It’s hard to breathe and you can’t think clearly – if you defend your home against a bushfire, be mentally prepared


Danielle Every, CQUniversity Australia and Mel Taylor, Macquarie University

If you live in a bushfire-prone area, you’ll likely have considered what you will do in the event of a bushfire.

The decision, which should be made well in advance of bushfire season, is whether to stay and actively defend a well-prepared property or to leave the area while it’s safe to do so.

The emphasis in bushfire safety is on leaving early. This is the safest option.

In “catastrophic” fire conditions, the message from NSW Rural Fire Service is that for your survival, leaving early is the only option.




Read more:
How a bushfire can destroy a home


In other fire conditions, staying and defending requires accurately assessing the safety of your house and the surrounding environment, preparing your property in line with current best practice and understanding fire conditions.

It also requires a realistic assessment of not just your personal physical capacity to stay and defend but also your psychological capacity.

Why do people stay and defend?

Our survey of people who experienced the 2017 NSW bushfires asked what they would do next summer if there were catastrophic conditions. Some 27% would get ready to stay and defend, and 24% said they would wait to see if there was a fire before deciding whether to stay and defend or leave.

Animal ownership, a lack of insurance, and valuable assets such as agricultural sheds and equipment, are motivators for decisions to stay and defend.




Read more:
How we plan for animals in emergencies


If animal owners aren’t home they will often return to their properties when bushfire warnings are issued, contrary to official advice, to retrieve or protect their animals and physical assets.

Although these decisions are understandable they can also lead people who aren’t physically or psychologically suited to staying and defending to do so.

What if you’re not psychologically up to it?

The reality is that a bushfire is a threatening, high-risk situation. It’s hard to see, hard to breathe, noisy and hot.

These conditions can overwhelm our ability to think clearly and act calmly. People in the Sampson Flat Fire in South Australia in 2015, for example, experienced high levels of stress which caused them to:

  • change their plan at the last minute, including leaving late which is the most dangerous response to a fire
  • drive unsafely, especially speeding
  • forget to take important items (such as medication)
  • leave their animals behind
  • engage in unrelated tasks that took up precious time
  • ignore the threat (by going to sleep, for example).

This is one person’s account of how they responded as the fire approached:

[I] grabbed my son […] saw the smoke and […] went and got the boxes that I’d prepared which I packed when he was a baby. So I had stupid things in the boxes, like baby outfits. But I can’t freak him out […]

[I]n the back of my mind I’m thinking about what do I need to do […] I’ve quarter a tank of diesel, I’d better go get diesel. I also had a back seat full of books that I’d been tidying up [from] his room, so I thought op shop, better do that because I’ll clear the back seat. […]

Came in the house like a mad woman screaming for cats, nowhere in sight. I’ve got four cats and not one of them [is there]. Grabbed a bag and then started putting stupid amounts of clothes in like 20 pair of socks, and then basically I threw the dog in the car. […] So flat panic.




Read more:
Bushfires can make kids scared and anxious: here are 5 steps to help them cope


What’s going on with our thinking?

The spectrum of actions from frenzy and flight to freezing reflects the model of “affective tolerance”. When stress exceeds what we can tolerate, we can become hyper-aroused and may have racing thoughts and act impulsively.

Or we may experience hypo-arousal, where we shut down and feel numb and passive.

Our brains consist of three basic parts: the brain stem, limbic system and cortex. These are sometimes described as the primitive, emotional and thinking brains.

In most situations, our thinking brain mediates physical responses to the world around us.

But under high amounts of stress, this connecting loop between the more reactive emotional and physical parts of our brain and our thinking cortex becomes separated. University of California, Los Angeles, professor of psychiatry Dan Siegel describes this as flipping our lid.

Flipping our lid is an automatic response and, from an evolutionary perspective, it’s a highly useful one – we don’t have time to think about whether or not to run when our lives are threatened.

But in a bushfire, these automatic responses are often not the best way to respond and can prompt us to make unsafe decisions.

To survive a bushfire, we need to make complex and often highly emotional decisions in rapidly changing conditions.

How do you control the fear?

In an analysis of 33 people who survived extreme conditions in the Black Saturday bushfires, researchers tentatively concluded that the major contributor to their survival was their ability to maintain their mental focus. They could control their fear and keep their attention on the threat and how to respond.

In order to stay and defend safely, it’s vital to have the skills to re-connect the loop between the thinking and the automatic and feeling parts of the brain.

