Even short periods of physical inactivity are damaging to our health



That two-week beach vacation you’ve been dreaming of could have long-term effects on your health.
PVStudio/ Shutterstock

Tori Sprung, Liverpool John Moores University and Kelly Bowden Davies, Newcastle University

As a society, we aren’t getting as much exercise as we should. In fact, current activity guidelines state that adults should get at least 150 minutes of moderately intense activity – or 75 minutes of vigorous activity – every week. But research has found that one in four adults aren’t active enough.

It’s easy to see why. Many of us drive to work instead of walking – and for those of us who work desk jobs, many are often so focused on what we’re doing we rarely get up from our desks except to visit the bathroom or get a drink. In short, though we might be busy, we aren’t moving very much. But after dealing with the stress of work week after week, it’s easy to daydream about unwinding on a warm beach, doing nothing but lounge around for a fortnight. But this might not be what our bodies need. In fact, it might actually be more harmful than we realise.

Our research looked at what effect even short periods of physical inactivity had on our bodies. We found that even just two weeks of low activity actually increased participants’ risk of later developing serious health conditions such as cardiovascular disease.

Keeping active

We know that physical activity is good for us. This is irrefutable, and we’ve known this for a long time. As far back as the 1950s, the link between day-to-day physical activity and health was first identified in the London transport workers study.

The study found that bus drivers were more likely to experience a heart attack compared to their bus conductor counterparts. The main difference between these two groups was that conductors spent their working day on their feet collecting fares from commuters, while bus drivers spent their days sitting down.

Since then, some have branded physical activity a “miracle cure” for cardiovascular risk. Yet, as a society, we are more sedentary than ever, and cardiovascular-related deaths remain the leading cause of death worldwide.

While we know that having a physically active lifestyle will improve our health, surely we aren’t doing any additional harm, even if we choose not to be physically active? We decided to examine exactly what the harmful effects of being physically inactive are.




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For our study, we recruited young (aged 18-50 years), healthy weight (BMI less than 30), physically active individuals (meaning that they take more than 10,000 steps per day on average). After carrying out assessments to measure blood vessel health, body composition and blood sugar control, we asked them to become inactive for two weeks.

To achieve this, participants were provided with a step counter and asked not to exceed 1,500 steps per day, which equates to approximately two laps of a full sized football pitch. After two weeks, we reassessed their blood vessel health, body composition and blood sugar control to examine what effects two weeks of inactivity had on them. We then asked them to resume their usual routine and behaviours. Two weeks after resuming their normal daily lifestyles, we checked participants’ health markers to see if they’d returned to where they were when they’d started the trial.

Our group of participants successfully reduced their step count by an average of around 10,000 steps per day and, in doing so, increased their waking sedentary time by an average of 103 minutes per day. Artery function decreased following this two-week period of relative inactivity, but returned to their normal levels after two weeks following their usual lifestyles.

Decreased artery function is an early sign of cardiovascular disease.
Rost9/ Shutterstock

We were interested in seeing how activity levels influenced blood vessel health, since this is where most cardiovascular disease starts. Most of us don’t realise that our blood vessels are a complex system. They’re lined with muscle and constantly adapt to our needs by dilating (opening) and constricting (closing) to distribute blood where it’s most needed. For example, during exercise vessels feeding organs such as the stomach will constrict, as it is inactive at this time, and so blood is redistributed to our working muscles to fuel movement. One of the earliest detectable signs of cardiovascular risk is a reduced function of this dilatory capacity.

To measure this, we used an imaging technique called flow-mediated dilation or FMD. FMD measures how well the arteries dilate and constrict, and it has been found to predict our future cardiovascular risk.

Heart health

We found that after as little as two weeks of inactivity there was a reduction in artery function. This indicates the start of cardiovascular disease development as a result of being inactive. We also observed an increase in traditional risk factors, such as body fat, waist circumference, fitness and diabetes markers, including liver fat, and insulin sensitivity.

Something we also observed – which we initially weren’t researching – was that resuming normal activity levels following two weeks of being physically inactive was below baseline. That is to say, our participants did not return back to normal within two weeks of completing the intervention.

This is interesting to consider, especially regarding the potential longer-term effects of acute physical inactivity. In real-world terms, acute physical inactivity could mean a bout of flu or a two-week beach holiday – anything that can have a potential longer-term effect on our usual habits and behaviour.

These results show us that we need to make changes to public health messages and emphasise the harmful effect of even short-term physical inactivity. Small alterations to daily living can have a significant impact on health – positively, or negatively. People should be encouraged to increase their physical activity levels, in any way possible. Simply increasing daily physical activity can have measurable benefits. This could include having a ten-minute walk during your lunch hour, standing from your desk on an hourly basis to break up sitting time or parking your car at the back of the supermarket car park to get more steps in.

The impact of spending a large proportion of the day being inactive has received a lot of research in recent years. In fact, it has become a hot point of discussion among exercise scientists. As technology advances and our lives become increasingly geared towards convenience, it’s important this kind of research continues.

The health consequences of sedentary behaviour are severe and numerous. Moving more in everyday life could be key in improving your overall health.The Conversation

Tori Sprung, Senior Lecturer in Sport & Exercise Sciences, Liverpool John Moores University and Kelly Bowden Davies, Teaching Fellow in Sport and Exercise Science, Newcastle University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Our ability to manufacture minerals could transform the gem market, medical industries and even help suck carbon from the air



Pictured is a slag pile at Broken Hill in New South Wales. Slag is a man-made waste product created during smelting.
Anita Parbhakar-Fox, Author provided

Anita Parbhakar-Fox, The University of Queensland and Paul Gow, The University of Queensland

Last month, scientists uncovered a mineral called Edscottite. Minerals are solid, naturally occurring substances that are not living, such as quartz or haematite. This new mineral was discovered after an examination of the Wedderburn Meteorite, a metallic-looking rock found in Central Victoria back in 1951.

