, such as patients undergoing surgery and those with weakened immune systems.</p> <p>But antibiotics aren’t always used appropriately. <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30084-0/fulltext">Studies</a> consistently show a dose or two will adequately prevent infections after surgery, but antibiotics are <a href="https://irp.cdn-website.com/d820f98f/files/uploaded/surgical-prophylaxis-prescribing-in-australian-hospitals-results-of-the-2020-surgical-national-antimicrobial-prescribing-survey.pdf">often</a> continued for several days unnecessarily. And sometimes we use the wrong type of antibiotic.</p> <p><a href="https://irp.cdn-website.com/d820f98f/files/uploaded/antimicrobial-prescribing-practice-in-australian-hospitals-results-of-the-2020-hospital-national-antimicrobial-prescribing-survey.pdf">Surveys</a> have found 22% of antimicrobial use in hospitals is inappropriate.</p> <p>In some situations, this is understandable. Infections in different body sites are usually due to different types of bacteria. When the diagnosis isn’t certain, we often <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/resp.13334">err</a> on the side of caution by giving broad spectrum antibiotics to make sure we have active treatments for all possible infections, until further information becomes available.</p> <p>In other situations, there is a degree of inertia. If the patient is improving, doctors tend to simply continue the same treatment, rather than change to more appropriate choice.</p> <p>In general practice, the issue of diagnostic uncertainty and therapeutic inertia are often magnified. Patients who recover after starting antibiotics don’t usually require tests or come back for review, so there is no easy way of knowing if the antibiotic was actually required.</p> <p>Antibiotic prescribing can be more complex again if <a href="https://www.mja.com.au/journal/2014/201/2/antibiotic-prescribing-practice-residential-aged-care-facilities-health-care">patients</a> are expecting “a pill for every ill”. While doctors are generally good at educating patients when antibiotics are not likely to work (for example, for viral infections), without confirmatory tests there can always be a lingering doubt in the minds of both doctors and patients. Or sometimes the patient goes elsewhere to find a prescription.</p> <p>For other infections, resistance can develop if treatments aren’t given for long enough. This is particularly the <a href="https://pubmed.ncbi.nlm.nih.gov/11971765/">case</a> for tuberculosis, caused by a slow growing bacterium that requires a particularly long course of antibiotics to cure.</p> <p>As in humans, antibiotics are also used to prevent and treat infections in animals. However, a proportion of antibiotics are used for growth promotion. In Australia, an <a href="https://www.mja.com.au/journal/2019/211/4/antibiotic-use-animals-and-humans-australia">estimated</a> 60% of antibiotics were used in animals between 2005-2010, despite growth-promotion being phased out.</p> <h2>Why is overuse a problem?</h2> <p>Bacteria become resistant to the effect of antibiotics through natural selection – those that survive exposure to antibiotics are the strains that have a mechanism to evade their effects.</p> <p>For example, antibiotics are sometimes given to <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30279-2/fulltext">prevent</a> recurrent urinary tract infections, but a consequence, any infection that does <a href="https://academic.oup.com/cid/article/73/3/e782/6141409">develop</a> tends to be with resistant bacteria.</p> <p>When resistance to the commonly used first-line antibiotics occurs, we often need to reach deeper into the bag to find other effective treatments.</p> <p>Some of these last-line antibiotics are those that had been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4202707/">superseded</a> because they had serious side effects or couldn’t be given conveniently as tablets.</p> <p>New drugs for some bacteria have been developed, but many are much more <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7955006/">expensive</a> than older ones.</p> <h2>Treating antibiotics as a valuable resource</h2> <p>The concept of antibiotics as a valuable resource has led to the <a href="https://pubmed.ncbi.nlm.nih.gov/8856755/">concept</a> of “antimicrobial stewardship”, with programs to promote the responsible use of antibiotics. It’s a similar concept to environmental stewardship to prevent climate change and environmental degradation.</p> <p>Antibiotics are a rare class of medication where treatment of one patient can potentially affect the outcome of other patients, through the transmission of antibiotic resistant bacteria. Therefore, like efforts to combat climate change, antibiotic stewardship relies on changing individual actions to benefit the broader community.</p> <p>Like climate change, antibiotic resistance is a complex problem when seen in a broader context. Studies have linked resistance to the values and priorities <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(18)30186-4/fulltext">of governments</a> such as corruption and infrastructure, including the availability of electricity and public services. This highlights that there are broader “causes of the causes”, such as public spending on sanitation and health care.</p> <p>Other <a href="https://academic.oup.com/jac/article/74/9/2803/5512029?login=true">studies</a> have suggested individuals need to be considered within the broader social and institutional influences on prescribing behaviour. Like all human behaviour, antibiotic prescribing is complicated, and factors like what doctors feel is “normal” prescribing, whether junior staff feel they can challenge senior doctors, and even their <a href="https://www.nytimes.com/2016/10/07/upshot/your-surgeon-is-probably-a-republican-your-psychiatrist-probably-a-democrat.html">political views</a> may be important.</p> <p>There are also issues with the <a href="https://www.cambridge.org/core/journals/international-journal-of-technology-assessment-in-health-care/article/value-assessment-of-antimicrobials-and-the-implications-for-development-access-and-funding-of-effective-treatments-australian-stakeholder-perspective/D45758CFB95520DA4FF06E46135E0628">economic model</a> for developing new antibiotics. When a new antibiotic is first approved for use, the first reaction for prescribers is not to use it, whether to ensure it retains its effectiveness or because it is often very expensive.</p> <p>However, this doesn’t really <a href="https://academic.oup.com/cid/article/50/8/1081/449089?login=true">encourage</a> the development of new antibiotics, particularly when pharma research and development budgets can easily be diverted to developing drugs for conditions patients take for years, rather than a few days.</p> <h2>The slow moving pandemic of resistance</h2> <blockquote> <p>If we fail to act, we are looking at an almost unthinkable scenario where antibiotics no longer work and we are cast back into the dark ages of medicine – <a href="https://amr-review.org/">David Cameron</a>, former UK Prime Minister</p> </blockquote> <p>Antibiotic resistance is already a problem. Almost all infectious diseases physicians have had the dreaded call about patients with infections that were essentially untreatable, or where they had to scramble to find supplies of long-forgotten last-line antibiotics.</p> <p>There are already hospitals in some parts of the world that have had to carefully <a href="https://www.reactgroup.org/news-and-views/news-and-opinions/year-2022/the-impact-of-antibiotic-resistance-on-cancer-treatment-especially-in-low-and-middle-income-countries-and-the-way-forward/">consider</a> whether it’s still viable to treat cancers, because of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6276316/">high risk</a> of infections with antibiotic-resistant bacteria.</p> <p>A global <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02724-0/fulltext">study</a> estimated that in 2019, almost 5 million deaths occurred with an infection involving antibiotic-resistant bacteria. Some 1.3 million would not have occurred if the bacteria were not resistant.</p> <p>The UK’s 2014 <a href="https://amr-review.org/sites/default/files/AMR%20Review%20Paper%20-%20Tackling%20a%20crisis%20for%20the%20health%20and%20wealth%20of%20nations_1.pdf">O'Neill report</a> predicted deaths from antimicrobial resistance could rise to 10 million deaths each year, and cost 2-3.5% of global GDP, by 2050 based on trends at that time.</p> <h2>What can we do about it?</h2> <p>There is a lot we can do to prevent antibiotic resistance. We can:</p> <ul> <li> <p><a href="https://www.marketingmag.com.au/news/film-picking-gonorrhoea-wins-tropfest-prize/">raise</a> <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7258-3">awareness</a> that many infections will get better by themselves, and don’t necessarily need antibiotics</p> </li> <li> <p>use the antibiotics we have more appropriately and for as short a time as possible, supported by co-ordinated clinical and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437704/">public policy</a>, and <a href="https://www.amr.gov.au/">national</a> <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00796-4/fulltext">oversight</a></p> </li> <li> <p><a href="https://www.safetyandquality.gov.au/our-work/antimicrobial-resistance/antimicrobial-use-and-resistance-australia-surveillance-system/about-aura-surveillance-system">monitor</a> for infections due to resistant bacterial to inform control policies</p> </li> <li> <p>reduce the inappropriate use of antibiotics in animals, such as <a href="https://nam.edu/antibiotic-resistance-in-humans-and-animals/">growth promotion</a></p> </li> <li> <p><a href="https://pubmed.ncbi.nlm.nih.gov/11971765/">reduce</a> cross-transmission of resistant organisms in hospitals and in the community</p> </li> <li> <p>prevent infections by other means, such as clean water, <a href="https://apps.who.int/iris/bitstream/handle/10665/204948/WHO_FWC_WSH_14.7_eng.pdf">sanitation</a>, hygiene and <a href="https://www.who.int/teams/immunization-vaccines-and-biologicals/product-and-delivery-research/anti-microbial-resistance">vaccines</a></p> </li> <li> <p>continue developing new antibiotics and alternatives to antibiotics and ensure the right <a href="https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(23)00124-2/fulltext#:%7E:text=We%20consider%20four%20incentive%20options,exclusivity%20extensions%2C%20and%20milestone%20payments.">incentives</a> are in place to encourage a continuous pipeline of new drugs.</p> </li> </ul> <p><a href="https://theconversation.com/profiles/allen-cheng-94997"><em>Allen Cheng</em></a><em>, Professor in Infectious Diseases Epidemiology, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/the-rise-and-fall-of-antibiotics-what-would-a-post-antibiotic-world-look-like-213450">original article</a>.</em></p>