The AIM model, based on stress inoculation theory, suggests preparing before bushfire by anticipating, identifying and developing strategies for coping with stress:

  • anticipate: know how the brain and body responds in an emergency (and that these are normal)

  • identify: be aware that this response is occurring (what is happening in your mind/body that tells you that you are acting from the “basement brain”)

  • manage: have practised strategies for switching mindsets and re-establishing the brain loop.

A large Australian study shows people who are better psychologically prepared for a bushfire:

  • have accessed information on what it means to be mentally prepared
  • have previous experience of bushfires
  • are mindful (have the ability to stay present)
  • use an active coping style such as the AIM model (anticipate, identify, manage)
  • have low levels of stress and depression.

Currently, the most accessible resource on developing mental preparedness is the Australian Red Cross RediPlan guide which includes preparing your mind based on the AIM (anticipate, identify, manage) model.




Read more:
Our land is burning, and western science does not have all the answers


The Conversation


Danielle Every, Senior Research Fellow in social vulnerability and disasters, CQUniversity Australia and Mel Taylor, Senior Lecturer in Organisational Psychology, Macquarie University

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

What are parasites and how do they make us sick?



Giardia is an example of a parasite you don’t want to catch. Symptoms can include diarrhoea, abdominal cramps, fatigue, weakness and weight loss.
From shutterstock.com

Vincent Ho, Western Sydney University

A parasite is an organism that lives in or on an organism of another species.

Three main classes of parasites can cause disease in humans: protozoa, helminths, and ectoparasites. Protozoa and helminths largely affect the gut, while ectoparasites include lice and mites that can attach to or burrow into the skin, staying there for long periods of time.

The majority of protozoa and helminths tend to be non-pathogenic (meaning they don’t cause disease) or result in very mild illness. Some, however, can cause severe disease in humans.




Read more:
Health check: the low-down on ‘worms’ and how to get rid of them


Faecal-oral transmission, where parasites found in the stool of one person end up being swallowed by another person, is the most common mode of transmission of parasitic protozoa and helminths.

The initial symptoms tend to be gastrointestinal symptoms like diarrhoea. When parasites invade the red blood cells or organs, the consequences can become more serious.

Protozoa

Protozoa are tiny single-celled organisms that multiply inside the human body.

The protozoa giardia, for example, has a classic two-stage life cycle. In the first stage, called trophozoite, the parasite swims around and consumes nutrients from the small bowel. In the second stage it develops into a non-moving cyst.

Cysts excreted in faeces can contaminate the water supply, and ingesting contaminated food or water results in transmission. Close human to human contact and unsanitary living conditions can promote transmission.

Symptoms of giardia can include severe or chronic diarrhoea, abdominal cramps, fatigue, weakness and weight loss.

Once the parasite has been diagnosed, it can usually be treated effectively.
From shutterstock.com

Other important protozoa are the plasmodium species. Plasmodium develop in mosquitoes, and infected mosquitoes transmit the parasite to humans by biting them. Plasmodium destroys red blood cells which impacts organ function and causes a disease in humans known as malaria.

Malaria causes the most deaths of all parasitic diseases. In 2017 it was estimated malaria resulted in 435,000 deaths globally, most of them young children in sub-Saharan Africa.




Read more:
How our red blood cells keep evolving to fight malaria


Helminths

Helminths, often called worms, are large multicellular organisms usually visible to the naked eye in their adult stages. As a general rule, helminths cannot multiply inside the human body.

One major group of helminths are flatworms. Flatworms literally have flattened soft bodies. Their digestive cavity has only one opening for both the ingestion and removal of food. It’s thought 80% of flatworms are parasitic.

Tapeworms are one type of flatworm. The most common human tapeworm in Australia is the dwarf tapeworm. The prevalence of dwarf tapeworm in isolated communities in northwest Australia is estimated to be around 55%.

Infestation in humans comes from ingesting dwarf tapeworm eggs. Transmission from person to person occurs via the faecal-oral route. As with other parasites, the major risk factors are poor sanitation and shared living quarters. Symptoms include diarrhoea, abdominal pain, weight loss and weakness.

Some parasites, like plasmodium, which causes malaria, are transmitted to humans via mosquito bites.
From shutterstock.com

Another major group of helminths are nematodes, commonly known as roundworms. Nematodes are the most numerous multicellular animals on earth and can be found in almost every environment. Unlike flatworms, they do have a digestive system that extends from the mouth to the anus.

