No, eating chocolate won’t cure depression



If you’re depressed, the headlines might tempt you to reach out for a chocolate bar. But don’t believe the hype.
from www.shutterstock.com

Ben Desbrow, Griffith University

A recent study published in the journal Depression and Anxiety has attracted widespread media attention. Media reports said eating chocolate, in particular, dark chocolate, was linked to reduced symptoms of depression.

Unfortunately, we cannot use this type of evidence to promote eating chocolate as a safeguard against depression, a serious, common and sometimes debilitating mental health condition.

This is because this study looked at an association between diet and depression in the general population. It did not gauge causation. In other words, it was not designed to say whether eating dark chocolate caused a reduction in depressive symptoms.




Read more:
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What did the researchers do?

The authors explored data from the United States National Health and Nutrition Examination Survey. This shows how common health, nutrition and other factors are among a representative sample of the population.

People in the study reported what they had eaten in the previous 24 hours in two ways. First, they recalled in person, to a trained dietary interviewer using a standard questionnaire. The second time they recalled what they had eaten over the phone, several days after the first recall.

The researchers then calculated how much chocolate participants had eaten using the average of these two recalls.

Dark chocolate needed to contain at least 45% cocoa solids for it to count as “dark”.




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The researchers excluded from their analysis people who ate an implausibly large amount of chocolate, people who were underweight and/or had diabetes.

The remaining data (from 13,626 people) was then divided in two ways. One was by categories of chocolate consumption (no chocolate, chocolate but no dark chocolate, and any dark chocolate). The other way was by the amount of chocolate (no chocolate, and then in groups, from the lowest to highest chocolate consumption).




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The researchers assessed people’s depressive symptoms by having participants complete a short questionnaire asking about the frequency of these symptoms over the past two weeks.

The researchers controlled for other factors that might influence any relationship between chocolate and depression, such as weight, gender, socioeconomic factors, smoking, sugar intake and exercise.

What did the researchers find?

Of the entire sample, 1,332 (11%) of people said they had eaten chocolate in their two 24 hour dietary recalls, with only 148 (1.1%) reporting eating dark chocolate.

A total of 1,009 (7.4%) people reported depressive symptoms. But after adjusting for other factors, the researchers found no association between any chocolate consumption and depressive symptoms.

Few people said they’d eaten any chocolate in the past 24 hours. Were they telling the truth?
from www.shutterstock.com

However, people who ate dark chocolate had a 70% lower chance of reporting clinically relevant depressive symptoms than those who did not report eating chocolate.

When investigating the amount of chocolate consumed, people who ate the most chocolate were more likely to have fewer depressive symptoms.

What are the study’s limitations?

While the size of the dataset is impressive, there are major limitations to the investigation and its conclusions.

First, assessing chocolate intake is challenging. People may eat different amounts (and types) depending on the day. And asking what people ate over the past 24 hours (twice) is not the most accurate way of telling what people usually eat.

Then there’s whether people report what they actually eat. For instance, if you ate a whole block of chocolate yesterday, would you tell an interviewer? What about if you were also depressed?

This could be why so few people reported eating chocolate in this study, compared with what retail figures tell us people eat.




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Finally, the authors’ results are mathematically accurate, but misleading.

Only 1.1% of people in the analysis ate dark chocolate. And when they did, the amount was very small (about 12g a day). And only two people reported clinical symptoms of depression and ate any dark chocolate.

The authors conclude the small numbers and low consumption “attests to the strength of this finding”. I would suggest the opposite.

Finally, people who ate the most chocolate (104-454g a day) had an almost 60% lower chance of having depressive symptoms. But those who ate 100g a day had about a 30% chance. Who’d have thought four or so more grams of chocolate could be so important?

This study and the media coverage that followed are perfect examples of the pitfalls of translating population-based nutrition research to public recommendations for health.

My general advice is, if you enjoy chocolate, go for darker varieties, with fruit or nuts added, and eat it mindfully. — Ben Desbrow


Blind peer review

Chocolate manufacturers have been a good source of funding for much of the research into chocolate products.

While the authors of this new study declare no conflict of interest, any whisper of good news about chocolate attracts publicity. I agree with the author’s scepticism of the study.

Just 1.1% of people in the study ate dark chocolate (at least 45% cocoa solids) at an average 11.7g a day. There was a wide variation in reported clinically relevant depressive symptoms in this group. So, it is not valid to draw any real conclusion from the data collected.

For total chocolate consumption, the authors accurately report no statistically significant association with clinically relevant depressive symptoms.

However, they then claim eating more chocolate is of benefit, based on fewer symptoms among those who ate the most.

In fact, depressive symptoms were most common in the third-highest quartile (who ate 100g chocolate a day), followed by the first (4-35g a day), then the second (37-95g a day) and finally the lowest level (104-454g a day). Risks in sub-sets of data such as quartiles are only valid if they lie on the same slope.

The basic problems come from measurements and the many confounding factors. This study can’t validly be used to justify eating more chocolate of any kind. — Rosemary Stanton


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.The Conversation

Ben Desbrow, Associate Professor, Nutrition and Dietetics, Griffith University

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

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What is sepsis and how can it be treated?



At least 5,000 Australians die each year as a result of sepsis, more commonly known as blood poisoning.
From shutterstock.com

Hamsa Puthalakath, La Trobe University

Sepsis, colloquially known as blood poisoning, occurs as a result of an infection, usually from bacteria. Bacteria can enter the blood stream via an open wound, from another part of the body after a surgical procedure, or even from a urinary tract infection.

In Australia, more than 15,700 new cases of sepsis are reported each year. Of these, more than 5,000 people will die. Some who survive will need to have limbs amputated, and be left with lifelong disability.

