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From eye exams to blood tests and surgery: how doctors use light to diagnose disease

<p><em><a href="https://theconversation.com/profiles/matthew-griffith-1539353">Matthew Griffith</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a></em></p> <p>You’re not feeling well. You’ve had a pounding headache all week, dizzy spells and have vomited up your past few meals.</p> <p>You visit your GP to get some answers and sit while they shine a light in your eyes, order a blood test and request some medical imaging.</p> <p>Everything your GP just did relies on light. These are just some of the optical technologies that have had an enormous impact in how we diagnose disease.</p> <h2>1. On-the-spot tests</h2> <p>Point-of-care diagnostics allow doctors to test patients on the spot and get answers in minutes, rather than sending samples to a lab for analysis.</p> <p>The “flashlight” your GP uses to view the inside of your eye (known as an <a href="https://medlineplus.gov/ency/article/003881.htm">ophthalmoscope</a>) is a great example. This allows doctors to detect abnormal blood flow in the eye, deformations of the cornea (the outermost clear layer of the eye), or swollen optical discs (a round section at the back of the eye where the nerve link to the brain begins). Swollen discs are a sign of elevated pressure inside your head (or in the worst case, a brain tumour) that could be <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/headache/increased-intracranial-pressure-icp-headache">causing your headaches</a>.</p> <p>The invention of <a href="https://openmedscience.com/lighting-the-way-in-healthcare-the-transformative-role-of-lasers-in-medicine/">lasers and LEDs</a> has enabled many other miniaturised technologies to be provided at the bedside or clinic rather than in the lab.</p> <p><a href="https://theconversation.com/whats-a-pulse-oximeter-should-i-buy-one-to-monitor-covid-at-home-174457">Pulse oximetry</a> is a famous example, where a clip attached to your finger reports how well your blood is oxygenated. It does this by <a href="https://www.howequipmentworks.com/pulse_oximeter/">measuring</a> the different responses of oxygenated and de-oxygenated blood to different colours of light.</p> <p>Pulse oximetry is used at hospitals (and <a href="https://theconversation.com/whats-a-pulse-oximeter-should-i-buy-one-to-monitor-covid-at-home-174457">sometimes at home</a>) to monitor your respiratory and heart health. In hospitals, it is also a valuable tool for detecting <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60107-X/fulltext">heart defects in babies</a>.</p> <h2>2. Looking at molecules</h2> <p>Now, back to that blood test. Analysing a small amount of your blood can diagnose <a href="https://theconversation.com/blood-tests-and-diagnosing-illness-what-can-blood-tell-us-about-whats-happening-in-our-body-80327">many different diseases</a>.</p> <p>A machine called an automated “full blood count analyser” tests for general markers of your health. This machine directs focused beams of light through blood samples held in small glass tubes. It counts the number of blood cells, determines their specific type, and reports the level of haemoglobin (the protein in red blood cells that distributes oxygen around your body). In minutes, this machine can provide a <a href="https://www.nuffieldhealth.com/article/inside-the-pathology-lab-what-happens-to-my-blood">snapshot</a> of your overall health.</p> <p>For more specific disease markers, blood serum is separated from the heavier cells by spinning in a rotating instrument called a centrifuge. The serum is then exposed to special chemical stains and enzyme assays that change colour depending on whether specific molecules, which may be the sign of a disease, are present.</p> <p>These colour changes can’t be detected with the naked eye. However, a light beam from an instrument called a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5476943/#R88">spectrometer</a> can detect tiny amounts of these substances in the blood and determine if the biomarkers for diseases are present, and at what levels.</p> <h2>3. Medical imaging</h2> <p>Let’s re-visit those medical images your GP ordered. The development of fibre-optic technology, made famous for transforming high-speed digital communications (such as the NBN), allows light to get inside the body. The result? High-resolution optical imaging.</p> <p>A common example is an <a href="https://www.medicalnewstoday.com/articles/153737#risks-and-side-effects">endoscope</a>, where fibres with a tiny camera on the end are inserted into the body’s natural openings (such as your mouth or anus) to examine your gut or respiratory tracts.</p> <p>Surgeons can insert the same technology through tiny cuts to view the inside of the body on a video screen during <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9553337/">laparoscopic surgery</a> (also known as keyhole surgery) to diagnose and treat disease.</p> <h2>How about the future?</h2> <p>Progress in nanotechnology and a better understanding of the interactions of light with our tissues are leading to new light-based tools to help diagnose disease. These include:</p> <ul> <li> <p><a href="https://onlinelibrary.wiley.com/doi/full/10.1002/advs.201903441">nanomaterials</a> (materials on an extremely small scale, many thousands of times smaller than the width of a human hair). These are being used in next-generation sensors and new diagnostic tests</p> </li> <li> <p><a href="https://www.nature.com/articles/s41587-019-0045-y">wearable optical biosensors</a> the size of your fingernail can be included in devices such as watches, contact lenses or finger wraps. These devices allow non-invasive measurements of sweat, tears and saliva, in real time</p> </li> <li> <p>AI tools to analyse how blood serum scatters infrared light. This has allowed researchers to build a <a href="https://www.advancedsciencenews.com/powerful-diagnostic-approach-uses-light-to-detect-virtually-all-forms-of-cancer/">comprehensive database</a> of scatter patterns to detect <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/aisy.202300006">any cancer</a></p> </li> <li> <p>a type of non-invasive imaging called <a href="https://www.ncbi.nlm.nih.gov/books/NBK554044/">optical coherence tomography</a> for more detailed imaging of the eye, heart and skin</p> </li> <li> <p>fibre optic technology to deliver a tiny microscope into the body on the <a href="https://www.uwa.edu.au/projects/microscope-in-a-needle">tip of a needle</a>.</p> </li> </ul> <p>So the next time you’re at the GP and they perform (or order) some tests, chances are that at least one of those tests depend on light to help diagnose disease.<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/231379/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><a href="https://theconversation.com/profiles/matthew-griffith-1539353"><em>Matthew Griffith</em></a><em>, Associate Professor and ARC Future Fellow and Director, UniSA Microscopy and Microanalysis Facilities, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</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/from-eye-exams-to-blood-tests-and-surgery-how-doctors-use-light-to-diagnose-disease-231379">original article</a>.</em></p>

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Doctor defies terminal cancer diagnosis with breakthrough therapy

<p>Dr Tina Willits was told she had just 24 months to live after being diagnosed with breast cancer, but against all odds she is now in remission. </p> <p>The mother-of-five's disease was "everywhere" with three golf-ball sized tumors in her breast and cancerous masses in her ribs, spine, lymph nodes and legs.</p> <p>"When my cancer was detected, it was pretty past a stage four diagnosis and I was too far gone for a mastectomy," she told the <em>Daily M</em><em>ail</em>. </p> <p>She was placed on end-of-care chemotherapy and was told to "enjoy the time you have left". </p> <p>That was nearly three years ago. Now, the 53-year-old US mum is in remission thanks to a breakthrough cancer therapy that uses cold gases and the body's own cells to freeze and fight tumors. </p> <p>"I was devastated, but I was also like no, I was not ok with that diagnosis. I felt I had to do something," she recalled.</p> <p>"I was just really determined that I did not want to live my life with this cancer, even if they could stop it progressing, I didn't want that, I just wanted it gone."</p> <p>Dr Willits' cancer was HER2 positive, which account for about 20 percent of all diagnoses, and she had no family history of the disease.</p> <p>She underwent four rounds of chemotherapy before she sought alternative treatment at the Williams Cancer Institute. </p> <p>The institute sent her a list of supplements to begin taking and advised her to avoid sugar, which some researchers believe can help reduce inflammation and slow down the growth of cancer cells. </p> <p>She then underwent a treatment regimen that is not yet fully approved in the US, with cryoablation as the first step. </p> <p>Cryoablation is the process where doctors insert  a small metal probe through the skin and into the tumor, extremely cold gasses are then released directly into the mass to kill its cells.</p> <p>In the second phase of her treatment, she received immunotherapy, where eight drugs were administered directly into her tumor, which doctors say can prompt the immune system to recognise cancer cells as a threat and trigger an immune response. </p> <p>Dr Willits told the Dailymail that she was shocked when she got the results from her six-week scan after the treatment.</p> <p>"There were none, no tumors. They were just completely gone," she said. </p> <p>"All the metastasis (cancerous growths outside the breast) had completely healed, and the cancer in my lymph nodes was no longer there."</p> <p>After the treatment she had another four rounds of chemotherapy, and still undergoes PET scans every six months. </p> <p>So far the cancer has not been detected in her body since the treatment, and will need to wait for five years of clear results before she can be declared cancer free. </p> <p>Dr Williams, the founder of the institute, developed the treatment regimen over several years, and believes it could offer a better way to treat cancer.</p> <p>He is currently running a trial of the treatment in hard-to-treat prostate cancer patients, although he did not reveal how long the study had been going on for or how many rounds of treatment the patients had received. </p> <p>Since going into remission Dr Willits has travelled to Honduras and Colorado, tried mountain biking and is training for a 5k marathon for breast cancer awareness. </p> <p>"I wouldn't appreciate life like this if I had not gone through the cancer," she said. </p> <p>"No one on their deathbed says I wish I had worked more or got that job, you all say I wish I had spent more time with my parents and kids or gone to that place I had always wanted to." </p> <p><em>Images: DailyMail</em></p> <p> </p>

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You don’t need a doctor to get more physically active – here are 10 simple steps you can take by yourself

