tag:theconversation.com,2011:/us/topics/health-4159/articlesHealth – The Conversation2024-03-12T17:44:46Ztag:theconversation.com,2011:article/2213812024-03-12T17:44:46Z2024-03-12T17:44:46ZTotal solar eclipses, while stunning, can damage your eyes if viewed without the right protection<figure><img src="https://images.theconversation.com/files/580528/original/file-20240307-30-bxdz7t.jpg?ixlib=rb-1.1.0&rect=47%2C6%2C4468%2C2383&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Solar eclipses don't come around often, but make sure to view these rare events with eclipse glasses to protect your vision. </span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/USEclipseSchools/0f2e25e7620440c0be042b6516d1acde/photo?Query=eclipse%20viewing&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=524&digitizationType=Digitized&currentItemNo=18&vs=true&vs=true">AP Photo/Charlie Riedel</a></span></figcaption></figure><p>On April 8, 2024, and for the second time in the past decade, people in the U.S. will have an opportunity to <a href="https://science.nasa.gov/eclipses/future-eclipses/eclipse-2024/">view a total solar eclipse</a>. But to do so safely, you’ll need to <a href="https://preventblindness.org/get-ready-for-the-next-eclipse/">wear proper protection</a>, or risk eye damage.</p>
<p>Earth is the only planet in our solar system where <a href="https://theconversation.com/when-the-sun-goes-dark-5-questions-answered-about-the-solar-eclipse-81308">solar eclipses can occur</a>. During these celestial events, the Moon passes between our planet and the Sun, blocking the Sun and casting a shadow over the Earth. Total eclipses rarely happen multiple times in the same region of a country during one’s lifetime. </p>
<p>The path of totality for <a href="https://science.nasa.gov/eclipses/">this spring’s eclipse</a>, where you can view the total eclipse, will extend over a 100-mile path that crosses through Mexico, Texas, New England and eastern Canada.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/fmtGqOxxmEU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Those in the path of totality will have the opportunity to see a total solar eclipse this April.</span></figcaption>
</figure>
<p>As excitement for the celestial show grows across the country, <a href="https://www.forbes.com/sites/jamiecartereurope/2024/03/09/11-ways-to-find-your-last-minute-hotel-for-the-total-solar-eclipse---but-be-quick/?sh=415b5585f4e2">hotels in the path of totality</a> have been booked up by eclipse enthusiasts. Museums and schools have <a href="https://solarsystem.nasa.gov/embeddable-eclipse-events/">planned viewing events</a>, and researchers have developed technology for the <a href="https://astrolab.fas.harvard.edu/LightSound.html">visually impaired and those with hearing loss</a> so more people have the opportunity to experience the eclipse.</p>
<p>Seeing an eclipse is a rare and special opportunity, but <a href="https://directory.hsc.wvu.edu/Profile/28506">as an ophthalmologist</a>, I know that looking directly at the Sun, even for a few moments, can severely damage your eyes. With a few easy precautions, eclipse viewers can protect themselves from severe and irreparable eye damage and vision loss.</p>
<h2>Safe eclipse viewing</h2>
<p>This year’s eclipse will unfold over a 75-minute period, from the moment the Moon starts to partially block the Sun until it completely moves away from it again. </p>
<p>During the partial eclipse period, when the Moon is partly blocking the Sun, you should never look directly at the Sun nor through binoculars, <a href="https://www.masterclass.com/articles/how-to-photograph-a-solar-eclipse">cameras</a> or <a href="https://www.space.com/how-to-photograph-a-solar-eclipse-with-a-smartphone">cellphones</a>. Sunglasses, photographic filters, exposed color film and welding glasses will dim the sunlight, but these items do not prevent <a href="https://www.aao.org/eye-health/tips-prevention/solar-eclipse-eye-safety">eye damage from the Sun’s very intense light rays</a>. </p>
<p>Only <a href="https://preventblindness.org/solar-eclipse-glasses/">solar eclipse glasses</a> with filters designed specifically for observing the partial eclipse are safe to use. They are easily available <a href="https://www.cnn.com/cnn-underscored/outdoors/best-solar-eclipse-glasses?cid=ios_app">from a variety of sources</a>, and you can wear them by themselves or over your glasses or contact lenses. </p>
<p>Keep in mind that these safety filters will permit you to view only the eclipse, as they blacken out everything around you but the Sun itself. Before purchasing a pair, make sure your eclipse glasses are approved by the <a href="https://eclipse.aas.org/eye-safety/iso-certification">ISO 12312-2 international standard</a>.</p>
<p>Only during its <a href="https://eclipse.gsfc.nasa.gov/SEhelp/SEglossary.html">period of totality</a>, the time when the Sun is fully behind the Moon, is it safe to remove your filtered glasses – and then only with caution.</p>
