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Alzheimer’s may have once spread from person to person, but the risk of that happening today is incredibly low

<a href="https://theconversation.com/profiles/steve-macfarlane-4722">Steve Macfarlane</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> An article published this week in the prestigious journal <a href="https://www.nature.com/articles/s41591-023-02729-2">Nature Medicine</a> documents what is believed to be the first evidence that Alzheimer’s disease can be transmitted from person to person. The finding arose from long-term follow up of patients who received human growth hormone (hGH) that was taken from brain tissue of deceased donors. Preparations of donated hGH were used in medicine to treat a variety of conditions from 1959 onwards – including in Australia from the mid 60s. The practice stopped in 1985 when it was discovered around 200 patients worldwide who had received these donations went on to develop <a href="https://www.vdh.virginia.gov/epidemiology/epidemiology-fact-sheets/creutzfeldt-jakob-disease-cjd/">Creuztfeldt-Jakob disease</a> (CJD), which causes a rapidly progressive dementia. This is an otherwise extremely rare condition, affecting roughly one person in a million. <h2>What’s CJD got to do with Alzehimer’s?</h2> CJD is caused by prions: infective particles that are neither bacterial or viral, but consist of abnormally folded proteins that can be transmitted from cell to cell. Other prion diseases include kuru, a dementia seen in New Guinea tribespeople caused by eating human tissue, scrapie (a disease of sheep) and variant CJD or bovine spongiform encephalopathy, otherwise known as mad cow disease. This raised <a href="https://en.wikipedia.org/wiki/United_Kingdom_BSE_outbreak">public health concerns</a> over the eating of beef products in the United Kingdom in the 1980s. <h2>Human growth hormone used to come from donated organs</h2> Human growth hormone (hGH) is produced in the brain by the pituitary gland. Treatments were originally prepared from purified human pituitary tissue. But because the amount of hGH contained in a single gland is extremely small, any single dose given to any one patient could contain material from around <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/00000563.htm">16,000 donated glands</a>. An average course of hGH treatment lasts around four years, so the chances of receiving contaminated material – even for a very rare condition such as CJD – became quite high for such people. hGH is now manufactured synthetically in a laboratory, rather than from human tissue. So this particular mode of CJD transmission is no longer a risk. <h2>What are the latest findings about Alzheimer’s disease?</h2> The Nature Medicine paper provides the first evidence that transmission of Alzheimer’s disease can occur via human-to-human transmission. The authors examined the outcomes of people who received donated hGH until 1985. They found five such recipients had developed early-onset Alzheimer’s disease. They considered other explanations for the findings but concluded donated hGH was the likely cause. Given Alzheimer’s disease is a much more common illness than CJD, the authors presume those who received donated hGH before 1985 may be at higher risk of developing Alzheimer’s disease. Alzheimer’s disease is caused by presence of two abnormally folded proteins: amyloid and tau. There is <a href="https://actaneurocomms.biomedcentral.com/articles/10.1186/s40478-017-0488-7">increasing evidence</a> these proteins spread in the brain in a <a href="https://pubmed.ncbi.nlm.nih.gov/8086126/">similar way to prion diseases</a>. So the mode of transmission the authors propose is certainly plausible. However, given the amyloid protein deposits in the brain <a href="https://www.nia.nih.gov/news/estimates-amyloid-onset-may-predict-alzheimers-progression">at least 20 years</a> before clinical Alzheimer’s disease develops, there is likely to be a considerable time lag before cases that might arise from the receipt of donated hGH become evident. <h2>When was this process used in Australia?</h2> In Australia, donated pituitary material <a href="https://www.health.gov.au/sites/default/files/documents/2022/07/the-cjd-review-final-report.pdf">was used</a> from 1967 to 1985 to treat people with short stature and infertility. <a href="https://www.health.gov.au/sites/default/files/documents/2022/07/the-cjd-review-final-report.pdf">More than 2,000 people</a> received such treatment. Four developed CJD, the last case identified in 1991. All four cases were likely linked to a single contaminated batch. The risks of any other cases of CJD developing now in pituitary material recipients, so long after the occurrence of the last identified case in Australia, are <a href="https://www.mja.com.au/journal/2010/193/6/iatrogenic-creutzfeldt-jakob-disease-australia-time-amend-infection-control">considered to be</a> incredibly small. Early-onset Alzheimer’s disease (defined as occurring before the age of 65) is uncommon, accounting for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356853/">around 5%</a> of all cases. Below the age of 50 it’s rare and likely to have a genetic contribution. <h2>The risk is very low – and you can’t ‘catch’ it like a virus</h2> The Nature Medicine paper identified five cases which were diagnosed in people aged 38 to 55. This is more than could be expected by chance, but still very low in comparison to the total number of patients treated worldwide. Although the long “incubation period” of Alzheimer’s disease may mean more similar cases may be identified in the future, the absolute risk remains very low. The main scientific interest of the article lies in the fact it’s first to demonstrate that Alzheimer’s disease can be transmitted from person to person in a similar way to prion diseases, rather than in any public health risk. The authors were keen to emphasise, as I will, that Alzheimer’s cannot be contracted via contact with or providing care to people with Alzheimer’s 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/222374/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/steve-macfarlane-4722">Steve Macfarlane</a>, Head of Clinical Services, Dementia Support Australia, & Associate Professor of Psychiatry, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Getty Images 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/alzheimers-may-have-once-spread-from-person-to-person-but-the-risk-of-that-happening-today-is-incredibly-low-222374">original article</a>.

Mind

How does cancer spread to other parts of the body?

<a href="https://theconversation.com/profiles/sarah-diepstraten-1495268">Sarah Diepstraten</a>, <a href="https://theconversation.com/institutions/walter-and-eliza-hall-institute-822">Walter and Eliza Hall Institute</a> and <a href="https://theconversation.com/profiles/john-eddie-la-marca-1503690">John (Eddie) La Marca</a>, <a href="https://theconversation.com/institutions/walter-and-eliza-hall-institute-822">Walter and Eliza Hall Institute</a> All cancers begin in a single organ or tissue, such as the lungs or skin. When these cancers are confined in their original organ or tissue, they are generally more treatable. But a cancer that spreads is much more dangerous, as the organs it spreads to may be vital organs. A skin cancer, for example, might spread to the brain. This new growth makes the cancer much more challenging to treat, as it can be difficult to find all the new tumours. If a cancer can invade different organs or tissues, it can quickly become lethal. When cancer spreads in this way, it’s called metastasis. Metastasis is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6745820/">responsible for</a> the majority (67%) of cancer deaths. <h2>Cells are supposed to stick to surrounding tissue</h2> Our bodies are made up of trillions of tiny cells. To keep us healthy, our bodies are constantly replacing old or damaged cells. Each cell has a specific job and a set of instructions (DNA) that tells it what to do. However, sometimes DNA can get damaged. This damage might change the instructions. A cell might now multiply uncontrollably, or lose a property known as adherence. This refers to how sticky a cell is, and how well it can cling to other surrounding cells and stay where it’s supposed to be. If a cancer cell loses its adherence, it can break off from the original tumour and travel through the bloodstream or lymphatic system to almost anywhere. This is how metastasis happens. Many of these travelling cancer cells will die, but some will settle in a new location and begin to form new cancers. Particular cancers are more likely to metastasise to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381616/">particular organs</a> that help support their growth. Breast cancers commonly metastasise to the bones, liver, and lungs, while skin cancers like melanomas are more likely to end up in the brain and heart. Unlike cancers which form in solid organs or tissues, blood cancers like leukaemia already move freely through the bloodstream, but <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8722462/">can escape</a> to settle in other organs like the liver or brain. <h2>When do cancers metastasise?</h2> The longer a cancer grows, the more likely it is to metastasise. If not caught early, a patient’s cancer may have metastasised even before it’s initially diagnosed. Metastasis can also occur after cancer treatment. This happens when cancer cells are dormant during treatment – drugs may not “see” those cells. These invisible cells can remain hidden in the body, only to wake up and begin growing into a new cancer months or even years later. For patients who already have cancer metastases at diagnosis, identifying the location of the original tumour – called the “primary site” – is important. A cancer that began in the breast but has spread to the liver will probably still behave like a breast cancer, and so will respond best to an anti-breast cancer therapy, and not anti-liver cancer therapy. As metastases can sometimes grow faster than the original tumour, it’s not always easy to tell which tumour came first. These cancers are called “cancers of unknown primary” and are the <a href="https://www.canceraustralia.gov.au/cancer-types/unknown-primary-cancer/statistics">11th most commonly diagnosed cancers in Australia</a>. One way to improve the treatment of metastatic cancer is to improve our ways of detecting and identifying cancers, to ensure patients receive the most effective drugs for their cancer type. <h2>What increases the chances of metastasis and how can it be prevented?</h2> If left untreated, most cancers will eventually acquire the ability to metastasise. While there are currently no interventions that specifically prevent metastasis, cancer patients who have their tumours surgically removed may also be given chemotherapy (or other drugs) to try and weed out any hidden cancer cells still floating around. The best way to prevent metastasis is to diagnose and treat cancers early. Cancer screening initiatives such as Australia’s <a href="https://www.health.gov.au/our-work/national-cervical-screening-program">cervical</a>, <a href="https://www.health.gov.au/our-work/national-bowel-cancer-screening-program">bowel</a>, and <a href="https://www.health.gov.au/our-work/breastscreen-australia-program">breast</a> cancer screening programs are excellent ways to detect cancers early and reduce the chances of metastasis. New screening programs to detect cancers early are being researched for many types of cancer. Some of these are simple: CT scans of the body to look for any potential tumours, such as in England’s new <a href="https://theconversation.com/how-englands-new-lung-cancer-screening-could-save-thousands-of-lives-expert-qanda-208867">lung cancer screening program</a>. Using artificial intelligence (AI) to help examine patient scans is also <a href="https://theconversation.com/ai-can-help-detect-breast-cancer-but-we-dont-yet-know-if-it-can-improve-survival-rates-210800">possible</a>, which might identify new patterns that suggest a cancer is present, and improve cancer detection from these programs. More advanced screening methods are also in development. The United States government’s Cancer Moonshot program is currently funding research into blood tests that could detect <a href="https://theconversation.com/a-blood-test-that-screens-for-multiple-cancers-at-once-promises-to-boost-early-detection-191728">many types of cancer at early stages</a>. One day there might even be a RAT-type test for cancer, like there is for COVID. <h2>Will we be able to prevent metastasis in the future?</h2> Understanding how metastasis occurs allows us to figure out new ways to prevent it. One idea is to <a href="https://www.cancer.gov/news-events/cancer-currents-blog/2019/breast-cancer-chemotherapy-sensitizing-dormant-cells">target dormant cancer cells</a> and prevent them from waking up. Directly preventing metastasis with drugs is not yet possible. But there is hope that as research efforts continue to improve cancer therapies, they will also be more effective at treating metastatic cancers. For now, early detection is the best way to ensure a patient can beat their cancer.<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/219616/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/sarah-diepstraten-1495268">Sarah Diepstraten</a>, Senior Research Officer, Blood Cells and Blood Cancer Division, <a href="https://theconversation.com/institutions/walter-and-eliza-hall-institute-822">Walter and Eliza Hall Institute</a> and <a href="https://theconversation.com/profiles/john-eddie-la-marca-1503690">John (Eddie) La Marca</a>, Senior Resarch Officer, <a href="https://theconversation.com/institutions/walter-and-eliza-hall-institute-822">Walter and Eliza Hall Institute</a> Image credits: Getty Images 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/how-does-cancer-spread-to-other-parts-of-the-body-219616">original article</a>.