Each intensive care unit admission to treat sepsis costs close to A$40,000.




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But according to a recent Australian survey, only 40% of people have heard of sepsis. Even fewer know what the condition is.

More and more people are aware of sepsis globally, but there’s still a long way to go. If more people know about it (health professionals included), we’re more likely to recognise the condition early and intervene early, which will lead to improved survival rates.

Meanwhile, with the emergence of antibiotic resistant bacteria and the ageing population, the need to find a cure is becoming even more pressing. While a variety of treatments exist, rates of illness and death from sepsis haven’t dropped as they have for infectious diseases over recent decades.

Sepsis has two phases

The first phase occurs when an infection enters the bloodstream. This is called septicaemia. Our body’s immune system over-reacts – a process known as hyper inflammation, or septic shock – which leads to the failure of multiple organs. This phase normally lasts for seven to ten days, or longer, depending on the severity of infection.

If the condition is not caught and successfully treated during this first stage, an immune paralysis phase follows. During this phase, the body is left with no functional immune system to fight off the infection. This second phase accounts for the vast majority of sepsis-related deaths.

Sepsis can affect anyone, but is most dangerous in older adults, pregnant women, children younger than one year, and in those with a weakened immune system such as premature babies and people with chronic diseases like diabetes.

Patients in intensive care units are especially vulnerable to developing infections, which can then lead to sepsis.




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Symptoms and treatments

The pathogens causing sepsis can vary, with bacteria accounting for almost 80% of the cases. Pathogenic fungi and viruses contribute to the rest. For this reason, the symptoms aren’t always identical; and they often overlap with other common infections.

A person will be diagnosed with sepsis if they have a confirmed infection together with low systolic blood pressure (less than 100 mmHg), high fever (in some instances hypothermia), delirium and an increased breathing rate.

Treatment often includes antibiotics as well as dialysis. This is because the kidneys are one of the organs often affected when someone gets sepsis.

Other treatment methods such as blood purification by removing endotoxins (bacterial cell wall products that trigger the immune response) have been trialled with little or no success. This is most likely because these methods fail to remove infectious agents hidden in the body’s tissue.

Alternative treatments such as vitamin D have been reported but have not been proven to offer any clinical benefits.

Sepsis can be particularly dangerous in babies.
From shutterstock.com

Many doctors choose to treat with corticosteroids, a type of steroid. Although treatment with steroids reduces the time patients spend in intensive care units, it’s shown no reduction in mortality rates. Importantly, while corticosteroids reduce inflammation, they cause a steep reduction in the number of immune cells, which are needed to fight infection.

In spite of intensive care treatments involving antibiotics, neither the prevalence of sepsis nor death rates from the condition have changed in Australia over the last three decades. They both have actually risen slightly due to the emergence of drug-resistant bacteria and the ageing population.




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Where to from here?

Australian experts have recently called for a national action plan to reduce preventable death and disability from sepsis. This would be a positive step to bring more attention to the condition. But reducing the harm sepsis causes also relies on advances in treatment.

Experimental drug therapies for sepsis are at a crossroads, with more than 100 drug trials around the world failing to show any benefit over the last 30 years.

The common thread among all these trials was these treatments targeted the initial inflammatory phase of sepsis. But this phase accounts for less than 15% of all sepsis-related deaths.

And it’s the inflammation that alerts our immune system to an infection. If you completely block this response (for example, by using steroids), the body will not recognise there is an infection.




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Researchers have now switched their efforts to identifying the molecular mechanisms that lead to the immune-paralysis phase of sepsis. Understanding this better will hopefully lead to the development of new immunotherapies to target the second phase of the condition.

The time is ripe for measuring the success of sepsis treatment by the number of lives saved rather than the cost saved by reducing the time patients spend in intensive care units.The Conversation

Hamsa Puthalakath, Associate Professor, Biochemistry, La Trobe University

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

There’s no evidence 5G is going to harm our health, so let’s stop worrying about it



The scientific consensus is that 5G doesn’t pose a danger to our health.
From shutterstock.com

Sarah Loughran, University of Wollongong

Hype continues to surround the roll-out of 5G technology in Australia and across the world.

While there is promise of faster network speeds, and talk of exciting technologies like driverless cars, there’s also a growing movement to stop the implementation of 5G due to concerns about the effects it may have on our health.

But the scientific evidence we’ve got assures us there’s no reason to worry. The radio frequencies powering 5G will be well below the exposure limits known to cause harm.




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What is 5G and how does it work?

5G is the 5th generation of mobile phone technology. All generations of mobile phones work using what’s called electromagnetic energy. The specific type of electromagnetic energy used by mobile phones is known as radiofrequency, sometimes called radio waves.

This type of radiation is non-ionising, so it doesn’t damage our DNA like ionising radiation can, such as that from the sun or x-rays. Ionising means there’s enough energy to remove electrons from the atoms they are attached to. This makes them unstable and is something non-ionising radiation, such as that used by mobile phones, lacks the power to do.

Initially, 5G will use the same type of radio waves as used in 4G. But in the future it will operate at higher frequencies. Higher frequencies allow for faster connections and response times, while also increasing capacity for more users to be connected.

The higher the frequency, the shorter the distance the radio waves travel. As the 5G frequencies will be higher than those used by previous mobile phone technologies, a lot more mobile phone base stations will be required.

Much of the public concern has centred around these two new elements – that the frequencies used will be higher, and that there will be more mobile phone base stations. While some people believe these two factors alone will lead to higher exposures, the reality is actually very different.




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Higher frequencies don’t travel as far, meaning exposure is not as deep as previous generation technologies. This results in more superficial exposures which are mostly absorbed by the skin rather than deeper in the body.