Edscottite is made of iron and carbon, and was likely formed within the core of another planet. It’s a “true” mineral, meaning one which is naturally occurring and formed by geological processes either on Earth or in outer-space.

But while the Wedderburn Meteorite held the first-known discovery of Edscottite, other new mineral discoveries have been made on Earth, of substances formed as a result of human activities such as mining and mineral processing. These are called anthropogenic minerals.

While true minerals comprise the majority of the approximately 5,200 known minerals, there are about 208 human-made minerals which have been approved as minerals by the International Mineralogical Association.

Some are made on purpose and others are by-products. Either way, the ability to manufacture minerals has vast implications for the future of our rapidly growing population.

Modern-day alchemy

Climate change is one of the biggest challenges we face. While governments debate the future of coal-burning power stations, carbon dioxide continues to be released into the atmosphere. We need innovative strategies to capture it.

Actively manufacturing minerals such as nesquehonite is one possible approach. It has applications in building and construction, and making it requires removing carbon dioxide from the atmosphere.




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Nesquehonite occurs naturally when magnesian rocks slowly break down. It has been identified at the Paddy’s River mine in the Australian Capital Territory and locations in New South Wales.

But scientists discovered it can also be made by passing carbon dioxide into an alkaline solution and having it react with magnesium chloride or sodium carbonate/bicarbonate.

This is a growing area of research.

Other synthetic minerals such as hydrotalcite are produced when asbestos tailings passively absorb atmospheric carbon dioxide, as discovered by scientists at the Woodsreef asbestos mine in New South Wales.

You could say this is a kind of “modern-day alchemy” which, if taken advantage of, could be an effective way to suck carbon dioxide from the air at a large scale.

Meeting society’s metal demands

Mining and mineral processing is designed to recover metals from ore, which is a natural occurrence of rock or sediment containing sufficient minerals with economically important elements. But through mining and mineral processing, new minerals can also be created.

Smelting is used to produce a range of commodities such as lead, zinc and copper, by heating ore to high temperatures to produce pure metals.

The process also produces a glass-like waste product called slag, which is deposited as molten liquid, resembling lava.

This is a backscattered electron microscope image of historical slag collected from a Rio Tinto mine in Spain.
Image collected by Anita Parbhakar-Fox at the University of Tasmania (UTAS)

Once cooled, the textural and mineralogical similarities between lava and slag are crystal-clear.

Micro-scale inspection shows human-made minerals in slag have a unique ability to accommodate metals into their crystal lattice that would not be possible in nature.

This means metal recovery from mine waste (a potential secondary resource) could be an effective way to supplement society’s growing metal demands. The challenge lies in developing processes which are cost effective.




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Ethically-sourced jewellery

Our increasing knowledge on how to manufacture minerals may also have a major impact on the growing synthetic gem manufacturing industry.

In 2010, the world was awestruck by the engagement ring given to Duchess of Cambridge Kate Middleton, valued at about £300,000 (AUD$558,429).

The ring has a 12-carat blue sapphire, surrounded by 14 solitaire diamonds, with a setting made from 18-carat white gold.

Replicas of it have been acquired by people across the globe, but for only a fraction of the price. How?

In 1837, Marc Antoine Gardin demonstrated that sapphires (mineralogically known as corundum or aluminium oxide) can be replicated by reacting metals with other substances such as chromium or boric acid. This produces a range of seemingly identical coloured stones.

On close examination, some properties may vary such as the presence of flaws and air bubbles and the stone’s hardness. But only a gemologist or gem enthusiast would likely notice this.

Diamonds can also be synthetically made, through either a high pressure, high temperature, or chemical vapour deposition process.

Synthetic diamonds have essentially the same chemical composition, crystal structure and physical properties as natural diamonds.
Instytut Fizyki Uniwersytet Kazimierza Wielkiego

Creating synthetic gems is increasingly important as natural stones are becoming more difficult and expensive to source. In some countries, the rights of miners are also violated and this poses ethical concerns.

Medical and industrial applications

Synthetic gems have industrial applications too. They can be used in window manufacturing, semi-conducting circuits and cutting tools.

One example of an entirely manufactured mineral is something called yttrium aluminum garnet (or YAG) which can be used as a laser.

In medicine, these lasers are used to correct glaucoma. In dental surgery, they allow soft gum and tissues to be cut away.

The move to develop new minerals will also support technologies enabling deep space exploration through the creation of ‘quantum materials’.

Quantum materials have unique properties and will help us create a new generation of electronic products, which could have a significant impact on space travel technologies. Maybe this will allow us to one day visit the birthplace of Edscottite?




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In decades to come, the number of human-made minerals is set to increase. And as it does, so too does the opportunity to find new uses for them.

By expanding our ability to manufacture minerals, we could reduce pressure on existing resources and find new ways to tackle global challenges.The Conversation

Anita Parbhakar-Fox, Senior Research Fellow in Geometallurgy/Applied Geochemistry, The University of Queensland and Paul Gow, Principal Research Fellow, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Three reasons you have neck pain – and why ‘bad posture’ probably isn’t one of them



shutterstock/WAYHOME studio

Christian Worsfold, University of Hertfordshire

If you suffer from neck pain, you’re not alone. Spinal pain is one of the leading causes of disability worldwide and its occurrence has increased dramatically over the past 25 years. While most episodes of neck pain are likely to get better within a few months, half to three-quarters of people who have neck pain will experience repeated episodes of pain.

It’s often said there are “good and bad postures” and that specific postures can contribute to spinal pain but this belief is not supported by scientific evidence. Indeed, research shows that poor sleep, reduced physical activity and increased stress appear to be more important factors.