Body

Bring a plate! What to take to Christmas lunch that looks impressive (but won’t break the bank)

<a href="https://theconversation.com/profiles/lauren-ball-14718">Lauren Ball</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a>; <a href="https://theconversation.com/profiles/amy-kirkegaard-1401256">Amy Kirkegaard</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a>; <a href="https://theconversation.com/profiles/breanna-lepre-1401257">Breanna Lepre</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a>, and <a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> Christmas lunch is at your friend’s house this year, and they’ve asked you to bring a plate. Money is tight. So, you find yourself wondering, “What’s cheap, healthy but also looks impressive?” While a tray of mangoes would certainly be a cheap, healthy and colourful contribution, you want to look as if you’ve put in a bit of effort. If you’re struggling for inspiration, here are some tried and tested ideas. <h2>First, choose your ingredients</h2> Check your pantry for inspiration or ingredients. Crackers, dried fruit or nuts are great ideas for a charcuterie board. You can use herbs and spices to add flavour to dishes, or you could use up packets of dried pasta to make a <a href="https://nomoneynotime.com.au/healthy-easy-recipes/salmon-and-pasta-salad">pasta salad</a>. This is also a great way to clean out your pantry. Focus on fruit and vegetables that are in season, so are cheaper and more readily available. Keep an eye out at your local fruit and veggie shop or market as it will usually have in-season fruit and vegetables in bulk quantities at reduced prices. Check out <a href="http://seasonalfoodguide.com/australia-general-seasonal-fresh-produce-guide-fruits-vegetables-in-season-availability.html">this seasonal food guide</a> to help you plan your Christmas menu. Ask around for deals by chatting to your local butcher, fishmonger or grocer and let them know your budget. They may suggest cheaper cuts of meat (such as, <a href="https://www.australianbutchersguild.com.au/the-blog/the-abg-blog/underrated-cuts-of-beef/">oyster</a>, <a href="https://www.australianbeef.com.au/know-your-meat/beef-cuts/">blades, rump caps</a>). Try cooking <a href="https://www.bestrecipes.com.au/recipes/slow-cooker-corned-beef-mustard-sauce-recipe/z47lwrbv?r=entertaining/9clz7475&h=entertaining">corned beef</a> or <a href="https://www.bbcgoodfood.com/recipes/slow-cooker-roast-chicken">roast chicken</a> in a slow cooker with lots of vegetables. Slow-cooked meals can be frozen and can come in handy for left-overs. Lean into <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4608274/">legumes</a>. These are packed with fibre, protein, vitamins and minerals. They are also budget-friendly and a great way to add texture to salads. Tinned chickpeas, or cannellini, kidney, or butter beans are quick and easy additions that can make filling dishes go further. You could even turn tinned chickpeas into homemade hommus for a healthy and delicious side dish. Check out these healthy legume <a href="https://nomoneynotime.com.au/healthy-easy-recipes/filter/keywords--legumes">recipes</a>. <h2>7 ways to keep food costs down this Christmas</h2> 1. Plan ahead Plan your menu by asking how many people are coming and checking for any food preferences or dietary requirements. Check for items you already have at home, and make a shopping list for only what you <a href="https://www.emerald.com/insight/content/doi/10.1108/BFJ-12-2017-0726/full/html">need</a>. 2. Use free recipes Use free online recipe collections and e-books tailored for budget cooking that can help you design your Christmas menu to meet your budget. This <a href="https://nomoneynotime.com.au/uploads/Our-Guide-to-the-Perfect-Christmas-Feast.pdf">one</a> was created by a group of <a href="https://dietitiansaustralia.org.au/working-dietetics/standards-and-scope/role-accredited-practising-dietitian">accredited practising dietitians</a> and has healthy, budget friendly recipes and ideas. You could also try this budget friendly collection of Christmas recipes from <a href="https://www.taste.com.au/recipes/collections/budget-christmas-recipes">taste</a>. 3. Involve the family Get together with other family members and make it a challenge to see who can make the cheapest, most delicious dish. Get the kids involved in fun activities, such as making a DIY gingerbread house or putting together mixed skewers for the barbecue. 4. Pool your resources Larger quantities of a single dish will be cheaper than multiple different dishes (and easier to prepare). 5. Frozen is fine Use frozen fruits and vegetables if you need to. These can have just as <a href="https://pubmed.ncbi.nlm.nih.gov/25526594/">many vitamins and minerals</a> as fresh, are often cheaper than fresh produce and last longer. Try using frozen berries to decorate the pavlova or add them to your favourite cake, muffin or pie. 6. Make your own drinks You could make your own drinks, such as home-brewed iced tea. See if anyone in your family has a soda stream you can borrow to make sparkling mineral water. Add some freshly squeezed lemon or lime for extra flavour. 7. Reduce waste Use your own crockery and re-use leftovers to reduce waste. After all, washing up is cheaper than buying plastic or paper plates and better for the environment. Remember to save any leftovers and re-use them. Leftover fresh vegetables could be used to make a hearty soup or chutney. <h2>It doesn’t have to be perfect</h2> Christmas comes and goes quickly. If your cooking ideas don’t work out, it’s not the end of the world. Choosing healthy foods on a budget is important all year around, so you may like to think about trying these tips throughout the years to come. <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/196565/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/lauren-ball-14718">Lauren Ball</a>, Professor of Community Health and Wellbeing, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a>; <a href="https://theconversation.com/profiles/amy-kirkegaard-1401256">Amy Kirkegaard</a>, Postdoctoral Research Fellow, School of Human Movement and Nutrition Sciences, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a>; <a href="https://theconversation.com/profiles/breanna-lepre-1401257">Breanna Lepre</a>, Research Fellow, Mater Research Institute, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a>, and <a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, Dietitian and Researcher, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> Image credits: Getty Images 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/bring-a-plate-what-to-take-to-christmas-lunch-that-looks-impressive-but-wont-break-the-bank-196565">original article</a>.

Food & Wine

Yes, masks reduce the risk of spreading COVID, despite a review saying they don’t

The question of whether and to what extent face masks work to prevent respiratory infections such as COVID and influenza has split the scientific community for <a href="https://www.baltimoresun.com/news/bs-xpm-2007-03-06-0703060040-story.html">decades</a>. Although there is strong evidence face masks <a href="https://www.sciencedirect.com/science/article/pii/S0020748920301139?via%3Dihub">significantly reduce transmission of such infections</a> both in health-care settings and in the community, some experts do not agree. An updated <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006207.pub6/full">Cochrane Review</a> published last week is the latest to suggest face masks don’t work in the community. <blockquote class="twitter-tweet"> "Wearing masks in the community probably makes little or no difference to the outcome of laboratory‐confirmed influenza/SARS‐CoV‐2 compared to not wearing masks"<a href="https://twitter.com/CochraneLibrary?ref_src=twsrc%5Etfw">@CochraneLibrary</a> Review. Published: 30 January 2023 <a href="https://t.co/zODu6QEF1M">https://t.co/zODu6QEF1M</a> <a href="https://t.co/c26yHPaSCD">pic.twitter.com/c26yHPaSCD</a> — Robin Monotti (@robinmonotti) <a href="https://twitter.com/robinmonotti/status/1620311528523304960?ref_src=twsrc%5Etfw">January 31, 2023</a></blockquote> However there are problems with the review’s methodology and its underpinning assumptions about transmission. The Cochrane Review combined randomised controlled trials (RCTs) using <a href="https://ebn.bmj.com/content/16/1/3">meta-analysis</a>. RTCs test an intervention in one group and compare it with a “control” group that doesn’t receive the intervention or receives a different intervention. A meta-analysis pools the results of multiple studies. This approach assumes (a) RCTs are the “best” evidence and (b) combining results from multiple RCTs will give you an average “effect size”. But RCTs are only the undisputed gold standard for certain kinds of questions. For other questions, a mix of study designs is better. And RCTs should be combined in a meta-analysis only if they are all addressing the same research question in the same way. Here are some reasons why the conclusions of this Cochrane Review are misleading. <h2>It didn’t consider how COVID spreads and how masks work</h2> COVID, along with influenza and many other respiratory diseases, is transmitted primarily <a href="https://theconversation.com/covid-how-the-disease-moves-through-the-air-173490">through the air</a>. Respirators (such as N95s) are designed and regulated to prevent airborne infections by fitting <a href="https://theconversation.com/high-filtration-masks-only-work-when-they-fit-so-we-created-a-new-way-to-test-if-they-do-155987">closely to the face</a> to prevent air leakage and by filtering out 95% or more of potential infectious particles. In contrast, surgical masks are designed to prevent splatter of fluid on the face and are loose-fitting, causing unfiltered air to leak in through the gaps around the mask. The filtration of a surgical mask is not regulated. In other words, respirators are designed for respiratory protection and cloth and surgical masks are not. The review starts with an assumption that masks provide respiratory protection, which is flawed. An understanding of these differences should inform both studies and reviews of those studies. <h2>The studies addressed quite different questions</h2> A common mistake in meta-analysis is to combine apples and oranges. If apples work but oranges don’t, combining all studies in a single average figure may lead to the conclusion that apples do not work. This Cochrane Review combined RCTs where face masks or respirators were worn part of the time (for example, when caring for patients with known COVID or influenza: “occasional” or “targeted” use) with RCTs where they were worn at all times (“continuous use”). Because both SARS-CoV-2 and influenza viruses are airborne, an unmasked person could be infected anywhere in the building and even after an infectious patient has left the room, especially since some people have <a href="https://www.pnas.org/doi/10.1073/pnas.2109229118">no symptoms</a> while contagious. Most RCTs of masks and N95s included in the review have not had a <a href="https://jamanetwork.com/journals/jama/fullarticle/184819">control arm</a> – therefore finding no difference could indicate equal efficacy or equal inefficacy. <a href="https://jamanetwork.com/journals/jama/fullarticle/2749214">Studies</a> examining wearing a surgical mask or respirator (such as an N95) only when in contact with sick people or when doing a high-risk procedure (occasional use) have generally shown that, when worn in this way, there is no difference. An RCT comparing occasional versus continuous use of respirators in health care workers <a href="https://www.atsjournals.org/doi/10.1164/rccm.201207-1164OC?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubme">showed</a> N95 respirators and surgical masks were equally ineffective when only worn occasionally by hospital workers. They had to wear them all the time at work to be protected. We also combined only apples and apples in a <a href="https://onlinelibrary.wiley.com/doi/10.1111/irv.12474">meta-analysis</a> of two RCTs conducted in exactly the same way and measuring the same interventions and outcomes. We found N95 respirators provide significant protection against respiratory infections when surgical masks did not, even against infections assumed to be “droplet spread”. <h2>Most trials addressed only half the question</h2> Face masks and respirators work in two ways: they protect the wearer from becoming infected and they prevent an infected wearer from spreading their germs to other people. Most RCTs in this Cochrane Review looked only at the former scenario, not the latter. In other words, the researchers had asked people to wear masks and then tested to see if those people became infected. A previous <a href="https://pubmed.ncbi.nlm.nih.gov/20092668/">systematic review</a> found face masks worn by sick people during an influenza epidemic reduced the risk of them transmitting the infection to family members or other carers. Preventing an infection in one person also prevents onward transmission to others within a closed setting, which means such RCTs should use a special method called “cluster randomisation” to account for this. Data from a RCT of N95 respirator use by <a href="https://journals.sagepub.com/doi/full/10.1177/0300060516665491?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org">health workers</a> showed even their unmasked colleagues were protected. Yet some of the trials included in the review did not use cluster randomisation. <h2>The new paper combined health and community settings</h2> This is another apples-plus-oranges issue. Different settings have widely differing risks of transmission, since airborne particles build up when sick patients are exhaling the virus in <a href="https://theconversation.com/heres-where-and-how-you-are-most-likely-to-catch-covid-new-study-174473">underventilated, crowded settings</a> especially if many infected people are present (such as in a hospital). <blockquote class="twitter-tweet"> Here’s where (and how) you are most likely to catch COVID – new study <a href="https://t.co/Ro88Shc897">https://t.co/Ro88Shc897</a> <a href="https://t.co/TlFA9EQskF">pic.twitter.com/TlFA9EQskF</a> — Jeffrey J Davis (@JeffreyJDavis) <a href="https://twitter.com/JeffreyJDavis/status/1484210379093954564?ref_src=twsrc%5Etfw">January 20, 2022</a></blockquote> A genuine protective effect of masks or respirators shown in a RCT in a high-risk setting will be obscured if that trial is combined in a meta-analysis with several other RCTs that were conducted in low-risk settings. A large <a href="https://www.science.org/doi/10.1126/science.abi9069">RCT in the community in Bangladesh</a> found face masks reduced the risk of infection by 11% overall and 35% in people over 60 years. In contrast, in <a href="https://onlinelibrary.wiley.com/doi/10.1111/irv.12474">hospitals</a>, N95 reduce risk by 67% against bacterial infections and 54% against viral infections. Viruses like influenza also vary substantially from year to year – some years there is very little influenza, and if a RCT is conducted during such a year, it will not find enough infections to show a difference. The review failed to account for such seasonal effects. <h2>But did they actually wear the mask?</h2> The authors of the Cochrane Review acknowledged compliance with masking advice was poor in most studies. In the real world, we can’t force people to follow medical advice, so RCTs should be analysed on an “intention to treat” basis. For example, people who are prescribed the active drug but who choose not to take it should not be shifted to the placebo group for the analysis. But if in a study of masking, most people don’t actually wear them, you can’t conclude that masks don’t work when the study shows no difference between the groups. You can only conclude that the mask advice didn’t work in this study. There is a great deal of <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246317">psychological evidence</a> on why people do or don’t choose to comply with advice to mask and how to improve uptake. The science of masking needs to separate the impact of the mask itself from the impact of the advice to mask. Mask-wearing <a href="https://www.ijidonline.com/article/S1201-9712(21)00274-5/fulltext">goes up</a> substantially to over 70% if there is an actual mandate in place. <h2>It didn’t include other types of research</h2> A comprehensive review of the evidence would also include other types of study besides RCTs. For example, a <a href="https://www.sciencedirect.com/science/article/pii/S0140673620311429">large systematic review</a> of 172 various study designs, which included 25,697 patients with SARS-CoV-2, SARS, or MERS, concluded masks were effective in preventing transmission of respiratory viruses. Well-designed <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7106e1.htm?s_cid=mm7106e1_w">real-world studies</a> during the pandemic showed any mask reduces the risk of COVID transmission by 50–80%, with the highest protection offered by N95 respirators. <a href="https://pubmed.ncbi.nlm.nih.gov/20095070/">Many lab-based studies</a> have shown respirators are superior to masks at preventing airborne respiratory infections and the <a href="https://thorax.bmj.com/content/75/11/1024.long">incremental superiority</a> from a single to two layered cloth mask to a three-layered surgical mask in blocking respiratory aerosols. <h2>Yes, masks reduce the spread of COVID</h2> There is strong and consistent evidence for the effectiveness of masks and (even more so) respirators in protecting against respiratory infections. Masks are an important protection against serious infections. Current COVID vaccines protect against death and hospitalisation, but do <a href="https://fortune.com/well/2023/01/06/kraken-xbb15-omicron-covid-variant-most-transmissible-yet-could-spawn-more-immune-evasive-variants-study-china-vaccine-monoclonal-antibodies-breakthrough-infection/">not prevent infection</a> well due to waning vaccine immunity and substantial immune escape from new variants. A systematic review is only as good as the rigour it employs in combining similar studies of similar interventions, with similar measurement of outcomes. When very different studies of different interventions are combined, the results are not informative. Image credits: Getty Images This article originally appeared on <a href="https://theconversation.com/yes-masks-reduce-the-risk-of-spreading-covid-despite-a-review-saying-they-dont-198992" target="_blank" rel="noopener">The Conversation</a>.

