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How we diagnose and define obesity is set to change – here’s why, and what it means for treatment

<a href="https://theconversation.com/profiles/louise-baur-5284">Louise Baur</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/john-b-dixon-11630">John B. Dixon</a>, <a href="https://theconversation.com/institutions/swinburne-university-of-technology-767">Swinburne University of Technology</a>; <a href="https://theconversation.com/profiles/priya-sumithran-1529047">Priya Sumithran</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>, and <a href="https://theconversation.com/profiles/wendy-a-brown-1665">Wendy A. Brown</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Obesity is <a href="https://www.niddk.nih.gov/health-information/weight-management/adult-overweight-obesity/health-risks#:%7E:text=Having%20overweight%20or%20obesity%20increases,the%20cells%20in%20your%20body">linked to</a> many common diseases, such as type 2 diabetes, heart disease, fatty liver disease and knee osteoarthritis. Obesity is currently defined using a person’s body mass index, or BMI. This is <a href="https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight">calculated</a> as weight (in kilograms) divided by the square of height (in metres). In people of European descent, the BMI for obesity is 30 kg/m² and over. But the risk to health and wellbeing is not determined by weight – and therefore BMI – alone. We’ve been part of a global collaboration that has spent the past two years discussing how this should change. Today we publish how we think obesity should be defined and why. As we outline in <a href="https://www.thelancet.com/commissions/clinical-obesity">The Lancet</a>, having a larger body shouldn’t mean you’re diagnosed with “clinical obesity”. Such a diagnosis should depend on the level and location of body fat – and whether there are associated health problems. <h2>What’s wrong with BMI?</h2> The risk of ill health depends on the relative percentage of fat, bone and muscle making up a person’s body weight, as well as where the fat is distributed. Athletes with a relatively high muscle mass, for example, may have a higher BMI. Even when that athlete has a BMI over 30 kg/m², their higher weight is due to excess muscle rather than excess fatty tissue. People who carry their excess fatty tissue <a href="https://www.abc.net.au/news/health/2017-09-06/waist-size-why-it-matters-and-when-its-a-risk/8839708">around their waist</a> are at greatest risk of the health problems associated with obesity. Fat stored deep in the abdomen and around the internal organs can release damaging molecules into the blood. These can then <a href="https://theconversation.com/body-fat-deep-below-the-surface-is-a-toxic-risk-especially-for-your-heart-146307">cause problems</a> in other parts of the body. But BMI alone does not tell us whether a person has health problems related to excess body fat. People with excess body fat don’t always have a BMI over 30, meaning they are not investigated for health problems associated with excess body fat. This might occur in a very tall person or in someone who tends to store body fat in the abdomen but who is of a “healthy” weight. On the other hand, others who aren’t athletes but have excess fat may have a high BMI but no associated health problems. BMI is therefore an imperfect tool to help us diagnose obesity. <h2>What is the new definition?</h2> The goal of the <a href="https://pubmed.ncbi.nlm.nih.gov/36878238">Lancet Diabetes & Endocrinology Commission on the Definition and Diagnosis of Clinical Obesity </a>was to develop an approach to this definition and diagnosis. The commission, established in 2022 and led from King’s College London, has brought together 56 experts on aspects of obesity, including people with lived experience. The commission’s <a href="https://www.thelancet.com/commissions/clinical-obesity">definition and new diagnostic criteria</a> shifts the focus from BMI alone. It incorporates other measurements, such as waist circumference, to confirm an excess or unhealthy distribution of body fat. We define two categories of obesity based on objective signs and symptoms of poor health due to excess body fat. 1. Clinical obesity A person with clinical obesity has signs and symptoms of ongoing organ dysfunction and/or difficulty with day-to-day activities of daily living (such as bathing, going to the toilet or dressing). There are 18 diagnostic criteria for clinical obesity in adults and 13 in children and adolescents. These include: <ul> <li> breathlessness caused by the effect of obesity on the lungs </li> <li> obesity-induced heart failure </li> <li> raised blood pressure </li> <li> fatty liver disease </li> <li> abnormalities in bones and joints that limit movement in children. </li> </ul> 2. Pre-clinical obesity A person with pre-clinical obesity has high levels of body fat that are not causing any illness. People with pre-clinical obesity do not have any evidence of reduced tissue or organ function due to obesity and can complete day-to-day activities unhindered. However, people with pre-clinical obesity are generally at higher risk of developing diseases such as heart disease, some cancers and type 2 diabetes. <h2>What does this mean for obesity treatment?</h2> Clinical obesity is a disease requiring access to effective health care. For those with clinical obesity, the focus of health care should be on improving the health problems caused by obesity. People should be offered evidence-based treatment options after discussion with their health-care practitioner. <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01210-8/abstract">Treatment</a> will <a href="https://www.thelancet.com/journals/landia/article/PIIS2213-8587(22)00047-X/fulltext">include</a> management of obesity-associated complications and may include specific obesity treatment aiming at decreasing fat mass, such as: <ul> <li> support for <a href="https://www.obesityevidencehub.org.au/collections/treatment/behavioural-interventions-for-the-management-of-overweight-and-obesity-in-adults">behaviour change</a> <a href="https://www.obesityevidencehub.org.au/collections/treatment/managing-overweight-and-obesity-in-children-and-adolescents">around</a> diet, physical activity, sleep and screen use </li> <li> obesity-management medications to reduce appetite, lower weight and <a href="https://www.obesityevidencehub.org.au/collections/treatment/medication-and-surgery-for-the-treatment-of-overweight-and-obesity-in-adults">improve health</a> outcomes such as blood glucose (sugar) and blood pressure </li> <li> metabolic <a href="https://theconversation.com/thinking-about-bariatric-surgery-for-weight-loss-heres-what-to-consider-184153">bariatric surgery</a> to treat obesity or reduce weight-related health complications. </li> </ul> <h2>Should pre-clinical obesity be treated?</h2> For those with pre-clinical obesity, health care should be about risk-reduction and prevention of health problems related to obesity. This may require health counselling, including support for health behaviour change, and monitoring over time. Depending on the person’s individual risk – such as a family history of disease, level of body fat and changes over time – they may opt for one of the obesity treatments above. Distinguishing people who don’t have illness from those who already have ongoing illness will enable personalised approaches to obesity prevention, management and treatment with more appropriate and cost-effective allocation of resources. <h2>What happens next?</h2> These new criteria for the diagnosis of clinical obesity will need to be adopted into national and international clinical practice guidelines and a range of obesity strategies. Once adopted, training health professionals and health service managers, and educating the general public, will be vital. Reframing the narrative of obesity may help eradicate misconceptions that contribute to stigma, including making false assumptions about the health status of people in larger bodies. A better understanding of the biology and health effects of obesity should also mean people in larger bodies are not blamed for their condition. People with obesity or who have larger bodies should expect personalised, evidence-based assessments and advice, free of stigma and blame.<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/245164/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/louise-baur-5284">Louise Baur</a>, Professor, Discipline of Child and Adolescent Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/john-b-dixon-11630">John B. Dixon</a>, Adjunct Professor, Iverson Health Innovation Research Institute, <a href="https://theconversation.com/institutions/swinburne-university-of-technology-767">Swinburne University of Technology</a>; <a href="https://theconversation.com/profiles/priya-sumithran-1529047">Priya Sumithran</a>, Head of the Obesity and Metabolic Medicine Group in the Department of Surgery, School of Translational Medicine, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>, and <a href="https://theconversation.com/profiles/wendy-a-brown-1665">Wendy A. Brown</a>, Professor and Chair, Monash University Department of Surgery, School of Translational Medicine, Alfred Health, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Shutterstock 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-we-diagnose-and-define-obesity-is-set-to-change-heres-why-and-what-it-means-for-treatment-245164">original article</a>.

Body

Your friend has been diagnosed with cancer. Here are 6 things you can do to support them