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/nerys-m-astbury-410114">Nerys M Astbury</a>, <a href="https://theconversation.com/institutions/university-of-oxford-1260">University of Oxford</a></em></p> <p>We all know physical activity has many <a href="https://www.nhs.uk/live-well/exercise/exercise-health-benefits/">health benefits</a>, including for mental health. It helps <a href="https://theconversation.com/exercise-can-reduce-stress-and-improve-sleep-particularly-for-women-with-breast-cancer-186144">manage stress</a>, ease joint or back pain, and boost energy levels.</p> <p>Exercise can also improve <a href="https://theconversation.com/exercise-and-the-brain-three-ways-physical-activity-changes-its-very-structure-150203">brain function</a> and <a href="https://theconversation.com/exercise-really-can-help-you-sleep-better-at-night-heres-why-that-may-be-192427">sleep</a>, and lift mood. In contrast, inactivity or spending too much time <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6308180/">sedentary</a> is a leading factor in developing a range of diseases.</p> <p>The <a href="https://www.who.int/publications/i/item/9789240015128">World Health Organization</a> recommends we should do a weekly minimum of 150-300 minutes of moderate intensity physical activity, such as walking, or 75 minutes of vigorous physical activity, such as swimming, jogging or an exercise class – as well as <a href="https://theconversation.com/strength-training-could-be-the-answer-to-one-of-the-worlds-worst-killers-228665">regular strength training</a>.</p> <p>However, many people <a href="https://www.who.int/teams/health-promotion/physical-activity/global-status-report-on-physical-activity-2022">fail to meet these guidelines</a>. So what to do about this <a href="https://www.weforum.org/agenda/2022/12/lack-exercise-inactivity-preventable-diseases/">health crisis</a>?</p> <p>There is already <a href="https://www.bmj.com/content/376/bmj-2021-068465">evidence</a> that when GPs give patients guidance and continued support to increase physical activity, this encourages them to be more physically active – at least in the short term. However, we don’t yet know the best way for doctors to communicate with patients to help them sustain these increased activity levels so the current guidance and support on offer to patients isn’t as effective as it could be.</p> <figure><iframe src="https://www.youtube.com/embed/vCCD1xHKpZc?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p>For example, my <a href="https://www.bmj.com/content/386/bmj-2023-078713">latest research</a> examines the <a href="https://www.bmj.com/content/340/bmj.c1900">“motivational interviewing” (MI)</a> method GPs currently use to encourage patients to change their lifestyle. MI is a patient-centred, non-confrontational communication style that helps patients address any problem behaviour by exploring their ambivalence towards changing it. MI has been shown to help patients with a host of health problems, including <a href="https://pubmed.ncbi.nlm.nih.gov/25577724/">addiction issues</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/23001832/">eating disorders</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/25726920/">smokers</a> and those with <a href="https://pubmed.ncbi.nlm.nih.gov/33637368/">diabetes</a> to change their behaviour.</p> <p>However, I found that while MI programmes can help patients increase their total amount of physical activity – the benefits are only short term.</p> <h2>Ten simple ways to be more physically active</h2> <p>If you want more physical activity in your life, then, there are many self-directed things you can do to help yourself, without joining a programme or seeing your GP.</p> <p>Here are ten simple and effective ways to help you become – and stay – more physically active:</p> <p><strong>1) Don’t sit, stand</strong></p> <p>We <a href="https://theconversation.com/sitting-is-bad-for-your-health-and-exercise-doesnt-seem-to-offset-the-harmful-effects-225056">sit a lot</a>. In fact, it’s likely you’re sitting right now – and you needn’t be. Sitting for long periods has been <a href="https://doi.org/10.1016/j.amepre.2010.05.024">linked</a> with many adverse health outcomes, so try to stand more.</p> <figure><iframe src="https://www.youtube.com/embed/wUEl8KrMz14?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p><strong>2) Take the stairs</strong></p> <p>Being physically active needn’t mean expensive gym memberships. Try building physical activity into your daily routine. One easy way to do this is by swapping the lift or escalator for the stairs.</p> <p><strong>3) Make it fun</strong></p> <p>If you like doing something, you’re <a href="https://theconversation.com/why-you-shouldnt-let-guilt-motivate-you-to-exercise-220342">more likely</a> to continue doing it. Why not try an activity you liked doing as a child, or even something new? Who knows, you might enjoy it.</p> <p><strong>4) Phone a friend</strong></p> <p>Exercising <a href="https://theconversation.com/exercise-can-be-punishing-but-heres-how-to-stop-thinking-of-it-as-a-punishment-76167">with a friend</a> or loved one is a great way to stay motivated, and it can make physical activity more fun too.</p> <p><strong>5) Do less, more often</strong></p> <p><a href="https://pilotfeasibilitystudies.biomedcentral.com/articles/10.1186/s40814-023-01272-8">“Snacktivity”</a> – a term for breaking up your activity into shorter <a href="https://theconversation.com/forget-the-gym-in-january-exercise-snacking-is-the-way-forward-69702">activity “snacks”</a> – can help you increase activity in convenient, manageable bursts while reaping the health benefits.</p> <p><strong>6) Track your progress</strong></p> <p>Activity trackers aren’t a fad. There is <a href="https://doi.org/10.1016/S2589-7500(22)00111-X">evidence</a> that just using an activity tracker such as a pedometer to count steps or a smart watch that logs activity can help increase your activity levels, reduce body fat and increase muscle mass – and increase your overall physical fitness.</p> <p><strong>7) Get into a habit</strong></p> <p>We know it takes about ten weeks to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505409/">form a habit</a>. Repetition is key – so stick with it and keep going. Once you’ve formed a physical activity habit, it will be <a href="https://www.psychologytoday.com/gb/basics/habit-formation#:%7E:text=Building%20healthy%20habits%20can%20involve,listening%20to%20music%20while%20exercising">hard to shake it off</a>.).</p> <p><strong>8) Hold still</strong></p> <p>Try to incorporate <a href="https://en.wikipedia.org/wiki/Isometric_exercise">isometric exercises</a> like the plank or wall squats into your routine. These exercises, which need no equipment, require you to tighten muscles and hold still – and have been shown to <a href="https://bjsm.bmj.com/content/57/20/1317">lower your blood pressure</a>.</p> <p><strong>9) Set a goal</strong></p> <p>Give yourself an achievable target to work towards – it will <a href="https://theconversation.com/three-tips-to-help-you-stay-motivated-to-keep-exercising-all-year-long-175868">motivate you</a> to reach your goal.</p> <p><strong>10) Reward yourself</strong></p> <p>And don’t forget to reward yourself when you meet that goal. You can also build in rewards to mark your progress along the way. After all, who doesn’t like to treat themselves when they’ve done well?<!-- 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/231991/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><em><a href="https://theconversation.com/profiles/nerys-m-astbury-410114">Nerys M Astbury</a>, Associate professor, <a href="https://theconversation.com/institutions/university-of-oxford-1260">University of Oxford</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/you-dont-need-a-doctor-to-get-more-physically-active-here-are-10-simple-steps-you-can-take-by-yourself-231991">original article</a>.</em></p> </div>

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Doctor shares her holy grail tips for overcoming eye sensitivity

<p>As the chill of winter sets in, many people find that their eyes become more sensitive and prone to dryness. This can be particularly challenging for those who already suffer from dry eye syndrome. </p> <p>Dr. Jacqueline Beltz is a leading Australian Ophthalmologist and the founder of <a href="https://www.okkiyo.com" target="_blank" rel="noopener">OKKIYO</a>, a beauty brand that makes PRIORITEYES mascara for people with sensitive eyes.</p> <p>Dr Beltz has shared her insights into dry eye syndrome and how winter can exacerbate symptoms, also sharing her top tips for managing eye sensitivity during the colder months.</p> <p><strong>Understanding Dry Eye Syndrome</strong></p> <p>The surface of the eye is covered by a delicate layer of tears, essential for comfort, vision, protection, and nutrition. The tear film comprises two main layers: an outer lipid (oily) layer and an inner aqueous (watery) layer. The lipid layer, produced by oil glands in the eyelids, prevents tears from evaporating too quickly, while the aqueous layer, consisting of water, electrolytes, and proteins, spreads tears evenly across the eye and helps them adhere to the surface.</p> <p>When the balance of tear production, evaporation, absorption, and drainage is disrupted, it can lead to dry eye syndrome. Symptoms may include redness, irritation, a gritty sensation, tired eyes, itching, excessive watering, and fluctuating vision. In severe cases, dry eye can be painful and significantly impact daily life.</p> <p><strong>How common is dry eye syndrome?</strong></p> <p>Dry eye syndrome is a widespread issue, particularly among older adults. According to the Blue Mountains Eye Study, 57% of adults over the age of 50 experience some degree of dry eye. This condition is notably more prevalent in women, with higher rates observed compared to their male counterparts. The increased prevalence in women is often attributed to hormonal changes, particularly during and after menopause. </p> <p>A more recent study, Optometry Australia’s 2022 Vision index found that over 85% of Australians are estimated to have experienced dry eyes at some point in their lives.  Of those affected, 55% say they only developed the condition following the beginning of the pandemic in 2020.  They reported that almost 1 in 5 (18%) of people experience dry eye symptoms frequently.  </p> <p>These statistics highlight the importance of understanding and managing dry eye, especially as we age.</p> <p><strong>DEWS II Study and Treatment Approaches</strong></p> <p>The DEWS II (Dry Eye Workshop II) study provides a comprehensive framework for understanding and treating dry eye syndrome. According to the study, dry eye is a multifactorial disease characterised by a loss of homeostasis (or balance) in the tear film, accompanied by eye symptoms. Factors such as tear film instability, hyperosmolarity (increased saltiness), inflammation, and neurosensory (altered feelings or sensations) abnormalities play significant roles.</p> <p>There are two primary types of dry eye: aqueous deficient and evaporative. Most individuals have a combination of both. Aqueous deficient dry eye occurs when there is insufficient production of the watery layer of tears, often due to aging, hormonal changes, or certain medications. Evaporative dry eye is typically caused by environmental factors or conditions affecting the lipid layer, such as meibomian gland dysfunction (MGD).</p> <p><strong>Winter's Impact on Dry Eyes</strong></p> <p>Winter poses unique challenges for dry eye sufferers. Cold, dry air, indoor heating, and wind can all exacerbate symptoms. Here's how to combat these winter-specific issues:</p> <p><em><strong>1. Humidify Your Environment</strong></em></p> <p>Indoor heating reduces humidity levels, leading to increased tear evaporation. Consider using a humidifier to maintain moisture in the air, especially in bedrooms and living spaces. This helps keep your eyes hydrated.</p> <p><em><strong>2. Protect Your Eyes Outdoors</strong></em></p> <p>Cold winds can strip away the tear film. When outside, wear wraparound sunglasses to shield your eyes from the elements. This not only protects your eyes from the wind but also from UV rays, which can be strong even in winter.</p> <p><em><strong>3. Stay Hydrated</strong></em></p> <p>Dehydration can worsen dry eye symptoms. Drink plenty of water throughout the day to maintain overall hydration, which supports healthy tear production.</p> <p><em><strong>4. Optimise Your Diet</strong></em></p> <p>Certain foods can promote eye health. Omega-3 fatty acids, found in fish like salmon and flaxseeds, have anti-inflammatory properties that can help manage dry eye symptoms. Incorporate these into your diet for added benefits.</p> <p><em><strong>5. Use a Warm Compress</strong></em></p> <p>A warm compress can help improve the function of the meibomian glands, which produce the oily layer of the tear film. This is particularly helpful for those with meibomian gland dysfunction, or MGD. Gently apply a warm, damp cloth to your closed eyelids for 10-15 minutes, followed by a gentle massage of the eyelids to encourage oil secretion. It is important to avoid rubbing or compressing the eyeballs.</p> <p><em><strong>6. Use Over-the-Counter Lubricant Eye Drops</strong></em></p> <p>Artificial tears can provide temporary relief by supplementing the natural tear film. Choose preservative-free options to avoid further irritation, and use them frequently.</p> <p><em><strong>7.  Remember to have regular eye checks</strong></em></p> <p>In Australia, Optometrists provide our primary eye health check ups. Dr Beltz recommends adults over the age of 40 see their optometrist once a year, but if you’re struggling with symptoms of dry eye in winter, an extra check up might help and your optometrist will be able to help you to come up with an individualised treatment plan.</p> <p><em><strong>8. Invest in Quality Eye Products</strong></em></p> <p>For those who wear makeup, using products designed for sensitive eyes is crucial. <a href="https://www.okkiyo.com/products/protect-and-preserve-mascara" target="_blank" rel="noopener">PRIORITEYES</a> mascara by OKKIYO has been specifically formulated to be gentle on sensitive eyes, avoiding common irritants while providing excellent performance.</p> <p><strong>Managing Dry Eye in Winter: A Recap</strong></p> <p>Winter can be tough on our eyes, but with the right strategies, you can manage dry eye symptoms effectively. Maintain a humid environment, protect your eyes from cold winds, stay hydrated, and incorporate eye-healthy foods into your diet. Regularly use warm compresses and opt for gentle, high-quality eye products like PRIORITEYES mascara.  </p> <p>Dry eye syndrome may be a common condition, but it doesn't have to dominate your life, especially during the harsh winter months. With these tips, you can keep your eyes comfortable and healthy all season long. For personalised advice and treatment, always consult with your eye care professional.</p> <p>Stay warm, stay hydrated and take care of your eyes this winter!</p> <p><em>Image credits: Shutterstock </em></p>