Body

Air travel spreads infections globally, but health advice from inflight magazines can limit that

“Travel safe, travel far, travel wide, and travel often,” <a href="https://thoughtcatalog.com/matthew-kepnes/2014/01/53-travel-quotes-to-inspire-you-to-see-the-world/">says</a> <a href="https://www.nomadicmatt.com/">Nomadic Matt</a>, the American who quit his job to travel the world, write about it and coach others to do the same. But there’s a downside to all this travel, with its unprecedented volume of passengers moving from one side of the world to the other, largely by plane. There’s the risk of those passengers spreading infectious diseases and microorganisms resistant to multiple drugs (superbugs) around the world. Yet, our recently published <a href="https://www.sciencedirect.com/science/article/pii/S1477893919301218">research</a> into health advice provided by inflight magazines shows plane passengers are given practically no advice on how to limit the spread of infectious diseases. Should we be worried about the part air travel plays in spreading infectious diseases? And what can we do about it? How big is the risk? Low airfares and a series of social and economic factors have made global air travel more common than ever. According to the Australian government department of infrastructure, transport, cities and regional development the <a href="https://www.bitre.gov.au/publications/ongoing/files/International_airline_activity_CY2018.pdf">number of passengers taking international scheduled flights in 2018 was 41.575 million</a>. But the International Air Transport Association projects passenger demand will <a href="https://www.iata.org/pressroom/pr/Pages/2019-02-27-02.aspx">reach 8.2 billion by 2037</a>. There are many examples of infectious diseases spread via international flying. The World Health Organization documented <a href="https://www.who.int/ith/mode_of_travel/tcd_aircraft/en/">transmission of tuberculosis</a> (TB) on board commercial aircraft during long-haul flights during the 1980s. Research published in 2011 documents the <a href="https://wwwnc.cdc.gov/eid/article/17/7/10-1135_article">transmission of influenza</a> on two transcontinental international flights in May 2009. More recently, the current <a href="https://theconversation.com/why-people-born-between-1966-and-1994-are-at-greater-risk-of-measles-and-what-to-do-about-it-110167">global outbreak of measles</a> in many countries, including the Philippines and the United States, gave rise to the risk of transmission during international travel. In a recent case a <a href="https://www.health.nsw.gov.au/Infectious/alerts/Pages/measles-alert-january.aspx">baby</a> too young to be vaccinated who had <a href="https://www.smh.com.au/national/nsw/measles-alert-after-infectious-baby-flew-from-manila-went-to-central-coast-20190603-p51tzs.html">measles</a> returned from Manilla in the Philippines to Sydney, exposing travellers on that flight to infection. Then there is the risk of transmitting antimicrobial-resistant organisms that cause disease, such as <a href="https://theconversation.com/explainer-what-is-tb-and-am-i-at-risk-of-getting-it-in-australia-75290">multi-drug resistant TB</a>. Recently, patients in Victoria and New South Wales were identified as carrying the drug-resistant fungus <a href="https://www2.health.vic.gov.au/about/news-and-events/healthalerts/candida-auris-case-detected-in-victoria">Candida auris</a>, which they acquired overseas. <a href="https://www.ncbi.nlm.nih.gov/pubmed/27890665">One study</a> estimates that over 300 million travellers visit high-risk areas, such as the western Pacific, Southeast Asia and Eastern Mediterranean, each year worldwide, and more than 20% return as new carriers of resistant organisms. These popular destinations, as well as the Middle East, have high rates of drug resistant organisms. How is this happening? Aircraft move large volumes of people around the world swiftly. But what sets them apart from buses and trains is that passengers are close together, in confined spaces, for a long time. This increases the risk of transmitting infections. Passengers interact with high-touch surfaces, such as tray tables, headsets, seats and handles. We cough, sneeze and touch multiple surfaces multiple times during a flight, with limited opportunities to clean our hands with soap and water. Many infections, such as gastroenteritis and diarrhoea, are spread and contracted by touch and contact. What can we do about it? Providing plane travellers with relevant health advice is one way to limit the spread of infectious diseases via air travel. This would include information and advice on routine hand washing with soap and water, or using alcohol-based hand rubs, and other basic measures including cough etiquette, such as coughing into your elbow and covering your nose and face. <a href="https://academic.oup.com/jtm/article/4/2/102/1847252">Researchers</a> have looked at the role commercial websites and travel agencies might play in providing that advice. And since the 1990s, airline magazines have been <a href="https://academic.oup.com/jtm/article/4/2/102/1847252">highlighted</a> as an underused source of traveller health advice. More than 20 years on, we discovered little has changed. In our recent study, published in the journal <a href="https://www.sciencedirect.com/science/article/pii/S1477893919301218">Travel Medicine and Infectious Disease</a>, we looked at the content of inflight magazines from 103 airlines issued during January 2019. Of the 47 available online, only a quarter (11) included an official section on passengers’ general health and well-being, of which only two contained information related to infection control and the preventing infectious diseases. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/284424/original/file-20190717-173366-w48bmn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/284424/original/file-20190717-173366-w48bmn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/284424/original/file-20190717-173366-w48bmn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/284424/original/file-20190717-173366-w48bmn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/284424/original/file-20190717-173366-w48bmn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/284424/original/file-20190717-173366-w48bmn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/284424/original/file-20190717-173366-w48bmn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/284424/original/file-20190717-173366-w48bmn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" alt="" /></a><figcaption>Inflight magazines have a potential audience of billions. So why not include advice on hand hygiene and coughing etiquette? <a class="source" href="https://www.shutterstock.com/download/confirm/1424594042?src=vUDfEziJwFDV7GZr5OYMRA-1-2&studio=1&size=medium_jpg">from www.shutterstock.com</a></figcaption></figure> The first magazine, from a UAE-based airline, had an official section on passenger health and well-being that included very limited relevant content. It advised passengers “with blood diseases or ear, nose and sinus infections should seek medical advice before flying”. There was no further explanation or information, nor were there any strategies to prevent these or other infections. The second magazine, from a USA-based airline, contained general travel health advice, but none specifically about infectious diseases. However there was a full-page, colour advertisement next to the health section. This contained images of many disease causing microorganisms on passengers’ tray tables and advocated the use of a disinfectant wipe for hands and other inflight surfaces. The slogan “because germs are frequent fliers” was displayed across the tray table. This was accompanied by information about the use and effectiveness of disinfectant wipes for hand hygiene and disinfecting surfaces during air travel, public transport use, and in hotels and restaurants. Inflight magazines are valuable assets for airlines and are the source of considerable advertising revenue. They are read by potentially billions of passengers every year. The results of this study show that they are a greatly underused source of information about infection control and measures to prevent the spread of infectious diseases. Airlines should also provide health advice to passengers in other media, in particular video screens, about infection prevention and basic control measures such as hand hygiene, cough etiquette and personal hygiene. Such advice should be provided before, during and after the flight. It could also include destination-related advice for particularly risky travel routes and destinations. More information for passengers Airlines providing health advice to passengers is just one way to limit the spread of infectious diseases and antimicrobial-resistant organisms around the world via air travel. This would need to sit alongside other measures, such as <a href="https://wwwnc.cdc.gov/travel/page/travel-industry-information-center">information and guidelines</a> provided to those who travel via the sea. The simple, low-cost measures highlighted in our research could go a long way to help passengers stay healthy and avoid illness from infectious diseases. At the same time, these measures could reduce the impact of outbreaks of infectious diseases for airlines and society as a whole.<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/120283/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> Writen by Ramon Zenel Shaban and Cristina Sotomayor-Castillo. Republished with permission from <a href="https://theconversation.com/air-travel-spreads-infections-globally-but-health-advice-from-inflight-magazines-can-limit-that-120283" target="_blank" rel="noopener">The Conversation</a>. Image: Getty Images