So despite attempts by health professionals to correct your posture and the use of “ergonomic” chairs, desks, keyboards and other gadgets chances are so-called “lifestyle factors” – such as getting enough sleep, making sure you exercise and keeping stress to a minimum – seem to be more salient in relieving and preventing the pain in your neck.

The posture myth

Although beliefs about posture run deep, science is telling a very different story – and there is a strong challenge to the long-assumed role of posture as a cause of neck pain.

A recent high-quality study, of more than 1,000 teenagers, for example, showed no statistically significant relationship between spinal posture and neck pain – despite there being easily identifiable postural subgroups in the study, such as those who sat slumped or those who sat upright. So yes, people do sit in positions that vary from person to person, but it appears to have nothing to do with pain. In fact, it appears from this particular study that the adolescent’s “posture” has more to do with their mood.

Research has also shown that changing the way you sit while working – by altering your workstation – so-called “ergonomic interventions”, have little to no impact on whether a person develops neck pain. Also, there is little high-quality evidence that ergonomic interventions can lead to a speedier recovery for someone with neck pain.

A pain in the neck or just not enough sleep?
ShutterstockMDGRPHCS

In various studies, researchers have followed groups of people who don’t have neck pain along with those who only experience occasional neck pain for periods. Some people in these groups developed troublesome neck pain and the researchers looked closely at them. Those with neck pain were found to be getting less quality and quantity of sleep and were working in jobs with high strain. They were also less physically active and had depressed mood. Their bodies are essentially experiencing greater stress and they notice more “muscle tension” in their neck. Importantly, this is all before the pain has even developed.

Researchers have found that, even among children as young as nine years old, symptoms such as tiredness and sleep difficulties – along with headaches, abdominal pain and lower mood – were risk factors for both the occurrence and persistence of weekly neck pain when the children were monitored for four years.

Sleep, exercise and relaxation

The flip side of this is that having a stronger neck, enjoying exercise – even simply walking a greater number of steps each day – have all been shown to protect against getting neck pain. This, along with making sure we don’t become sleep deprived, less physically active and stressed will hopefully manage and prevent neck pain more successfully.

So feel free to sit how you want to at your desk. If you find yourself sitting for long periods in one position make an effort to switch it up – as one of the key things to avoid getting pain in your neck is to change positions frequently through the day.

And if you do have neck pain, get a few early nights, consider doing something relaxing – and why not go for a walk at lunchtime. Importantly, you also need to stop worrying about how you sit or walk, because science seems to show that there may be no such thing as a “bad” posture after all.The Conversation

Christian Worsfold, Visiting Lecturer in Physiotherapy, University of Hertfordshire

This article is republished from The Conversation under a Creative Commons license. Read the original article.

For people with a mental illness, loved ones who care are as important as formal supports



People with mental illness are especially vulnerable after they are discharged from hospital.
From shutterstock.com

Emily Hielscher, The University of Queensland; James Graham Scott, QIMR Berghofer Medical Research Institute, and Sandra Diminic, The University of Queensland

People living with mental illness often require support from carers, such as family and friends, on a long-term and somewhat unpredictable basis.

But these support networks are not always in place. Geographical or emotional distance from family members, conflict with friends, and the tendency for people with mental illness to withdraw from others means these individuals are often isolated.

In two Australian surveys – a national snapshot survey of Australian adults with psychosis and another looking at adults with long-term mental health conditions such as depression, anxiety, and psychosis – only one-quarter reported receiving regular assistance from family or friends. About three out of every four people living with mental illness reported the absence of a carer or other informal support.




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For someone living with mental illness, having a carer or support person facilitates continuity of care and provides advocacy and support, particularly during and after episodes of acute illness.

People with mental illness are at their most vulnerable following discharge from hospital or other inpatient facilities. Reintegrating back into society can be challenging. And during this time, the risk of suicide is high.

It’s somewhat unsurprising, then, that people without a carer or support network face poorer outcomes in terms of recovery.

How does having a carer help?

Following hospitalisation for an acute episode of mental illness, people typically require assistance with a myriad of tasks.

They may need help with day-to-day activities like grocery shopping, cooking and cleaning. People in recovery may also need support to re-engage with the community, including returning to work or study.

They will likely benefit from assistance in adhering to care plans, including managing medications and attending follow-up appointments. A person recovering from hospitalisation for an eating disorder may need support from family members to ensure they are eating as much as they need to at mealtimes.

As well as these practical supports, someone recovering from an acute episode of mental illness requires ongoing emotional support which reaffirms their sense of self and capacity to recover.




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We surveyed 105 Australian mental health carers and found the most commonly reported care tasks were “providing encouragement and motivation”, “prompting their loved ones to do things”, and “liaising with health professionals”.

Carers spent the majority of their caring time providing emotional support, and the least of their care time assisting with activities of daily living, such as feeding and dressing.

Research has shown having a carer increases the likelihood of follow-up care and better health outcomes in the short and long term. Following hospitalisation, carers can recognise and respond to early warning signs of relapse and encourage better engagement in prescribed care plans.

And although it’s rarely considered part of the caring role, safe and stable housing is crucial for recovery. Most mental health carers also live with the person they are caring for.




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Looking after loved ones with mental illness puts carers at risk themselves. They need more support


What about discharged patients who don’t have informal supports?

The transition from hospital to home can be frightening and difficult. Patients tend to become accustomed to the day-to-day hospital routine and in turn can feel increasingly disconnected from the outside world. These challenges are exacerbated in the absence of support from health professionals, family or friends.

Without family or carer involvement at discharge, a person with mental illness may be more likely to relapse and be readmitted, falling into a “revolving door” pattern of multiple hospitalisations.