The idea that more base stations lead to higher exposures is also a common misconception. A larger number of base stations will actually provide a more efficient network. This means mobile phones can operate at a reduced power, which is likely to result in reduced overall personal exposure.

Research and regulation

Importantly, we have no evidence of any established health effects from the exposures related to mobile phones, despite extensive research. This consensus has been reiterated by independent international expert bodies.

We know a lot about how radiofrequency interacts with the human body. Health effects occur from exposure when there is a large rise in body temperature. But this will only be seen at power levels far higher than those used in telecommunications, like from a microwave oven.

The temperature changes associated with mobile phones are very small, especially when compared with normal day-to-day or exercise-induced temperature variations.

5G is the next generation of mobile phone technology, and is currently being rolled out.
From shutterstock.com

Exposures from mobile phones and their base stations are tightly regulated. In Australia, safety standards are set by the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA).

These standards are based on the current scientific evidence. They also cover the new frequencies that will be used by 5G. Importantly, the safety limits are set well below levels known to cause harm. And although technology can legally run at the safety limit, in reality, exposures are typically hundreds of times below these safety limits.

Challenging misconceptions

There is a lot of misinformation out there regarding 5G, and the electromagnetic energy associated with telecommunications more generally. While there’s no evidence of harm from such electromagnetic energy, there is evidence fear and anxiety can be harmful to our health and overall well-being.

While anti-5G sentiment and campaigning might be well-intentioned, without the scientific evidence to back these sentiments, it’s likely doing more harm than good. The challenge we now face is counteracting the misinformation out there.




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The Conversation


Sarah Loughran, Research Fellow, University of Wollongong

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

What is herd immunity and how many people need to be vaccinated to protect a community?



The vaccine coverage needed for herd immunity varies from disease to disease.
Ryoji Iwata/Unsplash

Hassan Vally, La Trobe University

The term herd immunity comes from the observation of how a herd of buffalo forms a circle, with the strong on the outside protecting the weaker and more vulnerable on the inside.

This is similar to how herd immunity works in preventing the spread of infectious diseases. Those who are strong enough to get vaccinated directly protect themselves from infection. They also indirectly shield vulnerable people who cannot be vaccinated.

There are various reasons a person may not be able to be successfully vaccinated. People undergoing cancer treatment, and whose immune systems are compromised, for instance, are impaired in their ability to develop protective immunity from all vaccines. Often, people who can’t be vaccinated are susceptible to the most serious consequences from being infected.

Another vulnerable group are babies. Infants under six months of age are susceptible to serious complications from influenza. Yet they can’t be given the flu vaccine as their immune systems are not strong enough.




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How does herd immunity work?

For a contagious disease to spread, an infectious agent needs to find susceptible (non-immune) people to infect. If it can’t, the chain of infection is interrupted and the amount of disease in the population reduces.

Another way of thinking about it is that the disease needs susceptible victims to survive in the population. Without these, it effectively starves and dies out.

If most of the population is immunised, the disease dies out.
NIAID, CC BY

What level of coverage provides herd immunity?

How many people need to be vaccinated to achieve herd immunity varies from disease to disease.

Measles can be transmitted through coughing and sneezing and the virus causing measles can survive outside the body for up to two hours. So it’s possible to catch measles just by being in the same room as someone who is ill if you touch a surface they’ve coughed or sneezed on.

In contrast, Ebola can only be spread by direct contact with infected secretions (blood, faeces or vomit) and therefore requires close contact with an ill person. This makes it much less spreadable.




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We can determine how contagious a disease is by tracking its spread throughout a population. In doing so, we can attribute each disease a reproductive number denoted by the symbol Ro. The bigger the Ro the more easily the disease is spread throughout the population.

If everyone who has a disease on average infects two people, the Ro for that disease is 2. This means the disease, relatively speaking, is not particularly contagious. However, if everyone who has a disease infects ten people on average, it would have an Ro of 10, which means it’s a much more contagious disease.

We can use the Ro for a disease to calculate the herd immunity threshold, which is the minimum percentage of people in the population that would need to be vaccinated to ensure a disease does not persist in the population. The more contagious a disease, the higher the threshold.

Measles is one of the most infectious diseases to affect humans with an Ro of 12-18. To achieve herd immunity to measles in a population we need 92-95% of the population to be vaccinated.

Current data indicates full vaccine coverage for five year olds in Australia is sitting at around the 95% level. However, vaccination rates in some communities have fallen below ideal levels, making them susceptible to measles outbreaks.

The overwhelming success of measles vaccinations means many people have no memory of what this disease looks like, and this has resulted in its effects being underestimated. Measles can cause blindness and acute encephalitis (inflammation of the brain), which can result in permanent brain damage.




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Herd immunity, or community immunity, as it’s sometimes called, is a powerful public health tool. By ensuring those who can be vaccinated do get vaccinated we can achieve herd immunity and prevent the illness and suffering that comes from the spread of infectious diseases.The Conversation

Hassan Vally, Associate Professor, La Trobe University

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

Are there certain foods you can eat to reduce your risk of Alzheimer’s disease?



Eating healthy foods doesn’t just improve our physical health. It can benefit our mental health, too.
From shutterstock.com

Ralph Martins, Macquarie University

With the rise of fad diets, “superfoods”, and a growing range of dietary supplement choices, it’s sometimes hard to know what to eat.

This can be particularly relevant as we grow older, and are trying to make the best choices to minimise the risk of health problems such as high blood pressure, obesity, type 2 diabetes, and heart (cardiovascular) problems.

We now have evidence these health problems also all affect brain function: they increase nerve degeneration in the brain, leading to a higher risk of Alzheimer’s disease and other brain conditions including vascular dementia and Parkinson’s disease.