International Travel

Democracy spreads in waves – but shared cultural history might matter more than geography

Recent events like the war in Ukraine, conflicts over Taiwan and the rise of authoritarian ideology have renewed interest in the foundations of modern democracy. They have raised questions about why some nations are more democratic than others, and how democratic institutions, freedoms and values are spread or lost. We tend to think of this variation in terms of geography – democratic Western Europe or autocratic Middle East. But in a <a href="https://www.cambridge.org/core/journals/evolutionary-human-sciences/article/shared-cultural-ancestry-predicts-the-global-diffusion-of-democracy/90C7A170B924FC305DD66FF8853799FC" target="_blank" rel="noopener">new analysis of 220 years of political data</a>, we show that deep cultural connections between countries such as shared linguistic or religious ancestry matter more than geography. <h2>Waves of democratisation</h2> The emergence of modern democracy coincides with the rise of nation states in Europe at the beginning of the 19th century. Democracy spread across European nations and their colonies, over <a href="https://en.wikipedia.org/wiki/The_Third_Wave:_Democratization_in_the_Late_Twentieth_Century" target="_blank" rel="noopener">three waves</a>. The first wave lasted about a century, from 1828 to 1926, halting after the first world war. A second, rapid wave (1945-1962) followed the second world war and decolonisation. The third wave began in 1974 and continues today. It encompassed political transitions and new countries in Europe, Latin America and the Pacific. Each wave was followed by a period of reversals when nations turned to autocratic regimes, junta or fascism. Indeed, some researchers speculate we are heading into <a href="https://www.tandfonline.com/doi/full/10.1080/13510347.2019.1582029" target="_blank" rel="noopener">another period of reversal</a>. <h2>What drives modern democracy?</h2> Scholars traditionally considered factors internal to a country – economic growth, rates of education or the natural environment – as the drivers of these waves. However, the geographic clustering of democracy and the wave-like pattern of expansion suggest the process may also involve a kind of contagion where democracy passes from one nation to another. One explanation for this is that democratic change spreads across borders, so that neighbouring countries end up with similar levels of democracy. Culture provides another explanation. Neighbouring countries tend to share a common cultural heritage, such as related languages or religions. This shapes national institutions, norms and values. In our research, we tested the idea that common cultural ancestry explains variation and change in democracy around the globe. We brought together 220 years of democracy data with information on the cultural relationships between nations. The cultural relationships we examined were based on languages and religious beliefs. For example, Portugal is linguistically closer to Spanish-speaking Argentina and Spain than to England and Germany (which speak Germanic languages). Likewise, Myanmar, a Theravada Buddhist country, is religiously closer to Mongolia (where Vajrayana Buddhism is predominant) than to Muslim Malaysia. <h2>Culture is more important than geography</h2> The democracy data we studied cover 269 modern and historical nations and three widely-used democracy indicators, measuring democratic and autocratic authority in governing institutions (<a href="https://www.systemicpeace.org/polityproject.html" target="_blank" rel="noopener">Polity 5</a>), electoral participation and competition (<a href="https://www.prio.org/data/20" target="_blank" rel="noopener">Vanhanen Index</a>) and individual rights and freedoms (<a href="https://freedomhouse.org/" target="_blank" rel="noopener">Freedom House</a>). Across all three indicators of democracy, we found countries that share linguistic or religious ancestry tend to have more similar democracy scores. These shared cultural ties were better predictors of democracy than geography, especially during the third wave of democratisation. Knowing the democratic status of a country’s linguistic or religious relatives helps predict that country’s future level of democracy five, ten or even 20 years later. These effects were not just due to countries sharing a language (for example, the English-speaking world) or religion (such as the Sunni Islam majority countries). This suggests deeper cultural connections between countries are important. <h2>What this means for the spread of democracy</h2> These effects could be the result of a number of processes. One possibility is that countries directly inherited institutions along the same pathways they inherited cultural features like language. For instance, Aotearoa New Zealand and other Commonwealth countries inherited the British legal system along with the English language. Another possibility is that cultural similarities might make countries more likely to maintain ongoing social connections, including foreign relations, which then aid the spread of institutions. For example, the <a href="https://theconversation.com/how-the-arab-spring-changed-the-middle-east-and-north-africa-forever-161394" target="_blank" rel="noopener">Arab Spring</a> spread among a set of countries with common linguistic and religious heritage. A third possibility is that inherited cultural values could steer countries towards similar institutions. For example, <a href="https://www.nature.com/articles/s41562-019-0769-1" target="_blank" rel="noopener">in previous research</a> we found that tolerance of diversity (cosmopolitan values) promotes a shift to more democratic institutions, but the reverse is not true. Democratic institutions do not shift tolerance. Countries that have inherited cosmopolitan values as part of their shared cultural ancestry may be more likely to shift towards democracy. If this theory is correct, it calls into question the assumption that democratic institutions can endure without sustained efforts to promote the cultural values that support them. The US interventions in Afghanistan and Iraq may be tragic examples of this. Our findings indicate cultural history matters for understanding the spread of democracy around the globe. This does not mean culture is the only factor at play (our analyses still leave a lot of variation unexplained). Neither do our findings speak to a population’s ultimate potential to achieve democratic outcomes, but we see this as within the reach of all populations. This means those wishing to support democracy at home or abroad should take cultural barriers seriously. We cannot assume that institutions that work well in one cultural setting can be easily transplanted to another, very different setting, with different values, norms and traditions. We should pay more attention to culturally closely related countries that have succeeded at merging local norms and values with democratic institutions. This article originally appeared on <a href="https://theconversation.com/democracy-spreads-in-waves-but-shared-cultural-history-might-matter-more-than-geography-189959" target="_blank" rel="noopener">The Conversation</a>. Image: Shutterstock

Legal

Fake viral footage is spreading alongside the real horror in Ukraine. Here are 5 ways to spot it