<a href="https://theconversation.com/profiles/stephanie-cowdery-2217734">Stephanie Cowdery</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a>; <a href="https://theconversation.com/profiles/anna-ugalde-2232654">Anna Ugalde</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a>; <a href="https://theconversation.com/profiles/trish-livingston-163686">Trish Livingston</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a>, and <a href="https://theconversation.com/profiles/victoria-white-1888110">Victoria White</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> Across the world, <a href="https://www.who.int/news/item/01-02-2024-global-cancer-burden-growing--amidst-mounting-need-for-services">one in five</a> people are diagnosed with cancer during their lifetime. By age 85, almost <a href="https://www.cancer.org.au/cancer-information/what-is-cancer/facts-and-figures">one in two</a> Australians will be diagnosed with cancer. When it happens to someone you care about, it can be hard to know what to say or how to help them. But providing the right support to a friend can make all the difference as they face the emotional and physical challenges of a new diagnosis and treatment. Here are six ways to offer meaningful support to a friend who has been diagnosed with cancer. <h2>1. Recognise and respond to emotions</h2> When facing a cancer diagnosis and treatment, it’s normal to experience a range of <a href="https://www.canceraustralia.gov.au/impacted-by-cancer/emotions#:%7E:text=It's%20likely%20that%20feelings%20will,these%20feelings%20ease%20with%20time">emotions</a> including fear, anger, grief and sadness. Your friend’s moods may fluctuate. It is also common for feelings to <a href="https://link.springer.com/article/10.1007/s00520-014-2492-9">change over time</a>, for example your friend’s anxiety may decrease, but they may feel more depressed. Some friends may want to share details while others will prefer privacy. Always ask permission to raise sensitive topics (such as changes in physical appearance or their thoughts regarding fears and anxiety) and don’t make assumptions. It’s OK to tell them you feel awkward, as this acknowledges the challenging situation they are facing. When they feel comfortable to talk, follow their lead. Your support and willingness <a href="https://www.cancervic.org.au/get-support/stories/what-to-say-and-not-say.html">to listen without judgement</a> can provide great comfort. You don’t have to have the answers. Simply acknowledging what has been said, providing your full attention and being present for them will be a great help. <h2>2. Understand their diagnosis and treatment</h2> <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/pon.4722">Understanding</a> your friend’s diagnosis and what they’ll go through when being <a href="https://www.cancer.org/cancer/caregivers/what-a-caregiver-does/treatment-timeline.html">treated</a> may be helpful. Being informed can reduce your own worry. It may also help you to listen better and reduce the amount of explaining your friend has to do, especially when they’re tired or overwhelmed. Explore reputable sources such as the <a href="https://www.cancer.org.au/">Cancer Council website</a> for accurate information, so you can have meaningful conversations. But keep in mind your friend has a trusted medical team to offer personalised and accurate advice. <h2>3. Check in regularly</h2> Cancer treatment can be isolating, so regular check-ins, texts, calls or visits can help your friend feel less alone. Having a normal conversation and sharing a joke can be very welcome. But everyone copes with cancer differently. Be patient and flexible in your support – some days will be harder for them than others. Remembering key dates – such as the next round of chemotherapy – can help your friend feel supported. Celebrating milestones, including the end of treatment or anniversary dates, may boost morale and remind your friend of positive moments in their cancer journey. Always ask if it’s a good time to visit, as your friend’s immune system <a href="https://www.cancerresearchuk.org/about-cancer/what-is-cancer/body-systems-and-cancer/the-immune-system-and-cancer#:%7E:text=to%20fight%20cancer-,Cancer%20and%20treatments%20may%20weaken%20immunity,high%20dose%20of%20steroids">may be compromised</a> by their cancer or treatments such as chemotherapy or radiotherapy. If you’re feeling unwell, it’s best to postpone visits – but they may still appreciate a call or text. <h2>4. Offer practical support</h2> Sometimes the best way to show your care is through practical support. There may be different ways to offer help, and what your friend needs might change at the beginning, during and after treatment. For example, you could offer to pick up prescriptions, drive them to appointments so they have transport and company to debrief, or wait with them at appointments. Meals will always be welcome. However it’s important to remember cancer and its treatments may <a href="https://www.cancer.gov/about-cancer/treatment/side-effects/nutrition#effects-of-cancer-treatment-on-nutrition">affect</a> taste, smell and appetite, as well as your friend’s ability to eat enough or absorb nutrients. You may want to check first if there are particular foods they like. <a href="https://www.cancervic.org.au/downloads/resources/booklets/nutrition-cancer.pdf">Good nutrition</a> can help boost their strength while dealing with the side effects of treatment. There may also be family responsibilities you can help with, for example, babysitting kids, grocery shopping or taking care of pets. <h2>5. Explore supports together</h2> Studies <a href="https://pubmed.ncbi.nlm.nih.gov/35834503/">have shown</a> mindfulness practices can be an effective way for people to manage anxiety associated with a cancer diagnosis and its treatment. If this is something your friend is interested in, it may be enjoyable to explore classes (either online or in-person) together. You may also be able to help your friend connect with organisations that provide emotional and practical help, such as the Cancer Council’s <a href="https://www.cancer.org.au/support-and-services/cancer-council-13-11-20">support line</a>, which offers free, confidential information and support for anyone affected by cancer, including family, friends and carers. <a href="https://www.researchgate.net/publication/5659099_Systematic_review_of_peer-support_programs_for_people_with_cancer">Peer support groups</a> can also reduce your friend’s feelings of isolation and foster shared understanding and empathy with people who’ve gone through a similar experience. GPs <a href="https://pubmed.ncbi.nlm.nih.gov/34333571/">can help</a> with referrals to support programs. <h2>6. Stick with them</h2> Be committed. Many people feel <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC11120751/">isolated</a> after their treatment. This may be because regular appointments have reduced or stopped – which can feel like losing a safety net – or because their relationships with others have changed. Your friend may also experience emotions such as worry, lack of confidence and uncertainty as they adjust to a <a href="https://www.cancer.gov/about-cancer/coping/survivorship/new-normal">new way of living</a> after their treatment has ended. This will be an important time to support your friend. But don’t forget: looking after <a href="https://www.healthdirect.gov.au/caring-for-someone-with-cancer">yourself</a> is important too. Making sure you eat well, sleep, exercise and have emotional support will help steady you through what may be a challenging time for you, as well as the friend you love. <a href="https://www.deakin.edu.au/faculty-of-health/research/cancer-carer-hub">Our research</a> team is developing new programs and resources to support carers of people who live with cancer. While it can be a challenging experience, it can also be immensely rewarding, and your small acts of kindness can make a big difference.<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/239844/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/stephanie-cowdery-2217734">Stephanie Cowdery</a>, Research Fellow, Carer Hub: A Centre of Excellence in Cancer Carer Research, Translation and Impact, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a>; <a href="https://theconversation.com/profiles/anna-ugalde-2232654">Anna Ugalde</a>, Associate Professor & Victorian Cancer Agency Fellow, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a>; <a href="https://theconversation.com/profiles/trish-livingston-163686">Trish Livingston</a>, Distinguished Professor & Director of Special Projects, Faculty of Health, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a>, and <a href="https://theconversation.com/profiles/victoria-white-1888110">Victoria White</a>, Professor of Pyscho-Oncology, School of Psychology, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> Image credits: Shutterstock 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/your-friend-has-been-diagnosed-with-cancer-here-are-6-things-you-can-do-to-support-them-239844">original article</a>.

Caring

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

<a href="https://theconversation.com/profiles/matthew-griffith-1539353">Matthew Griffith</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> You’re not feeling well. You’ve had a pounding headache all week, dizzy spells and have vomited up your past few meals. You visit your GP to get some answers and sit while they shine a light in your eyes, order a blood test and request some medical imaging. Everything your GP just did relies on light. These are just some of the optical technologies that have had an enormous impact in how we diagnose disease. <h2>1. On-the-spot tests</h2> Point-of-care diagnostics allow doctors to test patients on the spot and get answers in minutes, rather than sending samples to a lab for analysis. The “flashlight” your GP uses to view the inside of your eye (known as an <a href="https://medlineplus.gov/ency/article/003881.htm">ophthalmoscope</a>) is a great example. This allows doctors to detect abnormal blood flow in the eye, deformations of the cornea (the outermost clear layer of the eye), or swollen optical discs (a round section at the back of the eye where the nerve link to the brain begins). Swollen discs are a sign of elevated pressure inside your head (or in the worst case, a brain tumour) that could be <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/headache/increased-intracranial-pressure-icp-headache">causing your headaches</a>. The invention of <a href="https://openmedscience.com/lighting-the-way-in-healthcare-the-transformative-role-of-lasers-in-medicine/">lasers and LEDs</a> has enabled many other miniaturised technologies to be provided at the bedside or clinic rather than in the lab. <a href="https://theconversation.com/whats-a-pulse-oximeter-should-i-buy-one-to-monitor-covid-at-home-174457">Pulse oximetry</a> is a famous example, where a clip attached to your finger reports how well your blood is oxygenated. It does this by <a href="https://www.howequipmentworks.com/pulse_oximeter/">measuring</a> the different responses of oxygenated and de-oxygenated blood to different colours of light. Pulse oximetry is used at hospitals (and <a href="https://theconversation.com/whats-a-pulse-oximeter-should-i-buy-one-to-monitor-covid-at-home-174457">sometimes at home</a>) to monitor your respiratory and heart health. In hospitals, it is also a valuable tool for detecting <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60107-X/fulltext">heart defects in babies</a>. <h2>2. Looking at molecules</h2> Now, back to that blood test. Analysing a small amount of your blood can diagnose <a href="https://theconversation.com/blood-tests-and-diagnosing-illness-what-can-blood-tell-us-about-whats-happening-in-our-body-80327">many different diseases</a>. A machine called an automated “full blood count analyser” tests for general markers of your health. This machine directs focused beams of light through blood samples held in small glass tubes. It counts the number of blood cells, determines their specific type, and reports the level of haemoglobin (the protein in red blood cells that distributes oxygen around your body). In minutes, this machine can provide a <a href="https://www.nuffieldhealth.com/article/inside-the-pathology-lab-what-happens-to-my-blood">snapshot</a> of your overall health. For more specific disease markers, blood serum is separated from the heavier cells by spinning in a rotating instrument called a centrifuge. The serum is then exposed to special chemical stains and enzyme assays that change colour depending on whether specific molecules, which may be the sign of a disease, are present. These colour changes can’t be detected with the naked eye. However, a light beam from an instrument called a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5476943/#R88">spectrometer</a> can detect tiny amounts of these substances in the blood and determine if the biomarkers for diseases are present, and at what levels. <h2>3. Medical imaging</h2> Let’s re-visit those medical images your GP ordered. The development of fibre-optic technology, made famous for transforming high-speed digital communications (such as the NBN), allows light to get inside the body. The result? High-resolution optical imaging. A common example is an <a href="https://www.medicalnewstoday.com/articles/153737#risks-and-side-effects">endoscope</a>, where fibres with a tiny camera on the end are inserted into the body’s natural openings (such as your mouth or anus) to examine your gut or respiratory tracts. Surgeons can insert the same technology through tiny cuts to view the inside of the body on a video screen during <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9553337/">laparoscopic surgery</a> (also known as keyhole surgery) to diagnose and treat disease. <h2>How about the future?</h2> Progress in nanotechnology and a better understanding of the interactions of light with our tissues are leading to new light-based tools to help diagnose disease. These include: <ul> <li> <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/advs.201903441">nanomaterials</a> (materials on an extremely small scale, many thousands of times smaller than the width of a human hair). These are being used in next-generation sensors and new diagnostic tests </li> <li> <a href="https://www.nature.com/articles/s41587-019-0045-y">wearable optical biosensors</a> the size of your fingernail can be included in devices such as watches, contact lenses or finger wraps. These devices allow non-invasive measurements of sweat, tears and saliva, in real time </li> <li> AI tools to analyse how blood serum scatters infrared light. This has allowed researchers to build a <a href="https://www.advancedsciencenews.com/powerful-diagnostic-approach-uses-light-to-detect-virtually-all-forms-of-cancer/">comprehensive database</a> of scatter patterns to detect <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/aisy.202300006">any cancer</a> </li> <li> a type of non-invasive imaging called <a href="https://www.ncbi.nlm.nih.gov/books/NBK554044/">optical coherence tomography</a> for more detailed imaging of the eye, heart and skin </li> <li> fibre optic technology to deliver a tiny microscope into the body on the <a href="https://www.uwa.edu.au/projects/microscope-in-a-needle">tip of a needle</a>. </li> </ul> So the next time you’re at the GP and they perform (or order) some tests, chances are that at least one of those tests depend on light to help diagnose disease.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/231379/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/matthew-griffith-1539353">Matthew Griffith</a>, Associate Professor and ARC Future Fellow and Director, UniSA Microscopy and Microanalysis Facilities, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/from-eye-exams-to-blood-tests-and-surgery-how-doctors-use-light-to-diagnose-disease-231379">original article</a>.