<p>This year, totality will last an unusually long <a href="https://science.nasa.gov/eclipses/future-eclipses/eclipse-2024/">four and a half minutes</a>. If you leave your eclipse glasses on, you will miss seeing the Sun’s bright ring, or corona, behind the Moon. But then, as the Moon moves on, the sky will brighten and you’ll need to put the eclipse glasses back on.</p>
<h2>Eyes and light</h2>
<p>While the pupils of our eyes naturally constrict to limit bright light, and our eyes have pigments to absorb light, direct sunlight overwhelms these functions. Even viewing the Sun for a few brief moments <a href="https://theconversation.com/turn-around-bright-eyes-heres-how-to-see-the-eclipse-and-protect-your-vision-203571">can cause permanent vision loss</a>. </p>
<p>The Sun emits intense <a href="https://www.britannica.com/science/sunlight-solar-radiation">ultraviolet and infrared light</a>, which, while not visible to the human eye, can burn sensitive ocular tissues, such as the cornea and retina.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/581353/original/file-20240312-24-e55u1i.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A diagram of an eye as viewed from the side." src="https://images.theconversation.com/files/581353/original/file-20240312-24-e55u1i.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/581353/original/file-20240312-24-e55u1i.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=486&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581353/original/file-20240312-24-e55u1i.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=486&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581353/original/file-20240312-24-e55u1i.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=486&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581353/original/file-20240312-24-e55u1i.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=611&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581353/original/file-20240312-24-e55u1i.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=611&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581353/original/file-20240312-24-e55u1i.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=611&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The cornea is the clear front surface of the eye, which lets light in. The retina is the inner lining of the back part of the eye, which sends signals to your brain, allowing you to see.</span>
<span class="attribution"><a class="source" href="https://aapos.org/glossary/how-to-safely-view-a-solar-eclipse">American Association for Pediatric Ophthalmology and Strabismus</a></span>
</figcaption>
</figure>
<p>Corneal damage from sunlight, called <a href="https://www.mayoclinic.org/diseases-conditions/actinic-keratosis/symptoms-causes/syc-20354969">solar keratosis</a>, can blur vision and be quite painful. While the cornea can heal itself, it may require several days to get better and lead to lost time at work or school. </p>
<p>Retinal damage, called <a href="https://www.health.wa.gov.au/Articles/S_T/Solar-retinopathy">solar retinopathy</a>, occurs inside the eye. While it isn’t painful, it can be more severe than corneal damage and can dramatically impair vision. Solar retinopathy symptoms include a blind spot in one’s central vision, visual distortions and altered color vision. </p>
<p>In mild cases, these symptoms may go away, but in more severe cases, and even with treatment, <a href="https://aapos.org/glossary/how-to-safely-view-a-solar-eclipse">they may become permanent</a>. </p>
<p>To both enjoy the eclipse and prevent eye damage, make sure you and your loved ones all view the event with strict proper precautions.</p><img src="https://counter.theconversation.com/content/221381/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Geoffrey Bradford does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Now’s the time to get your hands on a pair of eclipse glasses in preparation for April’s display of celestial wonder.Geoffrey Bradford, Professor of Pediatrics and Ophthalmology, West Virginia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2217202024-03-11T21:26:04Z2024-03-11T21:26:04ZAllergen warning: “Vegan” foods may contain milk and eggs<figure><img src="https://images.theconversation.com/files/570731/original/file-20240112-29-t9z77z.jpg?ixlib=rb-1.1.0&rect=4%2C0%2C989%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">When buying pre-packaged foods, consumers with allergies rely on the declarations in the list of ingredients to identify safe foods.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>The popularity of vegan diets continues to increase around the world. Indeed, in 2023, the vegan food market grew to <a href="https://www.expertmarketresearch.com/reports/vegan-food-market">more than US$27 billion</a>.</p>