A support person can help ensure medical appointments are organised and attended.
From shutterstock.com

One study of older psychiatric patients found absent or dysfunctional family support was one of the strongest predictors of hospital readmission in the 18 months after discharge. Patients without reliable family support were nearly twice as likely to be readmitted to hospital than those who had dedicated family carers.

Similar results have been found in broader and larger samples. Among 1,384 adult patients admitted to a psychiatric hospital, unreliable social support at discharge was associated with an increased risk of being readmitted to hospital within one year.

Further, reduced social support and lack of continuity of care has been shown to be an important predictor of suicide following hospital discharge. For self-harm and suicide, the risk is most pronounced in the three months following discharge from hospital.

What needs to improve?

Alongside the absence of family support, lack of connection with community-based services and supports is similarly associated with poor post-discharge outcomes.

Discharge planning and transitional programs have been established to provide additional practical and emotional support to people with mental illness after they leave hospital. These have reported promising results in terms of preventing hospital readmission and promoting engagement with community treatment (such as psychological support services, medication monitoring, and alcohol and drug recovery services). Further research which identifies the key benefits of such programs is needed, using larger controlled studies.

Another solution is improving housing support for mental health patients after discharge. Programs such as Housing Mental Health Pathways in Victoria assist people with mental illness and a history of homelessness who have no suitable accommodation at the time of hospital discharge. More programs like this are needed.




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The time following hospitalisation is one of the most vulnerable for people with mental illness. More needs to be done at both a community and policy level to better support people during this period – particularly those without a carer or informal support network.

If this article has raised issues for you or you’re concerned about someone you know, call Lifeline on 13 11 14.The Conversation

Emily Hielscher, PhD Candidate, The University of Queensland; James Graham Scott, Associate Professor of Psychiatry, Senior Scientist and Head of Mental Health, QIMR Berghofer Medical Research Institute, and Sandra Diminic, Adjunct Fellow, School of Public Health, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

In contrast to Australia’s success with hepatitis C, our response to hepatitis B is lagging


While hepatitis B can’t be cured in the same way hepatitis C can, effective treatment is available.
From shutterstock.com

Benjamin Cowie, The Peter Doherty Institute for Infection and Immunity; Karen McCulloch, University of Melbourne, and Nicole Romero, The Peter Doherty Institute for Infection and Immunity

Around one-third of Australians living with hepatitis C have been cured in the last four years.

Hepatitis means inflammation of the liver. Hepatitis C is one of five varieties of viral hepatitis (A-E), and alongside hepatitis B, is responsible for the majority of illness caused by hepatitis.

Australia’s response to hepatitis C is seen as a leading example around the world, and the elimination of the disease as a major public health threat is looking like an increasingly achievable goal.




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Australia leads the world in hepatitis C treatment – what’s behind its success?


But the situation is much less promising for Australians living with hepatitis B, which is now the most common blood-borne viral infection in Australia. It affects more people than hepatitis C and HIV combined.

In our research published today, we show Australia is falling short of its targets to reduce the burden of hepatitis B. Looking to the way we’ve responded to hepatitis C may set us on a better path.

Hepatitis C treatment

There were an estimated 182,144 people living with chronic hepatitis C in Australia at the end of 2017.

A number of important drugs were listed on the Pharmaceutical Benefits Scheme (PBS) from 2016, making curative treatments available to nearly all Australians living with hepatitis C.

The number of treatments being initiated has fallen significantly since the early peak, and significant differences exist in who has accessed the treatments across Australia. Nonetheless, Australia’s response to hepatitis C is highly regarded as an example of how to rapidly scale up hepatitis C treatment in a population, including among people who inject drugs.

Recent data from New South Wales demonstrate access to hepatitis C cures has led to a drop in the number of people with hepatitis C dying from liver cancer, with the bend in the curve coinciding with listing of these new treatments on the PBS in 2016.




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Explainer: the A, B, C, D and E of hepatitis


Hepatitis B treatment

There were an estimated 221,420 people living with chronic hepatitis B in Australia in 2017. Along the trajectory of the disease, those who have liver disease or are at risk of developing liver disease require treatment.

Unlike hepatitis C, hepatitis B cannot be cured with current treatments, so ongoing antiviral therapy is required. This is similar to the treatment received by someone with HIV.

Although not a cure, the available treatments are effective. Current hepatitis B treatments have been associated with reducing the risk of liver cancer by around 50% in the first five years of treatment.

Scaling up such treatment and care will be a critical element in reversing the increasing tide of liver cancer deaths in Australia.

Hepatitis can cause mild to severe liver damage.
From shutterstock.com

Targets

By 2030, the World Health Organisation has set out that 90% of people with hepatitis B should be diagnosed, 80% of those who meet criteria for treatment should be treated, and deaths due to hepatitis B should be reduced by 65% relative to 2015 globally.

In Australia, our Third National Hepatitis B Strategy sets targets to be achieved by 2022, including diagnosing 80% of people, engaging 50% of people in care, treating 20% of people, and reducing deaths due to hepatitis B by 30%.




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Measuring progress towards these targets is complicated and requires consideration of a range of demographic and other factors. Considering most people living with hepatitis B in Australia were born overseas or are Aboriginal or Torres Strait Islander peoples, up-to-date estimates of Indigenous status and migration flows into and out of Australia are essential. Estimates of the prevalence of hepatitis B in different groups and detailed information about the natural history of hepatitis B in individuals over time is also important.

Our research

Taking these complexities into account, we’ve constructed a mathematical model simulating the burden of hepatitis B in the Australian population from 1951 to 2030. We wanted to see how Australia is faring in terms of meeting national and international targets.

By 2022, if current trends continue, the proportion of people diagnosed will reach 71% (short of the 80% goal). Some 11.2% of Australians living with hepatitis B will be on treatment (short of the 20% target). But we estimate the proportion who actually need treatment is around 30%, so we have a long way to go.