Caring

Placeholder Content Image

Will we still have antibiotics in 50 years? We asked 7 global experts

<p>Almost since antibiotics were <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2937522/#:%7E:text=Since%20the%20introduction%20in%201937,operate%20some%2070%20years%20later.">first discovered</a>, we’ve been aware bacteria can learn how to overcome these medicines, a phenomenon known as antimicrobial resistance.</p> <p>The World Health Organization says we’re currently <a href="https://www.who.int/news/item/20-09-2017-the-world-is-running-out-of-antibiotics-who-report-confirms">losing to the bugs</a>, with resistance increasing and too few new antibiotics in the pipeline. </p> <p>We wanted to know whether experts around the world think we will still have effective antibiotics in 50 years. Seven out of seven experts said yes.</p> <p><strong>Lori Burrows - Biochemist, Canada</strong></p> <p>Yes! Antibiotics are a crucial component of modern medicine, and we can't afford to lose them. Despite the rise of resistance in important pathogens (bugs), and the substantial decrease in new drugs in development, we have multiple tools at our disposal to protect antibiotics. Stewardship - the principle of using antibiotics only when absolutely necessary - is key to maintaining the usefulness of current antibiotics and preventing resistance to new drugs from arising. New diagnostics, such as the rapid tests that became widely available during the pandemic, can inform stewardship efforts, reducing inappropriate antibiotic use for viral diseases. </p> <p>Finally, researchers continue to find creative ways, including the use of powerful artificial intelligence approaches, to identify antimicrobial compounds with new targets or new modes of action. Other promising tactics include using viruses that naturally kill bacteria, stimulating the host's immune system to fight the bacteria, or combining existing antibiotics with molecules that can enhance antibiotic activity by, for example, increasing uptake or blocking resistance.</p> <p><strong>André Hudson - Biochemist, United States</strong></p> <p>Yes. The real question is not whether we will have antibiotics 50 years from now, but what form of antibiotics will be used. Most antibiotics we use today are modelled after natural products isolated from organisms such as fungi and plants. The use of <a href="https://news.mit.edu/2020/artificial-intelligence-identifies-new-antibiotic-0220">AI</a>, machine learning, and other <a href="https://www.theguardian.com/technology/2023/may/25/artificial-intelligence-antibiotic-deadly-superbug-hospital">computational tools</a> to help design novel, unnatural compounds that can circumvent the evolution of antibiotic resistance are only in the very early stages of development. </p> <p>Many of the traditional medicines such as penicillins and other common antibiotics of today which are already waning in efficacy, will probably be of very little use in 50 years. Over time, with the aid of new technology, I predict we will have new medicines to fight bacterial infections.</p> <p><strong>Ray Robins-Browne - Microbiologist, Australia</strong></p> <p>Yes, we will have antibiotics (by which I mean antimicrobial drugs), because people will still get infections despite advances in immunisation and other forms of prevention. Having said this, drugs of the future will be quite different from those we use today, which will have become obsolete well within the next 50 years. The new drugs will have a narrow spectrum, meaning they will be targeted directly at the specific cause of the infection, which we will determine by using rapid, point-of-care diagnostic tests, similar to the RATS we currently use to diagnose COVID. </p> <p>Antimicrobials of the future won’t kill bacteria or limit their growth, because this encourages the development of resistance. Instead, they will limit the ability of the bacteria to cause disease or evade our immune systems.</p> <p><strong>Raúl Rivas González - Microbiologist, Spain</strong></p> <p>Yes, but not without effort. Currently, antimicrobial resistance is a leading cause of death globally, and will continue to rise. But in my opinion, there will still be useful antibiotics to combat bacterial infections within 50 years. To achieve this, innovation and investment is required. Artificial intelligence may even be able to help. An example is the compound "RS102895", which eliminates the multi-resistant superbug Acinetobacter baumannii. This was identified through a machine learning algorithm. </p> <p>The future of antibiotics requires substantial changes in the search for new active molecules and in the design of therapies that can eliminate bacteria without developing resistance. We are on the right path. An example is the discovery of clovibactin, recently isolated from uncultured soil bacteria. Clovibactin effectively kills antibiotic-resistant gram-positive bacteria without generating detectable resistance. Future antimicrobial therapy may consist of new antibiotics, viruses that kill bacteria, specific antibodies, drugs that counter antibiotic resistance, and other new technology.</p> <p><strong>Fidelma Fitzpatrick - Microbiologist, United Kingdom</strong></p> <p>Yes, but not many. Without rapid scale-up of measures to curtail the "<a href="https://www.oecd.org/health/embracing-a-one-health-framework-to-fight-antimicrobial-resistance-ce44c755-en.htm">alarming global health threat</a>" of antimicrobial resistance by 2073, there will be few effective antibiotics left to treat sepsis. The <a href="https://www.cdc.gov/drugresistance/covid19.html">Centre for Disease Control</a> has indicated a reversal of progress following the pandemic, when all focus in healthcare, government and society was on COVID. Without an approach targeting people, animals, agri-food systems and the environment, antimicrobial resistance will continue its upward trajectory. <a href="https://www.worldbank.org/en/topic/health/publication/drug-resistant-infections-a-threat-to-our-economic-future">Doing nothing</a> is unacceptable – lives will be lost, healthcare expenditure will increase and workforce productivity will suffer. </p> <p>The highest burden of antimicrobial resistance is in <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02724-0/fulltext">low-income countries</a>. <a href="https://www.ncbi.nlm.nih.gov/books/NBK543407/">Action plans</a> exist in most OECD, European and G20 countries. In all countries plans need to be funded and implemented across all relevant sectors as above. Better integrated data to track antibiotic use and resistance across human and animal health and the environment, in addition to research and development for new antibiotics, vaccines and diagnostics, will be necessary.</p> <p><strong>Juliana Côrrea - Public health expert, Brazil </strong></p> <p>Yes. However, <a href="https://www.sciencedirect.com/science/article/pii/S0188440905002730?via%3Dihub">available data</a> suggest that without a shift in the political agenda towards the control and prevention of antimicrobial resistance, several antibiotics will have lost their utility. The problem of bacterial resistance is not new and the risk of antibiotics becoming ineffective in the face of the evolutionary capacity of bacteria is one of the main problems facing global health. The creation of policies to promote the appropriate use of this resource has not progressed at the same speed as inappropriate use in human and animal health and in agricultural production. </p> <p>The factors that impact antibiotic use are complex and vary according to local contexts. The response to the problem goes far beyond controlling use at the individual level. We must recognise the social, political, and economic dimensions in proposing more effective governance.</p> <p><strong>Yori Yuliandra -  Pharmacist, Indonesia</strong></p> <p>Yes. Despite their <a href="https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance">reduced efficacy over time</a>, antibiotics continue to be produced every year. Researchers are tirelessly working to develop new and more effective antibiotics. And researchers are actively exploring combinations of antibiotics to enhance their efficacy. While antimicrobial resistance is rising, researchers have been making remarkable progress in addressing this issue. They have developed innovative antibiotic classes such as <a href="https://doi.org/10.4155/fmc-2016-0041">FtsZ inhibitors</a> which can inhibit cell division, a process necessary for bacteria to multiply. <a href="https://www.who.int/publications/i/item/9789240021303">Clinical trials</a> are currently taking place.</p> <p>A deeper understanding of the molecular aspects of bacterial resistance has led to the discovery of new treatment strategies, such as the <a href="https://doi.org/10.1039/D2MD00263A">inhibition of key enzymes</a> that play a pivotal role in bugs becoming resistant. And <a href="https://doi.org/10.1038/s42003-021-02586-0">advances in computer technology</a> have greatly accelerated drug discovery and development efforts, offering hope for the rapid discovery of new antibiotics and treatment strategies.</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a href="https://theconversation.com/will-we-still-have-antibiotics-in-50-years-we-asked-7-global-experts-214950" target="_blank" rel="noopener">The Conversation</a>. </em></p>

Body

Placeholder Content Image

Resistance to mega-tourism is rising in the South Pacific – but will governments put words into action?

<p>With COVID-19 travel restrictions largely a thing of the past for Australian and <a href="https://www.newshub.co.nz/home/travel/2022/12/fiji-more-popular-with-kiwi-tourists-than-it-was-pre-covid-19.html">New Zealand tourists</a>, Pacific destinations are enjoying the return of visitors – albeit at a <a href="https://devpolicy.org/the-pacific-emerging-from-covid-slowly-20221019/">slower pace</a> than in other parts of the world.</p> <p>Tourism in Fiji, Samoa, Vanuatu and the Cook Islands was <a href="https://www.imf.org/-/media/Files/Countries/ResRep/pis-region/small-states-monitor/pacific-islands-monitor-issue-17-october-2022.ashx">hit hard by the pandemic</a>, but <a href="https://www.massey.ac.nz/about/news/pacific-islands-resilient-as-covid-19-topples-tourism/">patience and resilience</a> are starting to pay off. Foreign dollars are once again circulating in those small economies. Recently, <a href="https://www.mvariety.com/business/kiribati-welcomes-first-cruise-ship-visit/article_30ca4be0-b0f7-11ed-9b9d-93619a4dfba6.html">Kiribati welcomed</a> its first international cruise ship since 2020.</p> <p>But this isn’t a simple case of returning to normal. The past three years have allowed time for reflection, leading to a rising awareness of <a href="https://southpacificislands.travel/pacific-sustainable-tourism-leadership-summit-calls-on-pacific-leaders-to-work-together-to-build-resilient-futures/">possible alternatives</a> to pre-pandemic tourism models.</p> <p>From senior levels within governments to grassroots tourism operators and citizens, there has been serious discussion about the resumption of business as usual, including several <a href="https://southpacificislands.travel/2021-ends-on-a-high-with-pacific-islands-tourism-research-symposium/">regional symposiums</a> hosted by the South Pacific Tourism Organisation.</p> <p>Issues of sovereignty and future resilience have been very much to the fore – quite untypical in a global tourism industry largely focused on <a href="https://etc-corporate.org/news/europes-tourism-rebound-predicted-to-continue-into-2023/">boosting numbers</a> as soon as possible. Questions remain, however, about the gap between rhetoric and reality.</p> <h2>Flipping the narrative</h2> <p>The <a href="https://southpacificislands.travel/2022-pacific-sustainable-tourism-leadership-summit/">Pacific Sustainable Tourism Leaders Summit</a> in November 2022 brought together tourism ministers and industry stakeholders to discuss the future of regional tourism. This led to a <a href="https://southpacificislands.travel/pacific-sustainable-tourism-leadership-summit-calls-on-pacific-leaders-to-work-together-to-build-resilient-futures/">regional commitment</a> signed by 11 countries focused on promoting sustainable tourism.</p> <p>Essentially, the aim is to flip the narrative: rather than Pacific nations being seen as dependent on tourism, regional tourism itself depends on the Pacific and its people surviving and thriving. Accordingly, Pacific countries are calling for fairer and more meaningful relationships with tourism partners.</p> <p>Cook Islands’ associate minister of foreign affairs and immigration, Tingika Elikana, urged other Pacific leaders at the summit to rebuild tourism in a way that was <a href="https://www.fijitimes.com/inclusive-pacific-summit-calls-on-regional-leaders-to-work-together/">equitable and inclusive</a>, "[it] is crucial that lessons are learned from recent crises and that steps are taken to embed long-term inclusivity, sustainability, and resilience into our tourism offering as it faces evolving challenges and risks."</p> <p>Vanuatu has been heading in this direction since early in the pandemic, when it made “destination wellbeing” <a href="https://www.traveldailymedia.com/vanuatu-tourism-adopts-well-being-approach-for-covid-19-recovery/">central to its tourism recovery</a>. The aim of “moving beyond solely measuring visitor arrivals and contribution to GDP” then fed into the country’s <a href="https://tourism.gov.vu/images/DoT-Documents/Presentations/Vanuatu_Sustainable_Tourism_Strategy_2020-2030-2020_.pdf">Sustainable Tourism Strategy</a>, launched at the height of the pandemic.</p> <h2>Push-back on resorts and cruise ships</h2> <p>This reappraisal of scale and priorities has perhaps been most evident in Fiji where there has been <a href="https://www.fijitimes.com/project-unoriginal/">strong opposition</a> to a US$300 million mega-project proposed by Chinese developers.</p> <p>The hotel, apartment and marina complex would be built in an area containing one of the last remaining remnants of mangrove forest near the capital, Suva. Conservationists and local residents have been critical of the <a href="https://www.rnz.co.nz/international/pacific-news/484141/conservationist-calls-on-fiji-govt-to-preserve-rare-mangrove">environmental</a> and <a href="https://www.fijitimes.com/how-can-fiji-supply-water-to-project/">infrastructural</a> impact of the proposed development, as well as the <a href="https://www.fijitimes.com/project-unoriginal/">authenticity of its design</a>.</p> <p>There is <a href="https://www.rnz.co.nz/international/pacific-news/484710/costly-development-of-suva-forest-may-now-not-happen">now doubt</a> about whether the government will renew the developer’s lease, due to expire in June. The minister for lands and mineral resources has said “there’s been a lack of transparency” from the developers, and that he “will continue to monitor the remaining conditions of the development lease”.</p> <p>A leading opponent of the project, Reverend James Bhagwan, <a href="https://www.rnz.co.nz/international/pacific-news/484710/costly-development-of-suva-forest-may-now-not-happen">told Radio New Zealand</a>, "we'’re not anti-development, but what we’re saying is we need to look at development from a perspective that places the environment at the centre, not at the periphery.</p> <p>There is a precedent here: approval for a multi-million-dollar resort and casino development on Malolo island was revoked in 2019 after another Chinese developer, Freesoul Investments, destroyed part of a reef, dumped waste and disrupted traditional fisheries. In 2022, the High Court fined the company <a href="https://www.newsroom.co.nz/resort-developers-found-guilty-over-fiji-island-disaster-1">FJD$1 million</a>. It was the first time a developer had been punished for an “environmental crime”.</p> <p>Environmental concerns are also causing other Pacific countries to resist a return to mass tourism. In Rarotonga, Cook Islands, annual visitor numbers before the pandemic were ten times the island’s local population. The ability to cope with that level of tourism has since been <a href="https://www.rnz.co.nz/international/pacific-news/443141/cook-islanders-considering-how-much-tourism-is-too-much">seriously questioned</a>.</p> <p>And in French Polynesia, the government has <a href="https://www.nzherald.co.nz/travel/french-polynesia-the-latest-country-to-ban-mega-cruise-ships/RXY2PDLCWPAIZRVNENLHJ6Z2N4/">banned port calls</a> for cruise ships with a capacity greater than 3,500 passengers. The decision was based on concerns about air pollution, stress on the marine environment and social impacts. Daily cruise arrivals to Bora Bora are now restricted to 1,200 passengers, much to the <a href="https://www.rnz.co.nz/international/pacific-news/407885/bora-bora-calls-for-ban-on-large-cruise-ships">relief of locals</a>.</p> <h2>A new kind of tourism?</h2> <p>In the face of uncertainties due to climate change and geopolitical tensions in the region, it’s encouraging to hear local voices being heard in debates about the future of Pacific tourism – and political leaders appearing to respond.</p> <p>The Pacific Island Forum leaders’ retreat in Fiji late last month discussed the tourism industry. The forum’s signature <a href="https://www.forumsec.org/2050strategy/">Blue Pacific Strategy</a> for regional co-operation recognises tourism is an important component of national development, and the need to balance economic pressures with environmental and cultural protection.</p> <p>But despite the apparent political will and regional focus on building resilience, tourism development will undoubtedly continue to challenge the desires and initiatives of Pacific peoples seeking more sustainable futures.</p> <p>While the policy rhetoric sounds good, it remains to be seen whether Pacific governments will remain steadfast and united under mounting pressures from major cruise operators, Chinese commercial interests and large hotels looking to maximise occupancy rates.</p> <p>Many Pacific people reported the natural environment – along with social, spiritual, physical and mental wellbeing – <a href="https://www.internationaljournalofwellbeing.org/index.php/ijow/article/view/2539">improved during the pandemic pause</a> in tourism. But the reality of putting local wellbeing ahead of profits and increased tax revenue is yet to be fully tested as tourism bounces back.</p> <p><em>Images: Getty</em></p> <p><em style="box-sizing: border-box; color: #212529; font-family: -apple-system, 'system-ui', 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif, 'Apple Color Emoji', 'Segoe UI Emoji', 'Segoe UI Symbol', 'Noto Color Emoji'; font-size: 16px; background-color: #ffffff;">This article originally appeared on <a href="https://theconversation.com/resistance-to-mega-tourism-is-rising-in-the-south-pacific-but-will-governments-put-words-into-action-201071" target="_blank" rel="noopener">The Conversation</a>. </em></p>