<p>The term “vegan” usually refers to foods that contain no animal ingredients (meat, poultry, eggs, milk, fish, seafood).</p>
<p>While some consumers consider them to be healthier, vegan foods are also an interesting alternative for consumers concerned about the environment, sustainable development, and animal welfare.</p>
<p>But another type of consumer may be turning to these products for a completely different reason: people who are allergic to proteins of animal origin, such as cow’s milk and eggs.</p>
<p>In view of this, <a href="https://parera.ulaval.ca">our research group</a>, a leader in food allergen risk analysis in Canada, decided to explore <a href="https://link.springer.com/article/10.1186/s13223-023-00836-w">the following two questions</a>:</p>
<ul>
<li><p>Do consumers who are allergic to animal proteins consider vegan products to be safe?</p></li>
<li><p>And, if so, are these products truly safe for them?</p></li>
</ul>
<h2>What’s in it for consumers with allergies?</h2>
<p>The answers to these questions are crucial for people with food allergies who risk suffering potentially severe reactions (anaphylaxis) from consuming these products.</p>
<p>Food allergies affect around <a href="https://www.jaci-inpractice.org/article/S2213-2198(19)30912-2/fulltext">six per cent of Canadians</a>, including 0.8 per cent who are allergic to eggs, and 1.1 per cent to milk.</p>
<p>Despite the fact that different forms <a href="https://foodallergycanada.ca/living-with-allergies/allergy-treatments-and-therapies/treatments-and-therapies/">of immunotherapy or allergen desensitization</a> have shown promising results, the most effective strategy for avoiding allergic reactions is still to refrain from eating foods that may contain allergens.</p>
<p>When buying pre-packaged foods, consumers with allergies rely on declarations in the list of ingredients to identify foods that are safe for them. Regulatory authorities who are responsible for the quality and safety of food recognize the importance of accurate ingredients declarations for allergic consumers. Thus, it is <a href="https://www.canada.ca/en/health-canada/services/food-nutrition/food-labelling/allergen-labelling.html">mandatory</a> to list every allergen that has been voluntarily added to a pre-packaged food item.</p>
<p>However, when it comes to ingredients that may be unintentionally present — for example, as due to cross-contact during food processing — there is a regulatory gap. These ingredients are generally identified with the warning “may contain,” which is used (or sometimes <a href="https://www.sciencedirect.com/science/article/abs/pii/S2213219818300102">overused</a>) voluntarily and randomly by food processors.</p>
<p>Furthermore, the term “vegan” is neither standardized nor defined in Canadian regulations. In fact, <a href="https://inspection.canada.ca/food-labels/labelling/industry/composition-and-quality/eng/1625516122300/1625516122800?chap=2">the Canadian Food Inspection Agency</a> notes that, with regard to the use of the term “vegan,”</p>
<blockquote>
<p>…companies can apply additional criteria or standards that take account of other factors in addition to the ingredients of the food.</p>
</blockquote>
<p>However, details or examples of these elements are not provided. This lack of a precise regulatory definition prevents the implementation of compliance requirements.</p>
<p>Yet, most <a href="https://recalls-rappels.canada.ca/en/search/site?search_api_fulltext=vegan">recalls</a> of products marketed as “vegan” are due to the presence of undeclared ingredients of animal origin, in particular milk and eggs.</p>
<h2>What do consumers with food allergies say?</h2>
<p>In this context, and as part of a <a href="https://www.researchsquare.com/article/rs-2583779/v1">survey</a> of consumers with allergies conducted in collaboration with <a href="https://foodallergycanada.ca">Food Allergy Canada</a>, we asked participants who indicated that they were allergic (or were the parents of a child who was allergic) to eggs or milk if they bought products marketed as “vegan.”</p>
<p>Of the 337 respondents, 72 per cent said they sometimes included these products in their purchases, 14 per cent said they always did, and 14 per cent never.</p>
<p>These <a href="https://link.springer.com/article/10.1186/s13223-023-00836-w">results</a> suggest that these consumers do, indeed, consider the claim “vegan” as an indicator of the absence of animal proteins — an absence which, again, is not supported by any regulatory requirement or definition.</p>
<p>Since the absence of these ingredients is not guaranteed, these consumption habits could put people who are allergic to eggs and/or milk at risk.</p>