We know a healthy diet can protect against conditions like type 2 diabetes, obesity and heart disease. Fortunately, evidence shows that what’s good for the body is generally also good for the brain.




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Oxidative stress

As we age, our metabolism becomes less efficient, and is less able to get rid of compounds generated from what’s called “oxidative stress”.

The body’s normal chemical reactions can sometimes cause chemical damage, or generate side-products known as free radicals – which in turn cause damage to other chemicals in the body.

To neutralise these free radicals, our bodies draw on protective mechanisms, in the form of antioxidants or specific proteins. But as we get older, these systems become less efficient. When your body can no longer neutralise the free radical damage, it’s under oxidative stress.

The toxic compounds generated by oxidative stress steadily build up, slowly damaging the brain and eventually leading to symptoms of Alzheimer’s disease.




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To reduce your risk, you need to reduce oxidative stress and the long-term inflammation it can cause.

Increasing physical activity is important. But here we are focusing on diet, which is our major source of ANTIoxidants.

Foods to add

There are plenty of foods you can include in your diet that will positively influence brain health. These include fresh fruits, seafood, green leafy vegetables, pulses (including beans, lentils and peas), as well as nuts and healthy oils.

Fish

Fish is a good source of complete protein. Importantly, oily fish in particular is rich in omega-3 fatty acids.

Laboratory studies have shown omega-3 fatty acids protect against oxidative stress, and they’ve been found to be lacking in the brains of people with Alzheimer’s disease.

They are essential for memory, learning and cognitive processes, and improve the gut microbiota and function.

Oily fish, like salmon, is high in omega-3 fatty acids, which research shows can benefit our brain health.
From shutterstock.com

Low dietary intake of omega-3 fatty acids, meanwhile, is linked to faster cognitive decline, and the development of preclinical Alzheimer’s disease (changes in the brain that can be seen several years before for onset of symptoms such as memory loss).

Omega-3 fatty acids are generally lacking in western diets, and this has been linked to reduced brain cell health and function.

Fish also provides vitamin D. This is important because a lack of vitamin D has been linked to Alzheimer’s disease, Parkinson’s disease, and vascular dementia (a common form of dementia caused by reduced blood supply to the brain as a result of a series of small strokes).

Berries

Berries are especially high in the antioxidants vitamin C (strawberries), anthocyanins (blueberries, raspberries and blackberries) and resveratrol (blueberries).

In research conducted on mouse brain cells, anthocyanins have been associated with lower toxic Alzheimer’s disease-related protein changes, and reduced signs of oxidative stress and inflammation specifically related to brain cell (neuron) damage. Human studies have shown improvements in brain function and blood flow, and signs of reduced brain inflammation.




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Red and purple sweet potato

Longevity has been associated with a small number of traditional diets, and one of these is the diet of the Okinawan people of Japan. The starchy staple of their diet is the purple sweet potato – rich in anthocyanin antioxidants.

Studies in mice have shown this potato’s anthocyanins protect against the effects of obesity on blood sugar regulation and cognitive function, and can reduce obesity-induced brain inflammation.

Green vegetables and herbs

The traditional Mediterranean diet has also been studied for its links to longevity and lower risk of Alzheimer’s disease.

Green vegetables and herbs feature prominently in this diet. They are rich sources of antioxidants including vitamins A and C, folate, polyphenols such as apigenin, and the carotenoid xanthophylls (especially if raw). A carotenoid is an orange or red pigment commonly found in carrots.

Green vegetables and herbs provide us with several types of antioxidants.
From shutterstock.com

The antioxidants and anti-inflammatory chemicals in the vegetables are believed to be responsible for slowing Alzheimer’s pathology development, the build up of specific proteins which are toxic to brain cells.

Parsley is rich in apigenin, a powerful antioxidant. It readily crosses the barrier between the blood and the brain (unlike many drugs), where it reduces inflammation and oxidative stress, and helps brain tissue recovery after injury.




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Beetroot

Beetroot is a rich source of folate and polyphenol antioxidants, as well as copper and manganese. In particular, beetroot is rich in betalain pigments, which reduce oxidative stress and have anti-inflammatory properties.

Due to its nitrate content, beetroot can also boost the body’s nitric oxide levels. Nitric oxide relaxes blood vessels resulting in lowered blood pressure, a benefit which has been associated with drinking beetroot juice.

A recent review of clinical studies in older adults also indicated clear benefits of nitrate-rich beetroot juice on the health of our hearts and blood vessels.

Foods to reduce

Equally as important as adding good sources of antioxidants to your diet is minimising foods that are unhealthy: some foods contain damaged fats and proteins, which are major sources of oxidative stress and inflammation.

A high intake of “junk foods” including sweets, soft drinks, refined carbohydrates, processed meats and deep fried foods has been linked to obesity, type 2 diabetes and cardiovascular disease.

Where these conditions are are all risk factors for cognitive decline and Alzheimer’s disease, they should be kept to a minimum to reduce health risks and improve longevity.




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The Conversation


Ralph Martins, Professor, Department of Biomedical Sciences, Macquarie University

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

More Australians are diagnosed with depression and anxiety but it doesn’t mean mental illness is rising



Women are almost twice as likely to be diagnosed with depression or anxiety as men.
Eric Ward

Anthony Jorm, University of Melbourne

Diagnoses of depression and anxiety disorders have risen dramatically over the past eight years. That’s according to new data out today from the Housing Income and Labour Dynamics (HILDA) Survey, which tracks the lives of 17,500 Australians.

The increase spans across all age groups, but is most notably in young people.