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Doctor Who actor dies at the age of 99

<p>Legendary <em>Doctor Who</em> actor William Russell has died at the age of 99. </p> <p>Russell made his debut on the long-running hit sci-fi show back during its first episode in 1963 as the character Ian Chesterson, where he became the first companion alongside the then doctor William Hartnell. </p> <p><em>Doctor Who</em> show runner Russell T Davies led the tributes online, writing, "What a sad loss."</p> <p>"William played the Doctor's very first companion, Ian Chesterton, back in 1963," Davies explained in the Instagram tribute alongside an image of the two together.</p> <p>"A schoolteacher, trapped on the Tardis by a wily old Doctor, unable to get home, whisked off to the Stone Age, Skaro, the Crusades, planet of the Zarbi..! Wonderful! A fine, nimble, witty, heartfelt actor who absolutely sold the truth of those early years."</p> <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-permalink="https://www.instagram.com/p/C7zaEDQNPv5/?utm_source=ig_embed&amp;utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/C7zaEDQNPv5/?utm_source=ig_embed&amp;utm_campaign=loading" target="_blank" rel="noopener">A post shared by Russell T Davies (@russelltdavies63)</a></p> </div> </blockquote> <p>Davies said that Russell had been a "star booking" for the show, praising both the actor and man he knew off set.</p> <p>"He later went on to marry Rita Fairclough as Ted Sullivan on <em>Coronation Street</em>. In the photo, I bumped into him on a train in 2018! I was star-struck," he continued.</p> <p>"He spoke with so much pride and joy about his son, Alfred Enoch, who I'd seen in King Lear at the Royal Exchange. Absolutely lovely man. A fine, long life. Well done, sir, well played."</p> <p>William Russell made his television debut in 1956, starring in the TV series <em>The Adventures of Sir Lancelot</em>, which led to an illustrious career both on the screen and the stage. </p> <p>Russell appeared once more in <em>Doctor Who</em> after his initial episode, reprising his role in 2022 during the final episode of Jodie Whitaker's run as the Doctor, 57 years after his own last appearance. </p> <p>Not only did fans of the show adore his appearance, but it also scored him a Guinness World Record for having the biggest gap between TV appearances.</p> <p>He is survived by his four children, Robert, Laetitia, Vanessa and Alfred, as well as four grandchildren, James, Elise, Amy and Ayo.</p> <p><em>Image credits: BBC / Dan Wooller / Shutterstock Editorial </em></p> <p style="box-sizing: border-box; margin: 16px 0px 20px; padding: 0px; border: 0px; font-stretch: inherit; font-size: 18px; line-height: 28px; font-family: 'Proxima Nova', system-ui, -apple-system, BlinkMacSystemFont, 'Segoe UI', Roboto, Oxygen, Ubuntu, Cantarell, 'Fira Sans', 'Droid Sans', 'Helvetica Neue'; font-size-adjust: inherit; font-kerning: inherit; font-variant-alternates: inherit; font-variant-ligatures: inherit; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-position: inherit; font-feature-settings: inherit; font-optical-sizing: inherit; font-variation-settings: inherit; vertical-align: baseline; caret-color: #333333; color: #333333;"> </p>

Caring

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University gives resident cat an honorary doctorate

<p>A university in the US has handed out an honorary doctorate to a surprising recipient: the resident campus cat. </p> <p>For four years, Max the cat has been a respected member of the Vermont State University, putting a smile on students' faces through his friendly demeanour. </p> <p>When Max's owner Ashley was contacted by the school and told their plans to give Max the special honour, she "thought they were crazy", but it brought a big smile to her face.</p> <p>"We live on the main entrance to campus and when my daughter started attending as a junior, she started seeing everyone and how they kind of doted on Max," Ashley told <a href="https://9now.nine.com.au/today/vermont-state-university-resident-cat-max-dow-given-honorary-doctorate-in-literature/57d96d7c-ecc5-460f-85ac-ceee24e119b5" target="_blank" rel="noopener"><em>Today Extra</em></a>.</p> <p>"So we started an Instagram page that we keep updated with some of the photos and then I started getting tracked down by people on campus saying, 'Oh Max has been on the Dean's desk and he's been on the desk of the head of graduate studies, and he just kind of makes himself at home.'"</p> <p>Ashely said that Max's calming presence has helped many students who are stressed about their studies, or those who are feeling homesick. </p> <p>"They were just talking about how he was so helpful during finals week because everybody was picking him up and doing selfies with him and he was making everyone calmer," she said.</p> <p>"There's a real sense of community because I heard he was getting attacked by feral cats if he was on campus after 5pm, so I put up some posters and asked the students to give me a call or shoot me a text if they see him out after dark and they started arriving on our doorstep with him saying 'Hey, we brought Max home.'"</p> <p>Max was bestowed the honorary degree of "doctor of litter-ature", although will not be attending the next graduation ceremony. </p> <p style="box-sizing: border-box; margin: 24px 0px 0px; padding: 0px; border: 0px; font-stretch: inherit; line-height: 1.333; font-size-adjust: inherit; font-kerning: inherit; font-variant-alternates: inherit; font-variant-ligatures: inherit; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-position: inherit; font-feature-settings: inherit; font-optical-sizing: inherit; font-variation-settings: inherit; vertical-align: baseline;"><em>Image credits: Today Extra / Vermont State University</em></p>

Family & Pets

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Doctor beats cancer using his own treatment

<p>Australian doctor Richard Scolyer has been declared cancer free, thanks to a first-of-its-kind treatment he helped to develop.</p> <p>The 56-year-old professor, who has been recognised around for the world for his pioneering melanoma research, was diagnosed with aglioblastoma, a terminal kind of brain tumour, after suffering a seizure last June.</p> <p>After receiving his devastating diagnosis, the doctor agreed to be a "guinea pig" to undergo a world-first cancer treatment that he had a hand in developing. </p> <p>Now the world-leading pathologist and Australian of the Year has given a remarkable update, stating he is cancer free.</p> <p>“I had brain #MRI scan last Thursday looking for recurrent #glioblastoma (&amp;/or treatment complications). I found out yesterday that there is still no sign of recurrence. I couldn’t be happier!!!!!” the professor shared on X, formerly known as Twitter.</p> <p>Before Dr Scolyer was diagnosed with cancer, he was fit and active, and had been hiking mountains in Poland with his wife.</p> <p>“I felt normal. I didn’t have any symptoms at all,” he told <em>A Current Affair</em> earlier this year.</p> <p>Just days after, he suffered a devastating seizure, and when he returned to Australia, underwent a series of tests which resulted in a diagnosis with glioblastoma – an aggressive and terminal form of brain cancer that would give him a average of 14 months to live. </p> <p>Teaming up with his friend and medical oncologist Georgina Long, Scolyer decided to undergo the new treatment, which came with a long list of risks. </p> <p>“No one knew what it was going to do, people were nervous because it could actually cause my life to end more quickly. But when you’re faced with certain death, it’s a no-brainer for me,” said Professor Scolyer, who also hoped the treatment would make a difference for other cancer patients.</p> <p>Dr Scolyer also underwent surgery to remove as much of his tumour as possible, and in April, he updated his social media followers to share that10 months after his diagnosis, his tumour had not returned. </p> <p>Speaking to ABC’s <em>Australian Story</em> at the time, Professor Scolyer said he was “blown away” by the results.</p> <p>“This is not what I expected. The average time to recurrence for the nasty type of brain cancer I’ve got is six months. So, to be out this far is amazing,” he said. </p> <p><em>Image credits: Instagram</em></p>