Amid the alarming images of <a href="https://theconversation.com/russia-invades-ukraine-5-essential-reads-from-experts-177815" target="_blank" rel="noopener">Russia’s invasion of Ukraine</a> over the past few days, millions of people have also seen <a href="https://www.politico.com/news/2022/02/24/social-media-platforms-russia-ukraine-disinformation-00011559" target="_blank" rel="noopener">misleading, manipulated or false information</a> about the conflict on social media platforms such as Facebook, Twitter, TikTok and Telegram. <figure class="align-right zoomable"><a href="https://images.theconversation.com/files/448664/original/file-20220226-31488-1blhz2o.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/448664/original/file-20220226-31488-1blhz2o.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/448664/original/file-20220226-31488-1blhz2o.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=891&fit=crop&dpr=1 600w, https://images.theconversation.com/files/448664/original/file-20220226-31488-1blhz2o.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=891&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/448664/original/file-20220226-31488-1blhz2o.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=891&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/448664/original/file-20220226-31488-1blhz2o.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1119&fit=crop&dpr=1 754w, https://images.theconversation.com/files/448664/original/file-20220226-31488-1blhz2o.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1119&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/448664/original/file-20220226-31488-1blhz2o.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1119&fit=crop&dpr=3 2262w" alt="Screenshot of fake news TikTok video" /></a><figcaption>Old footage, rebadged on TikTok as the latest from Ukraine. TikTok</figcaption></figure> One example is this <a href="https://www.tiktok.com/@notimundo/video/7068170668507974918?_t=8Q8LwdZRa8s&_r=1" target="_blank" rel="noopener">video of military jets posted to TikTok</a>, which is historical footage but captioned as live video of the situation in Ukraine. Visuals, because of their persuasive <a href="https://link.springer.com/article/10.1007/s12525-019-00345-y" target="_blank" rel="noopener">potential</a> and attention-grabbing nature, are an especially potent choice for those seeking to mislead. Where creating, editing or sharing inauthentic visual content isn’t satire or art, it is usually <a href="https://www.tandfonline.com/doi/pdf/10.1080/21670811.2017.1345645?casa_token=t8LANzDiQGUAAAAA:3vZ76fwtwpHt82jeB3mFJXPOpfsks4aRZHhDiCpcNVgJtDFIFcqskhUL796_P609UZm2KVwxeHy8xM4" target="_blank" rel="noopener">politically or economically motivated</a>. Disinformation campaigns aim to distract, confuse, manipulate and sow division, discord, and uncertainty in the community. This is a common strategy for <a href="http://repository.ou.ac.lk/bitstream/handle/94ousl/928/journalism_fake_news_disinformation_print_friendly_0%20(1).pdf?sequence=1" target="_blank" rel="noopener">highly polarised nations</a> where socioeconomic inequalities, disenfranchisement and propaganda are prevalent. How is this fake content created and spread, what’s being done to debunk it, and how can you ensure you don’t fall for it yourself? What are the most common fakery techniques? Using an existing photo or video and claiming it came from a different time or place is one of the most common forms of misinformation in this context. This requires no special software or technical skills – just a willingness to upload an old video of a missile attack or other arresting image, and describe it as new footage. Another low-tech option is to <a href="https://www.grid.news/story/misinformation/2022/02/23/autopsied-bodies-and-false-flags-how-pro-russian-disinformation-spreads-chaos-in-ukraine/" target="_blank" rel="noopener">stage or pose</a> actions or events and present them as reality. This was the case with destroyed vehicles that Russia claimed were bombed by Ukraine. Using a particular lens or vantage point can also change how the scene looks and can be used to deceive. A tight shot of people, for example, can make it hard to gauge how many were in a crowd, compared with an aerial shot. Taking things further still, Photoshop or equivalent software can be used to add or remove people or objects from a scene, or to crop elements out from a photograph. An example of object addition is the below photograph, which purports to show construction machinery outside a kindergarten in eastern Ukraine. The satirical text accompanying the image jokes about the “calibre of the construction machinery” - the author suggesting that reports of damage to buildings from military ordinance are exaggerated or untrue. Close inspection reveals this image was <a href="https://www.reuters.com/article/factcheck-ukraine-alteredmachinery-idUSL1N2UT2W0" target="_blank" rel="noopener">digitally altered</a> to include the machinery. This tweet could be seen as an attempt to downplay the extent of damage resulting from a Russian-backed missile attack, and in a wider context to create confusion and doubt as to veracity of other images emerging from the conflict zone. What’s being done about it? European organisations such as <a href="https://www.bellingcat.com/news/2022/02/23/documenting-and-debunking-dubious-footage-from-ukraines-frontlines/" target="_blank" rel="noopener">Bellingcat</a> have begun compiling lists of dubious social media claims about the Russia-Ukraine conflict and debunking them where necessary. Journalists and fact-checkers are also working to verify content and <a href="https://twitter.com/AricToler/status/1494738571483353092?s=20&t=bndDHkpko9nibN9LjRmaWw" target="_blank" rel="noopener">raise awareness</a> of known fakes. Large, well-resourced news outlets such as the BBC are also <a href="https://www.bbc.com/news/60513452" target="_blank" rel="noopener">calling out misinformation</a>. Social media platforms have added new <a href="https://help.twitter.com/en/rules-and-policies/state-affiliated" target="_blank" rel="noopener">labels</a> to identify state-run media organisations or provide more <a href="https://9to5mac.com/2018/04/03/facebook-newsfeed-update/" target="_blank" rel="noopener">background information</a> about sources or people in your networks who have also shared a particular story. They have also <a href="https://www.politico.com/news/2022/02/24/social-media-platforms-russia-ukraine-disinformation-00011559" target="_blank" rel="noopener">tweaked their algorithms</a> to change what content is amplified and have hired staff to spot and flag misleading content. Platforms are also doing some work behind the scenes to detect and <a href="https://transparency.twitter.com/en/reports/information-operations.html" target="_blank" rel="noopener">publicly share</a> information on state-linked information operations. What can I do about it? You can attempt to <a href="https://www.tandfonline.com/doi/full/10.1080/17512786.2020.1832139" target="_blank" rel="noopener">fact-check images</a> for yourself rather than taking them at face value. An <a href="https://www.aap.com.au/factcheck-resources/how-do-you-fact-check-an-image/" target="_blank" rel="noopener">article</a> we wrote late last year for the Australian Associated Press explains the fact-checking process at each stage: image creation, editing and distribution. Here are five simple steps you can take: 1. Examine the metadata This <a href="https://t.me/nm_dnr/6192" target="_blank" rel="noopener">Telegram post</a> claims Polish-speaking saboteurs attacked a sewage facility in an attempt to place a tank of chlorine for a “<a href="https://theconversation.com/what-are-false-flag-attacks-and-did-russia-stage-any-to-claim-justification-for-invading-ukraine-177879">false flag</a>” attack. But the video’s metadata – the details about how and when the video was created – <a href="https://twitter.com/EliotHiggins/status/1495356701717020681?s=20&t=DSIyWgyKfPu2vKvVQLjnOw">show</a> it was filmed days before the alleged date of the incident. To check metadata for yourself, you can download the file and use software such as Adobe Photoshop or Bridge to examine it. Online <a href="http://metapicz.com/#landing" target="_blank" rel="noopener">metadata viewers</a> also exist that allow you to check by using the image’s web link. One hurdle to this approach is that social media platforms such as Facebook and Twitter often strip the metadata from photos and videos when they are uploaded to their sites. In these cases, you can try requesting the original file or consulting fact-checking websites to see whether they have already verified or debunked the footage in question. 2. Consult a fact-checking resource Organisations such as the <a href="https://www.aap.com.au/factcheck/" target="_blank" rel="noopener">Australian Associated Press</a>, <a href="https://www.rmit.edu.au/about/schools-colleges/media-and-communication/industry/factlab/debunking-misinformation" target="_blank" rel="noopener">RMIT/ABC</a>, <a href="https://factcheck.afp.com/" target="_blank" rel="noopener">Agence France-Presse (AFP)</a> and <a href="https://www.bellingcat.com/news/2022/02/23/documenting-and-debunking-dubious-footage-from-ukraines-frontlines/" target="_blank" rel="noopener">Bellingcat</a> maintain lists of fact-checks their teams have performed. The AFP has already <a href="https://factcheck.afp.com/doc.afp.com.323W3V8" target="_blank" rel="noopener">debunked</a> a video claiming to show an explosion from the current conflict in Ukraine as being from the <a href="https://theconversation.com/what-is-ammonium-nitrate-the-chemical-that-exploded-in-beirut-143979" target="_blank" rel="noopener">2020 port disaster</a> in Beirut. 3. Search more broadly If old content has been recycled and repurposed, you may be able to find the same footage used elsewhere. You can use <a href="https://www.google.com/imghp?hl=EN" target="_blank" rel="noopener">Google Images</a> or <a href="https://tineye.com/" target="_blank" rel="noopener">TinEye</a> to “reverse image search” a picture and see where else it appears online. But be aware that simple edits such as reversing the left-right orientation of an image can fool search engines and make them think the flipped image is new. 4. Look for inconsistencies Does the purported time of day match the direction of light you would expect at that time, for example? Do <a href="https://twitter.com/Forrest_Rogers/status/1496254107660738568?s=20&t=KSr6GYxwMhqW719GhZPvlA" target="_blank" rel="noopener">watches</a> or clocks visible in the image correspond to the alleged timeline claimed? You can also compare other data points, such as politicians’ schedules or verified sightings, <a href="https://earth.google.com/static/9.157.0.0/app_min.html" target="_blank" rel="noopener">Google Earth</a> vision or <a href="https://www.google.com/maps" target="_blank" rel="noopener">Google Maps</a> imagery, to try and triangulate claims and see whether the details are consistent. 5. Ask yourself some simple questions Do you know where, when and why the photo or video was made? Do you know who made it, and whether what you’re looking at is the original version? Using online tools such as <a href="https://www.invid-project.eu/" target="_blank" rel="noopener">InVID</a> or <a href="https://29a.ch/photo-forensics/#forensic-magnifier" target="_blank" rel="noopener">Forensically</a> can potentially help answer some of these questions. Or you might like to refer to this list of <a href="https://drive.google.com/file/d/1kRfo1ToexG8dEiMqurXKqzEeXdyHn7Ic/view" target="_blank" rel="noopener">20 questions</a> you can use to “interrogate” social media footage with the right level of healthy scepticism. Ultimately, if you’re in doubt, don’t share or repeat claims that haven’t been published by a reputable source such as an international news organisation. And consider using some of these <a href="https://www.aap.com.au/factcheck-resources/how-do-you-know-what-information-sources-to-trust/" target="_blank" rel="noopener">principles</a> when deciding which sources to trust. By doing this, you can help limit the influence of misinformation, and help clarify the true situation in Ukraine.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;" src="https://counter.theconversation.com/content/177921/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/t-j-thomson-503845" target="_blank" rel="noopener">T.J. Thomson</a>, Senior Lecturer in Visual Communication & Media, <a href="https://theconversation.com/institutions/queensland-university-of-technology-847" target="_blank" rel="noopener">Queensland University of Technology</a>; <a href="https://theconversation.com/profiles/daniel-angus-12403" target="_blank" rel="noopener">Daniel Angus</a>, Professor of Digital Communication, <a href="https://theconversation.com/institutions/queensland-university-of-technology-847" target="_blank" rel="noopener">Queensland University of Technology</a>, and <a href="https://theconversation.com/profiles/paula-dootson-129022" target="_blank" rel="noopener">Paula Dootson</a>, Senior Lecturer, <a href="https://theconversation.com/institutions/queensland-university-of-technology-847" target="_blank" rel="noopener">Queensland University of Technology</a> This article is republished from <a href="https://theconversation.com" target="_blank" rel="noopener">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/fake-viral-footage-is-spreading-alongside-the-real-horror-in-ukraine-here-are-5-ways-to-spot-it-177921" target="_blank" rel="noopener">original article</a>. Image: Getty Images

Technology

Common ingredient found to encourage aggressive cancer spread

New research has found that a fatty acid found in palm oil and dairy products contributes to the aggressive nature of tumours and allows them to spread. The study from Barcelona’s Institute for Research in Biomedicine (IRB) saw researchers expose samples of mouth and skin cancers to a diet rich in palmitic acid - a major component of palm oil - before transplanting the sample tumours into mice. Palm oil is the most widely consumed vegetable oil in the world and can be found in food, beauty products, and detergents, according to the <a rel="noopener" href="https://www.worldwildlife.org/pages/which-everyday-products-contain-palm-oil" target="_blank">World Wildlife Fund</a>. The team found that the tumours had a greater capacity to metastasize - meaning they were more likely to spread to other parts of the body. They also identified that the cancer cells were permanently changed after being exposed to palmitic acid and were able to maintain this improved ability to metastasize months after. When they compared palmitic acid to linoleic acid and oleic acid - found in ingredients such as olive oil and linseed oil - the team discovered that palmitic acid was the only one to have any effect on the tumours. <blockquote 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);" class="instagram-media" data-instgrm-captioned="" data-instgrm-permalink="https://www.instagram.com/p/CWGewZNIOOx/?utm_source=ig_embed&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> <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;" rel="noopener" href="https://www.instagram.com/p/CWGewZNIOOx/?utm_source=ig_embed&utm_campaign=loading" target="_blank">A post shared by IRBBarcelona (@irbbarcelona)</a> </div> </blockquote> They also found that the fatty acids didn’t increase the risk of developing cancer in the first place. “There is something very special about palmitic acid that makes it an extremely potent promoter of metastasis,” researcher Dr Salvador Aznar-Benitah told <a rel="noopener" href="https://www.theguardian.com/society/2021/nov/10/fatty-acid-found-in-palm-oil-linked-to-spread-of-cancer" target="_blank">The Guardian</a>. In previous work, the same team showed that there was a correlation between palmitic acid and increased risks of metastasis. “In 2017, we published a study indicating that palmitic acid correlates with an increased risk of metastasis, but we didn’t know the mechanism responsible for this,” Dr Aznar-Benitah <a rel="noopener" href="https://www.irbbarcelona.org/en/news/scientific/palmitic-acid-promotes-cancer-metastasis-and-leaves-more-aggressive-memory-tumour" target="_blank">explained</a>. In their latest study, published in <a rel="noopener" href="https://www.nature.com/articles/s41586-021-04075-0" target="_blank">Nature</a>, they identified that the altered, aggressive cancer cells attracted the attention of the body’s nervous system and led to the construction of a network of neurons around the tumour, which helps the cancer cells to keep growing and spreading. But, the team found that blocking Schwann cells - cells that surround and protect the neurons - could stop the network from developing and prevent metastasis. “This discovery paves the way for research into and the development of therapies that specifically block cancer metastasis, a process that is almost always the cause of death by cancer,” researcher Dr Gloria Pascual said. <blockquote class="twitter-tweet"> Dr. <a href="https://twitter.com/SalvadorAznar3?ref_src=twsrc%5Etfw">@SalvadorAznar3</a>: “In this study, we detail the process and reveal the involvement of a metastatic capacity “memory” factor and we point to a therapeutic approach to reverse it. This is promising”. <a href="https://t.co/DW1zOpaIk8">pic.twitter.com/DW1zOpaIk8</a> — IRB Barcelona (@IRBBarcelona) <a href="https://twitter.com/IRBBarcelona/status/1458464584113827845?ref_src=twsrc%5Etfw">November 10, 2021</a></blockquote> Helen Rippon, the chief executive at Worldwide Cancer Research, praised the work as a “huge breakthrough”. “This discovery is a huge breakthrough in our understanding of how diet and cancer are linked and, perhaps more importantly, how we can use this knowledge to start new cures for cancer,” she <a rel="noopener" href="https://7news.com.au/lifestyle/health-wellbeing/acid-found-in-palm-oil-encourages-cancer-spread-new-research-finds-c-4543186" target="_blank">said</a>. Ms Rippon said about 90 percent of cancer deaths across the world can be attributed to metastasis. “Learning more about what makes cancer spread and - importantly - how to stop it is the way forward to reduce those numbers.” Image: Getty Images / @worldwidecancerresearch (Instagram)

Body

Aussie researchers find drugs that can stop breast cancer spreading

Australian researchers have made a major medical breakthrough in stopping the spread of breast cancer throughout the body. Scientists at Monash University discovered that everyday anti-stress drugs known as beta-blockers could slow the spread of the deadly disease. “We harnessed that knowledge by repurposing existing drugs. Our goal was to see if we could stop cancer cells spreading in the body,” Associate Professor Erica Sloan explained in a statement. She said that the research team made the discovery after identifying that stress activates the "fight or flight" response in the body, which helps spread cancer through the body. “We found that beta-blockers – which halt the stress response – stopped the cancer invading,” Professor Sloan said to <a rel="noopener" href="https://7news.com.au/sunrise/on-the-show/researchers-find-anti-stress-drugs-can-stop-breast-cancer-spreading-c-2242455" target="_blank">7NEWS</a>. A randomised trial was conducted with 60 women who were either given a beta-blocker called propanolol or a placebo. The trial ran from the time of diagnosis to the time of surgery, and will now be conducted on a larger scale. The larger trials are being run with the hope that anti-stress drugs could be prescribed to breast cancer patients in the future.