More than 50% of the world’s population are thought to be affected at one point during their life by at least one of six main classes of nematodes.

The eggs or larvae of these nematodes usually develop in soil before being transmitted to the human host. For this reason these nematodes are often called soil-transmitted helminths. A good example are hookworms which infest humans by penetrating the skin from contaminated soil. So wearing appropriate footwear is an important way to prevent hookworm transmission.




Read more:
A parasite attack on Darwin’s finches means they’re losing their lovesong


The pinworm Enterobius vermicularis has a different life cycle to the other nematodes. Pinworm larvae develop in eggs on the skin near the anus or under the fingernails.

Pinworm, also known as threadworm, is the most common helminth parasite in Australia. Itching around the anus is a major symptom of pinworm. Pinworms are easily passed from one person to another and it’s common for entire families to be infested.

Ectoparasites

The term ectoparasites generally refers to organisms such as ticks, fleas, lice and mites that can attach or burrow into the skin and remain there for long periods of time.

Scabies, for example, a contagious skin disease marked by itching and small raised red spots, is caused by the human itch mite. Scabies usually is spread by direct, prolonged, skin-to-skin contact.

Head lice are small, wingless insects that live and breed in human hair and feed by sucking blood from the scalp.

Head lice, a type of ectoparasite, are common in children.
From shutterstock.com

Prevention and treatment

Some parasites can lie dormant for extended periods of time. This can make the diagnosis of parasitic infestation challenging as there may be no symptoms, or symptoms can be vague and non-specific.

The good news is we have very good medications to treat many different kinds of parasites once they’ve been diagnosed. These medications do have side effects but on the whole are very effective.




Read more:
Six human parasites you definitely don’t want to host


Treatment of parasites should be accompanied by preventative strategies such as improving sanitation and ensuring the availability of appropriate clothing and footwear in affected areas.

The World Health Organisation has recommended periodic medical treatment (deworming) to all at-risk people living in endemic areas, but widespread implementation remains challenging.The Conversation

Vincent Ho, Senior Lecturer and clinical academic gastroenterologist, Western Sydney University

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

How does poor air quality from bushfire smoke affect our health?


Brian Oliver, University of Technology Sydney

New South Wales and Queensland are in the grip of a devastating bushfire emergency, which has tragically resulted in the loss of homes and lives.

But the smoke produced can affect many more people not immediately impacted by the fires – even people many kilometres from the fire. The smoke haze blanketing parts of NSW and Queensland has seen air quality indicators exceed national standards over recent days.

Studies have shown there is no safe level of air pollution, and as pollution levels increase, so too do the health risks. Air pollution caused nine million premature deaths globally in 2015. In many ways, airborne pollution is like cigarette smoking – causing respiratory disease, heart disease and stroke, lung infections, and even lung cancer.




Read more:
Firestorms and flaming tornadoes: how bushfires create their own ferocious weather systems


However, these are long-term studies looking at what happens over a person’s life with prolonged exposure to air pollution. With bushfire-related air pollution, air quality is reduced for relatively short periods.

But it’s still worth exercising caution if you live in an affected area, particularly if you have an existing health condition that might put you at higher risk.

Air quality standards

The exposure levels will vary widely from the site of the fire to 10 or 50 kilometres away from the source.

The national standard for clean air in Australia is less than 8 micrograms/m³ of ultrafine particles. This is among the lowest in the world, meaning the Australian government wants us to remain one of the least polluted countries there is.

8 micrograms/m³ refers to the weight of the particles in micrograms contained in one cubic meter of air. A typical grain of sand weighs 50 micrograms. When people talk about ultrafine particles the term PM, referring to particulate matter, is often used. The size of PM we worry the most about are the small particles of less than 2.5 micrometres which can penetrate deep into the lungs, called PM2.5.

People with pre-existing medical conditions are at highest risk.
From shutterstock.com

To put this in perspective, Randwick, a coastal suburb in Sydney which was more than 25km from any of the fires yesterday, had PM2.5 readings of around 40 micrograms/m³. Some suburbs which sit more inland had readings of around 50 micrograms/m³. Today, these levels have already reduced to around 20 micrograms/m³ across Sydney.

We’re seeing a similar effect in Queensland. Today’s PM2.5 readings at Cannon Hill, a suburb close to central Brisbane, are 21.5 micrograms/m³, compared with 4.7 micrograms/m³ one month ago.

A number of health alerts were issued for areas across NSW and Queensland earlier this week.