Body

Major breakthrough holds the key to diagnosing Alzheimer's

A new study has found that a simple blood test could be key to diagnosing Alzheimer's more quickly and more accurately. The research, published on the Journal of the American Medical Association, was conducted by a team of scientists at Sweden’s Lund University, was based off 1213 patients there with the condition. They found that a blood test could correctly identify whether patients with memory problems had Alzheimer’s 90 per cent of the time – making it “significantly” more accurate than cognitive tests and CAT scans in diagnosing the condition. The test itself measures tau protein 217, which if there is an abnormal build up of both in and around brain cells, may be the cause of the disease. “Increases in p tau-217 concentrations in the blood are quite profound in Alzheimer’s disease,” study co-author, Lund University associate professor and senior consultant neurologist, Dr Sebastian Palmqvist, told CNN. “At the dementia stage of the disease, levels are more than eight times higher compared with elderly (people) without Alzheimer’s.” As part of the study, the p tau-217 test was combined with one testing for another blood biomarker for Alzheimer’s called the amyloid 42/40 ratio. Other doctors have shared their thoughts on the research findings, with Chief science officer of America’s Alzheimer’s Association, Dr Maria Carrillo, telling CNN that doctors would “love to have a blood test that can be used in a primary care physician’s office, functioning like a cholesterol test but for Alzheimer’s”. “The p tau-217 blood test is turning out to be the most specific for Alzheimer’s and the one with the most validity. It seems to be the frontrunner,” she added. Blood tests like this could “change the game in the speed in which we can conduct Alzheimer’s trials and get to the next new medication”. Dr Jason Karlawish, the co-director at the University of Pennsylvania’s Penn Memory Centre, said of the research: “Not too long ago measuring pathology in the brain of a living human was considered just impossible.” “This study adds to the revolution that has occurred in our ability to measure what’s going on in the brain of living humans.” Image: Shutterstock

Caring

I’ve been diagnosed with cancer. How do I tell my children?

<a href="https://theconversation.com/profiles/cassy-dittman-1380541">Cassy Dittman</a>, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a>; <a href="https://theconversation.com/profiles/govind-krishnamoorthy-1467986">Govind Krishnamoorthy</a>, <a href="https://theconversation.com/institutions/university-of-southern-queensland-1069">University of Southern Queensland</a>, and <a href="https://theconversation.com/profiles/marg-rogers-867368">Marg Rogers</a>, <a href="https://theconversation.com/institutions/university-of-new-england-919">University of New England</a> With around <a href="https://www.abs.gov.au/statistics/health/health-conditions-and-risks/cancer/2022">one in 50 adults</a> diagnosed with cancer each year, many people are faced with the difficult task of sharing the news of their diagnosis with their loved ones. Parents with cancer may be most <a href="https://www.sciencedirect.com/science/article/pii/S1462388914000994">worried about</a> telling their children. It’s best to give children factual and age-appropriate information, so children don’t create their own explanations or <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)33202-1/fulltext">blame themselves</a>. Over time, supportive family relationships and open communication <a href="https://link.springer.com/article/10.1007/s00520-016-3214-2">help children adjust</a> to their parent’s diagnosis and treatment. It’s natural to feel you don’t have the <a href="https://onlinelibrary.wiley.com/doi/10.1111/ecc.12018">skills or knowledge</a> to talk with your children about cancer. But preparing for the conversation can improve your confidence. <h2>Preparing for the conversation</h2> Choose a suitable time and location in a place where your children feel comfortable. Turn off distractions such as screens and phones. For teenagers, who can find face-to-face conversations confronting, think about talking while you are going for a walk. Consider if you will tell all children at once or separately. Will you be the only adult present, or will having another adult close to your child be helpful? Another adult might give your children a person they can talk to later, especially to answer questions they might be worried about asking you. Finally, plan what to do after the conversation, like doing an activity with them that they enjoy. Older children and teenagers might want some time alone to digest the news, but you can suggest things you know they like to do to relax. Also consider what you might need to support yourself. <h2>Preparing the words</h2> Parents might be worried about the <a href="https://www.bmj.com/content/321/7259/479.full.pdf+html">best words or language</a> to use to make sure the explanations are at a level their child understands. Make a plan for what you will say and take notes to stay on track. The toughest part is likely to be saying to your children that you have cancer. It can help to practise saying those words out aloud. Ask family and friends for their feedback on what you want to say. <a href="https://www.cancer.org.au/cancer-information/types-of-cancer/childhood-cancers/talking-to-kids-about-cancer">Make use of guides</a> by the Cancer Council, which provide age-appropriate wording for explaining medical terms like “cancer”, “chemotherapy” and “tumour”. <h2>Having the conversation</h2> Being open, honest and factual is important. Consider the balance between being too vague, and providing too much information. The <a href="https://www.sciencedirect.com/science/article/pii/S1462388914000994">amount and type</a> of information you give will be based on their age and previous experiences with illness. Remember, if things don’t go as planned, you can always try again later. Start by telling your children the news in a few short sentences, describing what you know about the diagnosis in language suitable for their age. Generally, this information will include the name of the cancer, the area of the body affected and what will be involved in treatment. Let them know what to expect in the coming weeks and months. Balance hope with reality. For example: <blockquote> The doctors will do everything they can to help me get well. But, it is going to be a long road and the treatments will make me quite sick. </blockquote> Check what your child knows about cancer. Young children may not know much about cancer, while primary school-aged children are starting to understand that it is a <a href="https://journals.sagepub.com/doi/epdf/10.1177/0165025408093663">serious illness</a>. Young children may worry about becoming unwell themselves, or other loved ones becoming sick. Older children and teenagers may have experiences with cancer through other family members, friends at school or social media. This process allows you to correct any misconceptions and provides opportunities for them to ask questions. Regardless of their level of knowledge, it is important to reassure them that the cancer is not their fault. Ask them if there is anything they want to know or say. Talk to them about what will stay the same as well as what may change. For example: <blockquote> You can still do gymnastics, but sometimes Kate’s mum will have to pick you up if I am having treatment. </blockquote> If you can’t answer their questions, be OK with saying “I’m not sure”, or “I will try to find out”. Finally, tell children you love them and offer them comfort. <h2>How might they respond?</h2> Be prepared for a range of <a href="https://link.springer.com/article/10.1007/s00520-016-3214-2">different responses</a>. Some might be distressed and cry, others might be angry, and some might not seem upset at all. This might be due to shock, or a sign they need time to process the news. It also might mean they are trying to be brave because they don’t want to upset you. Children’s reactions will change over time as they come to terms with the news and process the information. They might seem like they are happy and coping well, then be teary and clingy, or angry and irritable. Older children and teenagers may ask if they can tell their friends and family about what is happening. It may be useful to come together as a family to discuss how to inform friends and family. <h2>What’s next?</h2> Consider the conversation the first of many ongoing discussions. Let children know they can talk to you and ask questions. Resources might also help; for example, The Cancer Council’s <a href="https://www.campquality.org.au/kids-guide-to-cancer/">app for children and teenagers</a> and Redkite’s <a href="https://www.redkite.org.au/service/book-club/">library of free books</a> for families affected by cancer. If you or other adults involved in the children’s lives are concerned about how they are coping, speak to your GP or treating specialist about options for psychological support.<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/228012/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/cassy-dittman-1380541">Cassy Dittman</a>, Senior Lecturer/Head of Course (Undergraduate Psychology), Research Fellow, Manna Institute, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a>; <a href="https://theconversation.com/profiles/govind-krishnamoorthy-1467986">Govind Krishnamoorthy</a>, Senior Lecturer, School of Psychology and Wellbeing, Post Doctoral Fellow, Manna Institute, <a href="https://theconversation.com/institutions/university-of-southern-queensland-1069">University of Southern Queensland</a>, and <a href="https://theconversation.com/profiles/marg-rogers-867368">Marg Rogers</a>, Senior Lecturer, Early Childhood Education; Post Doctoral Fellow, Manna Institute, <a href="https://theconversation.com/institutions/university-of-new-england-919">University of New England</a> Image credits: Shutterstock 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/ive-been-diagnosed-with-cancer-how-do-i-tell-my-children-228012">original article</a>.

Family & Pets

Do you have a mental illness? Why some people answer ‘yes’, even if they haven’t been diagnosed