Body

Second wave: Coronavirus spreading faster than ever

<div class="post_body_wrapper"> <div class="post_body"> <div class="body_text "> World Health Organisation Director-General Tedros Adhanom Ghebreyesus said that the coronavirus pandemic is "accelerating" and more than 150,000 cases were reported on the 19th of June. In a media briefing, Ghebreyesus said that nearly half of the newly reported cases were from the Americas, with a significant increase from South Asia and the Middle East. "We are in a new and dangerous phase," he explained. "Many people are understandably fed up with being at home (and) countries are understandably eager to open up their societies." He warned that the virus is still "spreading fast" and that measures such as social distancing, mask-wearing and hand washing are still critical. "We have a shared duty to everything we can to prevent, detect and respond to the transmission of COVID-19 detected among refugees in hospitals." On the 22nd of June, the WHO reported that there have been more than 183,000 new cases in the last 24 hours around the world. Brazil had a shocking 54,771 new set of cases and the US followed behind with 36,617 new cases. In Australia, Victoria is bracing for a spike in COVID-19 cases meaning that a second wave of the virus is a "distinct possibility". Victoria confirmed a total of 160 new cases over the past week. </div> </div> </div>

News

Fleas to flu to coronavirus: how ‘death ships’ spread disease through the ages

One of the haunting images of this pandemic will be stationary cruise ships – deadly carriers of COVID-19 – at anchor in harbours and unwanted. Docked in ports and feared. The news of the dramatic spread of the virus on the <a href="https://www.bmj.com/content/369/bmj.m1632">Diamond Princess</a> from early February made the news real for many Australians who’d enjoyed holidays on the seas. Quarantined in Yokohama, Japan, over 700 of the ship’s crew and passengers became infected. To date, <a href="https://www.cruisemapper.com/accidents/Diamond-Princess-534">14 deaths</a> have been recorded. The Diamond Princess’s sister ship, the Ruby Princess, brought the pandemic to Australian shores. Now under <a href="https://www.smh.com.au/national/nsw/police-to-probe-second-ruby-princess-voyage-as-part-of-criminal-investigation-20200417-p54kpo.html">criminal investigation</a>, the events of the Ruby Princess forced a spotlight on the petri dish cruise ships can become. The ship has been <a href="https://www.theguardian.com/australia-news/2020/may/05/ruby-princess-was-initially-refused-permission-to-dock-over-coronavirus-fears-inquiry-told">linked to 21 deaths</a>. History shows the <a href="https://www.ncbi.nlm.nih.gov/pubmed/29737663">devastating role ships can play</a> in transmitting viruses across vast continents and over many centuries. Rats in the ranks Merchant ships carrying rats with infected fleas were transmitters of the <a href="https://academic.oup.com/past/article-abstract/244/1/3/5532056?redirectedFrom=fulltext">Plague of Justinian</a> (541-542 AD) that devastated the Byzantine Empire. Ships carrying grain from Egypt were home to flea-infested rats that fed off the granaries. Contantinople was especially inflicted, with estimates as high as <a href="https://www.history.com/news/microbe-behind-black-death-also-caused-devastating-plague-800-years-earlier">5,000 casualties a day</a>. Globally, up to 50 million people are estimated to have been killed – half the world’s population. The <a href="https://www.historyextra.com/period/medieval/plague-black-death-quarantine-history-how-stop-spread/">Black Death</a> was also carried by rats on merchant ships through the trade routes of Europe. It struck Europe in 1347, when 12 ships docked at the Sicilian port of Messina. Subsequently called “death ships”, those on board were either dead or sick. Soon, the Black Death spread to ports around the world, such as Marseilles, Rome and Florence, and by 1348 had reached London with devastating impact. The Italian writer, poet and scholar, Giovanni Boccaccio, <a href="https://www.historyextra.com/period/medieval/black-death-oh-father-why-have-you-abandoned-me/">wrote</a> how terror swept through Florence with relatives deserting infected family members. Almost inconceivably, he wrote, “fathers and mothers refused to nurse their own children, as though they did not belong to them”. Ships started being <a href="https://www.historyextra.com/period/medieval/plague-black-death-quarantine-history-how-stop-spread/">turned away</a> from European ports in 1347. Venice was the first city to close, with those permitted to enter forced into a 40-day quarantine: the word “quarantine” derives from the Italian quarantena, or 40 days. By January 1349, mass graves proliferated outside of London to bury the increasing numbers of dead. Army and naval ships, as well as travellers around the globe, also carried cholera pandemics throughout the 19th century. In the first pandemic <a href="https://www.history.com/topics/inventions/history-of-cholera">in 1817</a>, British army and navy ships are believed to have spread cholera beyond India where the outbreaks originated. By the 1820s, cholera had spread throughout Asia, reaching Thailand, Indonesia, China and Japan through shipping. British troops spread it to the Persian Gulf, eventually moving through Turkey and Syria. Subsequent outbreaks from the 1820s through to the 1860s relied on trade and troops to spread the disease across continents. At war with the Spanish Flu The Spanish influenza of 1918-1919 was originally carried by soldiers on overcrowded troop ships during the first world war. The rate of transmission on these ships was rapid, and soldiers died in large numbers. One New Zealand rifleman <a href="http://dx.doi.org/10.3201/eid1811.AD1811">wrote</a> in his diary in September 1918: More deaths and burials total now 42. A crying shame but it is only to be expected when human beings are herded together the way they have been on this boat. The flu was transmitted throughout Europe in France, Great Britain, Italy and Spain. Three-quarters of French troops and over half of British troops fell ill in 1918. Hundreds of thousands of US soldiers travelling on troop ships across the Atlantic and back provided the perfect conditions for transmission. The fate of cruising A new and lethal carrier in the 21st century has emerged in the pleasure industry of cruise ships. The <a href="https://www.forbes.com/sites/joemicallef/2020/01/20/state-of-the-cruise-industry-smooth-sailing-into-the-2020s/#364b397665fa">explosion</a> of cruise holidays in the past 20 years has led to a proliferation of luxury liners plying the seas. Like historical pandemics, the current crisis shares the characteristic of rapid spread through ships. The unknown is in what form cruise ships will continue to operate. Unlike the port-to-port trade and armed forces that carried viruses across continents centuries ago, the services cruise lines offer are non-essential. Whatever happens, the global spread of COVID-19 reminds us “death ships” are an enduring feature of the history of pandemics. Written by Joy Damousi. Republished with permission of <a href="https://theconversation.com/fleas-to-flu-to-coronavirus-how-death-ships-spread-disease-through-the-ages-137061">The Conversation.</a>

Cruising

Can mosquitos spread coronavirus?

The pathogens mosquitos spread by sucking our blood cause over half a million deaths each year and hundreds of millions of cases of severe illness. But there is no scientific evidence to suggest mosquitos are transmitting SARS-CoV-2, the virus that causes COVID-19. While there are many things we have yet to know about the coronavirus, current research supports that it’s highly unlikely a mosquito will pick up the virus by biting an infected person, let alone be able to pass it on. Mosquitos CAN transmit other viruses Female mosquitos need the nutrition found in blood to help develop their eggs. Viruses take advantage of this requirement as mosquitoes can easily move from host to host to transmit diseases. But for a mosquito to become infected, it first needs to bite an infected animal, such as a bird of kangaroo, or a person. The list of diseases a mosquito can transfer includes dengue, tallow fever, chikungunya, Zika and Ross River virus. They can also spread malaria, which is caused by a parasite. But they cannot transmit other viruses such as HIV and Ebola. Coronavirus is mainly spread through droplets produced when people sneeze or cough, and by touched surfaces that are contaminated. While the virus is found in blood, there’s no evidence that can spread via mosquitos. So if a mosquito does pick up a substantial dose of the virus, the virus won’t be able to infect the mosquito itself. And if the mosquito isn’t infected, it won’t be able to transmit it to the next person.

Body

Can mosquitoes spread coronavirus?

The pathogens mosquitoes spread by sucking our blood cause over <a href="https://www.who.int/malaria/en/">half a million deaths each year</a> and <a href="https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue">hundreds of millions of cases of severe illness</a>. But there is no scientific evidence to suggest mosquitoes are transmitting SARS-CoV-2, the virus that causes COVID-19. There is <a href="https://cmr.asm.org/content/20/4/660">much more to learn about the coronavirus</a> but based on current understandings, it’s highly unlikely a mosquito will pick up the virus by biting an infected person, let alone be able to pass it on. Yes, mosquitoes can transmit other viruses Female mosquitoes need the nutrition contained in blood to help develop their eggs. Viruses take advantage of this biological requirement of mosquitoes to move from host to host. But for a mosquito to become infected, it first needs to bite an infected animal, such as a bird or kangaroo, or a person. Mosquitoes can transmit a number of viruses, including dengue, yellow fever, chikungunya, Zika and Ross River virus. They can also transmit malaria, which is caused by a parasite. But they can’t transmit many other viruses, including HIV and Ebola. For <a href="https://europepmc.org/article/med/10554479">HIV</a>, mosquitoes themselves don’t become infected. It’s actually unlikely a mosquito will pick up the virus when it bites an infected person due to the low concentrations of the HIV circulating in their blood. For Ebola, <a href="https://www.ajtmh.org/content/journals/10.4269/ajtmh.1996.55.89">even when scientists inject the virus into mosquitoes</a>, they don’t become infected. One study collected tens of thousands of insects during an Ebola outbreak but <a href="https://academic.oup.com/jid/article/179/Supplement_1/S148/880615">found no virus</a>. No, not coronavirus The new coronavirus is <a href="https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations">mostly spread via droplets produced when we sneeze or cough</a>, and by touching <a href="https://theconversation.com/we-know-how-long-coronavirus-survives-on-surfaces-heres-what-it-means-for-handling-money-food-and-more-134671">contaminated surfaces</a>. Although coronavirus has been <a href="https://www.tandfonline.com/doi/full/10.1080/22221751.2020.1729071">found in blood samples from infected people</a>, there’s no evidence it can spread via mosquitoes. Even if a mosquito did pick up a high enough dose of the virus in a blood meal, there is no evidence the virus would be able to infect the mosquito itself. And if the mosquito isn’t infected, it won’t be able to transmit it to the next person she bites. Why some viruses and not others? It’s easy to think of mosquitoes as tiny flying dirty syringes transferring droplets of infected blood from person to person. The reality is far more complex. When a mosquito bites and sucks up some blood that contains a virus, the virus quickly ends up in the gut of the insect. From there, the virus needs to infect the cells lining the gut and “escape” to infect the rest of the body of the mosquito, spreading to the legs, wings, and head. The virus then has to infect the salivary glands before being passed on by the mosquito when it next bites. This process can take a few days to over a week. But time isn’t the only barrier. The virus also has to negotiate getting out of the gut, getting through the body, and then into the saliva. Each step in the process can be an impenetrable barrier for the virus. This may be straightforward for viruses that have adapted to this process but for others, the virus will perish in the gut or be excreted. <a href="https://theconversation.com/profiles/cameron-webb-6736">Cameron Webb</a>, Clinical Associate Professor and Principal Hospital Scientist, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> 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/can-mosquitoes-spread-coronavirus-134898">original article</a>.