In related work mapping the burden of hepatitis B and estimating differences in treatment and care nationally we estimate only 20% of people living with hepatitis B are engaged in care (either being appropriately monitored or receiving treatment). Again, this is well short of the 50% target.

So why aren’t we meeting these targets?

Broader inequities in health access and outcomes for culturally and linguistically diverse groups and Aboriginal and Torres Strait Islander peoples play a substantial role. Together they represent over two-thirds of Australians living with hepatitis B.

Current delivery of treatment and care differs across the country. The experience and strategies used in those areas with higher levels of treatment and care should be examined and shared to address the inequities observed across Australia.




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Eliminating hepatitis C – an ambitious but achievable goal


Like hepatitis C, Australia’s response to the needs of people living with HIV is viewed as being of a high standard. Two elements central to our responses to hepatitis C and HIV are currently missing for hepatitis B.

The first is strong, ongoing community engagement and leadership of the response by those affected. While organisations representing people living with HIV have existed since the 1980s and for hepatitis C since the 1990s, engagement with people living with hepatitis B has lagged well behind.

The second is treatment and care primarily being delivered in the community by primary care clinicians (especially GPs) – rather than in hospitals and by specialists, as is the case for most people living with hepatitis B. Many patients prefer seeing GPs and find this more convenient than waiting for hospital appointments and seeing specialists. This can be especially true for people living far from major hospitals, reflected in the fact hepatitis B treatment uptake is much lower than average in regional and rural areas of Australia.

Making it happen

Although both factors are priorities for action in the National Hepatitis B Strategy, progress will require ongoing funding and coordinated efforts by the Commonwealth, state and territory governments, primary health networks, and other partners.

The impact will be measured, not just in modelled estimates, but in real lives saved. While we’re not yet on track to meet our targets for hepatitis B in Australia, our modelling suggests even with the relatively low current uptake of treatment and care, 2,300 Australian lives were saved between 2000 and 2017, which otherwise would have been lost to liver cancer and liver failure caused by hepatitis B.

If we can translate what has been learned in our HIV and hepatitis C responses to increase access to essential care for Australians living with hepatitis B, thousands more lives can be saved in the next decade and beyond.




Read more:
Dr G. Yunupingu’s legacy: it’s time to get rid of chronic hepatitis B in Indigenous Australia


The Conversation


Benjamin Cowie, Director, WHO Collaborating Centre for Viral Hepatitis, The Peter Doherty Institute for Infection and Immunity; Karen McCulloch, Research Fellow, University of Melbourne, and Nicole Romero, Epidemiologist, WHO Collaboating Centre for Viral Hepatitis, The Peter Doherty Institute for Infection and Immunity

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Changing the terminology to ‘people with obesity’ won’t reduce stigma against fat people


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Fat activists argue fat is the most appropriate word to describe their bodies.
Yulia Grigoryeva/Shutterstock

Cat Pausé, Massey University

The British Psychological Society is calling for changes for how we talk about fatness, suggesting we should no longer use the phrase “obese people”, but instead, “people with obesity” or “people living with obesity”.

These changes are being proposed to recognise that fatness is not about personal choice and that fat shaming and fat stigma are harmful.

But this suggested language change is based on the idea obesity is a disease to be cured and fat people are not a natural part of the world. This serves to reinforce stigma, rather than prevent it.




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How does stigma and shame affect fat people?

Fat stigma can harm people’s physical health, mental health, and relationships.

Independent of body mass index (BMI), fat stigma increases blood pressure, inflammation, and levels of cortisol in the body, due to the activation of the fight or flight response.

Fat stigma reduces self-esteem and increases depression.
It isolates fat people, making them less likely to engage with the world. It also impacts on fat people’s relationships with family, colleagues, and friends.

Fat stigma erodes self-esteem and isolates people.
Motortion Films/Shutterstock

People around the world, and of all ages, hold negative attitudes about fatness and fat people. In a study in the United States, for example, more than one-third of the participants reported:

one of the worst things that could happen to a person would be for [them] to become obese.

How terminology reinforces stigma

While many people are uncomfortable with the term fat, fat activists prefer the term. They see it as both as an act of rebellion – to adopt a word that has been wielded against them – but also because they argue it’s the most appropriate word to describe their bodies.

To be overweight implies there is a natural weight to be; that within human diversity, we should all be the same proportion of height and weight.

Obesity is a medical term that has pathologised the fat body. The British Psychological Society’s acknowledgement that rather than saying “obese people”, we should call them “people with obesity” reinforces that obesity is a disease; a chronic illness people suffer from.




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What does fat discrimination look like?


The British Psychological Society’s desire to shift to person-first language is understandable. Person-first, or people-first, language is an attempt to not define people primarily by their disease, or disability, or other deviating factor.

Person-first language recognises people as individuals with rights to dignity and care, and puts the person, rather than their “condition”, first.

But others have argued person-first language attempts to erase, deny, or ignore the aspect of the person that isn’t “normal”, and reinforces that there is something shameful or dehumanising about their disability or disease.

They promote identity-first language, which allows people to take pride in who they are, rather than separating a person from that aspect of themself.

The problem with person-first language, they argue, is that those identities are stigmatised. But without the stigma, there would be no concern with calling someone a disabled person, for instance, rather than a person with disabilities.

So what should we do?

Ask people what they want to be called.
Rawpixel.com/Shutterstock

The best approach, especially for health-care professionals, is to ask people what they prefer their designation to be.

And for the rest of us, to acknowledge that what an individual wants to be called or how they want to talk about their experiences is up to them, not us. If a fat person wants to call themselves fat, it is not up to non-fat people to correct them.

Shifting the language we use to talk about fatness and fat people can reduce fat stigma. But continuing to frame fatness as a disease is not a helpful contribution.