<a href="https://theconversation.com/profiles/jesse-tse-1429151">Jesse Tse</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> and <a href="https://theconversation.com/profiles/nick-haslam-10182">Nick Haslam</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Mental illnesses such as depression and anxiety disorders have become more prevalent, especially among <a href="https://www.aihw.gov.au/mental-health/overview/prevalence-and-impact-of-mental-illness#changeovertime">young people</a>. Demand for treatment is surging and prescriptions of some <a href="https://pubmed.ncbi.nlm.nih.gov/35176912/">psychiatric medications</a> have climbed. These upswinging prevalence trends are paralleled by rising public attention to mental illness. Mental health messages saturate traditional and social media. Organisations and governments are developing awareness, prevention and treatment initiatives with growing urgency. The mounting cultural focus on mental health has obvious benefits. It increases awareness, reduces stigma and promotes help-seeking. However, it may also have costs. Critics worry <a href="https://www.bacp.co.uk/bacp-journals/therapy-today/2023/april-2023/the-big-issue/">social media</a> sites are incubating mental illness and that ordinary unhappiness is being pathologised by the overuse of diagnostic concepts and “<a href="https://www.bustle.com/wellness/is-therapy-speak-making-us-selfish">therapy speak</a>”. British psychologist <a href="https://www.psych.ox.ac.uk/team/lucy-foulkes">Lucy Foulkes</a> argues the trends for rising attention and prevalence are linked. Her “<a href="https://www.sciencedirect.com/science/article/pii/S0732118X2300003X">prevalence inflation hypothesis</a>” proposes that increasing awareness of mental illness may lead some people to diagnose themselves inaccurately when they are experiencing relatively mild or transient problems. Foulkes’ hypothesis implies that some people develop overly broad concepts of mental illness. Our research supports this view. In a new study, <a href="https://www.sciencedirect.com/science/article/pii/S2666560324000318?via%3Dihub">we show</a> that concepts of mental illness have broadened in recent years – a phenomenon we call “<a href="https://www.tandfonline.com/doi/full/10.1080/1047840X.2016.1082418">concept creep</a>” – and that <a href="https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-023-05152-6">people differ</a> in the breadth of their concepts of mental illness. <h2>Why do people self-diagnose mental illnesses?</h2> In our new <a href="https://doi.org/10.1016/j.ssmmh.2024.100326">study</a>, we examined whether people with broad concepts of mental illness are, in fact, more likely to self-diagnose. We defined self-diagnosis as a person’s belief they have an illness, whether or not they have received the diagnosis from a professional. We assessed people as having a “broad concept of mental illness” if they judged a wide variety of experiences and behaviours to be disorders, including relatively mild conditions. We asked a nationally representative sample of 474 American adults if they believed they had a mental disorder and if they had received a diagnosis from a health professional. We also asked about other possible contributing factors and demographics. Mental illness was common in our sample: 42% reported they had a current self-diagnosed condition, a majority of whom had received it from a health professional. Unsurprisingly, the strongest predictor of reporting a diagnosis was experiencing relatively severe distress. The second most important factor after distress was having a broad concept of mental illness. When their levels of distress were the same, people with broad concepts were substantially more likely to report a current diagnosis. The graph below illustrates this effect. It divides the sample by levels of distress and shows the proportion of people at each level who report a current diagnosis. People with broad concepts of mental illness (the highest quarter of the sample) are represented by the dark blue line. People with narrow concepts of mental illness (the lowest quarter of the sample) are represented by the light blue line. People with broad concepts were much more likely to report having a mental illness, especially when their distress was relatively high. People with greater mental health literacy and less stigmatising attitudes were also more likely to report a diagnosis. Two interesting further findings emerged from our study. People who self-diagnosed but had not received a professional diagnosis tended to have broader illness concepts than those who had. In addition, younger and politically progressive people were more likely to report a diagnosis, consistent with some <a href="https://www.sciencedirect.com/science/article/pii/S2666560321000438">previous research</a>, and held broader concepts of mental illness. Their tendency to hold these more expansive concepts partially explained their higher rates of diagnosis. <h2>Why does it matter?</h2> Our findings support the idea that expansive concepts of mental illness promote self-diagnosis and may thereby increase the apparent prevalence of mental ill health. People who have a lower threshold for defining distress as a disorder are more likely to identify themselves as having a mental illness. Our findings do not directly show that people with broad concepts over-diagnose or those with narrow concepts under-diagnose. Nor do they prove that having broad concepts causes self-diagnosis or results in actual increases in mental illness. Nevertheless, the findings raise important concerns. First, they suggest that rising mental health awareness may <a href="https://www.newscientist.com/article/mg25934573-900-why-being-more-open-about-mental-health-could-be-making-us-feel-worse/">come at a cost</a>. In addition to boosting mental health literacy it may increase the likelihood of people incorrectly identifying their problems as pathologies. Inappropriate self-diagnosis can have adverse effects. Diagnostic labels may become identity-defining and self-limiting, as people come to believe their problems are enduring, <a href="https://www.sciencedirect.com/science/article/abs/pii/S0165032724002489?via%3Dihub">hard-to-control</a> aspects of who they are. Second, unwarranted self-diagnosis may lead people experiencing relatively mild levels of distress to seek help that is unnecessary, inappropriate and ineffective. Recent <a href="https://pubmed.ncbi.nlm.nih.gov/37844607/">Australian research</a> found people with relatively mild distress who received psychotherapy worsened more often than they improved. Third, these effects may be particularly problematic for young people. They are most liable to hold broad concepts of mental illness, in part due to <a href="https://www.sciencedirect.com/science/article/pii/S0010440X22000682?via%3Dihub">social media</a> <a href="https://www.tandfonline.com/doi/full/10.1080/10810730.2023.2235563">consumption</a>, and they experience mental ill health at relatively high and rising rates. Whether expansive concepts of illness play a role in the youth mental health crisis remains to be seen. Ongoing cultural shifts are fostering increasingly expansive definitions of mental illness. These shifts are likely to have mixed blessings. By normalising mental illness they may help to remove its stigma. However, by pathologising some forms of everyday distress, they may have an unintended downside. As we wrestle with the mental health crisis, it is crucial we find ways to increase awareness of mental ill health without inadvertently inflating it.<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/231687/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/jesse-tse-1429151">Jesse Tse</a>, PhD Candidate at Melbourne School of Psychological Sciences, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> and <a href="https://theconversation.com/profiles/nick-haslam-10182">Nick Haslam</a>, Professor of Psychology, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/do-you-have-a-mental-illness-why-some-people-answer-yes-even-if-they-havent-been-diagnosed-231687">original article</a>.

Mind

If I’m diagnosed with one cancer, am I likely to get another?

<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/terry-boyle-1521638">Terry Boyle</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> Receiving a cancer diagnosis is life-changing and can cause a range of concerns about ongoing health. Fear of cancer returning is one of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9321869/">top health concerns</a>. And <a href="https://www.cancercouncil.com.au/cancer-information/living-well/after-cancer-treatment/fear-of-the-cancer-returning/managing-fear-of-recurrence/">managing this fear</a> is an important part of cancer treatment. But how likely is it to get cancer for a second time? <h2>Why can cancer return?</h2> While initial cancer treatment may seem successful, sometimes a few cancer cells remain dormant. Over time, these cancer cells can grow again and may start to cause symptoms. This is known as cancer recurrence: when a cancer returns after a period of remission. This period could be days, months or even years. The new cancer is the same type as the original cancer, but can sometimes grow in a new location through a process called <a href="https://theconversation.com/how-does-cancer-spread-to-other-parts-of-the-body-219616">metastasis</a>. Actor Hugh Jackman has gone public about his <a href="https://www.skincancer.org/blog/is-basal-cell-carcinoma-serious/">multiple diagnoses</a> of basal cell carcinoma (a type of skin cancer) over the <a href="https://www.bbc.com/news/world-australia-65158945">past decade</a>. The exact reason why cancer returns differs depending on the cancer type and the treatment received. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8486871/">Research</a> is <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.3408">ongoing</a> to identify genes associated with cancers returning. This may eventually allow doctors to tailor treatments for high-risk people. <h2>What are the chances of cancer returning?</h2> The risk of cancer returning differs between cancers, and between <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019423/">sub-types</a> of the same cancer. New screening and treatment options have seen reductions in recurrence rates for many types of cancer. For example, between 2004 and 2019, the risk of colon cancer recurring dropped by <a href="https://jamanetwork.com/journals/jamaoncology/fullarticle/2812113">31-68%</a>. It is important to remember that only someone’s treatment team can assess an individual’s personal risk of cancer returning. For most types of cancer, the highest risk of cancer returning is within the <a href="https://pubmed.ncbi.nlm.nih.gov/31231898/">first three years</a> after entering remission. This is because any leftover cancer cells not killed by treatment are likely to start growing again sooner rather than later. Three years after entering remission, recurrence rates for most cancers decrease, meaning that every day that passes lowers the risk of the cancer returning. Every day that passes also increases the numbers of new discoveries, and cancer drugs being developed. <h2>What about second, unrelated cancers?</h2> Earlier this year, we learned Sarah Ferguson, Duchess of York, had been diagnosed with malignant melanoma (a type of skin cancer) <a href="https://www.bbc.com/news/uk-68047608">shortly after</a> being treated for breast cancer. Although details have not been confirmed, this is likely a new cancer that isn’t a recurrence or metastasis of the first one. Australian research from <a href="https://bmccancer.biomedcentral.com/articles/10.1186/1471-2407-11-83">Queensland</a> and <a href="https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.31247">Tasmania</a> shows adults who have had cancer have around a 6-36% higher risk of developing a second primary cancer compared to the risk of cancer in the general population. <h2>Who’s at risk of another, unrelated cancer?</h2> With improvements in cancer diagnosis and treatment, people diagnosed with cancer are living longer than ever. This means they need to consider their long-term health, including their risk of developing another unrelated cancer. Reasons for such cancers <a href="https://www.cancer.net/survivorship/what-second-cancer">include</a> different types of cancers sharing the same kind of lifestyle, environmental and genetic risk factors. The increased risk is also likely partly due to the effects that some cancer treatments and imaging procedures have on the body. However, this increased risk is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6435077/">relatively small</a> when compared with the (sometimes lifesaving) benefits of these treatment and procedures. While a 6-36% greater chance of getting a second, unrelated cancer may seem large, only around 10-12% of participants developed a second cancer in the Australian studies we mentioned. Both had a median follow-up time of around five years. Similarly, in a <a href="https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.30164">large US study</a> only about one in 12 adult cancer patients developed a second type of cancer in the follow-up period (an average of seven years). The kind of first cancer you had also affects your risk of a second, unrelated cancer, as well as the type of second cancer you are at risk of. For example, in the two Australian studies we mentioned, the risk of a second cancer was greater for people with an initial diagnosis of head and neck cancer, or a haematological (blood) cancer. People diagnosed with cancer as a <a href="https://www.mja.com.au/journal/2020/212/3/second-primary-cancers-people-who-had-cancer-children-australian-childhood">child</a>, <a href="https://www.liebertpub.com/doi/10.1089/jayao.2022.0074">adolescent or young adult</a> also have a greater risk of a second, unrelated cancer. <h2>What can I do to lower my risk?</h2> Regular follow-up examinations can give peace of mind, and ensure any subsequent cancer is caught early, when there’s the best chance of successful treatment. <a href="https://www.lymphoma.org.au/lymphoma/treatments/maintenance-therapy/">Maintenance therapy</a> may be used to reduce the risk of some types of cancer returning. However, despite ongoing <a href="https://febs.onlinelibrary.wiley.com/doi/10.1111/febs.15626">research</a>, there are no specific treatments against cancer recurrence or developing a second, unrelated cancer. But there are things you can do to help lower your general risk of cancer – not smoking, being physically active, eating well, maintaining a healthy body weight, limiting alcohol intake and being sun safe. These all reduce the chance of <a href="https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21719">cancer returning</a> and <a href="https://www.cancer.net/survivorship/what-second-cancer">getting a second cancer</a>.<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/226386/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/terry-boyle-1521638">Terry Boyle</a>, Senior Lecturer in Cancer Epidemiology, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> Image credits: Shutterstock 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/if-im-diagnosed-with-one-cancer-am-i-likely-to-get-another-226386">original article</a>.