Caring

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Yes, Kate Middleton’s photo was doctored. But so are a lot of images we see today

<p><a href="https://theconversation.com/profiles/t-j-thomson-503845">T.J. Thomson</a>, <em><a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a></em></p> <p>Rumours and conspiracies have been <a href="https://www.nytimes.com/2024/02/28/style/princess-kate-middleton-health.html">swirling</a> following the abdominal surgery and long recovery period of Catherine, Princess of Wales, earlier this year. They intensified on Monday when Kensington Palace released a photo of the princess with her three children.</p> <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-captioned="" data-instgrm-permalink="https://www.instagram.com/p/C4U_IqTNaqU/?utm_source=ig_embed&amp;utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/C4U_IqTNaqU/?utm_source=ig_embed&amp;utm_campaign=loading" target="_blank" rel="noopener">A post shared by The Prince and Princess of Wales (@princeandprincessofwales)</a></p> </div> </blockquote> <p>The photo had clear signs of tampering, and international wire services <a href="https://apnews.com/article/kate-princess-photo-surgery-ca91acf667c87c6c70a7838347d6d4fb">withdrew the image</a> amid concerns around manipulation. The princess later <a href="https://twitter.com/KensingtonRoyal/status/1767135566645092616">apologised for any confusion</a> and said she had “experimented with editing” as many amateur photographers do.</p> <p>Image editing is extremely common these days, and not all of it is for nefarious purposes. However, in an age of rampant misinformation, how can we stay vigilant around suspicious images?</p> <h2>What happened with the royal photo?</h2> <p>A close look reveals at least eight inconsistencies with the image.</p> <p>Two of these relate to unnatural blur. Catherine’s right hand is unnaturally blurred, even though her left hand is sharp and at the same distance from the camera. The left side of Catherine’s hair is also unnaturally blurred, while the right side of her hair is sharp.</p> <p>These types of edits are usually made with a blur tool that softens pixels. It is often used to make the background of an image less distracting or to smooth rough patches of texture.</p> <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/581145/original/file-20240312-26-rhmkk1.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=1000&amp;fit=clip"><img src="https://images.theconversation.com/files/581145/original/file-20240312-26-rhmkk1.jpg?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/581145/original/file-20240312-26-rhmkk1.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=358&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/581145/original/file-20240312-26-rhmkk1.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=358&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/581145/original/file-20240312-26-rhmkk1.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=358&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/581145/original/file-20240312-26-rhmkk1.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=450&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/581145/original/file-20240312-26-rhmkk1.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=450&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/581145/original/file-20240312-26-rhmkk1.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=450&amp;fit=crop&amp;dpr=3 2262w" alt="" /></a><figcaption><span class="caption">At least eight logical inconsistencies exist in the doctored image the Prince and Princess of Wales posted on social media.</span> <span class="attribution"><a class="source" href="https://www.instagram.com/p/C4U_IqTNaqU/">Photo by the Prince of Wales/Chart by T.J. Thomson</a></span></figcaption></figure> <p>Five of the edits appear to use the “clone stamp” tool. This is a Photoshop tool that takes part of the same or a different image and “stamps” it onto another part.</p> <p>You can see this with the repeated pattern on Louis’s (on the left) sweater and the tile on the ground. You can also see it with the step behind Louis’s legs and on Charlotte’s hair and sleeve. The zipper on Catherine’s jacket also doesn’t line up.</p> <p>The most charitable interpretation is that the princess was trying to remove distracting or unflattering elements. But the artefacts could also point to multiple images being blended together. This could either be to try to show the best version of each person (for example, with a smiling face and open eyes), or for another purpose.</p> <blockquote class="twitter-tweet"> <p dir="ltr" lang="en">Like many amateur photographers, I do occasionally experiment with editing. I wanted to express my apologies for any confusion the family photograph we shared yesterday caused. I hope everyone celebrating had a very happy Mother’s Day. C</p> <p>— The Prince and Princess of Wales (@KensingtonRoyal) <a href="https://twitter.com/KensingtonRoyal/status/1767135566645092616?ref_src=twsrc%5Etfw">March 11, 2024</a></p></blockquote> <h2>How common are image edits?</h2> <p>Image editing is increasingly common as both photography and editing are increasingly becoming more automated.</p> <p>This sometimes happens without you even knowing.</p> <p>Take HDR (high dynamic range) images, for example. Point your iPhone or equivalent at a beautiful sunset and watch it capture the scene from the brightest highlights to the darkest shadows. What happens here is your camera makes multiple images and automatically stitches them together to make an image <a href="https://www.adobe.com/creativecloud/photography/hub/guides/what-is-hdr-photography.html">with a wider range of contrast</a>.</p> <p>While face-smoothing or teeth-whitening filters are nothing new, some smartphone camera apps apply them without being prompted. Newer technology like Google’s “Best Take” <a href="https://blog.google/products/photos/how-google-photos-best-take-works/">feature</a> can even combine the best attributes of multiple images to ensure everyone’s eyes are open and faces are smiling in group shots.</p> <p>On social media, it seems everyone tries to show themselves in their best light, which is partially why so few of the photos on our <a href="https://www.tandfonline.com/doi/abs/10.1080/15551393.2020.1862663">camera rolls</a> make it onto our social media feeds. It is also why we often edit our photos to show our best sides.</p> <p>But in other contexts, such as press photography, the <a href="https://www.ap.org/about/news-values-and-principles/telling-the-story/visuals">rules are much stricter</a>. The Associated Press, for example, bans all edits beyond simple crops, colour adjustments, and “minor adjustments” that “restore the authentic nature of the photograph”.</p> <p>Professional photojournalists haven’t always gotten it right, though. While the majority of lens-based news workers adhere to ethical guidelines like those published by the <a href="https://nppa.org/resources/code-ethics">National Press Photographers Association</a>, others have let deadline pressures, competition and the desire for exceptional imagery cloud their judgement.</p> <p>One such example was in 2017, when British photojournalist Souvid Datta admitted to <a href="https://time.com/4766312/souvid-datta/">visually plagiarising</a> another photographer’s work within his own composition.</p> <blockquote class="twitter-tweet"> <p dir="ltr" lang="en">Photographer Souvid Datta appears to have plagiarized Mary Ellen Mark: <a href="https://t.co/iO1Lm8CowU">https://t.co/iO1Lm8CowU</a> <a href="https://t.co/jswHyApGNj">pic.twitter.com/jswHyApGNj</a></p> <p>— PetaPixel (@petapixel) <a href="https://twitter.com/petapixel/status/859824132258537472?ref_src=twsrc%5Etfw">May 3, 2017</a></p></blockquote> <p>Concerns around false or misleading visual information are at an all-time high, given advances in <a href="https://theconversation.com/nine-was-slammed-for-ai-editing-a-victorian-mps-dress-how-can-news-media-use-ai-responsibly-222382">generative artificial intelligence (AI)</a>. In fact, this year the World Economic Forum named the risk of misinformation and disinformation as the world’s greatest <a href="https://www.weforum.org/agenda/2024/01/ai-disinformation-global-risks/">short-term threat</a>. It placed this above armed conflict and natural disasters.</p> <h2>What to do if you’re unsure about an image you’ve found online</h2> <p>It can be hard to keep up with the more than <a href="https://theconversation.com/3-2-billion-images-and-720-000-hours-of-video-are-shared-online-daily-can-you-sort-real-from-fake-148630">3 billion photos</a> that are shared each day.</p> <p>But, for the ones that matter, we owe it to ourselves to slow down, zoom in and ask ourselves a few simple <a href="https://www.aap.com.au/factcheck-resources/how-we-check-the-facts/">questions</a>:</p> <p>1. Who made or shared the image? This can give clues about reliability and the purpose of making or sharing the image.</p> <p>2. What’s the evidence? Can you find another version of the image, for example, using a <a href="https://tineye.com/">reverse-image search engine</a>?</p> <p>3. What do trusted sources say? Consult resources like <a href="https://www.aap.com.au/factcheck/">AAP FactCheck</a> or <a href="https://factcheck.afp.com/">AFP Fact Check</a> to see if authoritative sources have already weighed in.<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/225553/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><a href="https://theconversation.com/profiles/t-j-thomson-503845">T.J. Thomson</a>, Senior Lecturer in Visual Communication &amp; Digital Media, <em><a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a></em></p> <p>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/yes-kate-middletons-photo-was-doctored-but-so-are-a-lot-of-images-we-see-today-225553">original article</a>.</p> <p><em>Hero image: The Conversation / X / Instagram</em></p>

Technology

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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>

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Why a familiar face made Adele break down on stage

<p dir="ltr">Adele has broken down during an emotional show in Las Vegas, after she locked eyes with a special audience member. </p> <p dir="ltr">The British songstress was performing at her residency show with a special Halloween show when she spotted a familiar face in the crowd.</p> <p dir="ltr">While dressed as Morticia from the Addams Family for the spooky-themed concert, Adele began to perform her hit song <em>When We Were Young</em> from her award-winning album <em>25</em>. </p> <p dir="ltr">She suddenly burst into tears and ran into the audience, as she spotted the doctor who delivered her son Angelo ten years ago. </p> <p dir="ltr">Adele could be seen mouthing “Shut up!” in between lines of the heartbreaking ballad, as she couldn't believe what she was seeing.</p> <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-permalink="https://www.instagram.com/reel/Cy_HGsFrr7Q/?utm_source=ig_embed&amp;utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/reel/Cy_HGsFrr7Q/?utm_source=ig_embed&amp;utm_campaign=loading" target="_blank" rel="noopener">A post shared by 𝒜𝒹𝑒𝓁𝑒 𝐿𝒶𝓊𝓇𝒾𝑒 𝐵𝓁𝓊𝑒 𝒜𝒹𝓀𝒾𝓃𝓈 (@thirtyfreeadele)</a></p> </div> </blockquote> <p dir="ltr">“Oh my god, Colin! Oh my god! This is my doctor that gave birth to my baby!”</p> <p dir="ltr">“I haven't seen you for years!” she exclaimed, as she paused the song and ran up into the audience.</p> <p dir="ltr">As Adele caught up with her long-lost friend, the tune continued playing in the background. </p> <p dir="ltr">The singer apologised to her fans as she was caught up in the emotional moment.</p> <p dir="ltr">“Sorry!” she said to the crowd. “Will you sing it for me? That man delivered my baby!”</p> <p dir="ltr">Fans on Twitter rushed to praise the touching moment and Adele's sweet gesture to the doctor. </p> <p dir="ltr">One said, “This is so heartwarming,” while another added, “That's just the coolest thing ever!”</p> <p dir="ltr"><em>Image credits: Instagram</em></p>