Read more:
Study finds obesity stigma erodes will to exercise, socialise


The Conversation


Cat Pausé, Senior Lecturer in Human Development, Massey University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Organs ‘too risky’ to donate may be safer than we think. We crunched the numbers and here’s what we found



Accepting a donor kidney with a small risk of carrying HIV or hepatitis B or C might be worth thinking about.
from www.shutterstock.com

Karen Waller, University of Sydney and Angela Webster, University of Sydney

Organs from potential donors once rejected as being unsafe to transplant may not be as risky as once thought, new Australian research shows.

Our study, published in the Medical Journal of Australia, suggests organs from injecting drug users or men who have sex with men, for instance, could safely open up the pool of available organs. That’s so long as donors test negative for blood-borne infections, such as HIV, and hepatitis B and C.

Currently, organs from this and other groups considered high risk are often rejected outright, for fear of transmitting hidden infections to the recipient.

If transplant criteria were based on viral status rather than belonging to a particular group, we estimate this could mean up to 30 more people could receive a transplant a year in NSW alone.




Read more:
Why are only some viruses transmissible by blood and how are they actually spread?


Which high-risk groups are usually rejected as donors?

Many infections can potentially be transmitted as a result of an organ transplant. But this happens very rarely due to strict governance, involving careful screening and selection of donors.

Blood-borne viruses, such as hepatitis B, hepatitis C or HIV, are a particular concern, because historically these had the most potential to have devastating consequences for the organ recipient.

Some potential organ donors have behaviours that put them at increased risk of infection. National and international guidelines perceive high-risk groups for these viruses to include:

  • people who inject illicit drugs

  • men who have sex with men

  • sex workers

  • people who have recently been in jail

  • sexual partners of any of these groups, or of people with a blood-borne virus.

People from these groups are often declined as organ donors, even when tests for blood-borne viruses are negative, and sometimes without even being tested.

That’s because of the worry about the risk of the donor being recently infected but that infection not yet showing up in blood tests. This is know as the “window period”. If a window-period infection occurred, people could unwittingly transmit the virus.

When we used Australian data, here’s what we found

So how big a risk are we talking about?

Until recently, Australian guidelines have relied on US estimates of risk, although there are important differences in the prevalence of blood borne viruses in the US and elsewhere compared with Australia.

We believed the risk of window-period infection in Australia was likely to be lower, possibly much lower, than was appreciated. So, we were concerned some potential donors might be turned away who could actually have donated safely.

So, we identified data from sources including journal articles, government reports and conference abstracts between Jan 1, 2000 and Feb 14, 2019 to see how common blood-borne viruses were in people with high-risk behaviours in Australia.




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We found, as expected, men who have sex with men have the highest risk of HIV in Australia. But for each person who tests negative for HIV, the risk of transmitting the virus was around one in 6,500. This is lower than the US estimate, which sits at one in 2,500. The difference was more pronounced for injecting drug users in Australia, where one in 50,000 would have a window period infection, compared to one in 2,000 in the US.

The window period risk was higher for hepatitis C. Among the riskiest groups, this was around one in 500, similar to overseas studies. There were no studies overseas to compare to for hepatitis B. We found the risk of a window period infection was at most one in 200 from the riskiest group (although we may being cautious and over-estimating this risk).




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Explainer: the A, B, C, D and E of hepatitis


What does this mean?

First, we suggest all potential organ donors with high-risk behaviours be assessed with the test that gives the shortest window period, to minimise the chance of missing a recent infection.

All potential donors with an increased risk of infection should have blood tests, then their risk of transmission assessed.
from www.shutterstock.com

This means testing for the presence of the virus itself (via DNA or RNA testing) rather than relying on tests that look for markers of infection (serological testing).

For potential donors who test negative, our data can be used to help clinicians put the small risks of infection transmission in context for organ recipients.

What’s the alternative?

For most people, an organ transplant is the best treatment for organ failure and can be life-saving.

For people with kidney failure, the alternative is dialysis. But this gives shorter survival, poorer quality of life, and incurs higher costs to the health system than treatment with a kidney transplant. For the heart, liver and lungs, there are no other long-term options; without a transplant, people whose organs fail will eventually die.

But there are not enough organ donors to go round. Around 1,500 Australians are waiting for a transplant.

Even so, the option of receiving a donor organ with even a very small risk of transmitting infection may not seem immediately appealing. But this needs to be balanced against the considerable health consequences of foregoing a transplant and remaining on the waiting list.

For most people, an organ transplant is the best treatment for organ failure and can be life-saving.
from www.shutterstock.com

In 2018 in Australia there were 554 deceased donors who donated organs to 1,543 transplant recipients. Over the same period, 39 people died while waiting for a transplant, and a further 236 were removed from the waiting list due to ill health.

Even with our newly calculated low risk of transmission, there are ways of minimising the risks further, or with new treatments, curing the viral infections if they are transmitted.

For instance, with HIV, medications could be provided to recipients, to further reduce the risk of transmission. If the recipient develops hepatitis C, there are now drugs that can cure it completely. And, for hepatitis B, many people are now vaccinated, which prevents transmission.




Read more:
Three ethical ways to increase organ donation in Australia


What’s happening internationally?

Donors at increased risk of blood-borne viruses are used internationally.

In the US, over 25% of organ donors now fit these criteria, mainly due to the opioid epidemic and associated increased deaths from overdose.

This strategy has led to an increase in hepatitis C transmissions from donors to recipients. But hepatitis C can be cured with an eight-week course of treatment, even among transplant recipients.

Researchers have also shown an increase in survival for patients who accepted kidneys from people at increased risk of viral infection compared to those who opted to remain on the waiting list.

Does this mean more people could have transplants?

So could our work make a tangible impact on the number of Australians receiving transplants?