Body

Best-selling author diagnosed with "aggressive" brain cancer

Best-selling author Sophie Kinsella has shared that she has been fighting "aggressive" brain cancer since the end of 2022. The British writer took to Instagram to reveal she was diagnosed with glioblastoma 18 months ago, and shared why she chose to keep the devatstsing news out of the spotlight. The 54-year-old said she wanted to "make sure my children were able to hear and process the news in privacy and adapt to our new normal" before going public with her diagnosis. "I have been under the care of the excellent team at University College Hospital in London and have had successful surgery and subsequent radiotherapy and chemotherapy, which is still ongoing," she told her followers on Instagram. "At the moment all is stable and I am feeling generally very well, though I get very tired and my memory is even worse than it was before!" Kinsella said she is "so grateful to my family and close friends who have been an incredible support to me, and to the wonderful doctors and nurses who have treated me." She also thanked her readers for their "constant support", adding how the reception of her latest novel The Burnout, released in October 2023, "really buoyed me up during a difficult time." She ended her statement by saying, "To everyone who is suffering from cancer in any form I send love and best wishes, as well as to those who support them." "It can feel very lonely and scary to have a tough diagnosis, and the support and care of those around you means more than words can say." Image credits: Getty Images

Caring

Popular TV host diagnosed with same condition as Bruce Willis

Popular American TV host Wendy Williams has shared her diagnosis after being plagued by "hurtful rumours". The 59-year-old's medical team announced in a lengthy statement that she has been diagnosed with aphasia and frontotemporal dementia: the same conditions actor Bruce Willis is battling. The news comes after Williams' family confirmed she had checked in to a facility to treat cognitive issues. “Questions have been raised at times about Wendy’s ability to process information and many have speculated about Wendy’s condition, particularly when she began to lose words, act erratically at times, and have difficulty understanding financial transactions,” her medical team said. They said Williams' symptoms first began in 2023, and was diagnosed with the neurological conditions just weeks later after undergoing a series of tests. Her team said both conditions have “already presented significant hurdles in Wendy’s life”. “Wendy would not have received confirmation of these diagnoses were it not for the diligence of her current care team, who she chose, and the extraordinary work of the specialists at Weill Cornell Medicine,” they said. “Receiving a diagnosis has enabled Wendy to receive the medical care she requires.” Williams chose to share the news to “advocate for understanding” and to “raise awareness” for the difficult conditions. “Unfortunately, many individuals diagnosed with aphasia and frontotemporal dementia face stigma and misunderstanding, particularly when they begin to exhibit behavioural changes but have not yet received a diagnosis,” her team said. “There is hope that with early detection and far more empathy, the stigma associated with dementia will be eliminated, and those affected will receive the understanding, support, and care they deserve and need." “Wendy is still able to do many things for herself. Most importantly she maintains her trademark sense of humour and is receiving the care she requires to make sure she is protected and that her needs are addressed." “She is appreciative of the many kind thoughts and good wishes being sent her way.” The TV presenter has previously been open with her medical battle with Graves’ disease and lymphedema, as well as other significant challenges related to her health. Image credits: Getty Images

Caring

"I was not alone": Another royal diagnosed with cancer

Not long after King Charles announced his <a href="https://www.oversixty.com.au/health/caring/palace-reveals-king-charles-serious-health-diagnosis" target="_blank" rel="noopener">cancer diagnosis</a>, Crown Prince Alexander of Yugoslavia felt inspired by his "dear cousin and friend" and decided to go public with his own prostate cancer diagnosis. In a statement, Prince Alexander shared that he was moved by Charles’ courage in sharing his diagnosis with the public, as royal health matters are usually kept private. The 78-year-old royal then shared details of his own medical intervention. "The love of all of us who know him, and of his people, we deeply care for him, will support His Majesty in persevering and winning this most important battle. The news that it is early stage gives high hope," he said. "The unfortunate news about cancer is not something you wish to hear. "And I can say it personally, as I very well know how you feel once you hear it. How frightening and terrifying it is also for the family, how all the feelings get mixed up, and how you cannot think about anything else." He then revealed: "I can say it now because I only recently defeated cancer. "I had avoided speaking about it, as it is a personal matter concerning only me and my family, but King Charles' openness moved me and encouraged me to also speak up," he added. "I am sharing this now, because this kind of tragic news can encourage people to react and take care of their health." He added that news of King Charles' cancer diagnosis and his honesty about getting a check-up had resulted in a rise in online searches and appointments for medical check-ups in the UK. “That is why people should hear my story, to see it is something that can happen to all of us,” he said. “But when we are responsible, the outcome can be good.” He shared details of his own treatment, which began two years ago, after results from an MRI found a cancerous growth. "At that moment, I was terrified. But I was not alone. "I am not speaking about family and friends who knew this and shared their support, which meant so much and cannot be described in words, but also all the other people who are fighting this disease." He then underwent pre-intervention tests, surgery, and mandatory checkups, and has since received “the most joyous words from my doctor — ‘All is clear now’.” He then urged the public to be more vigilant about their health, and to not put of their doctors appointment any further. “Be responsible with yourself, listen to the doctor’s advice, and monitor your health,” he said. “Preserve it and nurture it as the greatest wealth and gift you will ever receive.” Images: Getty

Caring

Sarah Ferguson diagnosed with malignant melanoma – here are the latest treatments for this increasingly common skin cancer

<a href="https://theconversation.com/profiles/sarah-allinson-137762">Sarah Allinson</a>, <a href="https://theconversation.com/institutions/lancaster-university-1176">Lancaster University</a> News that Sarah Ferguson, the Duchess of York, has recently been diagnosed with malignant melanoma highlights the dangers of this increasingly common skin cancer. Malignant melanoma affects <a href="https://www.iarc.who.int/cancer-type/skin-cancer/">325,000 people worldwide</a> every year. While it’s not the most common form of skin cancer – typically, for every one diagnosed case of melanoma, up to ten non-melanoma skin cancers are diagnosed – it causes <a href="https://theconversation.com/skin-cancer-more-people-die-from-types-that-arent-melanoma-surprise-new-finding-215378">almost as many deaths</a>. The reason for this is because it’s far more likely to spread, or metastasise, to other sites in the body compared to non-melanoma skin cancers. Melanoma arises in a type of pigment-producing skin cell called a <a href="https://www.cancer.org/cancer/types/melanoma-skin-cancer/about/what-is-melanoma.html#:%7E:text=Melanoma%20is%20a%20type%20of,to%20grow%20out%20of%20control.">melanocyte</a>. These cells produce and export melanin in order to provide a protective layer in the skin which helps to screen out ultraviolet (UV) radiation. Mutations in genes that normally carefully regulate cell growth and survival override the controls that ensure the body only produces the cells it needs. The result is uncontrolled cellular growth, or a tumour, that normally appears as an unusual-looking mole. The mutations that drive the growth of a melanoma usually happen as a result of exposure to UV from the sun or from an artificial source, such as a tanning bed. We know this because when a melanoma’s genome is compared to that of a normal cell we can see a high number of mutations that have a <a href="https://www.nature.com/articles/s41586-020-1943-3">characteristic “UV signature”</a>. For this reason, melanoma skin cancers occur most frequently in people who have light-coloured skin and who are exposed to high amounts of UV. Non-melanoma skin cancers are also mainly caused by exposure to UV but arise from a different kind of skin cell called a keratinocyte. These are the cells that normally make up the majority of the outer part of our skin, called the epidermis. Cancers that arise from keratinocytes are less likely to spread than those that come from melanocytes – although <a href="https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/non-melanoma-skin-cancer#heading-One">they can still be fatal</a>. In the duchess’s case, the melanoma was discovered during treatment for breast cancer. Her dermatologist recommended that some moles be removed for biopsy during breast reconstruction surgery. After testing, one was identified as malignant melanoma. If the results of the biopsy show that the cancer hasn’t spread, then like the majority of patients with melanoma, the duchess will be treated with surgery. In this case the tumour will be removed along with some of the surrounding normal skin. The amount of normal skin removed depends on the results of the biopsy – in particular, how deep into the skin the tumour has penetrated (called the <a href="https://www.macmillan.org.uk/cancer-information-and-support/melanoma/staging-of-melanoma">Breslow thickness</a>). The normal skin will be checked for any signs that cancerous cells might have spread out of the tumour. For most people diagnosed with melanoma, particularly if it’s at an early stage, <a href="https://www.ncbi.nlm.nih.gov/books/NBK481850/">surgery will cure the cancer</a> and they will be able to go on with their lives. But for around <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8544364/">20% of patients</a>, additional treatment will be needed. This happens if their cancer has spread further into the body or if their cancer can’t be treated surgically. The <a href="https://ascopubs.org/doi/10.1200/OP.21.00686">good news</a> for these patients is that the past decade has seen huge improvements in treatment. Previously the only options other than surgery were radiotherapy or non-specific chemotherapy treatments. These treatments work by affecting the ability of cells to copy their DNA, which prevents them from duplicating and causes fast-growing cancer cells to die. But because these also affect the patient’s normal cells, they were accompanied by severe side effects – and were often ineffective. But we now have a better understanding of the specific changes melanoma makes to cell growth pathways. This has led to the development of drugs, such as <a href="https://www.cancer.gov/news-events/cancer-currents-blog/2022/fda-dabrafenib-trametinib-braf-solid-tumors">dabrafenib</a> and <a href="https://pubchem.ncbi.nlm.nih.gov/compound/Trametinib">trametinib</a>, that specifically target cells with these altered pathways. In other words, they only target the cancerous cells. These drugs are much more effective and have fewer side effects than traditional chemotherapies – although about half of patients who initially respond to them relapse within a year. In these patients a few of the tumour cells survive by activating other pathways for growth and use these to <a href="https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.30435">regrow the tumour</a>. Promisingly, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10417341/">a recent study</a> suggests that re-using these drugs after a period off them can have good results in relapsed patients. Another exciting development in the treatment of malignant melanoma has been the use of immunotherapies. These involve harnessing the patient’s own immune system to fight the tumour. One particularly successful immunotherapy approach for melanoma involves the use of drugs called checkpoint inhibitors. These prevent cancer cells from being able to hide from the body’s immune system. A <a href="https://www.ejcancer.com/article/S0959-8049(23)00694-9/fulltext">recent report</a> has highlighted how the introduction of these treatments has led to improved survival for melanoma patients. Although the duchess’s skin cancer was discovered while she was being treated for breast cancer, it’s unlikely that the two are related. A more likely risk factor is the duchess’s famous red hair. People with red hair and pale skin that tends to freckle and burn in the sun are at a greater risk of developing skin cancer because their skin produces <a href="https://medlineplus.gov/genetics/gene/mc1r/#conditions">less melanin</a>. This means that their melanocytes are exposed to higher levels of UV and are more likely to undergo cancer-causing mutations. While melanoma is much more common in people with the duchess’s skin type, it’s important to be aware that anyone can get it. It’s a good idea to regularly check your skin for unusual looking moles and to contact a doctor for advice if you have a mole with any of the so-called <a href="https://www.cancerresearchuk.org/about-cancer/melanoma/symptoms">ABCDE characteristics</a>: such as an asymmetrical shape, irregular, blurred or jagged border, uneven colour, is more than 6mm wide and is evolving (either in size, texture or even bleeding).<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/221647/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/sarah-allinson-137762">Sarah Allinson</a>, Professor, Department of Biomedical and Life Sciences, <a href="https://theconversation.com/institutions/lancaster-university-1176">Lancaster 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/sarah-ferguson-diagnosed-with-malignant-melanoma-here-are-the-latest-treatments-for-this-increasingly-common-skin-cancer-221647">original article</a>.