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All the reasons you might be having night sweats – and when to see a doctor

<p><em><a href="https://theconversation.com/profiles/siobhan-banks-18473">Siobhan Banks</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/linda-grosser-1461631">Linda Grosser</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a></em></p> <p>You’ve finished a workout, so you’re hot and drenched with perspiration – but soon you begin to feel cool again. Later, it’s a sweltering summer evening and you’re finding it hard to sleep, so you kick off the covers.</p> <p>Sweating is a normal part of the body’s cooling system, helping to release heat and maintain optimal body temperature. But regularly waking up during the night, soaked through from excessive sweating is not.</p> <p>Night sweats are <a href="https://www.mayoclinic.org/symptoms/night-sweats/basics/definition/sym-20050768">repeated episodes</a> of excessive or intense sweating at night. They are an unpleasant part of life for many people.</p> <p>Many conditions and factors can trigger night sweats by changing the body’s tightly regulated temperature set point, at which the body attempts to maintain its <a href="https://www.tandfonline.com/doi/full/10.4161/temp.29702">core temperature</a>. Some triggers are harmless (a hot bedroom) or even related to positive lifestyle changes (exercise). Others have an underlying cause like menopause, infection, disease or medication.</p> <h2>Temperature control and sweating</h2> <p>The hypothalamus, located in the brain, is part of the <a href="https://www.hormones-australia.org.au/the-endocrine-system/">endocrine system</a> and the temperature control centre for the body. It contains <a href="https://www.statpearls.com/point-of-care/29920#ref_19631766">temperature sensors</a> that receive information from nerve cells (thermoreceptors) located centrally (in the organs) and peripherally in the skin.</p> <p>Thermoreceptors detect changes in body temperature, sending signals back to the hypothalamus. These <a href="https://www.sciencedirect.com/science/article/pii/S1876034111000256">signals</a> will either activate sweating to cool the body or shivering to warm the body.</p> <h2>Hormones and night sweats</h2> <p>Anyone, regardless of age or gender, can experience night sweats. But women experience night sweats more often than men, largely because menopause and associated changing hormone levels are <a href="https://www.tandfonline.com/doi/abs/10.3109/13697137.2011.608596">a leading cause</a>.</p> <p>Approximately 80% of women experience <a href="https://link.springer.com/article/10.1007/s00737-007-0209-5">hot flashes</a> (also called hot flushes) or night sweats after <a href="https://www.menopause.org.au/hp/information-sheets/what-is-menopause">menopause</a> (when periods have ceased for 12 months) and during <a href="https://www.healthdirect.gov.au/perimenopause">perimenopause</a> (the time leading up to it).</p> <p>While both hot flashes and night sweats produce a feeling of overheating, they are different experiences associated with menopause. Hot flashes occur during the day, are transient episodes of flushing and may involve sweating. Night sweats occur at night and involve an intense period of <a href="https://www.proquest.com/docview/2821423865?accountid=14649">sweating</a>. Changing oestrogen levels are thought to impact norepinephrine and serotonin levels, two neurotransmitters that influence <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459071/#:%7E:text=%5B21%5D%20Estrogens%20stimulate%20the%20production,norepinephrine%20which%20disturbs%20hypothalamic%20thermostat">temperature regulation</a> in the hypothalamus.</p> <p>Hormones also influence night sweats in men, particularly those with low <a href="https://www.healthdirect.gov.au/testosterone">testosterone</a> levels, known as <a href="https://www.hormones-australia.org.au/endocrine-diseases/hypogonadism/">hypogonadism</a>. Around 38% of men aged 45 years or older have low testosterone <a href="https://www.scielo.br/j/ibju/a/RZqqfTn5tY6BFpV6rp3GMxJ/">levels</a> but it can affect men at any age.</p> <h2>Infections, disease and medications</h2> <p>When fighting infection, our body temperature often <a href="https://europepmc.org/article/nbk/nbk562334">rises</a>. This can stimulate sweating to cool and decrease body <a href="https://www.sciencedirect.com/science/article/pii/S1876034111000256">temperature</a>.</p> <p>Minor infections like the common cold can cause night sweats. They are also a symptom of serious infections such as human immunodeficiency virus (HIV) and diseases such as <a href="https://www.aafp.org/pubs/afp/issues/2020/0101/p34.html">Hodgkin’s</a> and <a href="https://link.springer.com/article/10.2165/00002018-200831020-00002">non-Hodgkin’s lymphoma</a>. However, night sweats are rarely the only symptom present.</p> <p>Medications such as selective serotonin reuptake inhibitors (SSRIs), corticosteroids, thyroid hormone replacement and methadone can cause night sweats. These medications affect parts of the <a href="https://link.springer.com/article/10.2165/00002018-200831020-00002">brain</a> and neurotransmitters that control and stimulate sweating.</p> <p>Regular alcohol (particularly alcohol dependence) and recreational drug use can also <a href="https://link.springer.com/article/10.2165/00002018-200831020-00002">increase the risk</a> of night sweats.</p> <h2>Stress, snoring and strenuous exercise</h2> <p>Night sweats are commonly reported by people with <a href="https://karger.com/spp/article-abstract/26/2/92/295722/Psychological-Sweating-A-Systematic-Review-Focused?redirectedFrom=fulltext">anxiety</a>.</p> <p>Psychological stress activates the body’s fight or flight system releasing neurotransmitters that increase heart rate, respiration, and blood pressure. This causes the body to heat up, at which point it starts sweating to cool the body back down. Night sweats may also increase anxiety, causing more sweating which in turn leads to less sleep and more anxiety.</p> <p>If anxiety causes night sweats and this causes distress, it’s best to get up, move around and engage in a <a href="https://www.calmclinic.com/anxiety/symptoms/night-sweats">calming routine</a>, preferably in a dark or dimly lit room.</p> <p>Night sweats have similarly been connected with sleep disorders like <a href="https://www.healthdirect.gov.au/obstructive-sleep-apnoea">obstructive sleep apnoea</a>, where the airway is repeatedly blocked during sleep and there is loud snoring. About one third of people with obstructive sleep apnoea regularly <a href="https://link.springer.com/article/10.1007/s11325-011-0502-4">experience night sweats</a>. The exact cause is undetermined but research shows it is linked with low blood oxygen levels (<a href="https://link.springer.com/article/10.1007/s11325-022-02701-3">hypoxemia</a>) and/or <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2869.2009.00743.x">high blood pressure</a>.</p> <p>People can experience night sweats after high-intensity workouts. Vigorous exercise can stimulate the thyroid, <a href="https://www.ncbi.nlm.nih.gov/books/NBK500006/#:%7E:text=Thyroid%20hormone%20increases%20the%20basal,respiration%20rate%2C%20and%20body%20temperature">increasing basal metabolic rate</a> and body temperature for up to <a href="https://journals.lww.com/acsm-msse/Fulltext/2011/09000/A_45_Minute_Vigorous_Exercise_Bout_Increases.6.aspx">14 hours post exercise</a>. So night sweats can occur even after a vigorous morning workout.</p> <p>Night sweats can indicate overtraining and/or under-fuelling. If not enough calories are consumed to support the increase in training, blood sugar could drop and you could experience <a href="https://www.aafp.org/pubs/afp/issues/2003/0301/p1019.pdf">hypoglycaemia</a>, which can cause night sweats.</p> <h2>When to seek help and 5 things to try</h2> <p>There are <a href="https://www.aafp.org/pubs/afp/issues/2020/1001/p427.html">numerous</a> health conditions and medications that can cause night sweats and interfere with sleep.</p> <p>If night sweats are regular, distressing, interfere with sleep or are accompanied by symptoms such as fatigue or weight loss (not related to lifestyle or diet changes) talk to a doctor to help determine the cause. They might suggest alternative medications to any you’re taking or recommend tests or investigations.</p> <p>In the meantime, you can try the following ideas:</p> <p><strong>1.</strong> sleep in a cool room and use a fan if needed</p> <p><strong>2.</strong> don’t overdress for bed. Wear breathable cotton or linen pyjamas</p> <p><strong>3.</strong> choose lightweight bedding you can kick off. Avoid synthetic fibres and flannel bedding</p> <p><strong>4.</strong> consider a cooling mattress or pillow and avoid those (such as foam ones) that can limit airflow</p> <p><strong>5.</strong> avoid spicy foods, caffeine or alcohol before bed.<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/211436/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><a href="https://theconversation.com/profiles/siobhan-banks-18473"><em>Siobhan Banks</em></a><em>, Research professor, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/linda-grosser-1461631">Linda Grosser</a>, , <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South 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/all-the-reasons-you-might-be-having-night-sweats-and-when-to-see-a-doctor-211436">original article</a>.</em></p>

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Woman dies after being accused by doctors of faking symptoms