International Travel

Placeholder Content Image

This Aussie discovery could save lives and beat antibiotic resistance

<p dir="ltr">Many if not all of us have been sick because of bacteria, with a trip to the GP seeing us walk away with a script for some kind of antibiotic.</p> <p dir="ltr">With bacterial infections having the potential to be quite deadly and causing people to deteriorate within hours while identifying the specific kind of bacteria (and which antibiotic is the best to treat with) can take days, doctors are often forced to use a best guess, “one-size-fits-all” antibiotic to treat patients.</p> <p dir="ltr">But, patients could soon be treated with a more targeted option, thanks to a new testing method that could identify bacteria within hours.</p> <p dir="ltr">A team of researchers from the Harry Perkins Institute of Medical Research, the University of Western Australia, and PathWest Laboratory Medicine WA have developed a process that first confirms that bacteria is causing a patient’s illness, before then determining which antibiotic will be the most effective.</p> <p dir="ltr">Dr Kieran Mulroney, a UWA Prospect Fellow involved in the research, says this new method not only helps doctors find the best treatments for their patients, but also combats the growing problem of antibiotic resistance.</p> <p dir="ltr">“The established method involves growing bacteria from a patient sample then applying different antibiotics to see which are effective. Patients with serious infections cannot wait the several days it can take to return antibiotic test results. Consequently, the patient's doctor has to rely on a best guess, 'one-size-fits-all', antibiotic choice to treat patients,” he <a href="https://www.scimex.org/newsfeed/lifesaving-australian-discovery-helps-combat-antibiotic-resistance-in-the-lancet-ebiomedicine">explains</a>.</p> <p dir="ltr">“The biggest problem with prescribing broad-spectrum antibiotics is that it encourages some bacteria to become resistant to the antibiotics. This is a growing and serious problem world-wide, because antibiotic resistant bacteria can spread from person to person and reduce treatment options.</p> <p dir="ltr">He says that using broad spectrum antibiotics is one of the “key drivers” in antibiotic resistance spreading.</p> <p dir="ltr">“New tests are urgently needed that give doctors evidence they can rely on to select the right antibiotic” he says.</p> <p dir="ltr">The new method consists of two stages, with the first involving a 30-minute test, rather than taking one to two days, to determine whether a person is ill as a result of a bacterial infection.</p> <p dir="ltr">“Once a patient has a confirmed bacterial infection, we then expose the bacteria to different types of antibiotics in the laboratory. Using a device that measures hundreds of thousands of individual bacteria in just a few seconds, the research team can detect the damage antibiotics cause to bacteria, and then use this information to confirm which antibiotic will be an effective treatment. We can predict which antibiotics will be effective to treat that infection with 96.9% accuracy,” Dr Mulroney said.</p> <p dir="ltr">Dr Aron Chakera, a renal physician at Sir Charles Gairdner Hospital who was also involved in the research, says it could be potentially life-saving for patients with chronic illnesses.</p> <p dir="ltr">“As a renal physician I treat patients with end-stage kidney disease who need to be in hospitals or clinics for several hours a week connected to dialysis machines. Many could manage their own dialysis using a surgically implanted catheter, which actually has better outcomes, is far less costly and is more satisfying for patients, but the ever-present fear of infection from the catheter deters many from choosing it,” Dr Charkera explains.</p> <p dir="ltr">“This new test would give confidence to patients and their treating doctors.”</p> <p dir="ltr">WA Country Health Service Translation Fellow Dr Tim Inglis, who was also involved in the research, notes that the need for rapid test results has been made all the more apparent since the start of the COVID-19 pandemic, and that the challenge of antibiotic resistance will still remain once Covid has tailed off.</p> <p dir="ltr">“Even in the most advanced health systems, hospital patients risk bacterial infection through trauma wounds, surgery sites, breathing machines and indwelling catheters,” he explains. </p> <p dir="ltr">“This can lead to pneumonia, urinary tract, abdominal and bloodstream infections. Applying the research team's new technology to these infections is expected to transform how quickly and effectively we treat patients in Western Australia and further afield.”</p> <p dir="ltr">Their work was published in the international medical journal <em><a href="https://doi.org/10.1016/j.ebiom.2022.104145" target="_blank" rel="noopener">The Lancet eBiomedicine</a></em>.</p> <p><span id="docs-internal-guid-03508f59-7fff-e26d-fc11-66583313c685"></span></p> <p dir="ltr"><em>Image: Dr Kieran Mulroney (Scimex)</em></p>

Body

Placeholder Content Image

It’s 2022. Why do we still not have waterproof phones?

<p>While manufacturers have successfully increased the water-repelling nature of smartphones, they are still far from “waterproof”. A water-resistant product can usually resist water penetration to some extent, but a waterproof product is (meant to be) totally impervious to water.</p> <p>Last week, Samsung Australia was <a href="https://www.accc.gov.au/media-release/samsung-australia-to-pay-14m-penalty-for-misleading-water-resistance-claims" target="_blank" rel="noopener">fined A$14 million</a> by the Australian Federal Court over false representations in ads of the water resistance of its Galaxy phones. The tech giant admitted that submerging Galaxy phones in pool or sea water could corrode the charging ports and stop the phones from working, if charged while still wet.</p> <p>Similarly, in 2020, Apple was fined <a href="https://www.cnet.com/tech/mobile/apple-fined-12m-dollars-by-italy-over-iphone-water-resistance-claims/" target="_blank" rel="noopener">€10 million</a> (about A$15.3 million) in Italy for misleading claims about the water resistance of iPhones.</p> <p>It’s very common for phones to become damaged as a result of being dropped in water. In a 2018 survey in the US, <a href="https://www.statista.com/statistics/959492/us-top-common-smartphone-damage-cause/" target="_blank" rel="noopener">39%</a> of respondents said they’d dropped their phones in water. <a href="https://www.consumeraffairs.com/news/damaged-devices-a-fact-of-life-for-most-smartphone-users-100614.html">Other</a> <a href="https://www.consumeraffairs.com/news/damaged-devices-a-fact-of-life-for-most-smartphone-users-100614.html" target="_blank" rel="noopener">surveys</a> have had similar results.</p> <p>So why is it in 2022 – a time where technological marvels surround us – we still don’t have waterproof phones?</p> <p><strong>Waterproof vs water-resistant</strong></p> <p>There’s a <a href="https://www.iec.ch/ip-ratings" target="_blank" rel="noopener">rating system</a> used to measure devices’ resistance against solids (such as dust) and liquids (namely water). It’s called the Ingress Protection (IP) rating.</p> <p>An IP rating will have two numbers. In a rating of IP68, the 6 refers to protection against solids on a scale of 0 (no protection) to 6 (high protection), and 8 refers to protection against water on a scale of 0 (no protection) to 9 (high protection).</p> <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/471066/original/file-20220627-13-hyrp6k.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=1000&amp;fit=clip"><img src="https://images.theconversation.com/files/471066/original/file-20220627-13-hyrp6k.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/471066/original/file-20220627-13-hyrp6k.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=600&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/471066/original/file-20220627-13-hyrp6k.png?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=600&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/471066/original/file-20220627-13-hyrp6k.png?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=600&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/471066/original/file-20220627-13-hyrp6k.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=754&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/471066/original/file-20220627-13-hyrp6k.png?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=754&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/471066/original/file-20220627-13-hyrp6k.png?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=754&amp;fit=crop&amp;dpr=3 2262w" alt="Chart showing International Electrotechnical Commission's IP Ratings Guide" /></a><figcaption><em><span class="caption">The International Electrotechnical Commission is the body behind the IP ratings guide.</span> <span class="attribution"><span class="source">International Electrotechnical Commission</span></span></em></figcaption></figure> <p>Interestingly, the benchmark for the water-resistance rating varies between manufacturers. For example, Samsung’s IP68-certified phones are <a href="https://www.samsung.com/global/galaxy/what-is/water-resistant/" target="_blank" rel="noopener">water-resistant</a> to a maximum depth of 1.5m in freshwater for up to 30 minutes, and the company cautions against beach or pool use. Some of <a href="https://support.apple.com/en-au/HT207043" target="_blank" rel="noopener">Apple’s iPhones</a> with an IP68 rating can be used at a maximum depth of 6m for up to 30 minutes.</p> <p>Yet both <a href="https://www.samsung.com/au/support/warranty/" target="_blank" rel="noopener">Samsung</a> and <a href="https://support.apple.com/en-au/HT207043" target="_blank" rel="noopener">Apple</a> are unlikely to consider repairing your water-damaged phone under their warranties.</p> <p>Moreover, IP rating testing is done under <a href="https://discussions.apple.com/thread/251513569" target="_blank" rel="noopener">controlled</a> laboratory conditions. In real-life scenarios such as boating, swimming or snorkelling, factors including speed, movement, water pressure and alkalinity all vary. So, gauging a phone’s level of water resistance becomes complicated.</p> <p><strong>How are phones made water-resistant?</strong></p> <p>Making a phone water-resistant requires several components and techniques. Typically, the first <a href="https://www.cnet.com/tech/mobile/how-does-waterproofing-work-apple-iphone-7-samsung-galaxy-s7-sony-xperia/" target="_blank" rel="noopener">point of protection</a> is to form a physical barrier around all ingress (entry) points where dust or water could enter. These include the buttons and switches, speakers and microphone outlets, the camera, flash, screen, phone enclosure, USB port and SIM card tray.</p> <p>These points are <a href="https://ieeexplore.ieee.org/stamp/stamp.jsp?arnumber=8671469" target="_blank" rel="noopener">covered and sealed</a> using glue, adhesive strips and tapes, silicone seals, rubber rings, gaskets, plastic and metal meshes and water-resistant membranes. After this, a layer of ultra-thin polymer <a href="https://www.conformalcoating.co.uk/index.php/materials/nano-coatings/%22%22" target="_blank" rel="noopener">nanocoating</a> is applied to the phone’s circuit board to help repel water.</p> <p>Nevertheless, a phone’s water resistance will still <a href="https://www.phonearena.com/news/phone-not-waterproof-water-resistant-forever_id115587" target="_blank" rel="noopener">decrease</a> with time as components age and deteriorate. Apple <a href="https://support.apple.com/en-au/HT207043" target="_blank" rel="noopener">admits</a> water- and dust-resistance are not permanent features of its phones.</p> <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/471544/original/file-20220629-19-pektlc.jpeg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=1000&amp;fit=clip"><img src="https://images.theconversation.com/files/471544/original/file-20220629-19-pektlc.jpeg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/471544/original/file-20220629-19-pektlc.jpeg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=400&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/471544/original/file-20220629-19-pektlc.jpeg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=400&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/471544/original/file-20220629-19-pektlc.jpeg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=400&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/471544/original/file-20220629-19-pektlc.jpeg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=503&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/471544/original/file-20220629-19-pektlc.jpeg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=503&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/471544/original/file-20220629-19-pektlc.jpeg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=503&amp;fit=crop&amp;dpr=3 2262w" alt="Phone gets flushed in a toilet bowl" /></a><figcaption><em><span class="caption">Many people drop their phones down the toilet – be careful!</span> <span class="attribution"><span class="source">Shutterstock</span></span></em></figcaption></figure> <p>Cameras are not entirely impervious to water, but some can tolerate submersion a lot better than smartphones. Often that’s because they’re relatively simpler devices.</p> <p>A smartphone has much more functionality, which means internal components are more sensitive, fragile, and must be built into a smaller casing. All of these factors make it doubly difficult to afford phones a similar level of water resistance.</p> <p>Adding water resistance to phones also <a href="https://inshorts.com/en/news/waterproof-phones-would-cost-2030-more-xiaomi-1466431118612" target="_blank" rel="noopener">increases their price</a> for consumers (by 20% to 30%, according to Xiaomi’s co-founder). This is a major consideration for manufacturers – especially since even a small crack can render any waterproofing void.</p> <p><strong>Keeping devices dry</strong></p> <p>Apart from nanocoating on the internal circuit boards, applying <a href="https://www.techradar.com/au/news/phone-and-communications/mobile-phones/why-aren-t-all-our-smartphones-waterproof-right-now-1327692" target="_blank" rel="noopener">water-repellent coating</a> to the exterior of a phone could boost protection. <a href="https://www.p2i.com/solutions/" target="_blank" rel="noopener">Some</a> <a href="https://www.hzo.com/solutions/protection-capabilities/" target="_blank" rel="noopener">companies</a> are working on this technology for manufacturers.</p> <p>Future phones <a href="https://www.sciencedirect.com/science/article/abs/pii/S003039922031327X" target="_blank" rel="noopener">might also have</a> circuitry that’s fabricated directly onto (waterproof) silicone material using laser writing techniques, and further coated with water-repellant technologies.</p> <p>For now, however, there’s no such thing as a <em>waterproof</em> phone. If your phone does find itself at the bottom of a pool or toilet and isn’t turning on, make sure you take the best steps to ensure it dries out properly (and isn’t further damaged).</p> <p>You can also buy a waterproof case or dry pouch if you want to completely waterproof your phone for water activities.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/185775/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/ritesh-chugh-162770" target="_blank" rel="noopener">Ritesh Chugh</a>, Associate Professor - Information and Communications Technology, <a href="https://theconversation.com/institutions/cquniversity-australia-2140" target="_blank" rel="noopener">CQUniversity Australia</a></em></p> <p><em>This article is republished from <a href="https://theconversation.com" target="_blank" rel="noopener">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/its-2022-why-do-we-still-not-have-waterproof-phones-185775" target="_blank" rel="noopener">original article</a>.</em></p> <p><em>Image: Getty Images</em></p>