While these numbers may seem alarming compared to the 8 microgram/m³ threshold, the recent air pollution in India’s New Delhi caused by crop burning reached levels of 900 micrograms/m³. So what we’re experiencing here pales in comparison.

Bushfire smoke and our health

However, this doesn’t mean the levels in NSW and Queensland are without danger. Historically, when there are bushfires, emergency department presentations for respiratory and heart conditions increase, showing people with these conditions are most at risk of experiencing adverse health effects.

Preliminary analysis of emergency department data shows hospitals in the mid-north coast of NSW, where fires were at their worst, have had 68 presentations to emergency departments for asthma or breathing problems over the last week. This is almost double the usual number.




Read more:
After the firestorm: the health implications of returning to a bushfire zone


One study looked at the association between exposure to smoke events in Sydney and premature deaths, and found there was a 5% increase in mortality during bushfires from 1994 to 2007.

But it’s important to understand these deaths would have occurred in the people most vulnerable to the effects of smoke, such as people with pre-exsisiting lung and heart conditions, who tend to be older people.

For people who are otherwise healthy, the health risks are much lower.

But as the frequency of bushfires increases, many scientists in the field speculate these health effects may become more of a concern across the population.

How to protect yourself

If you’re in an affected area, it’s best to avoid smoke exposure where possible by staying indoors with the windows and doors closed and the air conditioner turned on.

If you are experiencing any unusual symptoms, such as shortness of breath or chest pain, or just do not feel well, you should speak to your health care professional and in an emergency, go to hospital.




Read more:
How rising temperatures affect our health


Once the fires have been put out, depending upon the region, local weather conditions and the size of the fire, air quality can return to healthy levels within a few days.

In extreme situations, it might take weeks or months to return to normal. But we are fortunate to be living in a country with good air quality most of the time.The Conversation

Brian Oliver, Research Leader in Respiratory cellular and molecular biology at the Woolcock Institute of Medical Research and Senior Lecturer, School of Medical & Molecular Biosciences, University of Technology Sydney

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

What time of day should I take my medicine?



Does it matter if you take your medicine morning, noon or night? That depends on a number of factors.
from Kat Ka/www.shutterstock.com

Nial Wheate, University of Sydney and Andrew Bartlett, University of Sydney

Whether you need to take a drug at a specific time of day depends on the medication and the condition you are treating. For some medicines, it doesn’t matter what time you take it. And for others, the pharmacist may recommend you take it at the same time each day.

But we estimate that for around 30% of all medicines, the time of day you take it does matter. And a recent study shows blood pressure medications are more effective if you take them at night.

So, how do you know if the timing of your medication is critical?




Read more:
Health Check: what should you do with your unused medicine?


When timing doesn’t matter

In most cases, it’s not important when you take your medicine. For instance, you can take non-drowsy antihistamines for hay fever, or analgesics for pain when you need them. It doesn’t matter if it is morning, noon or night.

What is more important is the time interval between each dose. For instance, paracetamol needs to be taken at least four hours apart, any closer and you run the risk of taking a toxic dose.




Read more:
Australia has a paracetamol poisoning problem. This is what we should be doing to reduce harm


Even when a medication doesn’t need to be taken at a particular time, the pharmacist may still recommend you take it at the same time every day anyway.

This daily pattern helps remind you to take it. An example is taking the oral contraceptive at the same time each day, simply out of habit.

For the mini pill, taking it at the same time is actually necessary. But the actual time of day can be whatever works best for you.

When does it matter?

It may seem fairly obvious to take some medicines at particular times. For example, it makes sense to taking sleeping medications, such as temazepam, at night before you go to bed.

Some antidepressants, such as amitryptyline or mirtazapine, have drowsy side effects. So it also makes sense to take them at night.

For other medicines, taking them in the morning is more logical. This is true for diuretics, such as furosemide, which helps you get rid of excess fluid via your urine; you don’t want to be getting up in the night for this.

When a medicine needs to be taken at a specific time, this will be indicated on the box.
Author provided

For other medications, it’s not obvious why they have to be taken at a particular time of day. To understand why, we have to understand our circadian rhythm, our own internal body clock. Some systems in our body work at different times of day within that rhythm.

For instance, the enzymes controlling cholesterol production in your liver are most active at night. So there may be some benefit to taking lipid (cholesterol) lowering drugs, such as simvastatin, at night.

Finally, sometimes it’s important to take medications only on particular days. Methotrexate is a medicine used for rheumatoid arthritis and severe psoriasis, and the timing of this medication is critical.