Our preliminary work suggests there could have been up to a 5% increase in donors in NSW alone between 2010-2015, if we had accepted donors with risk behaviours but negative test results. There could have been five more donors a year, who can each donate to up to six recipients (so up to 30 additional recipients a year).

Our early results on the risk of infection were recently incorporated into national guidelines produced by the Transplantation Society of Australia and New Zealand for organ transplantation.

In Victoria, people waiting for a kidney transplant can now consent to receiving organs with these risks when they are put on the waiting list.

We hope our research sparks discussion among patients and doctors to consider what risks are important to patients, and where their values and preferences lie. Better evidence for decision-making should certainly help.The Conversation

Karen Waller, PhD candidate, University of Sydney and Angela Webster, Professor of Clinical Epidemiology, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Endometriosis costs women and society $30,000 a year for every sufferer



It can be difficult to get pain from endometriosis under control.
Shutterstock

Mike Armour, Western Sydney University and Kenny Lawson, Western Sydney University

The average cost for a woman with endometriosis both personally and for society is around A$30,000 a year, according to our research, published today in the journal PLOS ONE.

Most of these costs are not from medication, or doctors’ visits, although these do play a part. Rather, they’re due to lost productivity, as women are unable to work – or work to their usual level of efficiency – while experiencing high levels of pain.

Remind me, what is endometriosis?

Chronic pelvic pain is pain below the belly button that occurs on most days for at least six months. The most common identifiable cause is endometriosis. Endometriosis is the presence and growth of tissue (called lesions) similar to the lining of the uterus that’s found outside the uterus.

Women with the condition have a variety of symptoms, including non-cyclical pelvic pain (which is like period pain but occurs regularly throughout the month), severe period pain, pain during or after sexual intercourse, and severe fatigue. Gastrointestinal problems, such as severe bloating (often called “endo belly” by those who suffer from it) and pain with bowel motions, are also common.




Read more:
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Currently, surgery (a laparoscopy) is the only way to make a formal diagnosis of endometriosis – this is where a small camera is inserted into the pelvic/abdominal cavity to investigate the presence of endometriosis lesions.

Both medical and surgical treatments are commonly used for women with endometriosis. Medical therapies include non-steroidal anti-inflammatories (such as ibuprofen and naproxen), oral contraceptive pills and other forms of hormonal treatments.

While these medications can be effective for some, many women experience side effects and need to stop using them.

Surgery is the current “gold standard” of treatment, but despite successful surgery many women find their pain and symptoms can return within about five years after surgery.




Read more:
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How many women have it?

Around 7% of Australian women aged 25–29 and 11% of women aged 40–44 are likely to have endometriosis, which is similar to the worldwide estimate of one in ten women.

Delays in diagnosis are extremely common, and combined with needing surgery for a diagnosis, means many women suffer for years with chronic pelvic pain before being diagnosed with endometriosis later in life. This contributes to the difficulty in getting exact figures for how many women in Australia have endometriosis.

Worldwide estimates of chronic pelvic pain range from 5% to 26% of women. In New Zealand, it’s around 25% and is likely to be similar in Australia but we are lacking any up-to-date and reliable statistics on this.

What did our study find?

Endometriosis and chronic pelvic pain affect all aspects of women’s lives – social activities, romantic relationships and friendships, education, and work attendance and productivity.

We surveyed more than 400 women aged 18 to 45 who were either diagnosed with endometriosis or experiencing chronic pelvic pain. We asked about health-care costs (both out of pocket and funded), employment-related costs, and other costs related to childcare and household maintenance. We also asked about their pain levels.

Women with endometriosis sometimes have to work when they’re in extreme pain, affecting their productivity.
Flamingo Images/Shutterstock

We found the average cost for a woman with endometriosis was around A$30,000 per year.

Around one-fifth of this cost was in the health sector, for medications, doctors’ visits, hospital visits, assisted reproductive technology such as IVF, and any transport costs to get to these appointments. Of this, A$1,200 were out-of-pocket costs.

The bulk of the costs (over 80%) were due to lost productivity, either because of absenteeism (being off work) or presenteeism (not being as productive as usual because you’re sick). Women with endometriosis often use up all their sick leave and then often have to work when they are in severe pain.

Overall, if one in ten women aged 18 to 45 do have endometriosis, the total economic burden in Australia may be as high as A$9.7bn per year for endometriosis alone.

Pain scores had a very strong link with productivity costs. Women with the most severe pain had a 12-times greater loss of productivity, in terms of working hours lost, than those with minimal pain.

Overall, taking into account all costs (health sector, out-of-pocket, carers and productivity) women with severe pain have six-times greater costs (A$36,000) a year overall compared to those with minimal pain (A$5,700).

Finally, we also looked at the cost of illness not only of those women with a diagnosis of endometriosis, but also of those that had other causes of chronic pelvic pain, such as vulvodynia (pain, burning or discomfort in the vulva) and adenomyosis (growths in the muscular wall of the uterus).

We found the overall costs between the two groups – those with endometriosis and those with other types of pelvic pain – were very similar.




Read more:
Adenomyosis causes pain, heavy periods and infertility but you’ve probably never heard of it


The more pain a woman has, the bigger the impact on her productivity and out-of-pocket costs.
Iryna Inshyna/Shutterstock

So what should we be doing?

The economic burden of endometriosis is at least as high as other chronic disease burdens such as diabetes. However, many women are not receiving the support they need.




Read more:
Women aren’t responsible for endometriosis, nor should they be expected to cure themselves


We also need to prioritise funding for endometriosis research, which until recentlyhas attracted comparatively little research funding.

Plans are underway to increase awareness and education, and improve diagnosis and pain management. Unfortunately, there is no such plan for women with other forms of chronic pelvic pain.