Technology

Placeholder Content Image

15 winter nail colours and trends you won’t be able to resist

<p><strong>Winter nail colour trends</strong></p> <p>Even if you spend most of the winter bundled up, there are still parts of you worth showing off all year long. And let’s not forget about that moment of pure joy when you slip your hands out of your gloves to show off your favourite new nail polish. So, now that autumn is over, what are the hottest winter nail colours and trends that should be on your radar?</p> <p>From rich, jewel-toned hues to dupes for frosty snowflakes, winter nails aren’t following one set of rules right now. We’re still seeing a lot of nail art, but it’s less cutesy and more architectural. For example, according to celebrity nail artist Brittney Boyce, instead of going with an overt candy-cane look, opt for a “chic, angled half-French in a sultry red, or do a half white nail with a diagonal cut across that looks clean and elevated.” You also won’t find just the typical wintery shades this year – you might see pastels on the chicest nails. If we had to sum up winter 2022 in a word, it would be unexpected or bold.</p> <p>We asked celebrity nail artists and other experts for their take on what’s trending right now so you can take your manicure to the next level. To get salon-quality results, use non-toxic polishes and gel nail polishes.</p> <p><strong>Nail trend: a hint of sparkle</strong></p> <p>Don’t overdo the shimmer on your winter nail designs – a small amount will do the trick for this 2022 trend. Even if you use polish with chunky glitter in it, add only a dab or two. The idea is to catch the light, not pile on the glitter. “Adding a bit of sparkle is a great way to put a classic spin on a French mani and is also perfect for the winter,” says salon marketing manager, Jennifer Bell.</p> <p><strong>Nail trend: browns, taupes, and chocolatey shades</strong></p> <p>Winter is the time of year you can match your mani to your hot drink! “We will continue to see a lot of neutral browns and chestnuts throughout the winter,” Bell predicts. There are so many gorgeous shades in this family that you can take it from nearly nude to deep sueded shades, depending on your mood.</p> <p><strong>Nail trend: a touch of grey</strong></p> <p>Expect to see a lot of steely, slate, silver, or pale grey polish this season. “We [particularly] love a wintertime grey with a shimmery finish,” Bell says. Greys look great on nearly everyone, but a good rule of thumb (as it were) is that if you’re not sure which grey shade to choose, opt for a darker one because it flatters more skin tones.</p> <p><strong>Nail trend: naked nails</strong></p> <p>Believe it or not, one of the hottest winter nail looks is perfectly pampered hands and cuticles with barely any polish. “Nude nails have been a beauty staple for years and are back with a new twist that embraces the barely-there look,” says Patricia Freund, managing director for cuticle oil brand, Cuccio Naturalé. While nude or barely there polish is a classic look, it also makes sense as there’s no need to worry about chipping a nail or ruining your nail art!</p> <p>Freund advises applying cuticle oil daily “to maintain hydrated and healthy nails throughout the winter and keep the ‘less is more’ nude manicure looking fresh all season.” One more tip for your tips: while short nails make sense during glove season, a look that’s gaining traction right now is a slightly longer oval nail with the sheerest polish, perfectly groomed cuticles, and moisturised hands.</p> <p><strong>Nail trend: red hot</strong></p> <p>It wouldn’t be winter without classic red winter nails in every shade from spicy tomato to deep burgundy blacks. “We’ll also continue to see classic deep reds throughout the winter,” notes Bell. If you do plan on painting the town – or at least your nails – red, opt for a chip-proof top coat so you won’t have to keep touching up your mani.</p> <p><strong>Nail trend: black</strong></p> <p>Classic black will be having a moment this winter. “The opposite of the opaque white trend for spring/summer is onyx – shiny patent leather nails,” says celebrity manicurist Michelle Saunders. It’s all about high contrast and showing off your sparkly jewellery with this winter nail idea. Think black tie meets high fashion. Saunders says for maximum impact, be sure to use a high-shine top coat.</p> <p><strong>Nail trend: glitter ombré tips</strong></p> <p>If don’t want to go all-out with glitter, try using just a hint of it in your nail art. Boyce’s advice? “Apply a strip of glitter polish on the tip, then gently drag the glitter chunks downward with the brush. This way, most of the glitter is on the tip and you’ll get a nice ombré effect.”  You can also experiment with this effect to add a little oomph to your favourite shade. “Do this on a bare nail, a nude nail, a white nail, or even a darker one,” Boyce says. But if you’re going dark, stick to a neutral shade like a dark taupe or dark blue so there aren’t too many competing elements.</p> <p><strong>Nail trend: forest inspired</strong></p> <p>While some trees may be stripped bare, your nails will look amazing in a leafy-green polish. “All kinds of greens are still in the forefront of people’s minds,” Saunders says. And while you’d think deep, lush greens were the only trending verdant hues, you can also go playful and polish your nails any shade of green for an on-trend winter manicure.</p> <p><strong>Nail trend: baby shades</strong></p> <p>Despite light colours usually making an appearance in spring, Saunders says, “we are going to see a ‘pastel winter’ with muted, serene colours on fingertips.” Picture Easter-egg hues on your winter nails. If you’re not sure that light colours are your thing in the winter, opt for colours that are classic, not cutesy. Think shell pink instead of bubblegum, or shimmery apricot instead of a bolder orange.</p> <p><strong>Nail trend: winter blue</strong></p> <p>This winter nail colour can be rocked all season long. “Blue will win the race for this winter,” Saunders says. She’s predicting that everything from baby blue to deep metallic blue will be on all the chic nails this season. “It’s a nod to the ’90s, and super fun to create nail art with,” she adds.</p> <p><strong>Nail trend: rich jewel tones</strong></p> <p>If you love the look of lush nails, get ready to indulge. “Deep gemstone colours are always a classic during wintertime,” Saunders says, “and that isn’t changing anytime soon.” Add some oomph to your LBD with any of these rich colours. Think ruby, emerald, sapphire and amethyst for a super luxe look.</p> <p><strong>Nail trend: gold half moon</strong></p> <p>“Winter is a fun time to play up shimmer and texture,” Boyce says, adding that not all winter nail art needs to be complicated. “A gold half-moon near the cuticle is simple nail art that makes a big statement. You can play up different types of metallic shades for this [trend] depending on your look, from a standard gold to rose gold to even a bright orange bronze shade.”</p> <p><strong>Nail trend: dark meets light</strong></p> <p>Create a bit of drama with mostly sheer nails and a hint of a darker colours. “For winter, I like dark, still shades because it reminds me of just how quiet it gets during the night,” Boyce says. Think muted blues or purples contrasted with barely-there colour. “While black gives a lot of edge, you can soften it up with midnight navy or dark forest green shades,” she adds.</p> <p>How can you create this look at home? “An Angled Half French can be achieved easily by using washi tape as a guide and a dry brush dipped in nail polish remover to clean up the edges,” explains Boyce. “You then use a glossy top coat over the entire nail for a finished look.”</p> <p><strong>Nail trend: classic French tips in metallic shades</strong></p> <p>If you can’t get through the winter without a French mani, consider mixing things up. “A classic French tip using a shimmery shade on an oval-shaped nail, either short to medium length, looks really gorgeous for the holidays,” Boyce says, adding that the easiest way to get the perfect French tip is with a silicone nail stamper. Stampers are easy to use, but they come with a bit of a learning curve, so practise before that big event. If you’re not comfortable with a stamper, try dotting on a design with a nail art brush or using a fan brush to create a softened tip.</p> <p><strong>Nail trend: all the winter colours</strong></p> <p>Still can’t decide which winter nail colour or trend is your favourite? You don’t have to choose. Simply paint each nail a different colour for maximum wow. The experts we spoke with for this story all said winter nails this season are more about self-expression rather than sticking to any particular trend.</p> <p><em><span id="docs-internal-guid-792f2663-7fff-3448-7169-f7f270bb358e">Written by Rachel Weingarten. This article first appeared in <a href="https://www.readersdigest.co.nz/culture/15-winter-nail-colours-and-trends-you-wont-be-able-to-resist" target="_blank" rel="noopener">Reader’s Digest</a>. For more of what you love from the world’s best-loved magazine, <a href="http://readersdigest.innovations.co.nz/c/readersdigestemailsubscribe?utm_source=over60&amp;utm_medium=articles&amp;utm_campaign=RDSUB&amp;keycode=WRA87V" target="_blank" rel="noopener">here’s our best subscription offer.</a></span></em></p> <p><em>Image: Getty Images</em></p>