Read more:
What is rheumatoid arthritis, the condition tennis champion Caroline Wozniacki lives with?


You should only take it on the same day once a week, and when taken this way it is quite safe. But if you mistakenly take it daily, as happened recently with a patient in Victoria, then it can cause serious illness or even death.

What about blood pressure medicines?

One of the ways the body regulates blood pressure is through a pathway of hormones known as the renin, angiotensin and aldosterone system.

This system responds to various signals, like low blood pressure or stressful events, and controls blood volume and the constriction of blood vessels to regulate your blood pressure.

Importantly, this system is more active while you’re asleep at night. And a recent study, which found blood pressure medication is more effective at night,
may change the way we use medicines to treat high blood pressure.




Read more:
Health Check: what do my blood pressure numbers mean?


Two types of drugs typically prescribed to lower blood pressure are angiotensin converting enzyme (ACE) inhibitors, such as perindopril, and angiotensin receptor blockers (known as ARBs), such as irbesartan. These drugs dilate blood vessels (make them wider) to reduce your blood pressure.

Until now, doctors and pharmacists have often advised patients to take these medications in the morning, assuming it’s good to have a hit of the drugs when you’re up and about.

But this study found taking blood pressure medications at night produced a significant reduction (45%) in heart disease, including fewer strokes, heart attacks and heart failure compared to taking them in the morning.

Taking them at night also meant people’s blood pressure was better controlled and their kidneys were healthier.

So if you take one of these drugs to control your blood pressure and aren’t sure what you should do, talk to your pharmacist or doctor. While evidence is building to support taking them at night, this might not be appropriate for you.




Read more:
Health Check: is it OK to chew or crush your medicine?


The Conversation


Nial Wheate, Associate Professor | Program Director, Undergraduate Pharmacy, University of Sydney and Andrew Bartlett, Associate Lecturer Pharmacy Practice, University of Sydney

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

Does eating dairy foods increase your risk of prostate cancer?



If you’re a male who enjoys dairy, there’s no reason to stop having it.
From shutterstock.com

Rosemary Stanton, UNSW

Research Checks interrogate newly published studies and how they’re reported in the media. The analysis is undertaken by one or more academics not involved with the study, and reviewed by another, to make sure it’s accurate.


Recent headlines have warned a diet high in dairy foods may increase men’s risk of prostate cancer.

The news is based on a recent review published in the Journal of the American Osteopathic Association which claimed to find eating high quantities of plant-based foods may be associated with a decreased risk of prostate cancer, while eating high quantities of dairy products may be associated with an increased risk.

But if you’re a man, before you forego the enjoyment and known nutritional benefits of milk, cheese and yoghurt, let’s take a closer look at the findings.

What the study did

This study was a review, which means the researchers collated the findings of a number of existing studies to reach their conclusions.

They looked at 47 studies which they claim constitute a comprehensive review of all available data from 2006-2017. These studies examined prostate cancer risk and its association with a wide variety of foods including vegetables, fruits, legumes, grains, meat (red, white and processed), milk, cheese, butter, yoghurt, total diary, calcium (in foods and supplements), eggs, fish and fats.




Read more:
Six foods that increase or decrease your risk of cancer


Some studies followed groups of men initially free of prostate cancer over time to see if they developed the disease (these are called cohort studies). Others compared health habits of men with and without prostate cancer (called case-control studies). Some studies recorded the incidence of prostate cancer in the group while others concentrated on the progression of the cancer.

For every potential risk factor, the reviewers marked studies as showing no effect, or an increased or decreased risk of prostate cancer. The results varied significantly for all the foods examined.

For cohort studies (considered more reliable than case-control studies), three studies for vegan diets and one for legumes recorded decreased risk of prostate cancer. For vegetarian diets and vegetables, some reported decreased risk and some recorded no effect. Fruits, grains, white meat and fish appeared to have no effect either way.

An increased risk was reported for eggs and processed meats (one study each), red meat (one out of six studies), fats (two out of five), total dairy (seven out of 14), milk (six out of 15), cheese (one out of six), butter (one out of three), calcium (three out of four from diet and two out of three from supplements) and fats (two out of five).

Notably, some very large cohort studies included in the review showed no association for milk or other dairy products. And most case-control studies, though admittedly less reliable, showed no association.

The authors also omitted other studies published within the review period which showed no significant association between dairy and prostate cancer.