<p>An education campaign to clarify that the term “vegan” is an indicator of dietary <em>preferences</em> and not <em>risks</em> would therefore be important for this community.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/569134/original/file-20240112-29-5nq5bg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="dark chocolate" src="https://images.theconversation.com/files/569134/original/file-20240112-29-5nq5bg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/569134/original/file-20240112-29-5nq5bg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=372&fit=crop&dpr=1 600w, https://images.theconversation.com/files/569134/original/file-20240112-29-5nq5bg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=372&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/569134/original/file-20240112-29-5nq5bg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=372&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/569134/original/file-20240112-29-5nq5bg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=467&fit=crop&dpr=1 754w, https://images.theconversation.com/files/569134/original/file-20240112-29-5nq5bg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=467&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/569134/original/file-20240112-29-5nq5bg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=467&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some dark chocolate bars marketed as ‘certified vegan’ contain milk proteins.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Do vegan products contain ingredients of animal origin?</h2>
<p>The fact that 86 per cent of survey respondents buy “vegan” products suggests that the incidence of allergic reactions linked to these foods is potentially rare.</p>
<p>We therefore <a href="https://link.springer.com/article/10.1186/s13223-023-00836-w">analyzed</a> the egg and milk protein content of “vegan” and “plant-based” products marketed in Québec.</p>
<p>A total of 124 products were analyzed for the presence of egg (64) and/or milk (87) proteins.</p>
<p>Egg protein was not detected in any samples, but five samples contained milk proteins: these included four dark chocolate bars marketed as “certified vegan” and a supermarket brand chestnut cake.</p>
<p>These five products declared the potential presence of milk with a warning, “may contain milk.”</p>
<p>We used the concentrations of milk proteins quantified in these products, combined with the quantities of the food that would be consumed in a single eating occasion, to calculate an exposure dose, in milligrams of allergen protein. We then estimated the probability of these doses provoking a reaction in the allergic populations concerned by using <a href="https://www.sciencedirect.com/science/article/pii/S0278691520307213">correlation models</a>. Our results show that the calculated doses could trigger reactions in six per cent of milk-allergic consumers, for the chocolate bars, and one per cent, for the cake.</p>
<h2>How can consumers with food allergies protect themselves?</h2>
<p>Although this level of risk may be perceived as low, it is likely to vary without notice. And this will remain the case until regulatory requirements are put in place.</p>
<p>In fact, rather than attributing it to the presence of a “vegan” or “plant-based” claim, this level of risk most likely reflects <a href="https://www.cell.com/heliyon/pdf/S2405-8440(22)02590-7.pdf">good allergen management practices</a>, characteristic of the North American food manufacturing sector.</p>
<p>Thus, even if a statement “may contain milk” seems contradictory in a “vegan” or “plant-based” product, people allergic to milk should interpret it as an indication that this product may pose a risk to their health.</p><img src="https://counter.theconversation.com/content/221720/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Samuel Godefroy's research activities are funded by the Natural Sciences and Engineering Research Council of Canada, the Foreign Agriculture Service of the United States Department of Agriculture, R-Biopharm GmbH and R-Biopharm Canada Inc. He acts as an expert advisor to members of the food and beverage industry, international organizations (the Food and Agriculture Organization of the United Nations, the United Nations Industrial Development Organization and the World Bank), international food regulatory bodies such as the China National Centre for Food Safety Risk Assessment and consumer organizations such as Food Allergy Canada. Godefroy is Chairman of the Board of the Global Food Regulatory Science Society (GFoRSS).</span></em></p><p class="fine-print"><em><span>Jérémie Théolier et Silvia Dominguez ne travaillent pas, ne conseillent pas, ne possèdent pas de parts, ne reçoivent pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'ont déclaré aucune autre affiliation que leur poste universitaire.