Body

I’ve just been diagnosed with cancer, now what?

<a href="https://theconversation.com/profiles/marilynne-n-kirshbaum-1462224">Marilynne N Kirshbaum</a>, <a href="https://theconversation.com/institutions/charles-darwin-university-1066">Charles Darwin University</a> In one pivotal instant your life has changed and there will be no turning back. How will you accept, adjust and adapt to being “someone who has cancer”? Well, first, you are still the same person. But now you have a definitive diagnosis calling for your immediate attention. There are hundreds of kinds of cancer, <a href="https://www.cancer.gov/about-cancer/diagnosis-staging/staging">distinguished</a> and identified according to site, type of cell involved, aggressiveness and evidence of spread. These are the <a href="https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/cancer/overview">critical details</a> you need to know as you begin to understand what is going on in your body. There will be much to learn and understand about the disease and prognosis; social, emotional, sexual and spiritual effects; treatments, therapies and their side-effects; work implications and how all these opportunities and challenges will be intertwined. But you don’t need to do everything at once. In time, and with support, you’ll be able to move forward with poise, strength, calm and intelligence. <h2>Emotions will vary – from you and others</h2> Whatever your usual demeanour and emotional state, be ready for some surprises. This will be a period of uncertainty. Expect to find yourself experiencing the full gamut of reactions such as shock, anger, grief and guilt, along with warm and deep feelings of love, compassion and gratitude for the people and environment that surround you. In the first few days, you might want to limit who you tell about your diagnosis or keep your news private to give yourself a chance to adjust without interference. Because, although well meaning, some people will react in unexpected ways and might cause you distress rather than be truly supportive or helpful. Some people will be inclined to ask lots of questions, but you may not have all the answers. They might want to tell you other people’s stories, which you might not want or be ready to hear yet. You have the option to completely accept the guidance of health-care professionals, who will give you the information they think you need at the time and direct you to further diagnostic tests and appointments. However, you may want to know more about the type of cancer you have, the treatments being recommended, all possible side effects and seek out other sources. This will place the information you have received into perspective and will inform further questions. It is important to find <a href="https://www.cancer.org.au/cancer-information">resources</a> that are <a href="https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/cancer/overview">credible</a>. <h2>Continuing work might be beneficial</h2> For working people, the decision about returning to work will depend on how you feel and the flexibility of your workplace. Assuming your body is up to it and it’s not a period where you will be immunosuppressed and susceptible to harmful effects of infections, work done at a steady pace is usually not only a boost to finances, but will have <a href="https://www.cancer.net/navigating-cancer-care/young-adults-and-teenagers/school-and-work-during-cancer/going-work-during-and-after-cancer#:%7E:text=You%20might%20work%20as%20much,support%2C%20including%20health%20insurance%20benefits">cognitive, social and emotional benefits</a>. The strategy here is to do a risk assessment of your job. Specify the challenges and discuss how they could be reduced with your manager. If you are your own boss, be flexible and kind. <h2>Responding to cancer-related fatigue</h2> The most common side effect of living with cancer (before, during and after all types of treatment) is a specific kind of extreme tiredness and lethargy called cancer-related fatigue. Sometimes it appears alongside <a href="https://www.canceraustralia.gov.au/clinical-best-practice/psychosocial-care">non-clinical depression and hopelessness</a>. Some people can feel so awful they decline medical treatment, but for the majority, this type of fatigue gets in the way of enjoying life. Research on the most effective interventions to reduce cancer-related fatigue has <a href="https://pubmed.ncbi.nlm.nih.gov/20870636/">evaluated</a> a range of approaches, including medications and complementary therapies. Assuming the cause is not anaemia, which can be treated by a transfusion, the <a href="https://www.ncbi.nlm.nih.gov/books/NBK74155/">strongest evidence recommends</a> physical, moderately aerobic exercise, often defined as “enough to break a sweat”. However, for those who are not able to exercise at a moderate level – for example, if the cancer has metastasised to bones or if lung capacity is compromised – less physically demanding approaches <a href="https://link.springer.com/chapter/10.1007/978-3-030-76932-1_4">can be valuable</a>. <h2>Prioritising things that bring you joy</h2> A “<a href="https://link.springer.com/book/10.1007/978-3-030-76932-1">joyful freedom</a>” approach to cancer-related fatigue aims to bring back vitality through subtle, lifestyle adjustments. It’s a framework researchers developed based on a series of studies. The first task is to list activities that bring joy. Then categorise each joy according to five attributes of energy-restoring activities: <ul> <li>purposeful</li> <li>expansive</li> <li>connecting</li> <li>awe-inspiring</li> <li>nourishing.</li> </ul> This will raise awareness of how to best spend limited amounts of physical, emotional and cognitive energy. Consider adding more of what brings joy into your life and remove some of the energy-depleting activities you do not enjoy. Making small changes can have a profound effect on your energy levels and give you the boost you need to live well with cancer. In an ideal, well resourced national health service, GPs and specialist nurses would be available to provide holistic health promotion support for people with cancer. Realistically, this is rarely offered through mainstream public services. These services are more widely available in the private sector, or you may be able to find what you need through your <a href="https://www.cancer.org.au/">local Cancer Council</a>. <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/211522/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/marilynne-n-kirshbaum-1462224">Marilynne N Kirshbaum</a>, Professor and Chair of the Human Research Ethics Committee, <a href="https://theconversation.com/institutions/charles-darwin-university-1066">Charles Darwin 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/ive-just-been-diagnosed-with-cancer-now-what-211522">original article</a>.

Caring

1 in 6 women are diagnosed with gestational diabetes. But this diagnosis may not benefit them or their babies