A person’s weight likely has more influence on their risk of developing prostate cancer than whether or not they eat dairy.
From shutterstock.com

So the inconsistency in results across the studies reviewed – including large cohort studies – amount to very limited evidence dairy products are linked to prostate cancer.

Could it be vitamin D?

In earlier research, a link between milk and prostate cancer has been attributed to a high calcium intake, possibly changing the production of a particular form of vitamin D within the body.

Vitamin D is an important regulator of cell growth and proliferation, so scientists believed it may lead to prostate cancer cells growing unchecked. But the evidence on this is limited, and the review adds little to this hypothesis.




Read more:
PSA testing for prostate cancer is only worth it for some


Perhaps the review’s most surprising omission is mention of the World Cancer Research Fund (WCRF) Continuous Update Project report on prostate cancer. This rigorous global analysis of the scientific literature identified much stronger risk factors that should be considered as possible confounding factors.

For example, the evidence is rated as “strong” that being overweight or obese, and being tall (separate to weight), are associated with increased risk of prostate cancer. The exact reasons for this are not fully understood but could be especially significant in Australia where 74% of men are overweight or obese.

A new Australian study found a higher body mass index was a risk factor for aggressive prostate cancer.

For dairy products and diets high in calcium, according to the WCRF, the evidence remains “limited”.




Read more:
Why full-fat milk is now OK if you’re healthy, but reduced-fat dairy is still best if you’re not


It’s about the whole diet

It’s not wise to judge any diet by a single food group or nutrient. A healthy diet overall should be the goal.

That being said, milk, cheese and yoghurt are included in Australia’s Dietary Guidelines because of evidence linking them with a lower risk of heart disease, type 2 diabetes, bowel cancer and excess weight. These dairy products are also sources of protein, calcium, iodine, several of the B complex vitamins, and zinc.

Evidence about dairy products and prostate cancer remains uncertain. So before fussing about whether to skip milk, cheese and yoghurt, men who wish to reduce their risk of prostate cancer would be better advised to lose any excess weight. – Rosemary Stanton


Blind peer review

I agree with the author of this Research Check who highlights there is a high degree of variability in the results of the studies examined in this review.

While the authors searched three journal databases, most comprehensive reviews search up to eight databases. Further, the authors did not undertake any assessment of the methodological quality of the studies they looked at. So the results should be interpreted with caution.

Although the authors concluded higher amounts of plant foods may be protective against prostate cancer, the figure presented within the paper indicates more studies reported no effect compared to a decreased risk, so how they came to that conclusion in unclear. For total dairy they present a figure showing there were as many studies suggesting no effect or lower risk as there were showing higher risk.

Importantly, they did not conduct any meta-analyses, where data are mathematically pooled to generate and overall effect across all studies.

As the reviewer points out, many other important sources of high quality data have not been included and there are a number of recent higher quality systematic reviews that could be consulted on this topic. – Clare CollinsThe Conversation

Rosemary Stanton, Visiting Fellow, School of Medical Sciences, UNSW

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

What is rheumatoid arthritis, the condition tennis champion Caroline Wozniacki lives with?


Fabien B. Vincent, Monash University and Michelle Leech, Monash University

Arthritis is a broad term to describe inflammation of the joints which become swollen and painful. There are many different kinds. Osteoarthritis, the most common, is caused by wear and tear.

This is followed by rheumatoid arthritis, an autoimmune condition where the person’s immune system mistakenly attacks and damages its own joints and other organs.

Rheumatoid arthritis is relatively common, affecting around one in 100 people, including young people and even children.

Twenty-nine-year-old Danish tennis player Caroline Wozniacki told fans last year she was diagnosed with this condition. Earlier in 2018, she had won the Australian Open, then struggled with unexplained symptoms.

Researchers do not fully know what causes rheumatoid arthritis, but suspect certain genes may trigger it when combined with environmental and lifestyle factors such as smoking or infections.

How does it feel?

People commonly experience joint pain, but it is particularly bad in the mornings and when they rest. Joints in the hands, feet, wrists, elbows, knees and ankles may be stiff for hours at a time. But unlike osteoarthritis, the pain can actually get better with movement.

If the inflammation in rheumatoid arthritis is not controlled, people experience joint pain, stiffness, fatigue and can almost feel like they have the flu.

The inflammation can lead to damage to the bones and cartilage (cushion) in joints causing deformity and disability. This can affect work, and social and family life.