Body

The kindness we need right now – and it's spreading fast

As the coronavirus continues to strike fear into the hearts of many, some community members are turning to social media to spread some cheer around the world. A Facebook group called The Kindness Pandemic started the group as “so many people needs acts of kindness right now”. They are aware that the kindness “won’t make COVID19 go away, but it will make our lives easier and more rewarding”. People have taken to the group in droves to share their stories about their lives as well as gestures of kindness that have restored their faith in humanity. Steve Lucas shared the heart-breaking story of how his father suddenly passed away, but due to new funeral restrictions from the Australian government, his father can no longer have the send-off his Navy father deserves. “Last Wednesday, my Dad suddenly passed away. He was married to my Mom for nearly fifty years; she passed in July 2018,” Steve shared. “Services for my Dad are in the next few hours. With the current restrictions in place, there is no mass, no 21-gun salute (he was Navy) and no more than ten people can be in the room at once. “I don’t like asking for things, however, today I ask this: those that were in the military, salute my Dad sometime today. And, if one or more of your parents are still alive - tell them that you love them today!” <img style="width: 0px; height: 0px;" src="https://oversixtydev.blob.core.windows.net/media/7835285/stevelucas_720px_v2.jpg" alt="" data-udi="umb://media/82bb06d3353e4644aafa4300e9b191c0" /> Lysandra Beckett explained her story, saying that only six years ago, she was “a crackhead”, but things have gotten better. “Today I start my new job as the very first EVS [Environmental Services]manager of the very first stand alone ER in my state,” she said. “Everything I do from now on is a first. And to add to that I'm doing it in a time that is unprecedented. A pandemic is sweeping my nation and the world right now. I will be on the front line protecting my staff, practitioners and patients in this.” Environmental service workers are the workers who clean the facilities to hospital standards by thoroughly santising public and private rooms in the hospital. <img style="width: 500px; height: 434.72222222222223px;" src="https://oversixtydev.blob.core.windows.net/media/7835287/lysandra_720px.jpg" alt="" data-udi="umb://media/91f519adf8d543a9b6494794085eec34" /> Others are sharing random acts of kindness that they’ve been able to do in pandemic times. Sharleen Caruana shared to the group her random act of kindness. “Was at the pharmacy last week and the lady in front of me didn’t have $8 in her bank to buy medicine for her child. I told her that I will pay for it. She nearly cried with happiness. Was a lovely feeling.” <img style="width: 500px; height: 172.22222222222223px;" src="https://oversixtydev.blob.core.windows.net/media/7835286/sharleen_720px.jpg" alt="" data-udi="umb://media/ee2c47f5740c4d1a804eaf6fc5cd96e7" /> Kat Ashleigh shared the kindness of her neighbour after she was “feeling helpless and sorry for myself”. “My neighbor overheard me crying outside to my mum today because I’m struggling right now. I’ve been let off from my main job, have to move house in less than two weeks, and I genuinely had a moment of feeling helpless and sorry for myself,” she explained. “He knocked on my door tonight and apologized for listening in to my conversation, and offered me two bags full of food ( noodles, rice, pasta, canned items, deodorant, toilet paper, tampons) and continued to tell me his story of how he grew up in a country that was constantly in war & how he had the choice of either feeding himself or feeding his family. “He said that he came to Australia to live a better life and now that he is well off, it hurt him to hear that a fellow Aussie was so upset and in a bad place. “I broke down in tears in front of him. I couldn’t even comprehend his generosity and kind nature.” <img style="width: 431.6546762589928px; height: 500px;" src="https://oversixtydev.blob.core.windows.net/media/7835288/kat_720px.jpg" alt="" data-udi="umb://media/ea019db59121441caa77947cb308bbde" /> Many comments commended the neighbour for his kind gesture. “This has brought me to tears,” one woman wrote. Another agreed, saying “What a wonderful man. So thoughtful!” “Proud to call him an Aussie, need more caring people like him,” another commented. Source: <a rel="noopener" href="https://www.facebook.com/groups/515507852491119/" target="_blank">Kindness Pandemic Facebook page</a>

International Travel

"I am going to spread the virus"

A coronavirus patient in his 50s intentionally spread the virus in Japan by barhopping before Hazmat-suit wearing police took him to hospital. As the man tested positive for the disease but showed no symptoms, he was instructed to self-isolate after being sent home initially by medics. The man ignored advice and told a relative that he was going to “spread the virus” before hopping in a taxi to a local bar. He went to the first bar before going to a second one and announcing that he has “tested positive” for the disease. Police from the Gamagori Police Station rushed to the bar clad in hazmat suits, but the man had already made his way back home in a taxi. One staff member explained to <a rel="noopener noreferrer" href="https://www.tokyoreporter.com/japan/aichi-man-infected-with-coronavirus-goes-to-bars-to-spread-it/" target="_blank">The Tokyo Reporter</a> that they “can’t get it straight in my head”. “I cannot express it in words since I only have anger.” Both establishments are now undergoing sterilization, with staff members and customers undergoing examinations. “It is highly regrettable that he did not remain home as instructed,” Gamagori mayor Toshiaki Suzuki said. The man has since been taken to a medical centre for treatment.

International Travel

“No Chinese allowed”: Racism surges as fear around coronavirus spreads

The outbreak of the coronavirus has led to a surge in anti-Chinese racism that adds to the anxiety felt by expatriate communities worldwide. Social media sites such as Twitter and Facebook have been overrun with hate speech in the form of racist memes and slurs and in some cases, suggesting violence against Chinese people or calling for the country to be “nuked”. “I don’t think it’s necessarily turned people into racists but what it does is inflame the existing prejudices within the community,” said ANU researcher Yun Jiang, coeditor of the China Neican policy newsletter. “So now people who perhaps have existing prejudice suddenly have an excuse to act out with racist behaviour and remarks.” In South Korea, a number of businesses are <a rel="noopener noreferrer" href="http://english.hani.co.kr/arti/english_edition/e_international/926084.html" target="_blank" title="english.hani.co.kr">refusing to serve Chinese customers</a>, placing signs in windows reading, “No Chinese allowed.” <blockquote class="twitter-tweet" data-conversation="none"> As of 6 pm on Tuesday, the entrance to a seafood restaurant in downtown Seoul bore a sign that read, in red Chinese characters, “No Chinese allowed.” That same day, union of food delivery workers asked to be excused from making deliveries to areas with a large Chinese population <a href="https://t.co/tSE0Z7wwhk">pic.twitter.com/tSE0Z7wwhk</a> — Klaus (@Kakapolka) <a href="https://twitter.com/Kakapolka/status/1222451845534060544?ref_src=twsrc%5Etfw">January 29, 2020</a></blockquote> Similar notices have been placed in Japanese stores, saying that “No Chinese are allowed to enter the store. I do not want to spread the virus”. Chinese authorities have announced that the official death toll has risen to 170, with 7,711 cases now reported across the country. University of Manchester student Sam Phan wrote in <a rel="noopener noreferrer" href="https://www.theguardian.com/commentisfree/2020/jan/27/coronavirus-panic-uk-hostile-environment-east-asians" target="_blank">The Guardian</a> about how the panic was making him feel “more and more uncomfortable”. “On the train over the weekend, a group sat opposite me chattering about their weekend plans,” Mr Phan wrote. “One of them seriously advised the rest, ‘I wouldn’t go to Chinatown if I were you, they have that disease.’ In another loud conversation, I overheard a woman talking about how terrified she was that her friend, who had spent some time working with Chinese students, might have infected her with the virus.” Mr Phan said as the virus spread, it had “revealed more and more stereotyped judgments about Chinese people”. “East Asians have been accused of instigating the virus by having ‘revolting’ eating habits,” he said. “Most Asians know these stereotypes all too well.” Ms Jiang agreed. “You look at the history of racism, a lot of it is linked to concepts of hygiene and customs such as food — the western conception of what’s weird and not, what is hygienic — and I think that really plays into this racist discourse as well,” she said.

Travel Trouble

How contagious is the Wuhan coronavirus and can you spread it before symptoms start?

Cases of the Wuhan coronavirus have increased dramatically over the past week, prompting concerns about how contagious the virus is and how it spreads. According to the <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports">World Health Organisation</a>, 16-21% of people with the virus in China became severely ill and 2-3% of those infected have died. A key factor that influences transmission is whether the virus can spread in the absence of symptoms – either during the incubation period (the days before people become visibly ill) or in people who never get sick. On Sunday, <a href="https://www.bbc.com/news/world-asia-china-51254523">Chinese officials said</a> transmission had occurred during the incubation period. So what does the evidence tell us so far? Can you transmit it before you get symptoms? Influenza is the <a href="https://www.infectiousdiseaseadvisor.com/home/topics/respiratory/influenza/transfluas-study-asymptomatic-influenza-transmission-in-acute-health-care/">classic example</a> of a virus that can spread when people have no symptoms at all. In contrast, people with <a href="https://www.nhs.uk/conditions/sars/">SARS</a> (severe acute respiratory syndrome) only spread the virus when they had symptoms. No published scientific data are available to support China’s claim transmission of the Wuhan coronavirus occurred during the incubation period. However, <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30154-9/fulltext">one study published in the Lancet medical journal showed</a> children may be shedding (or transmitting) the virus while asymptomatic. The researchers found one child in an infected family had no symptoms but a chest CT scan revealed he had pneumonia and his test for the virus came back positive. This is different to transmission in the incubation period, as the child never got ill, but it suggests it’s possible for children and young people to be infectious without having any symptoms. This is a concern because if someone gets sick, you want to be able to identify them and track their contacts. If someone transmits the virus but never gets sick, they may not be on the radar at all. It also makes airport screening less useful because people who are infectious but don’t have symptoms would not be detected. How infectious is it? The Wuhan coronavirus epidemic began when people exposed to an <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext">unknown source at a seafood market</a> in Wuhan began falling ill in early December. Cases remained below 50 to 60 in total until around January 20, when numbers surged. There have now been <a href="https://flutrackers.com/forum/forum/-2019-ncov-new-coronavirus/823378-2019-ncov-confirmed-case-list-by-country-w-links-to-sources-total-cases-4-576-total-deaths-106-as-of-9-40-et-january-27-2020-disclaimer-we-do-not-endorse-any-of-these-numbers">more than 4,500 cases – mostly in China – and 106 deaths</a>. Researchers and public health officials determine how contagious a virus is by calculating a reproduction number, or R0. The R0 is the average number of other people that one infected person will infect, in a completely non-immune population. Different experts have <a href="https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/news--wuhan-coronavirus/">estimated</a> the R0 of the Wuhan coronavirus is anywhere from 1.4 to over five, however the <a href="https://www.bmj.com/content/bmj/368/bmj.m308.full.pdf">World Health Organisation believes</a> the RO is between 1.4 and 2.5. If the R0 was higher than 2-3, we should have seen more cases globally by mid January, given Wuhan is a travel and trade hub of 11 million people. How is it transmitted? Of the person-to-person modes of transmission, we fear respiratory transmission the most, because infections spread most rapidly this way. Two kinds of respiratory transmission are through large droplets, which is thought to be short-range, and airborne transmission on much smaller particles over longer distances. Airborne transmission is the most difficult to control. SARS was considered to be transmitted by contact and over short distances by droplets but can also be transmitted through smaller aerosols over long distances. In Hong Kong, <a href="https://academic.oup.com/cid/article/58/5/683/365793">infection was transmitted</a> from one floor of a building to the next. Initially, most cases of the Wuhan coronavirus were assumed to be from an animal source, localised to the seafood market in Wuhan. We <a href="https://jglobalbiosecurity.com/articles/51/">now know</a> it can spread from person to person in some cases. The Chinese government announced it can be spread by touching and contact. We don’t know how much transmission is person to person, but we have some clues. Coronaviruses are respiratory viruses, so they can be found in the nose, throat and lungs. The amount of Wuhan coronavirus appears to be <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext">higher in the lungs</a> than in the nose or throat. If the virus in the lungs is expelled, it could possibly be spread via fine, airborne particles, which are inhaled into the lungs of the recipient. How did the virus spread so rapidly? The continuing surge of cases in China since January 18 – despite the lockdowns, extended holidays, travel bans and banning of the wildlife trade – could be explained by several factors, or a combination of: <ol> <li> increased travel for New Year, resulting in the spread of cases around China and globally. Travel is a major factor in the spread of infections </li> <li> asymptomatic transmissions through children and young people. Such transmissions would not be detected by contact tracing because health authorities can only identify contacts of people who are visibly ill </li> <li> increased detection, testing and reporting of cases. There has been increased capacity for this by doctors and nurses coming in from all over China to help with the response in Wuhan </li> <li> substantial person-to-person transmission </li> <li> continued environmental or animal exposure to a source of infection. </li> </ol> However, with an incubation period as short as <a href="https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200127-sitrep-7-2019--ncov.pdf?sfvrsn=98ef79f5_2">one to two days</a>, if the Wuhan coronavirus was highly contagious, we would expect to already have seen widespread transmission or outbreaks in other countries. Rather, the increase in transmission is likely due to a combination of the factors above, to different degrees. The situation is changing daily, and we need to analyse the transmission data as it becomes available.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;" src="https://counter.theconversation.com/content/130686/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/c-raina-macintyre-101935">C Raina MacIntyre</a>, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, <a href="https://theconversation.com/institutions/unsw-1414">UNSW</a> This article is republished from <a href="http://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-contagious-is-the-wuhan-coronavirus-and-can-you-spread-it-before-symptoms-start-130686">original article</a>.