<p>A woman from New Zealand has passed away from a debilitating illness after being told by a doctor that her illness was “all in her head”.</p> <p>Stephanie Aston, 33, died after a long and public battle with Ehlers-Danlos Syndrome (EDS), a rare  genetic disorder affecting the body’s connective tissue, on September 1st. </p> <p>EDS, of which there are 13 different variants, is often referred to as an "invisible illness", as sufferers can often appear healthy despite experiencing excruciating symptoms, such as severe migraines, dislocating joints, easy bruising, abdominal pain, iron deficiency, fainting and an abnormally fast heart-rate.</p> <p>Aston said she was dismissed by a doctor in 2016, who dismissed her symptoms and told her that she was faking her disease. </p> <p>Despite being diagnosed with EDS by three different specialists, one doctor in Auckland, who Aston referred to as 'Doctor A', suggested she was not seriously unwell and indicated she was causing her illnesses, <em><a href="https://www.nzherald.co.nz/nz/stephanie-aston-death-eds-sufferers-call-for-change-after-doctors-accused-woman-of-faking-illness/VX4Q6CAWRVH25I6OCKGQ4KTW4M/">The NZ Herald</a></em> reports.</p> <p>Ehlers-Danlos Syndromes New Zealand founder Kelly McQuinlan said Stephanie's death has shocked the community, and said more needs to be done for those suffering with the debilitating condition. </p> <p>“A lot of people are feeling very lost,” she said.</p> <p>“I think most people in these rare positions or invisible illnesses, definitely experience setbacks and disbelieving because things can’t be seen but really the clinical symptoms are there that are being ignored.”</p> <p>Ms McQuinlan described Ms Aston as a “beacon” for those with the illness in a tribute to her on Facebook.</p> <p>“Most people in our community have experienced some form of sort of doctors not believing them or questioning their diagnosis which is extremely hard,” she wrote.</p> <p>“When they see someone in their community pass away, the first thing they think is ‘What if my care is not looked after? What’s going to happen to me?’.”</p> <p>“At the end of the day, if symptoms aren’t managed correctly, anyone can get sick enough that they will pass away.”</p> <p><em>Image credits: Facebook</em></p>

Caring

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6 silent signs you’re being lied to

<h4>Is there a liar in the room?</h4> <p>Lies occur between friends, teachers and students, husbands and wives, lawyers and clients – yet nobody wants to be caught.</p> <p>“I’ve interviewed crooks more apt to admit to a major crime than to lying,” says Glenn Woods, a criminal profiler, who’s been studying deceptive behaviour for more than a decade. “Everybody lies to some degree.”</p> <p>Of course, there’s a gulf that separates little white lies from the whoppers, but learning how to tell if someone is lying is a skill that’ll always come in handy. Here’s what to watch for.</p> <p><strong>1. Listen to the voices</strong></p> <p>Pay attention to voice changes like change in pitch or cracking; they may well indicate deceit.</p> <p>“A person’s voice pitch tends to be a bit higher when they’re lying than when they’re telling the truth,” says Dr Mary Ann Campbell, assistant professor of psychology. “It doesn’t mean they’re lying for sure, but there’s a higher likelihood.”</p> <p><strong>2. Watch those words</strong></p> <p>What about written material? Can we spot misleading behaviour in letters, emails and even resumés?</p> <p>Professor David Skillicorn and his students in the School of Computing at Queen’s University in Kingston, Ontario, created software – based on the deception model developed at the University of Texas at Austin – that can sniff out lies in emails and other written material by studying the frequency and kinds of words used. Skillicorn says liars tend to use fewer exclusive words such as but, or and except. They also tend to use more negative-emotion words such as ashamed, upset and embarrassed. “These are the words that send up red flags,” says Skillicorn. “It’s as though some part of the brain is feeling bad and this comes out in the writing.”</p> <p><strong>3. Look past shifty eyes</strong></p> <p>While most people may interpret darting, unfocused eyes as a classic sign of lying, it’s vital to consider the context of the behaviour. For example, experienced poker players are careful not to make too much of eye “tells.” People usually look to the left or right when thinking about an answer. Someone not making eye contact should arouse suspicion, but eye contact, cautions Woods, can be a tricky evaluation tool: consider that a psychopath can look you in the eye and lie with ease. And in some cultures, it’s considered inappropriate to maintain eye contact.</p> <p><strong>4. Get better at body language</strong></p> <p>Even though a high percentage of communication is thought to be non-verbal, no single part of the body – such as the eyes or hands – reveals the whole story when it comes to lying. Campbell says people who are lying often become more still: Hand gestures that normally accompany talking may occur with less frequency or intensity, and there may be fewer arm and leg movements. “The person becomes more focused on telling the lie,” explains Campbell, “so they get quieter in their body.”</p> <p><strong>5. Ask questions – quickly</strong></p> <p>If you suspect you’re being deceived, try this technique, which experts say can trip up a liar.</p> <p>Try asking questions quickly – one after the other. “The initial lie is easy,” explains Kang Lee, professor at the Ontario Institute for Studies in Education’s Department of Applied Psychology and Human Development. “The follow-up lie is more difficult. When you continue to ask questions and put people on the spot, it gets harder to maintain the lie.”</p> <p><strong>6. Check for emotional “leaks”</strong></p> <p>Micro-expressions that flit across the face often expose a person’s real thoughts. “If you were to watch people on videotape, frame by frame, you would see them showing their true emotion just before they show the fake expression designed to cover up the lie,” says Campbell.</p> <p>But these ultra-brief facial movements, some only lasting a quarter of a second, aren’t easy to spot. Even professionals trained in lie detection can’t always isolate them. And deliberate liars tend to add other expressions, like smiling, to disguise a lie.</p> <p>So, here’s hoping that the next time someone lobs a lie your way, you’ll know just how to catch it.</p> <p><em>Image: Getty</em></p> <p><em>This article is written by </em><em>Diane Sewell</em><em style="font-family: -apple-system, BlinkMacSystemFont, 'Segoe UI', Roboto, Oxygen, Ubuntu, Cantarell, 'Open Sans', 'Helvetica Neue', sans-serif;"> originally appeared on <a href="https://www.readersdigest.co.nz/true-stories-lifestyle/relationships/6-silent-signs-youre-being-lied-to" target="_blank" rel="noopener">Reader's Digest</a>.</em></p>

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Should GPs bring up a patient’s weight in consultations about other matters? We asked 5 experts