In 18% to 41% of patients, the condition can cause inflammation in other parts of the body, such as the lungs (this may cause a condition called interstitial lung disease) and the blood vessels (leading to a condition called vasculitis).

People with severe rheumatoid arthritis also have an increased risk of developing lymphoma, a type of cancer of the lymphatic system, which helps rid the body of toxic waste.

How is it diagnosed?

When a GP suspects someone has rheumatoid arthritis, the patient is referred to a rheumatologist for a detailed physical examination focusing on joint pain, tenderness, swelling and stiffness.

The patient will have some routine blood tests to look for signs of inflammation and “autoimmunity” – antibodies directed against the patient’s own tissues.




Read more:
Explainer: what is the immune system?


The person may also have an x-ray of the affected joints (if the symptoms have been present for more than three months) to look for signs of cartilage thinning and bone erosion (small bites out of the bone).

Ultrasound and MRI are less useful for diagnosis, but can sometimes be used to monitor the condition.

How is it treated?

While there is no cure for rheumatoid arthritis, medicines can effectively control the condition and stop visible signs of damage.

With good treatment, it’s now very rare to see deformed joints or people in wheel chairs.

Treatments should start as early as possible and will vary according to how active and severe the condition is. Some people need only a small amount of medicine whereas others will try many different medicines, sometimes in combination.

Because the immune system is overactive and mistaken in its target, the treatment approach is to dampen the immune response.

Initial treatment may include a low dose of steroids called prednisolone, as well as an immune-suppressing drug such as methotrexate or leflunomide, to control the inflammation.




Read more:
Weekly Dose: methotrexate, the anti-inflammatory drug that can kill if taken daily


If the condition is not controlled by these drugs, then other medicines, mostly injections, called “biological” drugs, can be added. These mimic substances naturally produced by the body and block specific substances in the immune system. Very recently, some newer tablets have been approved for rheumatoid arthritis.

Pain management may also be needed with medicines like non-steroidal anti-inflammatory drugs such as ibuprofen.

Inflamed, swollen joints can also periodically be treated by local joint injection of steroids.

If the first line treatments aren’t providing relief, others are progressively added.
Hriana/Shutterstock

People with rheumatoid arthritis will also greatly benefit from physiotherapy and occupational therapy. They will learn exercises to maintain joint flexibility, as well as alternative ways to perform daily tasks that may be difficult or painful.

But the fatigue is very difficult to treat. Gentle graduated exercise programs, a good healthy diet, understanding of the condition and its treatment, as well as psychological support, can help with fatigue.

Most people with rheumatoid arthritis can no longer be distinguished from people without the condition and live full and active lives. However, for a small percentage of unlucky patients who have aggressive disease or cannot tolerate any of the medicines, the course can be more difficult.




Read more:
Explainer: what is Sjögren’s syndrome, the condition Venus Williams lives with?


The Conversation


Fabien B. Vincent, Research Fellow; Rheumatology Research Group, Centre for Inflammatory Diseases, Monash University and Michelle Leech, Rheumatologist, Professor/Director Monash Medical Course/ Deputy Dean Health Faculty, Monash University

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

We have a vaccine for hepatitis B but here’s why we still need a cure



Around 5% of adults and 90% of babies who contract hepatitis B go on to have life-long infection that can only be managed with regular medication.
Ronald Rampsch/Shutterstock

Peter Revill, The Peter Doherty Institute for Infection and Immunity and Margaret Littlejohn, Melbourne Health

Hepatitis B is blood-borne virus that packs a punch. Worldwide, more than 1.3 billion people have been infected with hepatitis B, and 257 million people have developed a life-long infection. This includes 240,000 Australians, many of whom are Indigenous.

Globally, transmission most commonly occurs from mother to baby or in early life. But it’s possible to be infected in adulthood, through sex or blood-to-blood contact.

Most people who are infected in adulthood develop a short infection which their immune response controls. But in around 5% of adults and 90% of babies, the immune response is ineffective and chronic infection develops.




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


Hepatitis B virus causes almost 40% of all liver cancer, which is the fifth most common cancer and the second leading cause of cancer-related death worldwide.

Australian discovery

Hepatitis B virus was discovered in the serum of an Indigenous Australian in 1965 and was first known as the “Australia antigen”.

This quickly led to the development of an effective vaccine in the 1980s, which is now available worldwide. The vaccine has been given to Australian infants since May 2000.

(If you weren’t vaccinated as a baby, you might want to consider doing so through your GP, particularly if you plan to travel to Asia and Africa where hepatitis B is common.)