Reducing pain, by even a modest 10-20%, could improve women’s quality of life and potentially save billions of dollars each year.The Conversation

Mike Armour, Post-doctoral research fellow, Western Sydney University and Kenny Lawson, Adjunct Principal Health Economis, Translational Health Research Institute, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Pay pharmacists to improve our health, not just supply medicines



Pharmacists receive no financial incentive to counsel patients about how to take their medicines. That needs to change.
from www.shutterstock.com

John Jackson, Monash University and Ben Urick, University of North Carolina at Chapel Hill

When you have a medicine dispensed at your local pharmacy under the
Pharmaceutical Benefits Scheme (PBS), two things happen. The federal government determines how much the pharmacy receives for dispensing your medicine. It also decides what you need to pay.

This so-called fee-for-service funding means pharmacies maximise their revenue if they dispense many prescriptions quickly.

Rather than fast dispensing, it would be better for patients and the health-care system if the funding model paid pharmacists for improving the use of medicines, not just for supplying them.

This is possible, according to our research published recently in the Australian Health Review. And it should be considered as part of the next Community Pharmacy Agreement, which outlines how community pharmacy is delivered over the next five years.




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Explainer: what is the Community Pharmacy Agreement?


Dispensing medicine is more complex than it looks

Dispensing medications may seem simple but this can be misleading: it includes both commercial and professional functions.

Under the PBS, the pharmacy receives a handling fee and mark-up on the cost of the drug to cover the commercial cost of maintaining the pharmacy and stock.

It also receives a dispensing fee for the pharmacist’s professional activities. These include reviewing the prescription to ensure it is legal and appropriate, taking into account factors such as your age, whether you are pregnant and which medicines you’ve been prescribed before; creating a record of the dispensing; labelling the medicine; and counselling you, including providing a medicine information leaflet if needed.

Higher dispensing fees are paid for medicines needing greater levels of security (such as controlled drugs including opioids) and for medicines the pharmacist must make up (such as antibiotics in liquid form).




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But for the vast majority of PBS prescriptions, a pharmacy receives the same basic dispensing fee, currently A$7.39.

If you have a medicine dispensed for the first time, if it has a complicated dose, or it carries particular risks such as side effects or interactions, a pharmacist is professionally obliged to provide counselling matched to the risk. The more detailed the counselling, the greater the time needed.

However, at present, the dispensing fee to the pharmacy does not change depending on the level of counselling you need. Indeed, the current funding model is a disincentive for the pharmacist to spend time with you explaining your medicine. That’s because the longer they spend counselling, the fewer prescriptions they can dispense, and the fewer dispensing fees they receive.

What could we do better?

Performance-based funding, in which payment is adjusted in recognition of the efforts of the service provider or the outcomes of the service delivered, is becoming more common in health care and can correct some of the volume-related issues mentioned above.

It’s already being used in Australia. For instance, GPs are paid a Practice Incentives Program (PIP) to encourage improvements in services in areas such as asthma and Indigenous health.

However, performance-based funding has yet to be used for pharmacists’ dispensing in Australia.

We propose dispensing fees should be linked to the effort pharmacists make to promote improved use of medicines. This is based on the principle that counselling means people are more likely to take their medications as prescribed, which improves their health.

In other words, pharmacists would receive higher dispensing fees when more counselling is required or if counselling leads to patients taking their medications as prescribed.

Pharmacists who spend longer counselling, for instance if someone’s health status has changed, should be rewarded for it.
from www.shutterstock.com

Dispensing fees could be linked to the actual time taken to dispense a prescription: the longer the time, the higher the fee. The time taken would depend on the nature of the drug; the complexity of the patient’s treatment; recent changes in the patient’s health status or other medicines that need to be taken into account; consultation with the prescribing doctor; and the level of advice and education provided.

A blended payment model could include a fee-for-service payment for commercial processes and a performance-linked payment for professional functions.

The most experience with performance-based payments to pharmacy is in the United States, where evidence is developing of patients taking their medicine as prescribed and lower total health-care costs.

In England, the government’s Pharmacy Quality Scheme is similar to the Australian Practice Incentives Program for GPs. It funds improved performance in areas such as monitoring use of certain drugs and patient safety.

There is some concern about performance-linked payments. Performance targets need to be achievable without being onerous. And performance needs to be clearly linked to the payment being made, but not if other services suffer.

Incentives could apply to you too

Cost is a barrier to some people taking their medicines with over 7% of Australians delaying or not having prescriptions dispensed due to cost.

However, there is currently no financial incentive for you to have a generic (non-branded) medicine dispensed, which would save on PBS expenditure. So it makes sense for generic medicines to be a lower cost to you.




Read more:
Health Check: how do generic medicines compare with the big brands?


There is also currently no financial incentive for you to take your medicine as prescribed, which would likely improve your health and save the health budget in the long run. We are not aware of any country varying patient charges based upon this, although there are ways of monitoring if people take their medicines as directed.

However, countries such as New Zealand and the United Kingdom have lower or no patient prescription charges, minimising costs as a barrier to patients taking their medicine.

What would need to happen?

Dispensing a prescription should be an invitation for the pharmacist to interact with you and help you with advice on the effective and appropriate use of your medicine. At present, there is no incentive, other than professionalism, for pharmacists to add such value.

The proposed changes would require a major restructure to the funding of dispensing to provide incentives that are equitable and transparent and that did not adversely affect disadvantaged, rural and Indigenous people.

There would need to be agreement on reliable and valid performance measures and reliable information systems.

However, funding based on a professional service model rather than a dispensing volume model would support your pharmacist to provide greater benefit to you and the health-care system.The Conversation

John Jackson, Researcher, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University and Ben Urick, Research Assistant Professor, University of North Carolina at Chapel Hill

This article is republished from The Conversation under a Creative Commons license. Read the original article.