<a href="https://theconversation.com/profiles/paul-glasziou-13533">Paul Glasziou</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> and <a href="https://theconversation.com/profiles/jenny-doust-12412">Jenny Doust</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> When Sophie was pregnant with her first baby, she had an <a href="https://www.ncbi.nlm.nih.gov/books/NBK279331/#:%7E:text=Oral%20glucose%20tolerance%20tests%20(OGTT,enough%20by%20the%20body's%20cells.)">oral glucose tolerance</a> blood test. A few days later, the hospital phoned telling her she had gestational diabetes. Despite having only a slightly raised glucose (blood sugar) level, Sophie describes being diagnosed as affecting her pregnancy tremendously. She tested her blood glucose levels four times a day, kept food diaries and had extra appointments with doctors and dietitians. She was advised to have an induction because of the risk of having a large baby. At 39 weeks her son was born, weighing a very average 3.5kg. But he was separated from Sophie for four hours so his glucose levels could be monitored. Sophie is not alone. About <a href="https://www.aihw.gov.au/reports/diabetes/diabetes/contents/how-many-australians-have-diabetes/gestational-diabetes">one in six</a> pregnant women in Australia are now diagnosed with gestational diabetes. That was not always so. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2827530/">New criteria</a> were developed in 2010 which dropped an initial screening test and lowered the diagnostic set-points. Gestational diabetes diagnoses have since <a href="https://www.aihw.gov.au/reports/diabetes/diabetes/contents/how-many-australians-have-diabetes/gestational-diabetes">more than doubled</a>. <figure class="align-center "><img src="https://images.theconversation.com/files/536691/original/file-20230710-23-v8weyw.png?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/536691/original/file-20230710-23-v8weyw.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=388&fit=crop&dpr=1 600w, https://images.theconversation.com/files/536691/original/file-20230710-23-v8weyw.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=388&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/536691/original/file-20230710-23-v8weyw.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=388&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/536691/original/file-20230710-23-v8weyw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=487&fit=crop&dpr=1 754w, https://images.theconversation.com/files/536691/original/file-20230710-23-v8weyw.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=487&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/536691/original/file-20230710-23-v8weyw.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=487&fit=crop&dpr=3 2262w" alt="" /><figcaption>Gestational diabetes rates more than doubled after the threshold changed. AIHW, Author provided</figcaption></figure> But <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2204091">recent</a> <a href="https://pubmed.ncbi.nlm.nih.gov/33704936/">studies</a> cast doubt on the ways we diagnose and manage gestational diabetes, especially for women like Sophie with only mildly elevated glucose. Here’s what’s wrong with gestational diabetes screening. <h2>The glucose test is unreliable</h2> The test used to diagnose gestational diabetes – the oral glucose tolerance test – has poor reproducibility. This means subsequent tests may give a different result. In a <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2214956">recent Australian trial</a> of earlier testing in pregnancy, one-third of the women initially classified as having gestational diabetes (but neither told nor treated) did not have gestational diabetes when retested later in pregnancy. That is a problem. Usually when a test has poor reproducibility – for example, blood pressure or cholesterol – we repeat the test to confirm before making a diagnosis. Much of the increase in the incidence of gestational diabetes after the introduction of new diagnostic criteria was due to the switch from using two tests to only using a single test for diagnosis. <h2>The thresholds are too low</h2> Despite little evidence of benefit for either women or babies, the current Australian criteria diagnose women with only mildly abnormal results as having “gestational diabetes”. Recent studies have shown this doesn’t benefit women and may cause harms. A <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2204091">New Zealand trial</a> of more than 4,000 women randomly assigned women to be assessed based on the current Australian thresholds or to higher threshold levels (similar to the pre-2010 criteria). The trial found no additional benefit from using the current low threshold levels, with overall no difference in the proportion of infants born large for gestational age. However, the trial found several harms, including more neonatal hypoglycaemia (low blood sugar in newborns), induction of labour, use of diabetic medications including insulin injections, and use of health services. The study authors also looked at the subgroup of women who were diagnosed with glucose levels between the higher and lower thresholds. In this subgroup, there was some reduction in large babies, and in shoulder problems at delivery. But there was also an increase in small babies. This is of concern because being small for gestational age can also have consequences for babies, including long-term health consequences. <figure class="align-center "><img src="https://images.theconversation.com/files/540643/original/file-20230802-29-1dw2rw.png?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/540643/original/file-20230802-29-1dw2rw.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=349&fit=crop&dpr=1 600w, https://images.theconversation.com/files/540643/original/file-20230802-29-1dw2rw.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=349&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/540643/original/file-20230802-29-1dw2rw.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=349&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/540643/original/file-20230802-29-1dw2rw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=438&fit=crop&dpr=1 754w, https://images.theconversation.com/files/540643/original/file-20230802-29-1dw2rw.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=438&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/540643/original/file-20230802-29-1dw2rw.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=438&fit=crop&dpr=3 2262w" alt="" /><figcaption>NEJM, Author provided</figcaption></figure> <h2>Testing too early</h2> Some centres have begun testing women at higher risk of gestational diabetes earlier in the pregnancy (between 12 and 20 weeks). However, a <a href="https://pubmed.ncbi.nlm.nih.gov/37144983/">recent trial</a> showed no clear benefit compared with testing at the usual 24–28 weeks: possibly fewer large babies, but again matched by more small babies. There was a reduction in transient “respiratory distress” – needing extra oxygen for a few hours – but not in serious clinical events. <h2>Impact on women with gestational diabetes</h2> For women diagnosed using the higher glucose thresholds, dietary advice, glucose monitoring and, where necessary, insulin therapy has been shown to reduce complications during delivery and the post-natal period. However, current models of care can also cause harm. Women with gestational diabetes are often denied their preferred model of care – for example, midwifery continuity of carer. In rural areas, they may have to transfer to a larger hospital, requiring longer travel to antenatal visits and moving to a larger centre for their birth – away from their families and support networks for several weeks. Women say the diagnosis often dominates their antenatal care and their whole <a href="https://pubmed.ncbi.nlm.nih.gov/32028931/">experience of pregnancy</a>, reducing time for other issues or concerns. Women from culturally and linguistically diverse communities <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-021-03981-5">find it difficult</a> to reconcile the advice given about diet and exercise with their own cultural practices and beliefs about pregnancy. Some women with gestational diabetes <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-020-2745-1">become</a> extremely anxious about their eating and undertake extensive calorie restrictions or disordered eating habits. <h2>Time to reassess the advice</h2> Recent evidence from both randomised controlled trials and from qualitative studies with women diagnosed with gestational diabetes suggest we need to reassess how we currently diagnose and manage gestational diabetes, particularly for women with only slightly elevated levels. It is time for a review to consider all the problems described above. This review should include the views of all those impacted by these decisions: women in childbearing years, and the GPs, dietitians, diabetes educators, midwives and obstetricians who care for them. This article was co-authored by maternity services consumer advocate Leah Hardiman.<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/205919/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/paul-glasziou-13533">Paul Glasziou</a>, Professor of Medicine, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> and <a href="https://theconversation.com/profiles/jenny-doust-12412">Jenny Doust</a>, Clinical Professorial Research Fellow, <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/1-in-6-women-are-diagnosed-with-gestational-diabetes-but-this-diagnosis-may-not-benefit-them-or-their-babies-205919">original article</a>.

Body

Why young people are self-diagnosing illnesses

A lot of people turn to Google when they get symptoms of being sick, and jump to the conclusion that it may be a serious issue, however, for the younger crowd - Dr Google is now Dr TikTok. The social media app is filled with content about all sorts of topics, known for its 15-second clips it has been applauded for starting important conversations about mental health, especially among young people. It allows people to share experiences and support each other. However, as beneficial as that may be, it’s causing a lot of children to self-diagnose themselves with several mental and neurological disorders. These conditions include autism, attention deficit hyperactivity disorder (ADHD), borderline personality disorder (BPD), dissociative identity disorder (DID), obsessive-compulsive disorder (OCD), Tourette’s syndrome, and more. It’s troublesome as a doctor must diagnose a patient with an illness, and kids are taking it into their own hands based on videos that resonate with them. Psychologist Doreen Dodgen-Magee, said, “There are many accounts, hosted by educated, trained, and licensed professionals where reliable information can be found,” says Dr. Dodgen-Magee. But not all posts contain accurate, science-backed information — and many people scrolling through TikTok don’t know this”. It’s an issue that continues to grow as young people are getting medical advice from fellow TikTokers rather than seeing a doctor. If you have any symptoms of poor physical or mental health then you must be professionally diagnosed and set up with a treatment plan. Don’t rely on a social media app targeted towards children to diagnose you with health issues. Image credit: Shutterstock

Mind

Heading off autism diagnoses early

Australian researchers have shown for the first time that early intervention with parent-led therapy can help to reduce autism diagnoses in children that exhibit early signs of the condition. The study, <a style="font-size: 14px;" rel="noopener" href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2784066?guestAccessKey=4de62efc-31a1-4b0d-ae0f-fd3c858b2253&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=092021" target="_blank">published</a> in JAMA Pediatrics, found that a specific type of video-feedback-based therapy has the potential to reduce the clinical diagnosis of autism in children by two-thirds at age three. Autism Spectrum Disorder is a lifelong neurodevelopmental condition that affects children’s social skills, communication and behaviour. Around 2% of Australians have been diagnosed with autism, but more than half of all kids receiving support under the National Disability Insurance Scheme (NDIS) have an autism diagnosis. The average age of diagnosis is around 3 or 4. In an <a rel="noopener" href="https://www.scimex.org/newsfeed/news-briefing-early-help-can-reduce-autism-behaviours-in-kids" target="_blank">AusSMC briefing</a> on the JAMA research, lead researcher Professor Andrew Whitehouse, from the Telethon Kids Institute, said that the first two years of development are too important to be missed. “Anyone who’s seen a child develop language knows just how extraordinary that brain is in the first two years of life,” Whitehouse says. “And because we’re waiting and seeing during that period our therapies are currently missing that really critical period of brain development to support. Rather than providing starting support at age three, we’re saying let’s identify parental concerns, and then verify that with clinical observation in the first year of life.” The team identified that babies under a year old who begin to develop the behaviours associated with autism, such as differences in the way that they interact with the people around them, can fall “out of sync” with the interactions required for their brains to continue to develop. “So this can lead to what we call a developmental cascade, where disability becomes more entrenched over time,” says Whitehouse. “The children have an early vulnerability, which we know is genetic in origin, but because they are actually interacting with their caregivers in a different way, that disability becomes further and further entrenched.” This is where the therapy, called iBASIS-VIPP, is able to help. It involves a therapist filming the parent or caregiver interacting with the child who is suspected of developing autism. The therapist is then able to work with the parents, and highlight ways for them to alter their behaviour to support and enrich their child’s interactions using subtle changes to their everyday routines. Co-author of the research, Associate Professor Kristelle Hudry from La Trobe University, says this parental behaviour change at such an early stage of development can provide significant improvements in child communication skills and more generally for their development. “The hope then is that this changed parent behaviour will lead to increased child skills through the parent implementing these subtle changes in their everyday routines, all day every day, at home in everything that they’re doing, Hudry says. “And then ultimately that this will bring improvements in child social communication skills… and impact their skills to such an extent that the likelihood of autism is changed.” The Australian trial provided 10 fortnightly sessions of the therapy over five months for babies exhibiting early signs of autism between nine and 15 months of age. After following up with those families over three years, the trial found that only 6.7% of children receiving the therapy met the criteria for autism, compared to around 21% of children who did not receive the therapy. “That’s a significant reduction, and that’s the first time that has ever been shown that a pre-emptive support can be so effective in supporting development, that it actually reduces the likelihood that children go on to receive a diagnosis of autism,” says Whitehouse. The critical point here is that although those children have a lower likelihood of subsequently receiving a diagnosis of autism, they still require support services. Whitehouse says that the current system is flawed as it uses a diagnosis as the trigger or entry point to receive support. He says a needs-based service rather than a diagnosis-based service should be provided. Whitehouse also emphasises that they aren’t ‘curing’ autism and that the aims of the study are not about seeking a cure, but rather to “reduce the level of autism behaviours to the point that we can actually remove barriers in their life so children can reach their full potential”. Hudry and Whitehouse both make it clear that parents are not the cause of autism, but that parents are able to provide a key way to support their child’s development to reduce the barriers that autism can create. “This therapy is about working with each child’s unique differences,” says Whitehouse. “It’s not about trying to make kids more typical; it’s about actually identifying and nurturing and celebrating those differences and using them as a foundation for further development.”  <img id="cosmos-post-tracker" style="opacity: 0; height: 1px!important; width: 1px!important; border: 0!important; position: absolute!important; z-index: -1!important;" src="https://syndication.cosmosmagazine.com/?id=166915&title=Heading+off+autism+diagnoses+early" alt="" width="1" height="1" />  <div id="contributors"> <a rel="noopener" href="https://cosmosmagazine.com/health/body-and-mind/parent-led-autism-therapy-for-babies-reduces-behaviours/" target="_blank">This article</a> was originally published on <a rel="noopener" href="https://cosmosmagazine.com" target="_blank">Cosmos Magazine</a> and was written by <a rel="noopener" href="https://cosmosmagazine.com/contributor/steven-mew" target="_blank">Steven Mew</a>. Steven Mew is a media officer at the Australian Science Media Centre. Image: Science Media Centre </div>