Beauty & Style

Placeholder Content Image

Antibiotic resistance: an arms race going on millions of years

<p>In 2012, a team of microbial scientists, curious about the origins of antibiotic-resistant bacteria, decided to take samples from the walls of a deep, ancient underground cave system beneath the modern US state of New Mexico. </p> <p>The maze-like complex of <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0034953" target="_blank" rel="noreferrer noopener" data-type="URL" data-id="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0034953">Lechuguilla cave</a> stretches for more than 200 kilometres, and much of it is sealed from aboveground by an impermeable rock layer known as the Yates Formation. So, it was the perfect place to hunt for microbes unsullied by the modern world. </p> <p>What they found was both startling and spooky: the microbiome of the cave samples contained bacteria that were resistant to at least 14 different antibiotics currently on the market, even though they had been isolated for more than four million years.</p> <p>Given that antibiotics were first used clinically after Alexander Fleming cultured <em>Penicillium</em> moulds in 1928, antibiotic resistance is generally thought of as a distinctly modern problem – and there’s no doubt our use and abuse of these wonder-molecules have created a huge and growing issue. </p> <p>A <a href="https://www.thelancet.com/action/showPdf?pii=S0140-6736%2821%2902724-0" target="_blank" rel="noreferrer noopener">recent study</a> reported in <em>The Lancet </em>suggests more than 1.2 million people died in 2019 as a direct result of antimicrobial resistance. By some estimates, the death toll could reach 10 million per year by 2050 if nothing is done (by contrast, about  eight million people die from cancer each year). The <a href="https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance" target="_blank" rel="noreferrer noopener">World Health Organization</a> identifies resistance as one of the biggest threats to global health. </p> <p>Tony Velkov, an Associate Professor in biochemistry and pharmacology at the University of Melbourne, says not enough attention is being paid to finding answers from nature; more specifically, the organisms that make their own, naturally occurring antibiotics in a dynamic environment.</p> <p>“Lessons from nature, I call them,” Velkov says.</p> <p>The majority of antibiotic medicines used clinically today are derived from natural antibiotics produced by microbes in soil and which attack rival microbes, as part of a miniature war over precious resources.</p> <p>Indeed, Fleming’s discovery of the <em>Penicillium </em>mould’s antibacterial qualities was entirely by accident, says Velkov.</p> <p>“He was growing a bacterium called <em>Staphylococcus aureus, </em>and he decided to go on a long weekend and left the plate on the bench,” he says. “He came back about a week later and he found this mould growing in one corner of the plate, and he found the bacteria that he’d been growing were scared of this mould, and they were all dying or keeping away from it.”</p> <p>Fleming’s famously understated remark upon discovering this strange antibacterial interloper was: “That’s funny”. </p> <p>Velkov is particularly fascinated by the function of antibiotics in nature, as part of epic microbial conflicts taking place at every moment. A big part of his work is looking at a pugnacious little soil microbe called <em>Paenibacillus polymyxa, </em>which is able to kill gram-negative bacteria that enter its territory by producing polymyxins, a particularly aggressive type of antibiotic.</p> <p>“Polymyxin is used in hospitals when you’re really, really sick, because it’s pretty toxic,” he says. For that reason, it’s often a medicine of last resort, which means it hasn’t had as many opportunities as other more common antibiotics, to trigger the evolution of antibiotic resistance traits in pathogens.</p> <div class="newsletter-box"> <div id="wpcf7-f6-p187842-o1" class="wpcf7" dir="ltr" lang="en-US" role="form"> </div> </div> <p>Nonetheless, polymyxin-resistance genes <a href="https://pubmed.ncbi.nlm.nih.gov/31122100/" target="_blank" rel="noreferrer noopener">have been identified</a> in bacteria across Asia, Africa, Europe, North and South America and Oceania. If the power of polymyxins is usurped by these resistant pathogens, it could spell disaster for people suffering from drug-resistant bacterial infections.</p> <p>So, Velkov is trying to learn how to create new polymyxins, by mimicking soil-based battles.</p> <p>“I get the bacterium that makes that [polymyxin], and then I challenge it,” Velkov says. “I grow it opposite the bugs it hates, and they fight each other.”</p> <p>If it sounds a bit like a pathogenic boxing match, Velkov says that’s much like what he observes.</p> <p>“They actually have a bit of a battle,” he says. “You’ll see the one that makes the antibiotic starts growing towards the bacteria to push it out of the territory [the petri dish with nutrients on it], and then it secretes the polymyxins to kill it.</p> <p>“But the bug, the human pathogen, often fights back secreting stuff to kill the antibiotic-producing microbes.”</p> <p>How does all this lab-based micro-fighting translate to the real-world problem of resistance?</p> <p>According to Velkov, in medicine, humans mostly focus on producing one type of antibiotic at a time. But in the “wild”, he says, microbes can often produce a whole bunch of subtly different substances in the fight.</p> <p>“In the petri dish, when these guys are fighting each other, they make really different ones,” he says. “Ones we haven’t seen or discovered, they respond in ways we haven’t looked at.”</p> <p>In his research lab, Velkov says he’s discovered a number of new polymyxins, including one that’s in clinical development.</p> <p>So, by staging these kinds of epic battles in miniature in the laboratory, can we stave off antibiotic resistance altogether? According to Velkov, probably not. But we can optimise our participation in the evolutionary arms race.</p> <p>“You’re never going to make it go away,” he says. “This has been going on for millions of years.”</p> <p>But the hope is that by learning from how these microbes behave in nature, we can at least try to keep pace. </p> <p><img id="cosmos-post-tracker" style="opacity: 0; height: 1px!important; width: 1px!important; border: 0!important; position: absolute!important; z-index: -1!important;" src="https://syndication.cosmosmagazine.com/?id=187842&amp;title=Antibiotic+resistance%3A+an+arms+race+going+on+millions+of+years" width="1" height="1" data-spai-target="src" data-spai-orig="" data-spai-exclude="nocdn" /></p> <div id="contributors"> <p><em><a href="https://cosmosmagazine.com/health/medicine/antibiotic-resistance-millions-years/" target="_blank" rel="noopener">This article</a> was originally published on <a href="https://cosmosmagazine.com" target="_blank" rel="noopener">Cosmos Magazine</a> and was written by <a href="https://cosmosmagazine.com/contributor/amalyah-hart" target="_blank" rel="noopener">Amalyah Hart</a>. Amalyah Hart is a science journalist based in Melbourne. She has a BA (Hons) in Archaeology and Anthropology from the University of Oxford and an MA in Journalism from the University of Melbourne.</em></p> <p><em>Image: Getty Images</em></p> </div>

Body

Placeholder Content Image

Some Covid patients develop resistance to Sotrovimab treatment

<p dir="ltr">As treatments continue to be developed for patients with COVID-19, some scientists have found that one in particular may cause the virus to mutate so that it becomes harder to treat.</p> <p dir="ltr">A team of Australian researchers analysed samples from the first 100 people to be treated with Sotrovimab - an increasingly popular treatment that targets the Omicron variant and prevents severe COVID-19 symptoms - only to make some interesting findings.</p> <p dir="ltr">They took samples from the patients before and after they were treated with Sotrovimab and sequenced the genome of the virus in each sample.</p> <p dir="ltr">In four of the patients, the team found that the virus had mutated in ways that made it more resistant to treatment within 13 days of treatment.</p> <p dir="ltr">“We discovered that the virus that causes COVID-19 can develop mutations within the patient several days after Sotrovimab treatment, which reduces the effectiveness of this treatment by greater than 100-fold,” Dr Rebecca Rockett, a Sydney researcher in infectious disease and co-author of the study, <a href="https://www.scimex.org/newsfeed/covid-19-patients-can-develop-resistance-to-treatment-with-sotrovimab" target="_blank" rel="noopener">said</a>.</p> <p dir="ltr">This research, published in the <em><a href="https://www.nejm.org/doi/10.1056/NEJMc2120219" target="_blank" rel="noopener">New England Journal of Medicine</a></em>, is the first to show the mutations in clinical models, with previous research finding the mutations developed in animal models and when growing the virus in a lab setting.</p> <p dir="ltr">With this finding, the researchers are calling for the use of Sotrovimab to be monitored to prevent treatment-resistant versions of the virus from spreading in the community.</p> <p dir="ltr">“Resistant virus samples could be readily grown in the laboratory, a marker that individuals who develop resistance may transmit the resistance virus to others,” said Professor Vitali Sintchenko, the study’s senior author and a fellow researcher in infectious disease.</p> <p dir="ltr">“(Sotrovimab) is the only one (treatment) we have evidence against so far, but we need to be more on the front foot in terms of efficacy,” Dr Rockett told <em><a href="https://7news.com.au/news/coronavirus/australian-covid-19-patients-developed-resistance-to-antiviral-drug-as-virus-mutates-within-days-of-first-treatment-study-finds--c-6001171" target="_blank" rel="noopener">7News</a></em>.</p> <p dir="ltr">“I don’t think the infrastructure is in place to capture the resistance. We need better surveillance.”</p> <p dir="ltr">Since the research was published, GSK, the manufacturer of Sotrovimab, has confirmed that the study’s findings were consistent with the company’s large clinical studies.</p> <p dir="ltr">“Resistance is also seen in studies for other COVID-19 monoclonal antibodies and oral treatments, and relates to how the immune system interacts with the virus,” a spokesperson said, per <em>7News.com.au</em>.</p> <p dir="ltr">“This report does not change the positive benefit-risk of sotrovimab for use in the treatment of mild to moderate COVID-19 in patients at high risk of progression.”</p> <p><span id="docs-internal-guid-7f583be8-7fff-e05d-5e6b-eef460dbcdaf"></span></p> <p dir="ltr"><em>Image: Getty Images</em></p>

Body

Placeholder Content Image

Can’t resist splurging on online shopping? Here’s why

<p>The demand for online shopping has obviously increased since COVID-19 restrictions were put in place.</p> <p>But less obvious are the subtle psychological drivers behind our collective online shopping splurge. In fact, online shopping can relieve stress, provide entertainment and offers the reduced “pain” of paying online.</p> <p>In the last week of April, <a href="https://www.news.com.au/finance/work/posties-ditch-bikes-and-jump-in-vans-to-keep-up-with-demand-at-australia-post/news-story/67a18bcdebf223b5fbeb9dbcbe2957de">more than two million parcels a day</a> were delivered across the Australia Post network. This is 90% more than the same time last year.</p> <p>More recently, data based on a weekly sample (from May 11-17) of transactions <a href="https://www.alphabeta.com/illiontracking">revealed</a> food delivery increased by 230%, furniture and office goods purchases rose 140% and alcohol and tobacco sales rose 45%.</p> <p>Meanwhile, we’ve seen thousands of retail job losses, with Wesfarmers <a href="https://www.smh.com.au/business/companies/wesfarmers-to-close-or-convert-up-to-167-target-stores-in-massive-restructure-20200522-p54vex.html">announcing plans</a> on Friday to close up to 75 Target stores around the country, and Myer finally <a href="https://insideretail.com.au/news/myer-to-reopen-all-stores-next-week-202005">reopening stores</a> after nearly two months of closure.</p> <p><strong>Why the shopping frenzy?</strong></p> <p>Online sales of many product categories have increased, including for <a href="https://www.smh.com.au/business/companies/beauty-brains-and-brawn-what-we-are-buying-during-the-pandemic-20200403-p54gve.html">food, winter clothes and toys</a>. This isn’t surprising given people still need to eat, winter is coming and we’re bored at home.</p> <p>But beyond the fact most people are spending more time at home, there are a range of psychological factors behind the online shopping upheaval.</p> <p>Recent months have been stressful due to <a href="https://www.abc.net.au/news/2020-05-05/almost-one-million-australians-lose-jobs-due-to-coronavirus/12215494">financial uncertainty</a>, the inability to <a href="https://www.sbs.com.au/news/how-long-will-australia-s-borders-remain-closed">visit loved ones</a> and changes to our daily routines.</p> <p>Shopping can be a way to cope with stress. In fact, higher levels of distress have been linked with <a href="https://doi.org/10.1016/S0022-4359(99)00002-0">higher purchase intentions</a>. And this compulsion to buy is often part of an effort to reduce <a href="https://doi.org/10.1016/j.jcps.2017.07.006">negative emotions</a>.</p> <p>In other words, shopping is <a href="https://doi.org/10.1037/gpr0000078">an escape</a>.</p> <p>A <a href="https://doi.org/10.1080/15325024.2013.794670">2013 study</a> compared people living close to the Gaza-Israel border during a period of conflict with those from a central Israeli town that wasn’t under duress. The researchers found those living in the high-stress environment reported a higher degree of “materialism” and a desire to shop to relieve stress.</p> <p><strong>When mall trips aren’t an option</strong></p> <p>Indeed, in a time when typical forms of entertainment such as restaurants and cinemas are inaccessible, <a href="https://books.google.com.au/books?id=ojIoeYe8a1sC&amp;printsec=frontcover&amp;dq=Shopping+as+an+Entertainment+Experience&amp;hl=en&amp;sa=X&amp;ved=0ahUKEwj-naSGlcHpAhV_73MBHarfBO0Q6AEIKDAA#v=onepage&amp;q&amp;f=false">shopping becomes a form of entertainment</a>. The act of shopping alone produces <a href="https://www.jstor.org/stable/2489765">increased arousal, heightened involvement, perceived freedom, and fantasy fulfillment</a>.</p> <p>It seems the stress and boredom brought on by this pandemic has intensified our will to spend.</p> <p>What’s more, psychology research has demonstrated humans’ <a href="https://science.sciencemag.org/content/244/4907/933">inability to delay gratification</a>.</p> <p>We want things <em>now</em>. Even with stay-at-home orders, we still want new makeup, clothes, shoes, electronics and housewares.</p> <p>Another pleasant aspect of online shopping is it avoids the typical “pain of paying” experienced during in-person transactions.</p> <p>Most people don’t enjoy parting with their money. But research has shown the psychological pain produced from spending money <a href="https://doi.org/10.1287/mksc.17.1.4">depends on the transaction type</a>. The more tangible the transaction, the stronger the pain.</p> <p>Simply, paying for a product by physically giving cash <a href="https://doi.org/10.1023/A:1027444717586">hurts more than clicking a “buy now” button</a>.</p> <p><strong>Clear browsing history</strong></p> <p>Interestingly, online shopping also allows high levels of anonymity. While you may have to enter your name, address and card details – no one can see you.</p> <p>It’s easier to buy “<a href="https://www.sciencedirect.com/science/article/abs/pii/S1057740815000200">embarrassing</a>” products <a href="https://www.jstor.org/stable/10.1086/671761">when no one is looking</a>. Apart from lockdown restrictions making it more <a href="https://www.insider.com/personal-advice-for-virtual-dating-in-coronavirus-lockdown-uk-2020-3">difficult to date</a>, this may also help explain why sex toy sales <a href="https://www.westernadvocate.com.au/story/6702036/panic-buying-switches-to-lubricants-and-sex-toys-says-flirt-bathurst-owner/">have surged</a> during the pandemic.</p> <p>Sales of lingerie and other intimate apparel have also reportedly <a href="https://www.smh.com.au/business/companies/beauty-brains-and-brawn-what-we-are-buying-during-the-pandemic-20200403-p54gve.html">jumped 400%</a>.</p> <p><strong>How have businesses responded?</strong></p> <p>With <a href="https://www.cmo.com.au/article/672354/advertising-marketing-spend-significantly-impacted-by-covid-19/">advertising spend down</a>, businesses have responded in different ways to recent changes in online shopping.</p> <p>Many are offering discounts to encourage spending. Last week’s <a href="https://www.clickfrenzy.com.au/">Click Frenzy</a> became a central hub for thousands of deals across dozens of retailers such as Telstra, Target and Dell.</p> <p>Others have moved operations online for the first time. If you scroll through any major food delivery app, you’ll see offers from restaurants that <a href="https://www.broadsheet.com.au/sydney/guides/live-list-sydney-restaurants-pivoting-takeaway">previously specialised in dine-in services</a>.</p> <p>Meanwhile, existing meal delivery services such as <a href="https://www.hellofresh.com.au/about/covid-19-updates">HelloFresh</a> and <a href="https://www.liteneasy.com.au/how-it-works/faqs/#faq-group-coronavirus_update">Lite n’ Easy</a> are updating their methods to guarantee hygienic packing and transport.</p> <p>Several small Australian businesses have also <a href="https://au.finance.yahoo.com/news/rochford-winery-turns-into-gourmet-grocer-to-survive-003630325.html">pivoted</a>. <a href="http://www.clarkemurphyprint.com.au/">Clarke Murphy Print</a> responded to slowing print jobs by starting <a href="https://www.buildadesk.com.au/">Build-a-Desks</a>.</p> <p>Even established brands are getting creative. For example, Burger King outlets in the US <a href="https://www.contagious.com/news-and-views/burger-king-zoom-billboard-conference-call-campaign-of-the-wee">are offering</a> free burgers to customers who use one of their billboards as a virtual backdrop during conference calls.</p> <p><strong>Don’t buy better, be better</strong></p> <p>Unfortunately, with the ease of online purchasing, and our increased motivation to give in to improve our mood or seek entertainment, many people are now at risk of <a href="https://doi.org/10.1521/jscp.2007.26.3.334">overspending and landing in financial stress</a>.</p> <p>It’s important to control spending during this fraught time. Simple ways to do this <a href="https://www.abc.net.au/life/how-to-control-online-shopping-during-coronavirus-pandemic/12119332">include</a> creating a budget, avoiding “buy now, pay later” schemes, recognising your spending “triggers” and planning ahead.</p> <p>As isolation <a href="https://doi.org/10.1086/671564">increases materialism</a>, it’s also important to keep in touch with family and friends, whether that’s in person (<a href="https://www.theguardian.com/australia-news/2020/may/20/coronavirus-australia-lockdown-rules-travel-restrictions-nsw-victoria-queensland-qld-wa-sa-act-how-far-can-you-drive-visit-friends-family-parents-covid-19-guidelines">if allowed in your area</a>), via video calls or phone.</p> <p>So the next time you’re thinking of pulling out your credit card, why not get Skype up on the screen and play a virtual game of <a href="https://www.wired.com/gallery/board-games-for-remote-play/">Pictionary instead</a>?</p> <p><em>Written by Adrian R. Camilleri and Eugene Y. Chan. Republished with permission of <a href="https://theconversation.com/cant-resist-splurging-on-online-shopping-heres-why-138938">The Conversation.</a> </em></p>