<p><em><a href="https://theconversation.com/au/team#fron-jackson-webb">Fron Jackson-Webb</a>, <a href="http://www.theconversation.com/">The Conversation</a></em></p> <p>Australian of the Year and body positivity advocate Taryn Brumfitt has <a href="https://www.smh.com.au/healthcare/doctors-should-avoid-discussing-patient-s-weight-australian-of-the-year-says-20230707-p5dmhv.html">called for</a> doctors to avoid discussing a patient’s weight when they seek care for unrelated matters.</p> <p>A 15-minute consultation isn’t long enough to provide support to change behaviours, Brumfitt says, and GPs don’t have enough training and expertise to have these complex discussions.</p> <p>“Many people in larger bodies tell us they have gone to the doctor with something like a sore knee, and come out with a ‘prescription’ for a very restrictive diet, and no ongoing support,” Brumfitt <a href="https://www.smh.com.au/healthcare/doctors-should-avoid-discussing-patient-s-weight-australian-of-the-year-says-20230707-p5dmhv.html">told the Nine newspapers</a>.</p> <p>By raising the issue of weight, Brumfitt says, GPs also risk turning patients off seeking care for other health concerns.</p> <p>So should GPs bring up a patient’s weight in consultations about other matters? We asked 5 experts.</p> <p><strong>Brett Montgomery - GP academic</strong></p> <p>Yes, sometimes – but with great care.</p> <p>I agree that weight stigma is damaging, and insensitively raising weight in consultations can <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251566" target="_blank" rel="noopener">hurt people's feelings and create barriers</a>to other aspects of health care.</p> <p>I also agree people can sometimes be “overweight” yet <a href="https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0287218" target="_blank" rel="noopener">quite healthy</a>, and that common measures and categories of weight are <a href="https://theconversation.com/bmi-alone-will-no-longer-be-treated-as-the-go-to-measure-for-weight-management-an-obesity-medicine-physician-explains-the-seismic-shift-taking-place-208174">questionable</a>.</p> <p>On the other hand, I know obesity <a href="https://www.racgp.org.au/FSDEDEV/media/documents/RACGP/Position%20statements/Obesity-prevention-and-management.pdf" target="_blank" rel="noopener">is associated with</a> heart disease, joint problems, diabetes and cancers.</p> <p>GPs should be ready to help people with their weight when they want help. <a href="https://www.bmj.com/content/377/bmj-2021-069719.full?ijkey=FnARkmvxLOMFvlb&amp;keytype=ref">Our assistance somewhat effective</a>, though sadly dietary efforts often have minimal effect on weight in the long term. Meanwhile, treatments causing larger weight changes (<a href="https://insightplus.mja.com.au/2021/10/bariatric-surgery-public-system-access-still-terrible/">surgery</a> and <a href="https://www.nature.com/articles/s41366-022-01176-2">some medicines</a> are often financially inaccessible.</p> <p>I feel safe discussing weight when my patient raises the issue. Fearing hurting people, I often avoid raising it myself. I focus instead on health rather than weight, discussing physical activity and healthy diet – these are good things for people of any size.</p> <p><strong>Emma Beckett - Nutrition scientist</strong></p> <p>No. It’s not likely to succeed. Large systematic reviews bringing together multiple studies of multiple weight-loss diets show weight loss is not generally maintained long term (<a href="https://pubmed.ncbi.nlm.nih.gov/32238384/">12 months</a> to <a href="https://www.nature.com/articles/0802982">four years</a>).</p> <p>The idea that weight is about willpower is outdated. The current body of evidence <a href="https://theconversation.com/whats-the-weight-set-point-and-why-does-it-make-it-so-hard-to-keep-weight-off-195724">suggests</a> we each have a weight set point that our body defends. This is determined by genetics and environment more so than education.</p> <p>There may be associations between weight and health outcomes, but losing weight <a href="https://theconversation.com/just-because-youre-thin-doesnt-mean-youre-healthy-101185">does not necessarily equate</a> with improving health.</p> <p>Fat stigma and fatphobia are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866597/">harmful too</a> and can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381543/">compromise access to health care</a>.</p> <p>Instead, consider asking a better question. Healthy eating reduces disease risk <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935663/">regardless of weight</a>. So maybe ask how many vegetables are your patients eating. Would they like to see a dietitian to discuss strategies for a better-quality diet?</p> <p><strong>Liz Sturgiss - GP/researcher </strong></p> <p>No. A <a href="https://pubmed.ncbi.nlm.nih.gov/33211585/">US study</a> estimates it would take a family doctor 131% of their work hours to implement all preventive health-care recommendations. It's impossible to address every recommendation for preventative care at every consultation. One of the key skills of a GP is balancing the patient and doctor agenda.</p> <p><a href="https://www.obesityevidencehub.org.au/collections/treatment/weight-bias-and-stigma-in-health-care">Weight stigma</a> can deter people from seeking health care, so raising weight when a patient doesn't have it on their agenda can be harmful. A strong <a href="https://academic.oup.com/fampra/article/38/5/644/6244494?login=false">therapeutic relationship</a> is critical for safe and effective health care to address weight. </p> <p>Weight is always on my agenda when there is unexpected weight loss. If a patient has rapid weight loss, I am concerned about an undetected <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7283307/">cancer</a> or infection. Additionally, I am increasingly seeing patients who are unable to afford food, who often have <a href="https://www.aihw.gov.au/reports/dental-oral-health/oral-health-and-dental-care-in-australia/contents/introduction">poor oral health</a>, who lose weight due to <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/1747-0080.12580">poverty</a>. Weight loss for the wrong reasons is also a very concerning part of general practice.</p> <p><strong>Nick Fuller - Obesity researcher </strong></p> <p>Yes. GPs should play a role in the early detection of weight issues and direct patients to evidence-based care to slow this progression. <a href="https://pubmed.ncbi.nlm.nih.gov/31032548/">Research</a> shows many people with obesity are motivated to lose weight (48%). <a href="https://pubmed.ncbi.nlm.nih.gov/31032548/">Most</a> want their clinician to initiate a conversation about weight management and treatment options.</p> <p>However, this conversation <a href="https://pubmed.ncbi.nlm.nih.gov/32385580/">rarely occurs</a>, resulting in <a href="https://pubmed.ncbi.nlm.nih.gov/33621413/">significant delays to treatment</a>.</p> <p>Starting the conversation presents challenges. Although obesity is a complex disease related to multiple factors, it's still <a href="https://pubmed.ncbi.nlm.nih.gov/25752756/">highly stigmatised</a>in our society and even in the <a href="https://pubmed.ncbi.nlm.nih.gov/23144885/">clinical setting</a>. Sensitivity is required and the wording the clinician uses is important to make the patient feel safe and avoid placing blame on them. Patients often <a href="https://pubmed.ncbi.nlm.nih.gov/20823355/">prefer terms</a> such as “weight” and “BMI” (body mass index) over “fatness,” “size” or “obesity”, <a href="https://pubmed.ncbi.nlm.nih.gov/27354290/">particularly women</a>.</p> <p>Measuring weight, height and waist circumference should be <a href="https://pubmed.ncbi.nlm.nih.gov/33621413/">considered routine in primary care</a>. But this needs to be done without judgement, and in collaboration with the patient.</p> <p><strong>Helen Truby - Nutrition scientist </strong></p> <p>Yes. A high body weight contributes to many chronic conditions that negatively impact the <a href="https://www.aihw.gov.au/australias-health/summaries">quality of life and mental health</a> of millions of Australians.</p> <p>Not all GPs feel confident having weight conversations, given the sensitive nature of weight and its stigma. GPs' words matter – they are a <a href="https://doi.org/10.1111/nbu.12320">trusted source</a> of health information. It’s critical GPs gain the skills to know when and how to have <a href="https://doi.org/10.1186/s12875-019-1026-4">positive weight conversations</a>.</p> <p>GPs need to offer supportive and affordable solutions. But effective specialist weight management programs are few and far between. More equitable access to programs is essential so GPs have referral pathways after conversations about weight.</p> <p>GPs' time is valuable. Activating this critical workforce is essential to meet the <a href="https://www.health.gov.au/resources/publications/national-obesity-strategy-2022-2032?language=en">National Obesity Strategy.</a></p> <p><em><a href="https://theconversation.com/au/team#fron-jackson-webb">Fron Jackson-Webb</a>, Deputy Editor and Senior Health Editor, <a href="http://www.theconversation.com/">The Conversation</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/should-gps-bring-up-a-patients-weight-in-consultations-about-other-matters-we-asked-5-experts-209681">original article</a>.</em></p>

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Doctor debunks air fryer myth

<p>Air fryers have become somewhat of a commodity in many kitchens worldwide, with them rising in popularity over the past few years, so news that they could be damaging to our health may cause quite a stir.</p> <p>However, similar to how uncredited information seems to circle the internet, a doctor has told viewers not to take the latest warnings over “toxic” air fryers too seriously.</p> <p>One online user posted a TikTok claiming they had found out "air fryers were toxic because of the material used”, so UK doctor Karan Raj decided to weigh in on the matter.</p> <p>"The biggest worry from fear mongers centres around the non-stick materials used, also known as forever chemicals,” he said in a clip that’s since raked in over a million views.</p> <p>"Forever chemicals” earned the name because they don’t break down in the environment or in our bodies. Also known as PFAS, they are resistant to water, grease, and heat and are found in a number of everyday products such as food packaging, cosmetics, clothing and toilet paper.</p> <p>"Fun fact, every time you sit down to eat microplastics fall from the air and land in your food, or are already part of your food," he explained.</p> <p>The issue of “toxic” chemicals leeching into your food from cooking in an air fryer "is only really an issue if the air fryer is damaged,” Dr Raj added.</p> <p>It is recommended to minimise how much damage and scratching there is to the non-stick coating of the fryer so the chemicals don’t get into your food.</p> <p>"Clean it safely, avoid using abrasive scrubbing tools, use wood or silicone utensils and use liners," he said.</p> <p>"And if you're really worried about the non-stick coating, you can use a ceramic or stainless steel air fryer.”</p> <p>People in the comments thanked him for the explanation. " Some people will trust anyone EXCEPT actual Doctors,” one user teased.</p> <p>Dr Raj went on to ask his followers what their favourite meal to cook in an air fryer was, adding, "Air fried chips just taste special".</p> <p><em>Image credit: TikTok</em></p>

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5 ways alcohol can sabotage your weight loss goals, according to an obesity doctor

<p><strong>Alcohol and weight loss </strong></p> <p>“Hey Siri, can I still lose weight if I drink alcohol?” Goodness, we only wish the answer was that simple. Research is mixed (no pun intended) on whether alcohol can lead to weight gain. That’s because weight is complex – and some people notice a shift on the scale when they consume alcohol, while others don’t.</p> <p>As a doctor who specialises in the science of weight, I can say what we do know is that many of these alcoholic drinks are energy-dense (meaning high in kilojoules) and provide little to no nutrition, which may put a damper on your weight loss efforts. Here are five major reasons alcohol can impede you weight loss efforts.</p> <p><strong>Your body views alcohol as a toxin</strong></p> <p>Your body metabolises and eliminates alcohol from the body with the help of two enzymes: Alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH). When you imbibe, these two work together to break apart the alcohol molecules, producing a toxic substance, acetaldehyde, then acetate, so that your body can get rid of it – and fast.</p> <p>Here’s why that matters when you’re trying to lose weight. Since your body prioritises alcohol digestion, it puts digestion of other nutrients (like fat, carbs, and protein) on the back burner. In other words, your body might put off metabolising fat and carbs when it’s busy breaking down alcohol. Over time and repeated patterns, this could lead to increased fat storage and weight gain.</p> <p><strong>Alcohol can cause inflammation</strong></p> <p>Alcohol can impair the functions of the gut, liver, and other organs – interfering with the immune system and causing systemic inflammation. Alcohol consumption stimulates a cascade of inflammatory responses, one of which is the release of cortisol, the stress hormone. And research has shown that persistently high levels of cortisol are associated with obesity. That’s why it’s best for people with obesity, who are already at an increased risk of inflammation, to limit or avoid alcohol.</p> <p><strong>Alcohol affects sleep - and sleep impacts weight </strong></p> <p>It may seem like that nightcap helps you fall asleep, but alcohol can actually disrupt how well you snooze. One study, which looked at participants’ heart rates and ability to relax during sleep, showed that even small amounts (0.25 grams per kilogram or less) of alcohol decreased those markers of quality of sleep by 9.3%.</p> <p>And the more you drink, the worse you sleep – the same study linked moderate drinking to a 24% decrease in sleep quality, and heavy drinking to a 39.2% decrease in sleep quality.</p> <p>You may think a few nights of low-quality shut-eye is harmless, but research has shown that just one to three nights of poor sleep can lead to insulin resistance. Over time, that could put you at risk of obesity.</p> <p><strong>Alcohol is often full of sneaky of sneaky kilojoules and sugar</strong></p> <p>Many mixed drinks, tasty as they might be, contain added kilojoules and sugar on top of the naturally occurring sugars and kilojoules in alcohol.</p> <p>Even a so-called “lower-kilojoule” option, like a vodka tonic, can have as many kilojoules and grams of sugar as a serving of ice cream. Before you know it, your 30ml serving of vodka just jumped from 280 kilojoules to 700 kilojoules when you add 200ml of tonic. Have a few of those, and you’re looking at upwards of 2000 or more kilojoules on liquid alone – kilojoules that don’t provide your body with the best nutrition.</p> <p>Let’s compare these 2000 kilojoules in a few vodka tonics to a 2000-kilojoule meal of salmon, brown rice, and steamed veggies. The drinks are empty kilojoules, whereas the meal has fat, fibre and protein to keep you fuller and satisfied for longer – a win-win while trying to lose weight – while also providing high-quality nourishment.</p> <p><strong>Drinking impacts food choices</strong></p> <p>Have you ever noticed after drinking alcohol, you get a sudden hankering for a fast food run or pizza delivery? That’s because alcohol can impair decision-making and lead to impulse decisions when it comes to food – and research suggests it may even stimulate the appetite. Those who drink alcohol with a meal also tend to eat more – 30% more, according to one study.</p> <p>While alcohol won’t impact everyone’s weight the same way, it’s best to be mindful of how much you drink when trying to lose weight. Consider skipping it altogether or aim for moderation. Just know that even if you follow the limit for moderate drinking as recommended in the Australian Alcohol Guidelines by the National Health and Medical Research Council (NHMRC) —no more than 10 standard drinks a week and no more than 4 standard drinks on any one day – it still adds up over time. Several studies have shown that the risk of obesity is roughly two times higher in adults who consume alcohol than in those who don’t.</p> <p>Considering mocktails (non-alcoholic beverages) are popping up on more and more bar menus these days, rest assured your after-work social hour will still be filled with cheers. Just be sure to opt for a lower-kilojoule option, such as soda water with a squeeze of fresh lime or a craft mocktail with half the amount of simple syrup.</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a href="https://www.readersdigest.co.nz/healthsmart/diet/5-ways-alcohol-can-sabotage-your-weight-loss-goals-according-to-an-obesity-doctor" target="_blank" rel="noopener">Reader's Digest</a>. </em></p>