The percentage of young women (aged 15-34) who had been diagnosed with these conditions increased from 12.8% in 2009, to 20.1% in 2017.

In young men, there was a similar increase, from 6.1% to 11.2%.

But this doesn’t mean Australians’ mental health is worsening.




Read more:
Explainer: what is an anxiety disorder?


What’s behind the numbers?

HILDA surveys collate data on the “reported diagnosis” of depression and anxiety disorders. Many people with these conditions have remained undiagnosed by a health practitioner, so it could simply be a matter of more people seeking professional help and getting diagnosed.

To find out whether there is a real increase, we need to survey a sample of the public about their symptoms rather than ask about whether they have been diagnosed. This has been done for almost two decades in the National Health Survey.

This graph shows the percentage of the population reporting very high levels of depression and anxiety symptoms over the previous month, from 2001 to 2017-18.

Rather than worsening, the nation’s mental health has been steady over this period.

Shouldn’t our mental health be improving?

So it seems while our mental health is not getting worse, we are more likely to get diagnosed. With increased diagnosis, it’s no surprise Australians have been rapidly embracing treatments for mental-health problems.

Antidepressant use has been rising for decades, with Australians now among the world’s highest users. One in ten Australian adults take an antidepressant each day.




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Psychological treatment has also skyrocketed, particularly after the Australian government introduced Medicare coverage for psychology services in 2006. There are now around 20 psychology services per year for every 100 Australians.

The real concern is why we’re not seeing any benefit from these large increases in diagnosis and treatment. In theory, our mental health should be improving.

There are two likely reasons for the lack of progress: the treatments are often not up to standard and we have neglected prevention.

Treatment is often poor quality

A number of treatments work for depression and anxiety disorders. However, what Australians receive in practice falls far short of the ideal.

Antidepressants, for example, are most appropriate for severe depression, but are often used to treat people with mild symptoms that reflect difficult life circumstances.

It takes more than a couple of sessions with a psychologist to treat a mental health disorder.
Kylli Kittus

Psychological treatments can be effective, but require many sessions. Around 16 to 20 sessions are recommended to treat depression. Getting a couple of sessions with a psychologist is too often the norm and unlikely to produce much improvement.

Treatments are also not distributed to the people most in need. The biggest users of antidepressants are older people, whereas younger people are more likely to experience severe depression.

Similarly, people in wealthier areas are more likely to get psychological therapy, but depression and anxiety disorders are more common in poorer areas.




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When it’s easier to get meds than therapy: how poverty makes it hard to escape mental illness


Prevention is neglected

The big area of neglect in mental health is prevention. Australia achieved enormous gains in physical health during the 20th century, with big drops in premature death. Prevention of disease and injury played a major role in these gains.

We might expect a similar approach to work for mental-health problems, which are the next frontier for improving the nation’s health. However, while we have been putting increasing resources into treatment, prevention has been neglected.

There is now good evidence that prevention of mental-health problems is possible and that it makes good economic sense. For every dollar invested on school-based interventions to reduce bullying, for instance, there is an estimated economic return of $14.

Much could to be done to reduce the major risk factors for mental-health problems which occur during childhood and increase risk right across the lifespan.

Parents who are in conflict with each other and fight a lot, for example, may increase their children’s risk for depression and anxiety disorders, while parents who show warmth and affection towards their children decrease their risk. Parents can be trained to reduce these risk factors and increase protective factors.

Yet successive Australian governments have lacked the political will to invest in prevention.

Where to next?

There is an important opportunity to consider whether Australia should be heading in a very different direction in its approach to mental health. The Australian government has asked the Productivity Commission to investigate mental health.

While we’ve had many previous inquiries, this one is different because it’s looking at the social and economic benefits of mental health to the nation. This broader perspective is important because action on prevention is a whole-of-government concern with resource implications and benefits that extend well beyond the health sector.




Read more:
There’s a reason you’re feeling no better off than 10 years ago. Here’s what HILDA says about well-being


The Conversation


Anthony Jorm, Professor emeritus, University of Melbourne

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

Is whitening bad for teeth? We asked five experts



At-home dental whitening kits might be bad for your teeth. Better to talk to a dentist.
from http://www.shutterstock.com

Alexandra Hansen, The Conversation

If you’re anything like me, celebrity smiles and Colgate ads make you feel guilty about your regular consumption of coffee, red wine, tea, and all the other fun things we’re told will stain our teeth.

And the solution seems so easy – a box of whitening strips from the supermarket shelf tells us so. But does whitening teeth also remove some of what keeps them healthy? And might they be more easily stained afterwards?

We asked five experts if whitening is bad for teeth.

Five out of five experts said no…

But they all had a pretty big caveat. It’s safe provided it’s done by a dentist. So for this you’re looking at upwards of a few hundred dollars, rather than just a trip to the supermarket.

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


Disclosures: Alexander is a Federal Councillor for the Australian Dental Association Inc. and occasionally works clinically within private dental practice. Kelly is employed by CQUniversity to teach in the Bachelor of Oral Health program. Under the supervision of registered dental professionals, students deliver professional tooth whitening procedures at the university clinic. Madhan is a NHMRC Sidney Sax Research Fellow in Public Health and Health Services at the University of Sydney and Kings College London. He is a full time oral health researcher, and is not currently involved in any clinical practice. Rebecca works in paediatric practice that does not offer whitening procedures.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.

A wet cough for four weeks means it’s time to get it checked out



Lung disease can often be prevented with culturally appropriate health care and information.
Pamela Larid

Pamela Laird, Telethon Kids Institute and Andre Schultz, Telethon Kids Institute

As respiratory clinicians, we have been conducting outreach clinics to the Kimberley, in northern Western Australia, for about ten years, treating children with bronchiectasis, a chronic lung disease in which the breathing tubes in the lungs are damaged.