Beauty & Style

Placeholder Content Image

I’m taking antibiotics – how do I know I’ve been prescribed the right ones?

<p>In the days before antibiotics, <a href="http://www.bbc.co.uk/newsbeat/article/34866829/life-before-antibiotics-and-maybe-life-after-an-antibiotic-apocalypse">deaths from bacterial infections</a> were common. Seemingly minor illnesses could escalate in severity, becoming deadly in a matter of hours or days.</p> <p>These days, antibiotics can be life-savers. In the community, they’re <a href="https://theconversation.com/when-should-you-take-antibiotics-42751">commonly used</a> to treat bacterial infections of the lung, urinary tract, eye, throat, skin and gut.</p> <p>But they’re not needed for <em>all</em> bacterial infections – many infections will resolve on their own without treatment.</p> <p>And of course, antibiotics <a href="https://www.cdc.gov/features/antibioticuse/index.html">don’t treat viral infections</a> such as colds and flus, or fungal infections such as tinea or thrush.</p> <p>Even when antibiotics are necessary, they’re not a one-size-fits-all treatment: not all antibiotics kill all types of bacteria.</p> <p><strong>What type of bacteria is causing the infection?</strong></p> <p>If your doctor suspects you have a serious bacterial infection, they will often take a urine or blood test, or a swab to send to the pathologist.</p> <p>At the lab, these tests aim to detect and identify the bacteria causing the infection.</p> <p>Some methods only need to detect bacterial DNA. These DNA-based approaches are called “genotypic methods” and are quick and highly sensitive.</p> <p>Other methods involve attempting to culture and isolate bacteria from the sample. This can take one to four days.</p> <p><strong>What antibiotic can fight the infection?</strong></p> <p>If antibiotic treatment is necessary, the isolated bacteria can be used in a second series of tests to help determine the right antibiotic for your infection. These are called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6627445/">antimicrobial susceptibility tests</a>.</p> <p>Like the tests that first detected the bacterium causing your infection, they can be done using DNA-based (genotypic) methods or by culturing the bacterium in the presence of various antibiotics and assessing what happens (phenotypic methods).</p> <p>Genotypic tests tend to identify which antibiotics won’t work so they can be ruled out as treatment options; ruling out the ones that won’t work leaves the ones that <em>should</em> work.</p> <p>For phenotypic tests, the bacterium is regrown in the presence of a range of antibiotics to see which one stops its growth. A range of concentrations of each antibiotic are often used in these tests.</p> <p><strong>Why you sometimes get a script without testing</strong></p> <p>Whichever tests are done, the results may not be available for a couple of days. In the meantime, your doctor will probably get you started on an antibiotic that is <em>most likely</em> to be effective. This is called empiric therapy and is the “best guess” treatment while they wait for test results.</p> <p>Empiric antibiotic choice is based on the doctor’s prior experience with that type of infection, as well as clinical guidelines developed from evidence about that infection type, and ongoing surveillance data from the pathology lab about the types of bacteria generally causing that infection, and which antibiotics those bacteria are susceptible to.</p> <p>When available, the test results will either confirm the initial choice, or influence the doctor’s decision to prescribe a different antibiotic.</p> <p>Take urinary tract infections (UTIs), for example. Most are caused by <em>E. coli</em> and there are antibiotics that reliably treat these infections.</p> <p>Data from the thousands of pathology tests performed each year on the <em>E. coli</em>from other people’s UTIs helps inform the doctor’s choice of empiric antibiotic for you, as do the clinical guidelines.</p> <p>The doctor can therefore be reasonably confident in prescribing that antibiotic while you wait for the test results from your urine sample. You’ll either get better and need no further intervention, or you’ll come back to the doctor, by which time your test results should be available to fine-tune the choice of antibiotic.</p> <p><strong>Why it’s important to get the right antibiotic</strong></p> <p>Naturally, you want to receive an antibiotic that will effectively treat your infection. But what’s wrong with taking an antibiotic that does the job too well or, conversely, is ineffective?</p> <p>Antibiotics that are too strong will not only clear your infection but will also kill other good bacteria, <a href="https://www.nature.com/articles/d42859-019-00019-x">disrupting your microbiome</a> and possibly causing other knock-on effects.</p> <p>On the other hand, an ineffective antibiotic will not only fail to treat the infection adequately, it can still cause side effects and disrupt your microbiome.</p> <p>A broader consideration for the judicious use of antibiotics is that overuse, or ineffective use, contributes unnecessarily to the development of antibiotic resistance. All antibiotic use <a href="https://www.researchgate.net/profile/Sara_Hernando-Amado/publication/335337005_Defining_and_combating_antibiotic_resistance_from_One_Health_and_Global-Health_perspectives/links/5d7123f4299bf1cb8088bd73/Defining-and-combating-antibiotic-resistance-from-One-Health-and-Global-Health-perspectives.pdf">promotes resistance</a> in other bacteria they come in contact with, so minimising and optimising their targeted use is important.</p> <p>The right antibiotic choice for your infection is a complex decision that must often be made before key additional evidence to support the decision is available.</p> <p>As test results become available, the treatment antibiotics may be refined, changed or even stopped.</p> <p><em>Written by Christine Carson. Republished with permission of </em><a href="https://theconversation.com/im-taking-antibiotics-how-do-i-know-ive-been-prescribed-the-right-ones-122868"><em>The Conversation.</em></a></p>