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Longevity doctor shares secret to a long life

<p dir="ltr">A doctor who specialises in the science of longevity has shared his secret for living longer, and it's much more simple than you would think. </p> <p dir="ltr">Dr Peter Attia, a U.S.-Canadian physician, says exercising for just three hours a week is not only essential for a healthy lifestyle, but can reduce your chances of an early death by 50 per cent.</p> <p dir="ltr">“Exercising is the most underutilised change we can make to affect the length and quality of our life,” Dr Attia said.</p> <p dir="ltr">He encouraged everyone to include both strength training and cardiovascular fitness into regular exercise routines, and to eat enough protein in a balanced diet. </p> <p dir="ltr">“You want to make sure you're covering all your bases and that means both lifting weights, because strength is one of the most highly associated features with longevity, but also doing cardiorespiratory fitness,” he told the Sunrise breakfast show. </p> <p dir="ltr">Dr Attia believes that, in simple terms, if you're starting from zero, exercising for just 30 minutes a day, six days a week, can half your death rate.</p> <p dir="ltr">However, he said the “right” amount of exercise a person should be doing per week is dependent on an individuals’ level of fitness.</p> <p dir="ltr">While Dr Attia shared the physical benefits of regular exercise, he also reiterated how important daily movement is for mental health. </p> <p dir="ltr">“What we know is exercise is the single biggest elixir for brain health. And it's amazing how much more powerful it appears to be than nutrition, even sleep. And those things are very important, but exercise is on a league of its own,” he said.</p> <p dir="ltr">“I thought there had to be something more powerful. But as important as sleep [and] nutrition are, exercise kind of takes the cake.”</p> <p dir="ltr"><em>Image credits: Instagram</em></p>

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Gastro or endometriosis? How your GP discusses uncertainty can harm your health

<p>You wake with stomach pain that worsens during the day and decide to see your doctor. You describe your symptoms and your doctor examines you. Then the doctor says, “From what I hear, I think you could just have a stomach bug. Rest and come back in three days.”</p> <p>This might be a less definitive answer than you’re after. But doctors can’t always be sure of a diagnosis straight away. As <a href="https://link.springer.com/article/10.1007/s11606-022-07768-y">my review</a> shows, doctors use various ways of communicating such uncertainty.</p> <p>Sometimes there is a mismatch between what doctors say when they’re uncertain and how patients interpret what they say, which can have harmful consequences.</p> <h2>Why does uncertainty matter?</h2> <p>Doctors <a href="https://link.springer.com/article/10.1007/s11606-017-4164-1">cannot always explain</a> what your health problem is or what caused it. Such diagnostic uncertainty is a normal and <a href="https://doi.org/10.1001/jama.2022.2141">ever-present part</a> of the processes leading to a diagnosis. For instance, doctors often have to rule out other possible diagnoses before settling on one that’s most likely.</p> <p>While doctors ultimately get the diagnosis right <a href="http://dx.doi.org/10.1136/bmjqs-2012-001615">in 85-90%</a> of cases, diagnostic uncertainty can lead to diagnostic delays and is a huge contributor to harmful or even deadly misdiagnoses.</p> <p>Every year, <a href="https://www.mja.com.au/system/files/issues/213_07/mja250771.pdf">an estimated</a> 21,000 people are seriously harmed and 2,000-4,000 people die in Australia because their diagnosis was delayed, missed or wrong. That could be because the wrong treatment was provided and caused harm, or the right treatment was not started or given after the condition had already considerably progressed. More than <a href="https://www.mja.com.au/system/files/issues/213_07/mja250771.pdf">80% of diagnostic errors</a> could have been prevented.</p> <p>Three medical conditions – infections, cancer and major vascular events (such as strokes or heart attacks) – are the so-called “<a href="https://doi.org/10.1515/dx-2019-0019">Big Three</a>” and cause devastating harm if misdiagnosed.</p> <p>In my review, the top three symptoms – fever, chest pain and abdominal pain – were most often linked to diagnostic uncertainty. In other words, most of us will have had at least one of these very common symptoms and thus been at risk of uncertainty and misdiagnosis.</p> <p>Some groups are less likely to be diagnosed correctly or without inappropriate delay than others, leading to <a href="https://doi.org/10.1001/jama.2022.7252">diagnostic inequities</a>. This may be the case for <a href="https://www.liebertpub.com/doi/10.1089/whr.2022.0052">women</a>, and other groups marginalised because of their <a href="https://onlinelibrary.wiley.com/doi/10.1111/acem.14142">race or ethnicity</a>, <a href="https://doi.org/10.1016/j.socscimed.2020.113609">sexual orientation or gender identity</a>, or <a href="https://doi.org/10.1001/jama.2022.7252">language proficiency</a>.</p> <h2>How often do you hear ‘I don’t know’?</h2> <p>My research showed doctors often make diagnostic uncertainty clear to patients by using explicit phrases such as: “I don’t know.”</p> <p>But doctors can also keep quiet about any uncertainty or signal they’re uncertain in more subtle ways.</p> <p>When doctors believe patients prefer clear answers, they may only share the most likely diagnosis. They say: “It’s a stomach bug” but leave out, “it could also be constipation, appendicitis or endometriosis”. </p> <p>Patients leave thinking the doctor is confident about the (potentially correct or incorrect) diagnosis, and remain uninformed about possible other causes. </p> <p>This can be especially frustrating for patients with chronic symptoms, where such knowledge gaps can lead to lengthy diagnostic delays, as reported for <a href="https://doi.org/10.1016/j.ajog.2018.12.039">endometriosis</a>.</p> <p>Subtle ways of communicating uncertainty include hedging with certain words (could, maybe) or using introductory phrases (my guess, I think). Other implicit ways are consulting a colleague or the Internet, or making follow-up appointments.</p> <p>If patients hear “I think this could be a stomach bug” they may think there’s some uncertainty. But when they hear “come back in three days” the uncertainty may not be so obvious.</p> <p>Sharing uncertainty implicitly (rather than more directly), can leave patients unaware of new symptoms signalling a dangerous change in their condition.</p> <h2>What can you do about it?</h2> <p><strong>1. Ask about uncertainty</strong></p> <p>Ask your doctor to share any <a href="http://dx.doi.org/10.1515/dx-2021-0086">uncertainty and other diagnostic reasoning</a>. Ask about alternative diagnoses they’re considering. If you’re armed with such knowledge, you can better engage in your care, for example asking for a review when your symptoms worsen.</p> <p><strong>2. Manage expectations together</strong></p> <p>Making a diagnosis can be an evolving process rather than a single event. So ask your doctor to outline the diagnostic process to help manage any <a href="http://dx.doi.org/10.1136/ebm.14.3.66">mismatched expectations</a> about how long it might take, or what might be involved, to reach a diagnosis. Some conditions need time for symptoms to evolve, or further tests to exclude or confirm.</p> <p><strong>3. Book a long appointment</strong></p> <p>When we feel sick, we might get anxious or find we experience heightened levels of fear and other emotions. When we hear our doctor isn’t certain about what’s causing our symptoms, we may get even more anxious or fearful.</p> <p>In these cases, it can take time to discuss uncertainty and to learn about our options. So book a long appointment to give your doctor enough time to explain and for you to ask questions. If you feel you’d like some support, you can ask a close friend or family member to attend the appointment with you and to take notes for you.</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a href="https://theconversation.com/gastro-or-endometriosis-how-your-gp-discusses-uncertainty-can-harm-your-health-196943" target="_blank" rel="noopener">The Conversation</a>. </em></p>

Caring

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Man hides hefty lottery win from wife and child

<p dir="ltr">A Chinese man has kept his eye watering 219 million yuan (AUD$47,068,869) lottery win a secret from his wife and child so they don’t become lazy. </p> <p dir="ltr">Known only as Mr Li to conceal his identity, the man dressed up in a yellow cartoon costume when he accepted the huge win on October 24 at the lottery office in Nanning, in the southern region of Guangxi. </p> <p dir="ltr">“I did not tell my wife and child for fear that they would be too complacent and would not work or work hard in the future,” he told Nanning Evening News. </p> <p dir="ltr">Mr Li confessed that he bought 40 lottery tickets all of which had the same seven numbers, with the lottery company paying out 5.48 million yuan (AUD$1,177,811) for each ticket.</p> <p dir="ltr">Eventually he found out that he had the winning lottery numbers of 2, 15, 19, 26, 27, 29, and 2 and went to claim his prize.  </p> <p dir="ltr">After receiving the hefty sum, Mr Li donated 5 million yuan (AUD$1,074,597) to charity and is still unsure of what to do with his fortune.</p> <p dir="ltr">Mr Li has been playing the lottery for a decade and only won minor prizes until this time round.  </p> <p dir="ltr">“I regard buying the lottery as a hobby, and my family does not care. Plus, I do not spend much money on it, and the lottery provides a ray of hope for me,” he told the South China Morning Post. </p> <p dir="ltr"><em>Image: Guangxi Welfare Lottery Centre</em></p>

Money & Banking