Mind

How new smartphone tech will help diagnose mental health issues

Apple is reportedly working on new technology that could be used to diagnose mental health conditions such as depression and cognitive decline. In collaboration with the biotech Biogen, Apple is hoping to utilise their digital sensors to their potential, which already include heart, sleep and activity monitoring through the Apple Watch and iPhone. Researchers told the <a href="https://www.wsj.com/articles/apple-wants-iphones-to-help-detect-depression-cognitive-decline-sources-say-11632216601">Wall Street Journal</a> they will be able to use data from iPhone sensors to track digital signals that are linked to mental health issues, such as anxiety and depression, and feed them into an algorithm. This should be able to predict depression and other conditions and form the basis of new features in a future version of Apple's operating system. The research is an amalgamation of two research projects that involve tracking Apple devices to predict mental health habits. One project, codenamed ‘Seabreeze’, explores stress and anxiety-induced tendencies in partnership with Apple. The other, codenamed ‘Pi’, has set out to further analyse mild cognitive impairment. As the projects remain in their early stages, Apple has yet to officially confirm if they will result in new iPhone features. To effectively diagnose a mental health condition, an individual requires close monitoring by experts to look for changes in behaviour from the norm. The data analysed by these projects include monitoring facial expressions, how often users speak, how often they go for a walk, how well they sleep as well as heart and breathing rates. People 'close to the study' told the WSJ they may also be looking at the speed of typing, frequency of typos, content they type and other points. All of these habits are thought to be “digital signals” that can hint at mental health issues. Image credit: Shutterstock

Technology

Why are more men diagnosed with schizophrenia?

New research has found a link between the genetic differences in men and women and their likelihood of developing certain psychotic and mood disorders. In a study <a href="https://www.biologicalpsychiatryjournal.com/article/S0006-3223(21)01139-2/fulltext">recently published</a> in Biological Psychiatry, researchers looked at the underlying genetic differences between the sexes for the reason why bipolar disorder, schizophrenia, and depression affect the two sexes in different ways and at different rates. After examining the genomes of 85,735 people with schizophrenia, bipolar disorder, or depression, and 109,946 people without any of those conditions, the researchers found almost a dozen single nucleotide polymorphisms (SNPs) that differed between men and women diagnosed with one of the three disorders. What are the impacts of SNPs? The four nucleotides - Adenine, Thymine, Cytosine, and Guanine - that are used to make DNA are compared in particular orders to make specific proteins. SNPs are a kind of mutation where a single nucleotide - either A, G, T, or C - is swapped for another in a specific spot in the genome. These substitutions can affect our risk of getting certain diseases. In the study of mental disorders in the different sexes, the team found that these mutations would have different impacts on the different sexes. Some SNPs were only linked to disease in one sex, while others decreased the likelihood of the disorder occurring in one sex but increased it in the other. The researchers also found that these mutations occurred in genes that are linked to vascular, immune, and neuronal development pathways, suggesting cardiovascular and neurological health are affected by each other in some way. “We found a SNP in the IDO2 gene,” Jill Goldstein, a clinical neuroscientist at Harvard Medical School and the senior author of the study, told <a href="https://www.the-scientist.com/news-opinion/genetic-variants-tied-to-sex-differences-in-psychiatric-disorders-68624">The Scientist</a>. This particular gene is associated with immune tolerance in humans, meaning it helps suppress the immune system so it doesn’t attack bodily tissues and other substances. The gene is also linked to and has different effects on different disorders. “The SNP [in the IDO2 gene] increased the risk of bipolar disorder in women and decreased the risk in men, but it also decreased the risk of major depression and schizophrenia,” she said. “With that same genetic SNP, we found a lower risk of depression and schizophrenia in women, but a higher risk in the men. “And what was even more exciting was that the pathways that were implicated - vascular pathways and immune pathways - fit with what has been found and mapped by neurobiology,” Goldstein said. In their studies of the shared abnormal changes between the brain and heart, Goldstein and her team found schizophrenia has a high comorbidity with cardiovascular disease. “I was thrilled to see we actually found these genes with shared sex differences in areas that we’ve been studying,” she said. Why this matters Though these differences are small, they can have implications for how treatment can be tailored to different patients. Gendered differences in the presentation and effectiveness of treatments have been previously identified in other diseases including cardiovascular disease and lung cancer. “There are real-life consequences if we do not develop sex-dependent therapeutics, and I think it is critical for precision medicine,” she said.

Mind

Could a blood test diagnose mental illnesses?

Australian scientists have developed the world’s first blood test that can accurately predict whether people have mood disorders. Following research into specific levels of a brain protein, researchers from the University of South Australia have developed a kit that can distinguish between three brain-derived neurotrophic factor (BDNF) proteins with precision. A link between mature BDNF (mBDNF) proteins and depression has been well-documented for some time, but it hasn’t been until now that the three forms of proteins could be distinguished in blood samples. Researchers say strong evidence suggests that psychological stress decreases mBDNF and that depression is caused by a lack of the protein. A study conducted with 215 people in China, including 90 patients with clinical depression and 15 with bipolar disorder, found clear links between low levels of the protein in blood and severe depression. The study also found that the severity of a person’s depression correlated with a lower mBDNF level. Patients on antidepressants were also found to have higher levels of the protein than those who weren’t taking them. UniSA Professor Xin-Fu Zhou said existing commercial kits aren’t specific, while the one developed by the university had an accuracy of 80 to 83 percent. “As mBDNF and (another of the three proteins) proBDNF have different biological activities, working in opposition to each other, it is essential that we distinguish between these two proteins and detect changes in their levels,” he said. The researchers believe mBDNF levels could be used to diagnose depression and bipolar disorder.

Mind

Aussie woman recovering from US train accident diagnosed with COVID-19

An Australian woman who lost her legs in an accident on the New York subway has revealed she has been diagnosed with COVID-19. Visaya Hoffie, 23, had to have both of her lower legs amputated after she fell onto subway tracks and was struck by two trains in January. The artist also suffered skull, neck and vertebrae fractures. Visaya shared her coronavirus diagnosis on Tuesday. “After over a month in complete isolation from friends and family with [COVID-19] they’re finally discharging me ... despite the fact I’m still testing positive,” she wrote on Instagram. It was six weeks into Visaya’s recovery from the accident at Manhattan’s Bellevue Hospital when the intense coronavirus outbreak in the city forced a decision to return to Brisbane, her family told <a href="https://www.abc.net.au/news/2020-05-12/visaya-hoffie-coronavirus-new-york-train-accident-victim/12222182">7.30</a>. “It was a very difficult decision to make to leave, because Visaya’s wounds were so compromised,” Visaya’s mother Pat said. The doctors declared Visaya fit to fly, but said her legs needed to be elevated throughout the trip. Pat sought a flat-bed seat in business or first class for the trip and asked for assistance from figures such as former prime minister Kevin Rudd, Australia’s Ambassador to the US Arthur Sinodinos, and Australia’s representative to the UN Mitch Fifield. Pat secured three tickets for her, Visaya and a nurse for the flight to Brisbane via Chicago and Doha, which cost $64,000. On arrival, Visaya was taken to Princess Alexandra Hospital where she tested positive for the virus. Her symptoms have remained mild, the program reported. Pat said she was impressed by her daughter’s ability to bounce back from the accidents. “She’s just so resilient, so funny, so open to taking on the next hurdle,” Pat told the program. “I’ve managed because she’s with me. She’s in the world. The rest is mere detail.”

Caring

The new smartphone app that has the ability to diagnose respiratory diseases

A new smartphone app that was developed by University of Queensland researchers has the ability to analyse a person’s cough. This could help diagnose respiratory disorders quickly and easily in patients who lack access to doctors. UQ biomedical engineer Associate Professor Udantha Abeyratne and his team have developed the diagnostic technology that uses smartphones to instantly identify common respiratory diseases. These include asthma, croup, pneumonia, lower respiratory tract disease, Chronic Obstructive Pulmonary Disease and bronchiolitis. Dr Abeyratne said that respiratory disease was the third leading cause of death, which means that the potential global health and economic impact of this technology is phenomenal. “Coughs can be described as wet or dry, brassy or raspy, ringing or barking; they can whistle, whoop or wheeze; but experts cannot always agree on the description or how to use cough sounds for diagnosis,” Dr Abeyratne said. “Our approach is to introduce signal processing, and machine classification and learning technologies to extract useful diagnostic characteristics from coughs, removing the subjective elements for characterising them. “We believe the technology can lead to earlier diagnosis and better patient outcomes throughout the world, including in remote locations with limited access to doctors.” A clinical study on childhood respiratory diseases found that the technology has an accuracy between 81 and 97 percent. Corresponding author, Paediatrician Dr Paul Porter from Joondalup Health Campus in Western Australia has said that it could be difficult to differentiate between respiratory disorders in children. This is the case for even experienced doctors in modern hospital facilities. “This study demonstrates how new technology, mathematical concepts, machine learning and clinical medicine can be successfully combined to produce completely new diagnostic tests using the expertise of several disciplines,” Dr Porter said. How the technology was developed The technology was developed by UQ researchers using trained algorithms to recognise features of coughs which are characteristic of five different respiratory diseases. The technology also allows users to report other noticeable systems to ensure that the diagnosis was as accurate as possible. The researchers the categorised the coughs of 585 children aged between 29 days and 12 years. The accuracy of the analyser was determined by comparing its diagnosis to one that was reached by a panel of paediatricians that had reviewed hospital charts and conducted all available clinical investigations.

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The new smartphone app that has the ability to diagnose respiratory diseases