Caring

Placeholder Content Image

What you can do to resist fake news

<p>Although the term itself is not new, fake news presents a growing threat for <a href="https://qz.com/africa/1473127/africas-fake-news-problem-is-worse-than-in-the-us/">societies across the world</a>.</p> <p>Only a <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0207383" title="Information-theoretic models of deception: Modelling cooperation and diffusion in populations exposed to fake news">small amount of fake news is needed</a> to disrupt a conversation, and at extremes it can have an impact on democratic processes, <a href="https://theconversation.com/trump-may-owe-his-2016-victory-to-fake-news-new-study-suggests-91538">including elections</a>.</p> <p>But what can we do to avoid fake news, at a time when we could be waiting a while for <a href="https://en.unesco.org/fightfakenews" title="Journalism, Fake News and Disinformation: A Handbook for Journalism Education and Training">mainstream media</a> and <a href="https://www.cnbc.com/2018/11/08/fake-news-is-going-to-get-worse-unless-companies-take-action-dnc-cto.html">social networks</a> to step up and <a href="https://www.marketplace.org/2018/08/24/tech/one-problem-fake-news-it-really-really-works">address the problem</a>?</p> <p>From a psychology perspective, an important step in tackling fake news is to understand why it gets into our mind. We can do this by <a href="https://theconversation.com/why-two-people-see-the-same-thing-but-have-different-memories-104327">examining how memory works</a> and <a href="https://www.amazon.com/Memory-Distortion-Brains-Societies-Reconstruct/dp/0674566769">how memories become distorted</a>.</p> <p>Using this viewpoint generates some tips you can use to work out whether you’re reading or sharing fake news – which might be handy in the coming election period.</p> <p><strong>How memory gets distorted at the source</strong></p> <p>Fake news often relies on <a href="https://www.psychologytoday.com/us/articles/200105/the-seven-sins-memory">misattribution</a> – instances in which we can retrieve things from memory but can’t remember their source.</p> <p>Misattribution is one of the reasons advertising is so effective. We see a product and feel a pleasant sense of familiarity because we’ve encountered it before, but fail to remember that the source of the memory was an ad.</p> <p><a href="https://www.researchgate.net/profile/David_Rand2/publication/327866113_Prior_Exposure_Increases_Perceived_Accuracy_of_Fake_News/" title="Prior Exposure Increases Perceived Accuracy of Fake News">One study</a> examined headlines from fake news published during the 2016 US Presidential Election.</p> <p>The researchers found even one presentation of a headline (such as “Donald Trump Sent His Own Plane to Transport 200 Stranded Marines”, <a href="https://www.snopes.com/fact-check/donald-trumps-marine-airlift/">based on claims shown to be false</a>) was enough to increase belief in its content. This effect persisted for at least a week, was still found when headlines were accompanied by a factcheck warning, and even when participants suspected it might be false.</p> <p>Repeated exposure can <a href="https://www.vox.com/science-and-health/2017/10/5/16410912/illusory-truth-fake-news-las-vegas-google-facebook">increase the sense that misinformation is true</a>. Repetition creates the perception of group consensus that can result in collective misremembering, a phenomenon called the <a href="https://theconversation.com/the-mandela-effect-and-how-your-mind-is-playing-tricks-on-you-89544">Mandela Effect</a>.</p> <p>It might be harmless when people collectively misremember something fun, such as a <a href="https://www.buzzfeed.com/christopherhudspeth/crazy-examples-of-the-mandela-effect-that-will-make-you-ques">childhood cartoon (did the Queen in Disney’s Snow White really NOT say “Mirror, mirror…”?)</a>. But it has serious consequences when a false sense of group consensus contributes to <a href="https://www.abc.net.au/radio/programs/the-signal/are-anti-vaxxers-having-a-moment/10957310">rising outbreaks of measles</a>.</p> <p>Scientists have investigated whether <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/acp.3274" title="Public Attitudes on the Ethics of Deceptively Planting False Memories to Motivate Healthy Behavior">targeted misinformation can promote healthy behaviour</a>. Dubbed false-memory diets, it is said that false memories of food experiences can encourage people to <a href="https://www.nytimes.com/2005/12/11/magazine/falsememory-diet-the.html">avoid fatty foods</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3627832/" title="Queasy does it: False alcohol beliefs and memories may lead to diminished alcohol preferences">alcohol</a> and even <a href="https://www.ncbi.nlm.nih.gov/pubmed/25116296" title="Asparagus, a love story: healthier eating could be just a false memory away">convince them to love asparagus</a>.</p> <p>Creative people that have a strong ability to associate different words are <a href="https://www.researchgate.net/profile/Thomas_Ormerod/publication/251531367_Convergent_but_not_divergent_thinking_predicts_susceptibility_to_associative_memory_illusions/" title="Convergent, but not divergent, thinking predicts susceptibility to associative memory illusions">especially susceptible to false memories</a>. Some people might be more vulnerable than others to believe fake news, but <a href="https://www.nytimes.com/2016/12/24/world/asia/pakistan-israel-khawaja-asif-fake-news-nuclear.html">everyone is at risk</a>.</p> <p><strong>How bias can reinforce fake news</strong></p> <p><a href="https://www.psychologytoday.com/us/articles/200105/the-seven-sins-memory">Bias</a> is how our feelings and worldview affect the <a href="https://theconversation.com/why-two-people-see-the-same-thing-but-have-different-memories-104327">encoding and retrieval of memory</a>. We might like to think of our memory as an archivist that carefully preserves events, but <a href="https://www.taylorfrancis.com/books/e/9781351660020/chapters/10.4324/9781315159591-4" title="New Directions in the Philosophy of Memory">sometimes it’s more like a storyteller</a>. Memories are shaped by our beliefs and can function to <a href="https://www.sciencedirect.com/topics/neuroscience/autobiographical-memory">maintain a consistent narrative rather than an accurate record</a>.</p> <p>An example of this is selective exposure, our tendency to seek information that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4797953/" title="Feeling Validated Versus Being Correct: A Meta-Analysis of Selective Exposure to Information">reinforces our pre-existing beliefs</a> and to avoid information that brings those beliefs into question. This effect is supported by evidence that television news audiences are <a href="https://www.journalism.org/2014/10/21/political-polarization-media-habits/">overwhelmingly partisan</a> and exist in their own echo chambers.</p> <p>It was thought that online communities exhibit the same behaviour, contributing to the spread of fake news, but this <a href="https://theconversation.com/the-myth-of-the-echo-chamber-92544">appears to be a myth</a>. Political news sites are often populated by people with <a href="https://www.academia.edu/34506137/The_Myth_of_Partisan_Selective_Exposure_A_Portrait_of_the_Online_Political_News_Audience">diverse ideological backgrounds</a> and echo chambers are <a href="https://medium.com/trust-media-and-democracy/avoiding-the-echo-chamber-about-echo-chambers-6e1f1a1a0f39">more likely to exist in real life than online</a>.</p> <p>Our brains are wired to assume things we believe <a href="https://journals.sagepub.com/doi/abs/10.1177/0146167203259933" title="Evolving Informational Credentials: The (Mis)Attribution of Believable Facts to Credible Sources">originated from a credible source</a>. But are we more inclined to remember information that reinforces our beliefs? <a href="https://www.researchgate.net/publication/247781236_Do_Attitudes_Affect_Memory_Tests_of_the_Congeniality_Hypothesis" title="Do Attitudes Affect Memory? Tests of the Congeniality Hypothesis">This is probably not the case</a>.</p> <p>People who hold strong beliefs remember things that are relevant to their beliefs but they remember opposing information too. This happens because people are motivated to defend their beliefs against opposing views.</p> <p>Belief echoes are a related phenomenon that <a href="https://www.washingtonpost.com/opinions/why-correcting-donald-trump--or-anyone-else--doesnt-work/2016/01/08/9e5ef5d4-b57d-11e5-a842-0feb51d1d124_story.html?utm_term=.912e5b8e4409">highlight the difficulty of correcting misinformation</a>. Fake news is often designed to be attention-grabbing.</p> <p>It can continue to shape people’s attitudes after it has been discredited because it produces a vivid emotional reaction and builds on our existing narratives.</p> <p>Corrections have a much smaller emotional impact, especially if they require policy details, so should be <a href="https://www.researchgate.net/publication/258180567_Misinformation_and_Its_Correction_Continued_Influence_and_Successful_Debiasing" title="Misinformation and Its Correction Continued Influence and Successful Debiasing">designed to satisfy a similar narrative urge</a> to be effective.</p> <p><strong>Tips for resisting fake news</strong></p> <p>The way our memory works means it might be impossible to resist fake news completely.</p> <p>But one approach is to start <a href="https://qz.com/858887/how-to-know-if-fake-news-is-fake-learn-to-think-like-a-scientist/">thinking like a scientist</a>. This involves adopting a questioning attitude that is motivated by curiosity, and being aware of personal bias.</p> <p>For fake news, this might involve asking ourselves the following questions:</p> <ul> <li> <p><strong>What type of content is this?</strong> <a href="https://theconversation.com/australians-born-overseas-prefer-the-online-world-for-their-news-84355">Many people rely on social media and aggregators as their main source of news</a>. By reflecting on whether information is news, opinion or even humour, this can help consolidate information more completely into memory.</p> </li> <li> <p><strong>Where is it published?</strong> Paying attention to where information is published is crucial for encoding the source of information into memory. If something is a big deal, a wide variety of sources will discuss it, so attending to this detail is important.</p> </li> <li> <p><strong>Who benefits?</strong> Reflecting on who benefits from you believing the content helps consolidate the source of that information into memory. It can also help us reflect on our own interests and whether our personal biases are at play.</p> </li> </ul> <p>Some people <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3023545" title="Who Falls for Fake News? The Roles of Bullshit Receptivity, Overclaiming, Familiarity, and Analytic Thinking">tend to be more susceptible to fake news</a> because they are more accepting of weak claims.</p> <p>But we can strive to be more reflective in our open-mindedness by paying attention to the source of information, and questioning our own knowledge if and when we are unable to remember the context of our memories.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;" src="https://counter.theconversation.com/content/114921/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: http://theconversation.com/republishing-guidelines --></p> <p><em>Written by <span>Julian Matthews, Research Officer - Cognitive Neurology Lab, Monash University</span>. Republished with permission of </em><a rel="noopener" href="https://theconversation.com/how-fake-news-gets-into-our-minds-and-what-you-can-do-to-resist-it-114921" target="_blank"><em>The Conversation</em></a><em>. </em></p>

Mind

Placeholder Content Image

How to resist fake news

<p>Although the term itself is not new, fake news presents a growing threat for <a href="https://qz.com/africa/1473127/africas-fake-news-problem-is-worse-than-in-the-us/">societies across the world</a>.</p> <p>Only a <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0207383">small amount of fake news is needed</a> to disrupt a conversation, and at extremes it can have an impact on democratic processes, <a href="https://theconversation.com/trump-may-owe-his-2016-victory-to-fake-news-new-study-suggests-91538">including elections</a>.</p> <p>But what can we do to avoid fake news, at a time when we could be waiting a while for <a href="https://en.unesco.org/fightfakenews">mainstream media</a> and <a href="https://www.cnbc.com/2018/11/08/fake-news-is-going-to-get-worse-unless-companies-take-action-dnc-cto.html">social networks</a> to step up and <a href="https://www.marketplace.org/2018/08/24/tech/one-problem-fake-news-it-really-really-works">address the problem</a>?</p> <p>From a psychology perspective, an important step in tackling fake news is to understand why it gets into our mind. We can do this by <a href="https://theconversation.com/why-two-people-see-the-same-thing-but-have-different-memories-104327">examining how memory works</a> and <a href="https://www.amazon.com/Memory-Distortion-Brains-Societies-Reconstruct/dp/0674566769">how memories become distorted</a>.</p> <p>Using this viewpoint generates some tips you can use to work out whether you’re reading or sharing fake news – which might be handy in the coming election period.</p> <p><strong>How memory gets distorted at the source</strong></p> <p>Fake news often relies on <a href="https://www.psychologytoday.com/us/articles/200105/the-seven-sins-memory">misattribution</a> – instances in which we can retrieve things from memory but can’t remember their source.</p> <p>Misattribution is one of the reasons advertising is so effective. We see a product and feel a pleasant sense of familiarity because we’ve encountered it before, but fail to remember that the source of the memory was an ad.</p> <p><a href="https://www.researchgate.net/profile/David_Rand2/publication/327866113_Prior_Exposure_Increases_Perceived_Accuracy_of_Fake_News/">One study</a> examined headlines from fake news published during the 2016 US Presidential Election.</p> <p>The researchers found even one presentation of a headline (such as “Donald Trump Sent His Own Plane to Transport 200 Stranded Marines”, <a href="https://www.snopes.com/fact-check/donald-trumps-marine-airlift/">based on claims shown to be false</a>) was enough to increase belief in its content. This effect persisted for at least a week, was still found when headlines were accompanied by a factcheck warning, and even when participants suspected it might be false.</p> <p>Repeated exposure can <a href="https://www.vox.com/science-and-health/2017/10/5/16410912/illusory-truth-fake-news-las-vegas-google-facebook">increase the sense that misinformation is true</a>. Repetition creates the perception of group consensus that can result in collective misremembering, a phenomenon called the <a href="https://theconversation.com/the-mandela-effect-and-how-your-mind-is-playing-tricks-on-you-89544">Mandela Effect</a>.</p> <p>It might be harmless when people collectively misremember something fun, such as a <a href="https://www.buzzfeed.com/christopherhudspeth/crazy-examples-of-the-mandela-effect-that-will-make-you-ques">childhood cartoon (did the Queen in Disney’s Snow White really NOT say “Mirror, mirror…”?)</a>. But it has serious consequences when a false sense of group consensus contributes to <a href="https://www.abc.net.au/radio/programs/the-signal/are-anti-vaxxers-having-a-moment/10957310">rising outbreaks of measles</a>.</p> <p>Scientists have investigated whether <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/acp.3274">targeted misinformation can promote healthy behaviour</a>. Dubbed false-memory diets, it is said that false memories of food experiences can encourage people to <a href="https://www.nytimes.com/2005/12/11/magazine/falsememory-diet-the.html">avoid fatty foods</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3627832/">alcohol</a> and even <a href="https://www.ncbi.nlm.nih.gov/pubmed/25116296">convince them to love asparagus</a>.</p> <p>Creative people that have a strong ability to associate different words are <a href="https://www.researchgate.net/profile/Thomas_Ormerod/publication/251531367_Convergent_but_not_divergent_thinking_predicts_susceptibility_to_associative_memory_illusions/">especially susceptible to false memories</a>. Some people might be more vulnerable than others to believe fake news, but <a href="https://www.nytimes.com/2016/12/24/world/asia/pakistan-israel-khawaja-asif-fake-news-nuclear.html">everyone is at risk</a>.</p> <p><strong>How bias can reinforce fake news</strong></p> <p><a href="https://www.psychologytoday.com/us/articles/200105/the-seven-sins-memory">Bias</a> is how our feelings and worldview affect the <a href="https://theconversation.com/why-two-people-see-the-same-thing-but-have-different-memories-104327">encoding and retrieval of memory</a>. We might like to think of our memory as an archivist that carefully preserves events, but <a href="https://www.taylorfrancis.com/books/e/9781351660020/chapters/10.4324/9781315159591-4">sometimes it’s more like a storyteller</a>. Memories are shaped by our beliefs and can function to <a href="https://www.sciencedirect.com/topics/neuroscience/autobiographical-memory">maintain a consistent narrative rather than an accurate record</a>.</p> <p>An example of this is selective exposure, our tendency to seek information that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4797953/">reinforces our pre-existing beliefs</a> and to avoid information that brings those beliefs into question. This effect is supported by evidence that television news audiences are <a href="https://www.journalism.org/2014/10/21/political-polarization-media-habits/">overwhelmingly partisan</a> and exist in their own echo chambers.</p> <p>It was thought that online communities exhibit the same behaviour, contributing to the spread of fake news, but this <a href="https://theconversation.com/the-myth-of-the-echo-chamber-92544">appears to be a myth</a>. Political news sites are often populated by people with <a href="https://www.academia.edu/34506137/The_Myth_of_Partisan_Selective_Exposure_A_Portrait_of_the_Online_Political_News_Audience">diverse ideological backgrounds</a> and echo chambers are <a href="https://medium.com/trust-media-and-democracy/avoiding-the-echo-chamber-about-echo-chambers-6e1f1a1a0f39">more likely to exist in real life than online</a>.</p> <p>Our brains are wired to assume things we believe <a href="https://journals.sagepub.com/doi/abs/10.1177/0146167203259933">originated from a credible source</a>. But are we more inclined to remember information that reinforces our beliefs? <a href="https://www.researchgate.net/publication/247781236_Do_Attitudes_Affect_Memory_Tests_of_the_Congeniality_Hypothesis">This is probably not the case</a>.</p> <p>People who hold strong beliefs remember things that are relevant to their beliefs but they remember opposing information too. This happens because people are motivated to defend their beliefs against opposing views.</p> <p>Belief echoes are a related phenomenon that <a href="https://www.washingtonpost.com/opinions/why-correcting-donald-trump--or-anyone-else--doesnt-work/2016/01/08/9e5ef5d4-b57d-11e5-a842-0feb51d1d124_story.html?utm_term=.912e5b8e4409">highlight the difficulty of correcting misinformation</a>. Fake news is often designed to be attention-grabbing.</p> <p>It can continue to shape people’s attitudes after it has been discredited because it produces a vivid emotional reaction and builds on our existing narratives.</p> <p>Corrections have a much smaller emotional impact, especially if they require policy details, so should be <a href="https://www.researchgate.net/publication/258180567_Misinformation_and_Its_Correction_Continued_Influence_and_Successful_Debiasing">designed to satisfy a similar narrative urge</a> to be effective.</p> <p><strong>Tips for resisting fake news</strong></p> <p>The way our memory works means it might be impossible to resist fake news completely. But one approach is to start <a href="https://qz.com/858887/how-to-know-if-fake-news-is-fake-learn-to-think-like-a-scientist/">thinking like a scientist</a>. This involves adopting a questioning attitude that is motivated by curiosity, and being aware of personal bias.</p> <p>For fake news, this might involve asking ourselves the following questions:</p> <ul> <li><strong>What type of content is this?</strong> <a href="https://theconversation.com/australians-born-overseas-prefer-the-online-world-for-their-news-84355">Many people rely on social media and aggregators as their main source of news</a>. By reflecting on whether information is news, opinion or even humour, this can help consolidate information more completely into memory.</li> <li><strong>Where is it published?</strong> Paying attention to where information is published is crucial for encoding the source of information into memory. If something is a big deal, a wide variety of sources will discuss it, so attending to this detail is important.</li> <li><strong>Who benefits?</strong> Reflecting on who benefits from you believing the content helps consolidate the source of that information into memory. It can also help us reflect on our own interests and whether our personal biases are at play.</li> </ul> <p>Some people <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3023545">tend to be more susceptible to fake news</a> because they are more accepting of weak claims.</p> <p>But we can strive to be more reflective in our open-mindedness by paying attention to the source of information, and questioning our own knowledge if and when we are unable to remember the context of our memories.</p> <p><em>Written by Julian Matthews. Republished with permission of </em><a href="https://theconversation.com/how-fake-news-gets-into-our-minds-and-what-you-can-do-to-resist-it-114921"><em>The Conversation.</em></a></p>