Travel Trouble

How chronic stress can help cancer spread

Rik Thompson, Professor of Breast Cancer Research, Institute of Health and Biomedical Innovation and School of Biomedical Sciences, Queensland University of Technology and Sandra Hayes, Professor, School of Public Health and Social Work, Queensland University of Technology, explain how chronic stress can help cancer spread. Chronic stress accelerates cancer growth in mice, according to a <a href="http://www.nature.com/ncomms/2016/160301/ncomms10634/full/ncomms10634.html" target="_blank">paper published in Nature Communications</a> this week. The finding points to potential treatment targets to slow the progression of cancer to other organs. The paper revealed findings from several studies, mostly on mice, conducted by a team of researchers from Monash University. Chronic stress refers to prolonged, repeated exposure to stressful situations, such as caring for a sick relative for a long period of time. To mimic the way people feel under significant stress, researchers restrained mice with breast cancer tumours, to make them feel like they couldn’t cope with their circumstances. Over time, the mice developed an increase in the number and size of of their lymphatic vessels – a network of vessels that transports fluid around the body. This enhanced the spread of cancer cells to new sites, a process called cancer progression or metastasis. By blocking the activity of proteins that detect stress, or those that enhance the formation of lymphatic vessels, researchers found they could reduce the spread of cancer cells in the mice. What stress does to the body The research focused on metastasis of breast cancer to other parts of the body, building on previous findings that neurological stress hinders our defence against disease. Previous findings <a href="http://www.nature.com/nrclinonc/journal/v5/n8/full/ncponc1134.html" target="_blank">from human studies</a> have shown poorer cancer survival in people exposed to stressful life experiences and those more prone to stress. Another <a href="http://onlinelibrary.wiley.com/doi/10.1002/cncr.23969/abstract;jsessionid=5F1E795CA48D6B71FC0A85B45799D348.f04t03" target="_blank">clinical trial</a> showed better survival rates for breast cancer patients in remission who participated in a 12-month intervention with strategies to reduce stress, improve mood and alter health behaviours. Everyday stressful experiences pose a threat to the body’s natural balance. This is because stress activates the <a href="https://www.sciencedaily.com/terms/sympathetic_nervous_system.htm" target="_blank">sympathetic nervous system (SNS)</a>, which is responsible for what we know as the fight or flight response. Under stress, the SNS releases higher levels of neurotransmitters. These hormones, such as epinephrine, signal to other cells to activate physiological flight or flight responses, such as a faster heart rate. This is important during times of threat because it makes us more alert and increases physiological functions needed for rapid reactions. But as shown in the Nature Communications study, chronic periods of stress can lead to changes in the lymphatic system. These include an increase in the number of vessels in the tumours as well as the size of these vessels. These changes are associated with the spread of cancer cells to lymph nodes and distant organs, such as the lung. Clinically, we know that when cancer cells have spread through blood vessels into the lymph vessels, that’s an important indicator of poorer prognosis. Preventing this could improve survival rates. It’s not so simple The latest findings have obvious treatment implications, which include using drugs to block stress responses that lead to changes in lymphatic vessels. But blocking any part of a natural pathway can promote a cascade of negative effects. The study reported that a number of patients on drugs often used to treat anxiety and high blood pressure (beta blockers that block the actions of adrenaline) were less likely to have secondary cancer that had spread from its primary site. This is good news, but more work is needed before such interventions can be further tested. This is because the lymphatic system is important in our immune response and manipulating any of its mechanisms could carry potential harms. These include limiting the immune system’s ability to respond to the cancer in the first place. It could also increase the risk of lymphedema – swelling in one or more extremities – that results from impaired flow of the lymphatic system. Although the authors did show supportive data from human clinical subjects, the bulk of the work was done in mouse models. Results from mice experiments don’t always translate to human systems, so further clinical testing is an essential step in translating these findings. Overall, though, the study points the way to potentially helping prevent cancer spreading so far from the original site that it’s too hard to treat. What are your thoughts? Written by Ric Thompson and Sandra Hayes. Republished with permission of <a href="http://www.theconversation.com" target="_blank">The Conversation</a>.<img width="1" height="1" src="https://counter.theconversation.com/content/55619/count.gif?distributor=republish-lightbox-advanced" alt="The Conversation"/>

Mind

6 foods that prevent middle age spread, according to a dietician

Susie Burrell is one of Australia’s leading dieticians. She is founder of <a href="http://www.shapeme.com.au/" target="_blank">Shape Me</a>, an online diet and lifestyle program which gives users direct access to her to support them with their weight loss goals. None of us like it, but inevitably we gain weight as we get older. The combination of hormonal changes, a reduction in metabolic rate as we lose muscle mass over time and less active lifestyles mean that ‘middle aged’ spread equates to gradual weight gain each and every year. Finally we have some scientific evidence to show that the types of foods we choose on a day to day basis are crucial when it comes to preventing the ‘age creep’ many of us see in our older years. The study published by Tuffs University in the American Journal of Clinical Nutrition tracked the dietary patterns of over 120 000 US health professionals over 16 years. The study found that the diets that had the highest glycaemic load caused by a regular intake of foods that course rapid rises in blood glucose levels were associated with weight gain over time. On the other hand, protein rich staples including dairy, seafood, lean chicken and nuts were associated with weight loss over time. From a physiological perspective these findings make sense – protein rich foods are not only nutrient rich but they help to control blood glucose levels and keep us fuller for longer after eating them. Refined carbs and sugars as found in white breads and rice, soft drinks, juices and snack food result in relatively high release of the hormone insulin, which is related to weight gain and increased blood glucose levels. From a practical perspective, the findings of this study are a good reminder of the need to work towards a balance of protein rich foods and a controlled amount of low glycaemic index carbohydrate in your daily diet rather than basing meals and snacks around carb rich foods such as rice, pasta, processed grains and processed snack foods made from white flour and sugars. For example Greek yoghurt with a couple of spoons of oats as opposed to a large bowl of cereal with a little milk; or a chicken salad with a slice of bread rather than a Turkish bread sandwich. Such changes reduce the glycaemic load of your diet which will only be of benefit for weight control and diabetes prevention long term. Specially, here are some of the other anti-aging superfoods shown in this study to keep your waistline thinner as the years tick by, as they do, seemingly so quickly! 1. Greek yoghurt Greek yoghurt not only contains much less sugar than the average serve of store bought yoghurt but it is much higher in protein which helps to keep your blood glucose levels regulated throughout the day. An added benefit will come if you choose a variety of Greek yoghurt which also contains probiotics, the live bacteria that will help to feed the good bacteria in the gut and is thought to have a powerful role in optimal immune functioning long term. Enjoy with some oats for breakfast, as a filling snack, as a light dessert option, add to smoothies and protein shakes or even as a dressing option with vegetables for a daily calcium boost. 2. Cottage cheese Cottage cheese is one of the most nutrient dense foods you can enjoy. With a hearty serve of more than 16g of protein per ½ cup along with calcium, magnesium and Vitamin B12, adding a serve of cottage cheese into your day is a great way to bump up your intake of essential nutrients for very few calories. When you consider that more than 4 million Australians have osteopenia, or a low bone density, eating calcium rich foods on a daily basis needs to be a priority throughout our adult lives. 3. Fish Exceptionally high in protein, low in fat and calories, any type of fish is a superfood when it comes to weight control. Served grilled, BBQ’d or even fried in a little olive oil, fish is a perfect base to light meals served with plenty of brightly coloured, nutrient rich veges. Of particular nutritional value are deep sea cold fish such as sardines and salmon which contain some of the highest concentrations from omega 3 fats, a natural anti-inflammatory. Aim for at least 2-3 serves of a mix of different types of fish each week and remember that fresh is always best as it contains much less salt than smoked or tinned varieties. 4. Chicken breast While good quality protein is required to protect muscle breakdown as we get older, the extra saturated fat found in fatty cuts of red meat or chicken legs and thighs is not. Chicken breast is exceptionally lean and is a rich source of protein, B-vitamins and magnesium. Enjoy with lunchtime salads, marinated with vegetables or made into mince to enjoy with zucchini pasta, burgers or in lettuce cups. 5. Nuts A serve of nuts each day ensures that we are getting a good dose of poly and mono unsaturated fat each day as well as protein, fibre and Vitamin E. When it comes to which type, a mix of different nuts will ensure you get the range of micronutrients different nuts offer. A nut based snack mid-afternoon is a great dietary habit. Not only will this help to ward off the pre-dinner munchies as nuts are a great source of protein and fibre, but the low carbohydrate content of nuts will help to taper off your fuel intake towards the second half of the day which is conducive to weight control. Just remember that 30g or ~20 nuts is a serve. 6. Eggs You will be hard pressed to find a more nutritionally complete food than the humble egg. Packed with protein, key nutrients including zinc as well as 20 other vitamins and minerals, eggs can easily be incorporated into any meal and prepared in minutes. Whether they are enjoyed for breakfast on wholegrain toast, added to sandwiches or salads at lunchtime or whipped into a quick frittata or omelette, eggs are the number one fridge food by far. And before you get too concerned about the cholesterol content of eggs, keep in mind that it is not cholesterol but saturated fat that increases blood cholesterol levels and 1-2 eggs each day will not have adverse effects on blood cholesterol when consumed as part of a nutritionally balanced diet.

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6 foods that prevent middle age spread, according to a dietician