If left untreated, bronchiectasis can eat away at the lungs and cause devastating long-term effects.

Our research, published today in the journal Respirology, shows how Aboriginal health providers, visiting clinicians, and Aboriginal families can work together to detect illness that may lead to bronchiectasis as symptoms first appear, using local language, stories, and resources.

These resources, including an animated video, highlight that chronic wet cough, in the absence of any other symptom or sign, can be the earliest and often only warning sign of lung disease.

Let’s kick this wet cough.

Why early detection is key

A persistent, low-grade wet cough is often a sign of mucus in the airway that has become infected. Over time, this mucus begins to destroy the lung tissue.


Joshya/Shutterstock

Limiting the extent of lung damage is predicated on timely recognition and management of the chronic wet cough. Treatment may include antibiotics and chest physiotherapy.

If left untreated, the disease can progress and result in a lot of coughing, feeling breathless, losing sleep, feeling worried and helpless, and, eventually, early death.

In Australia, lung infections are the most common reason Aboriginal children are hospitalised. Young Aboriginal children in WA are up to 13 times more likely to be admitted for lung infections than non-Aboriginal children.

More than a quarter of young Aboriginal children admitted with lung infections will go on to develop potentially life-shortening chronic lung disease.

Lung disease is a major contributor to the gap in life expectancy between Indigenous and other Australians. Indigenous Australians hospitalised with bronchiectasis die, on average, 24 years earlier than non-Indigenous Australians with the condition.




Read more:
How Australians Die: cause #4 – chronic lower respiratory diseases


Understanding the delay

Each quarter, Perth Children’s Hospital sends a multidisciplinary team to see about 30 children, mostly Aboriginal, who have been referred for specialist care by doctors from across the vast Kimberley region.

We have witnessed the consequences of lung disease being diagnosed too late. We once treated an adolescent Aboriginal boy with end-stage bronchiectasis. He was so sick that he was unable to walk or lie flat. His lung function was less than 25%, well below the threshold for lung transplantation.

This boy was dying from an illness that could have been halted or reversed had someone treated him effectively before his disease had progressed this far. A note in his medical record stated: “Lost to the system.”




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Words from Arnhem land: Aboriginal health messages need to be made with us rather than for us


In our clinics, we noticed a high prevalence of Aboriginal children with lung disease who were seen too late, when preventable lung damage was already permanent.

We found we were not always eliciting accurate histories from families. Specifically, when we asked engaged parents if their children had a wet cough, the parents would say “no” when, in fact, the children did have a wet cough.

Accurate medical history taking is crucial to providing good medical care, as is the provision of culturally appropriate care. But we realised a barrier was preventing us from communicating effectively with families, and preventing those families seeking timely medical care for their children.

From mucus to goonbee

We addressed the issues through partnerships with Aboriginal families, researchers, Aboriginal health providers, and government. We identified the barriers and enablers for both families and clinicians to recognise and manage early lung disease and stop it progressing to serious life-limiting illness.

We interviewed 77 Aboriginal families and clinicians in the Kimberley, and discovered that families had never heard that a daily wet cough for more than four weeks could indicate serious infection.

Coughing was so prevalent among Aboriginal children that symptoms were being normalised.

When families were given culturally appropriate health information, they sought medical help. Parents also gave an accurate history about the presence of wet cough once they better understood the topic.

This child, accompanied by her siblings and mother, undergoes chest physiotherapy as part of her daily routine to combat chronic lung disease.
Pamela Laird

Culturally appropriate information included use of local language terms – such as goonbee for mucus in Yawuru language – and use of stories or images that families could relate to.

Clinicians can liken the lungs to an upside-down tree, for instance, where the tree trunk is the windpipe, the branches are the breathing tubes, and the leaves are the air sacs where oxygen is transferred to the blood.

We also developed culturally relevant educational resources for clinicians and families, including an animated film and an information flip chart.

Through collaboration, mutual respect, and knowledge translation in our clinics, we are now witnessing little lungs growing stronger, Aboriginal families empowered with knowledge and advocating for their children, and clinicians skilled to provide culturally informed care to children. These observations are being supported by research soon to be published.

By engaging and working together, we will find sustainable solutions to kick chronic wet cough and help prevent Aboriginal children with sick lungs from flying beneath the radar.




Read more:
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The Conversation


Pamela Laird, Senior Respiratory Physiotherapsit & Researcher, Telethon Kids Institute and Andre Schultz, Paediatric Respiratory Physician and Research Fellow, Telethon Kids Institute

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

Health Check: why do I have a cough and what can I do about it?



No wonder you feel so bad. Coughing can be physically exhausting. But it’s your body’s way of getting rid of irritants or extra mucus.
from www.shutterstock.com

David King, The University of Queensland

Dry, moist, productive, hacking, chesty, whooping, barking, throaty. These are just some of the terms people use to describe their cough.

While we’re deep into cold and flu season, it’s one of the most common reasons people see their family doctor.

But what is a cough anyway? And what’s the best way to get rid of it?




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Health Check: I feel a bit sick, should I stay home or go to work?


What is a cough?

People can cough on purpose or spontaneously in a protective reflex action. The aim is to both protect the airways from material that shouldn’t be there (like dust) or to clear the secretions that come with respiratory diseases, such as the mucus and phlegm that come with colds and flu.

Nerve receptors throughout the lungs, and to a lesser extent in the sinuses, diaphragm and oesophagus (food pipe), detect the irritant or mucus. Then, they send messages via the vagus nerve to the brain. The brain, in turn, sends messages back through the motor nerves supplying the diaphragm, chest muscles and vocal cords.