Unfortunately the vaccine doesn’t do anything for the 240,000 or so Australians who currently live with chronic hepatitis B. Only around 60% of these people have been diagnosed; the rest don’t know they’re infected and don’t receive appropriate care.

How is it currently treated?

There is no cure for chronic hepatitis B virus.

In most cases, treatment requires taking a pill every day for life to remain effective and to reduce the risk of liver cancer. Even then, it doesn’t eliminate the risk.

Chronic hepatitis B hasn’t been cured so far in part because current therapies have failed to destroy the viral reservoir, where the virus hides in the cell.

This is in contrast to hepatitis C virus, which has no such viral reservoir and can now be cured with as little as 12 weeks of treatment.




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


Despite the huge human and economic toll of chronic hepatitis B, research to cure the disease remains underfunded. There is a misconception that because there is a vaccine, hepatitis B is no longer a problem.

The availability of effective cures for the unrelated hepatitis C virus has also led people to believe that “viral hepatitis” is no longer a problem.

Experts estimate that liver cancer deaths will substantially increase in coming decades without a cure for hepatitis B, despite deaths from most cancers decreasing.

Hepatitis B causes 40% of all liver cancer.
Napocska/Shutterstock

How far have we got?

Some exciting research is underway around the world, including the recent identification of the “cell receptor” which allows the virus to infect the body. This has enabled studies of the complete virus replication cycle including the viral reservoir that is untouched by current therapies.

New approaches to a possible cure include mechanisms to block the virus’ entry into the cell and to stop the virus from making the proteins it needs to replicate and infect new cells.

Studies are also underway to enhance patients’ immune responses so their own natural defences can control or even eliminate the virus. This is similar to immunotherapies already being used to treat some cancers.




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


It’s likely a hepatitis B cure will require a dual-pronged approach, directly targeting the virus while also enhancing the immune response in people who are infected.

The goal is to reduce the amount of virus in the body and restore the person’s immune responses. This is called a “functional cure” and is similar to what happens when a person naturally gets rid of the virus. It would also mean they didn’t need to take drugs any more.

Some of these approaches are now in early stage human clinical trials. More than 30 drugs have been developed and are being tested in people with chronic hepatitis B. However, much more work needs to be done to achieve a cure.The Conversation

Peter Revill, Senior Medical Scientist at VIDRL, Royal Melbourne Hospital, The Peter Doherty Institute for Infection and Immunity and Margaret Littlejohn, Medical Scientist, Melbourne Health

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

Is coconut water good for you? We asked five experts



Nutritionally, coconut water is OK, but it’s healthier to stick to plain water.
from http://www.shutterstock.com

Alexandra Hansen, The Conversation

In recent years coconut water has left the palm-treed shores of tropical islands where tourists on lounge chairs stick straws straight into the fruit, and exploded onto supermarket shelves – helped along by beverage giants such as Coca-Cola and PepsiCo.

Marketed as a natural health drink, brands spout various health claims promoting coconut water. So before we drank the Kool-Aid, we thought we’d check in with the experts whether the nutritional claims stack up. Is coconut water part of a healthy diet or we should just stick to good old water from the tap?

We asked five experts if coconut water is good for you.

Four out of five experts said no

Here are their detailed responses:


If you have a “yes or no” health question you’d like posed to Five Experts, email your suggestion to: alexandra.hansen@theconversation.edu.au


Clare Collins is affiliated with the Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, NSW. She is an NHMRC Senior Research and Gladys M Brawn Research Fellow. She has received research grants from NHMRC, ARC, Hunter Medical Research Institute, Meat and Livestock Australia, Diabetes Australia, Heart Foundation, Bill and Melinda Gates Foundation, nib foundation, Rijk Zwaan Australia and Greater Charitable Foundation. She has consulted to SHINE Australia, Novo Nordisk, Quality Bakers, the Sax Institute and the ABC. She was a team member conducting systematic reviews to inform the Australian Dietary Guidelines update and the Heart Foundation evidence reviews on meat and dietary patterns. Emma Beckett is a member of the Nutrition Society of Australia, Australian Institute for Food Science and Technology. Her research is funded by the NHMRC and AMP Foundation. She has previously consulted for Kellogg’s. Rebecca Reynolds is a registered nutritionist and the owner of The Real Bok Choy, a nutrition and lifestyle consultancy.The Conversation

Alexandra Hansen, Chief of Staff, The Conversation

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