Technology

Placeholder Content Image

Why we just can't resist coastal glamour

<p>Tourists are naturally drawn to Europe’s coastlines in the summer – but one particular type of seaside region has fascinated travellers more than most since the 19th century: the riviera. Although the word is usually used to refer to the French Côte d’Azur, the term has acquired a widely acknowledged meaning in our collective imagination. The concept of “riviera” (literally meaning “coastline” in Italian) defines a lakeside or seaside region composed of multiple resorts and small towns, all sharing a developed tourist industry. They are often, crucially, reserved for socioeconomic elites who can afford the regions’ high costs of living.</p> <p>The word riviera also denotes certain attributes. It speaks to comfort, the quietness of life and exceptional climate. Beyond its precise definition, we can easily visually imagine what a riviera looks like. It has palm trees along the sea, a clear blue sky, magnificent hotels and casinos. And, these days, it also probably has extortionate food and drinks and yachts hogging marinas that might once have been populated by fishing boats.</p> <p>This vision is epitomised by the French Riviera, with its glamorous Cannes Film Festival and the exclusive principality of Monaco, where one in three residents is a millionaire. All along the Mediterranean coast, right up until France meets Italy, holiday villas host elite visitors, seeking shelter from the paparazzi.</p> <p>Even the official summer residence of the French president is located just off the French Riviera, on a private peninsula. The current president Emmanuel Macron, for all his desire to shake things up, <a href="http://www.theweek.co.uk/95503/inside-fort-bregancon-may-invited-to-macron-s-summer-retreat">intends to keep this tradition alive</a>. His plan to build a private swimming pool there <a href="https://www.bbc.co.uk/news/world-europe-44562016">caused controversy at the beginning of the summer</a>.</p> <p><strong>More than just a coastline</strong></p> <p>We could easily decide to call any stretch of land along water a riviera. After all, most lakeside or seaside places feature the same environmental attributes – holiday accommodation, tourism and leisure services, transport infrastructure, usually a good climate. But a riviera is really defined by socioeconomic exclusivity. This is the ultimate factor that really turns a stretch of coastline into something more enticing.</p> <p>As the riviera is seen as the coastline <em>par excellence</em>, it captures our imagination more than any other beach resort. While sipping an overpriced spritz, one pretends, for an instant, to be part of the films, stories and social circles happening here. Not every coastal town can convey this feeling; it has to have been recognised and placed on everyone’s mental map. For instance, the entire French Mediterranean coast could not fall into this definition. Instead, only the collection of towns and cities between Cannes and Monaco truly embody the definition of France’s most exclusive coastline.</p> <p>This socioeconomic definition has enabled more areas to brand themselves as rivieras. Take the Swiss one, for example, which really only consists of a few towns around Vevey and Montreux. By travelling only a few miles too far to the west or to the east, some of the conditions of a riviera completely vanish. Switzerland has even renamed that local district “Riviera – Pays d’Enhaut”.</p> <p><strong>Can’t fake the feeling</strong></p> <p>A quick look at Wikipedia’s <a href="https://en.wikipedia.org/wiki/Riviera">list of rivieras</a> shows just how many countries, in one way or another, have acquired their own riviera.</p> <p>Some use the term to recognise the already existing touristic power of a certain region. Others adopt it as a strategy to attract more tourists. In England, the region of Torbay in Devon began being advertised as “the English Riviera” in the 1980s, following a peak of popularity in the 1970s. With its collection of small coastal villages, palm trees and relatively clement weather, Torbay can indeed resemble Nice or Cannes at times. But despite a concerted effort to push the label through campaigns, the region has actually seen fewer visitors since the initiative. Meanwhile, Cornwall, much of which very much matches the definition of a riviera, has retained its popularity without using the term.</p> <p>But rivieras are now facing more dynamic competition as a result of changes to the tourism industry. “Instagrammable” has also become more than a term in the tourism world: it’s an obligation. Travellers are looking for certain visual standards – something that rivieras have offered since the 19th century. The idealised scenes depicted in the famous advertising for riviera travel are practically an analogue version of an Instagram account: a couple lazing in the sun and sipping a cocktail on their hotel’s private jetty, with yachts and palm trees in the background. We’ve all seen this scene in our social media newsfeeds.</p> <p>The ubiquity of Instagram inevitably means that other coastal regions are catching on, becoming consciously more visually attractive rather than looking as though they’ve been destroyed by mass tourism. As a result, rivieras could lose their visual originality.</p> <p>At the same time, sites like AirBnB have made it cheaper and easier to access these once “exclusive areas”. While this might not have an impact on the prices of food, drinks, and social events, the overall socioeconomic balance of rivieras could indeed change – for better or for worse.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;" src="https://counter.theconversation.com/content/101637/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: http://theconversation.com/republishing-guidelines --></p> <p><em>Written by <span>Jordan Girardin, Associate lecturer, University of St Andrews</span>. Republished with permission of </em><a href="https://theconversation.com/a-short-history-of-the-riviera-why-we-just-cant-resist-coastal-glamour-101637"><em>The Conversation</em></a><em>. </em></p>

International Travel

Placeholder Content Image

Humans soon to become resistant to antibiotics

<p>Scientists are warning that antibiotic resistance will become a very real threat in the coming decades, at a “terrible human and economic cost.”</p> <p><a href="https://amr-review.org/sites/default/files/AMR%20Review%20Paper%20-%20Tackling%20a%20crisis%20for%20the%20health%20and%20wealth%20of%20nations_1.pdf" target="_blank"><strong><span style="text-decoration: underline;">The study</span></strong></a>, funded by the UK Government and undertaken by economist Lord Jim O’Neill, revealed that drug-resistant infections are growing at such a shocking rate that routine surgeries such as caesareans and joint replacements will become incredibly dangerous. In fact, it is believed that 10 million people a year will die from drug-resistant infections by 2050 – that’s even more than the current number of deaths due to cancer.</p> <p>The emergence of drug-resistant bacteria is being blamed on the over-prescription of antibiotics and anti-fungals to treat relatively minor ailments, including the common cold. Another possible source of resistance is coming from an unlikely place – your plate. Research has shown that pigs, which are often given antibiotics to prevent diseases spreading among livestock, could be passing them down to humans through eating pork. MRSA (a staph infection) is just one of the superbugs posing a challenge to doctors and scientists, as it is almost untreatable with antibiotics.</p> <p>England’s chief medical officer, Dame Sally Davies, <a href="http://www.independent.co.uk/life-style/health-and-families/health-news/antibiotics-will-soon-stop-working-and-make-chemotherapy-too-dangerous-to-be-performed-major-report-a7036776.html" target="_blank"><strong><span style="text-decoration: underline;">has warned</span></strong></a> that the UK and other countries could be facing an “apocalyptic scenario” if preventative measures are not put in place soon.</p> <p>What do you think can be done to stop antibiotic resistance? Tell us in the comment section below.</p> <p><strong>Related links:</strong></p> <p><a href="/health/caring/2016/06/understanding-the-symptoms-of-stroke/"><span style="text-decoration: underline;"><em><strong>Understanding the symptoms of stroke</strong></em></span></a></p> <p><a href="/health/caring/2016/06/stigma-keeping-cancer-patients-from-palliative-care/"><span style="text-decoration: underline;"><em><strong>Cancer patients are not getting palliative care due to stigma</strong></em></span></a></p> <p><a href="/health/caring/2016/06/what-ive-learnt-about-dying-as-an-intensive-care-physician/"><strong><em><span style="text-decoration: underline;">What I’ve learnt about dying as an intensive care physician</span></em></strong></a></p>

Caring

Placeholder Content Image

Experts anticipate rise in antibiotic-resistant superbugs

<p>Infectious disease experts believe an antibiotic-resistant superbug may be more widespread than previously believed, following two confirmed cases in the US.</p> <p>In May, US army scientists reported finding E. coli bacteria harbouring a gene which rendered the antibiotic colistin, generally used as a last ditch effort, useless.</p> <p>But just this week researchers have confirmed an another strain of E. coli with the same gene was present in a patient treated for an infection as early as last year, suggesting the antibiotic-resistant superbug is far more widespread than initially thought.</p> <p>The antibiotic-resistant strain has been identified in over 20 countries around the world over the past six months, although there are no confirmed case in Australia.</p> <p>But the thing that has health experts worried is the possibility for the troublesome gene to leap into bacteria that is already resistant to all or virtually all other types of antibiotics, which would theoretically make a range of infections untreatable.</p> <p>Dr Brad Spellberg, professor of medicine at the University of Southern California, told AAP, “You can be sure it is already in the guts of people throughout the United States and will continue to spread.”</p> <p>It’s quite a scary prospect. What’s your take on the situation? Do you think more should be done to prevent the occurrence of potentially deadly superbugs?</p> <p>Let us know in the comments. </p> <p><strong>Related links:</strong></p> <p><span style="text-decoration: underline;"><em><a href="/health/body/2016/06/paleo-diet-bad-for-heart-health/"><strong>Paleo diet bad for heart health</strong></a></em></span></p> <p><span style="text-decoration: underline;"><em><a href="/health/body/2016/07/the-unexpected-restless-legs-syndrome-treatments/"><strong>The unexpected restless legs syndrome treatments</strong></a></em></span></p> <p><span style="text-decoration: underline;"><em><a href="/health/body/2016/06/does-cold-weather-cause-the-flu/"><strong>Does cold weather actually cause the flu?</strong></a></em></span></p>

Body