This results in a sudden, forceful expulsion of air.

Your cough may be a one off. Alternatively, you can have a run of repeated coughs, especially in whooping cough, which people describe as a bout, attack or episode.

Which type of cough do I have?

There are many different types of cough but no one definition that everyone agrees on. This can be confusing as patients classify their cough in descriptive terms like hacking or chesty, while doctors classify them on how long they last: acute (under three weeks), subacute (three to eight weeks) and chronic cough (more than eight weeks).

Neither of these approaches tells us about the cause of the cough.

Patients tend to describe coughs using descriptive terms, like hacking or chesty, while doctors talk about how long the cough has lasted.
from www.shutterstock.com

Coughs can also be called wet or dry. Officially, you have a wet cough when you produce more than 10mL of phlegm a day.

For people with chronic coughs, their cough can further be classified after an x-ray — either with lung pathology to indicate something like pneumonia or tuberculosis, or without signs of underlying disease (an x-ray negative cough).

What caused my cough?

Whether you have a wet or dry cough may tell you what has caused it.

A dry cough indicates a non-infectious cough from conditions including asthma, emphysema, oesophageal reflux and upper airway cough syndrome, previously called post-nasal drip.

A wet cough is more common in people with sinus and chest infections, including influenza, bronchitis and pneumonia, and serious infections such as tuberculosis.
A smoker’s cough is usually wet, as the precursor to chronic bronchitis. As it progresses, or when complicated with infection, larger amounts of mucus may be coughed up daily.




Read more:
Health Check: what you need to know about mucus and phlegm


Then there is a dry cough associated with a cold or flu that turns into a moist cough. People tend to describe this as “chesty” and it makes them worry the infection has moved to their lungs.

Yet mostly their lungs are clear of infectious sounds when examined with a stethoscope. Even a small amount of mucus stuck around the vocal cords or back of the throat may produce a moist sounding cough. But this is not necessarily a wet or “productive” (producing lots of mucus) cough.

One study showed even doctors struggled to make an accurate diagnosis based only on the sound of the cough. Their diagnosis of the cough was correct only 34% of the time.

For people with chronic “unexplained cough”, a common hypothesis is that cough receptors become more sensitive to irritation the more they are exposed to the irritant. These cough receptors are so sensitive that even perfumes, temperature changes, talking and laughing may trigger the cough.




Read more:
Snout, sniff and sneeze: the language of the nose


People with upper airway cough syndrome may feel mucus secretions moving down the back of the throat, causing them to cough. New evidence suggests the cough is caused by the increased thickness of the mucus and slowness of that mucus being cleared by cilia (hair like structures in lining cells whose job is to move mucus along).

This mechanism keeps the chronic cough going through a feedback loop I call the “cough and mucus” cycle. In other words, the more the throat is irritated by the sticky mucus, the more you cough, but the cough is poor at shifting the mucus. Instead, coughing irritates the throat and fatigues the cilia, and the mucus becomes stickier and harder to shift, stimulating further coughing.

When coughing gets too much

Coughing is hard work so no wonder you can feel physically exhausted. In one study, people with asthma coughed as many as 1,577 times in one 24-hour period. But for people with a chronic cough, it was up to 3,639 times.

The high pressures generated in vigorous coughing can cause symptoms including chest pains, a hoarse voice, and even rib fractures and hernias. Other complications include vomiting, light-headedness, urinary incontinence, headaches and sleep deprivation. Chronic cough may also lead to people becoming embarrassed and avoiding others.

Is it true?

People still seemed surprised and worried when a cough persists after a cold and flu despite the fact cough outlasts other symptoms in most cases. When an Australian study followed 131 healthy adults with an upper respiratory tract infection, 58% had a cough for at least two weeks and 35% for up to three weeks.




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Curious Kids: Why does my snot turn green when I have a cold?


Then there’s the colour of your mucus. Patients and doctors commonly interpret discoloured mucus, particularly if green, as a sign of bacterial infection. But there’s clear evidence that the colour alone is not able to differentiate between viral and bacterial infections in otherwise healthy adults.

Another study found that people with acute cough who coughed up discoloured phlegm were more likely to be prescribed antibiotics, but they did not recover any faster than those not prescribed antibiotics.

When and how should I treat my cough?

Due to the multiple causes and types of cough there is not room to cover this question adequately. A safe approach is to diagnose the disease that is causing the cough and treat it appropriately.

For chronic dry coughs and coughs that last after acute upper respiratory tract infections, the cough is no longer serving a useful function and treatments can be targeted at breaking the cycle of irritation and further coughing. The evidence for effective treatments is patchy, but cough suppressants, steam inhalation and saline nasal irrigations, as well as prescribed anti-inflammatory sprays may help.

A spoonful of honey reduces cough in children more than placebo and some cough mixtures. It is thought that the soothing effect on the throat is the way this works.

There’s no good evidence that cough medicines work, and they could harm children.
from www.shutterstock.com

However, there is no good evidence for the effectiveness of commonly used over-the-counter medicine (cough medicine or syrup) to alleviate acute cough, yet they are still sold. Some contain drugs with the potential to cause harm in children, such as antihistamines, and codeine-like products.

Recent expert panel reports don’t recommend the use of these cough medicines for adults and children with acute cough, until they are shown to be effective.




Read more:
Health Check: do cough medicines work?


When should I be concerned?

It is fine to try to treat yourself, but if a cough persists or is bothersome, your doctor may be able to suggest or prescribe treatments to reduce your symptoms.

If you cough up blood or are becoming more unwell, consult a doctor, who will investigate further.

Children who cough up phlegm for more than four weeks have been found to benefit from medical investigations and antibiotics.The Conversation

David King, Senior Lecturer, The University of Queensland

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

Why is nursing home food so bad? Some spend just $6.08 per person a day – that’s lower than prison



If residents are given poor quality foods that don’t meet their needs or preferences, they’re less likely to eat it.
Shutterstock

Cherie Hugo, Bond University

The Royal Commission into Aged Care Quality and Safety this week turned its attention to food and nutrition. The testimony of maggots in bins and rotting food in refrigerators was horrific.

When so much of a resident’s waking hours is spent either at a meal, or thinking of a meal, the meal can either make or break an elderly person’s day.

So why are some aged care providers still offering residents meals they can’t stomach?

It comes down to three key factors: cost-cutting, aged care funding structures that don’t reward good food and mealtime experiences, and residents not being given a voice. And it has a devastating impact on nutrition.




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Nearly 2 out of 3 nursing homes are understaffed. These 10 charts explain why aged care is in crisis


How much are we spending on residents’ food?

Our research from 2017 found the average food spend in Australian aged care homes was A$6.08 per resident per day. This is the raw food cost for meals and drinks over breakfast, morning tea, lunch, afternoon tea, dinner and supper.

This A$6.08 is almost one-third of the average for older coupled adults living in the community (A$17.25), and less than the average in Australian prisons (A$8.25 per prisoner per day).

Over the time of the study, food spend reduced by A$0.31 per resident per day.

Meanwhile the expenditure on commercial nutrition supplements increased by A$0.50 per resident per day.

Commercial nutrition supplements may be in the form of a powder or liquid to offer additional nutrients. But they can never replace the value of a good meal and mealtime experience.




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What is ‘quality’ in aged care? Here’s what studies (and our readers) say


Cutting food budgets, poor staff training and insufficient staff time preparing food on-site inevitably impacts the quality of food provided.

At the royal commission, chefs spoke about using more frozen and processed meals, choosing poorer quality of meats and serving leftover meals in response to budget cuts.

Malnutrition is common, but we can address it

One in two aged care residents are malnourished and this figure has remained largely the same for the last 20 years.

Malnutrition has many causes – many of which are preventable or can be ameliorated. These include:

  • dental issues or ill-fitting dentures
  • dementia (because of difficulty swallowing and sensory sensitivities)
  • a poorly designed dining environment (such as poor acoustics, uncomfortable furniture, inappropriate crockery and table settings)
  • having too few staff members to help residents eat and drink and/or poor staff training
  • not supplying modified cutlery and crockery for those who need extra help
  • not offering residents food they want to eat or offering inadequate food choices.
Residents often need help at mealtimes.
Futurewalk/Shutterstock

My soon-to-be-published research shows disatisfaction with the food service significantly influences how much and what residents eat, and therefore contributes to the risk of malnutrition.

Malnutrition impacts all aspects of care and quality of life. It directly contributes to muscle wasting, reduced strength, heart and lung problems, pressure ulcers, delayed wound healing, increased falls risk and poor response to medications, to name a few.

Food supplements, funding and quality control

Reduced food budgets increase the risk of malnutrition but it’s not the only aged care funding issue related to mealtimes.

Aged care providers are increasingly giving oral nutrition supplements to residents with unplanned weight loss. This is a substandard solution that neglects fundamental aspects of malnutrition and quality of life. For instance, if a resident has lost weight as a result of ill-fitting dentures, offering a supplement will not identify and address the initial cause. And it ends up costing more than improving the quality of food and the residents’ mealtime experience.

Our other soon-to-be-published research shows the benefits of replacing supplements with staff training and offering high-quality food in the right mealtime environment. This approach significantly reduced malnutrition (44% over three months), saved money and improved the overall quality of life of residents.




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However, aged care funding does not reward quality in food, nutrition and mealtime experience. If a provider does well in these areas, they don’t attract more government funding.

It’s not surprising that organisations under financial pressure naturally focus on aspects that attract funding and often in turn, reduce investment in food.

A research team commissioned by the health department has been investigating how best to change aged care funding. So hopefully we’ll see changes in the future.

It’s not just about the food. Residents’ mealtime experiences affect their quality of life.
Ranta Images/Shutterstock

Aged care residents are unlikely to voice their opinions – they either won’t or can’t speak out. Unhappy residents often fear retribution about complaining – often choosing to accept current care despite feeling unhappy with it.




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How our residential aged-care system doesn’t care about older people’s emotional needs


We lived in an aged care home. This is what we learned

New Aged Care Quality Standards came into effect on July 1 (I was involved in developing the guidelines to help aged care providers meet these standards).

However, they provide limited guidance for organisations to interpret and make meaningful change when it comes to food, nutrition and mealtime experience. Aged care providers will need extra support to make this happen.

We’ve developed an evidence-based solution, designed with the aged care industry, to address key areas currently holding aged care back. The solution offers tools and identified key areas essential for a happier and more nourishing mealtime.

At the end of 2018, our team lived as residents in an aged care home on and off for three months. As a result of this, and earlier work, we developed three key solutions as part of the Lantern Project:

  • a food, nutrition and mealtime experience guide for industry with a feedback mechanism for facilities to improve their performance

  • free monthly meetings for aged care providers and staff to discuss areas affecting food provision

  • an app that gives staff, residents and providers the chance to share their food experiences. This can be everything from residents rating a meal to staff talking about the dining room or menu. For residents, in particular, this allows them to freely share their experience.

We have built, refined and researched these aspects over the past seven years and are ready to roll them out nationally to help all homes improve aged care food, nutrition and mealtime experience.The Conversation

Cherie Hugo, Teaching Fellow, Nutrition & Dietetics, Bond University

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