</span></em></p>Vegan foods are considered by most consumers to have no ingredients of animal origin, but they may actually contain milk proteins.Silvia Dominguez, Professionnelle de recherche en sciences des aliments, Université LavalJérémie Théolier, Professionel de recherche en sciences des aliments, Université LavalSamuel Godefroy, Professeur titulaire - Sciences des aliments, Université LavalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2228582024-03-08T13:38:33Z2024-03-08T13:38:33ZAsthma meds have become shockingly unaffordable − but relief may be on the way<figure><img src="https://images.theconversation.com/files/579691/original/file-20240304-18-r33cu5.jpg?ixlib=rb-1.1.0&rect=25%2C51%2C8538%2C5469&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Its price will take your breath away.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/man-using-blue-asthma-inhaler-medication-royalty-free-image/1179346207?">Brian Jackson/Getty Images</a></span></figcaption></figure><p>The <a href="https://www.businessinsider.com/cost-asthma-medication-doubled-unjust-2023-7">price of asthma medication has soared</a> in the U.S. over the past decade and a half. </p>
<p>The jump – in some cases from around <a href="https://doi.org/10.1001/jamainternmed.2015.1665">a little over US$10</a> <a href="https://www.singlecare.com/blog/albuterol-sulfate-hfa-proventil-hfa-without-insurance/">to almost $100</a> for an inhaler – has meant that patients in need of asthma-related products <a href="https://www.businessinsider.com/cost-asthma-medication-doubled-unjust-2023-7">often struggle</a> to buy them. Others simply <a href="https://asthma.net/living/cannot-afford-inhalers">can’t afford</a> them. </p>
<p>To make matters worse, asthma <a href="https://www.fda.gov/drugs/buying-using-medicine-safely/generic-drugs">disproportionately affects</a> lower-income patients. Black, Hispanic and Indigenous communities have the <a href="https://aafa.org/asthma-allergy-research/our-research/asthma-disparities-burden-on-minorities/">highest asthma rates</a>. They also shoulder <a href="https://aafa.org/asthma-allergy-research/our-research/asthma-disparities-burden-on-minorities/">the heaviest burden</a> of asthma-related deaths and hospitalizations. Climate change will likely <a href="https://www.hsph.harvard.edu/c-change/subtopics/climate-change-and-asthma/">worsen asthma rates</a> and, consequently, these disparities.</p>
<p>I’m a health law professor at <a href="https://www1.villanova.edu/university/law/faculty-scholarship/faculty-directory/profiles/AnaSantosRutschman.html">Villanova University</a>, <a href="https://papers.ssrn.com/sol3/cf_dev/AbsByAuth.cfm?per_id=2667484">where I study</a> whether patients can get the medicines they need. And I’ve been watching this affordability crisis closely.</p>
<p>In many ways, it shows what happens when law and policy decisions aren’t aligned with public health needs. The good news, however, is that there finally seems to be some political will to rein in the price of asthma meds.</p>
<h2>Why inhaler prices are skyrocketing</h2>
<p>In 2008, the U.S. Food and Drug Administration <a href="https://www.fda.gov/drugs/frequently-asked-questions-popular-topics/transition-cfc-propelled-albuterol-inhalers-hfa-propelled-albuterol-inhalers-questions-and-answers">banned inhalers</a> that use chlorofluorocarbons, or CFCs – which were once widely used as propellants – because they can damage the ozone layer. The FDA was following a timeline set by an environmental treaty, the <a href="https://www.unep.org/ozonaction/who-we-are/about-montreal-protocol">Montreal Protocol</a>, which the U.S. ratified in the late 1980s. </p>
<p>From 2009 onward, CFC inhalers were phased out and replaced with hydrofluoroalkane, or HFA, ones, which are more environmentally friendly. They’re also a lot pricier. For patients with insurance, the average out-of-pocket cost of an inhaler rose from $13.60 per prescription in 2004 to $25 immediately after the 2008 ban, <a href="https://doi.org/10.1001/jamainternmed.2015.1665">a 2015 study found</a>.</p>
<p>Today, the <a href="https://www.singlecare.com/blog/albuterol-sulfate-hfa-proventil-hfa-without-insurance/">average retail price</a> of an albuterol inhaler is $98. Unlike CFC inhalers, which have <a href="https://www.fda.gov/drugs/buying-using-medicine-safely/generic-drugs">generic versions</a>, HFA inhalers are <a href="https://www.scientificamerican.com/article/unlikely-victims-of-banning-cfcs/">covered by patents</a>. While <a href="http://doi.org/10.1089/jamp.2016.1297">the drug itself</a> hasn’t changed, the switch to a different device allowed companies to increase their prices.</p>
<p>In 2020, the FDA finally approved the <a href="https://www.fda.gov/news-events/press-announcements/fda-approves-first-generic-commonly-used-albuterol-inhaler-treat-and-prevent-bronchospasm">first generic version</a> of an albuterol inhaler. But generic competition still isn’t robust enough to lower prices meaningfully.</p>
<p>Patients with good insurance <a href="https://allergyasthmanetwork.org/advocacy-updates/united-healthcare-albuterol-epinephrine-cost/">may pay very little</a> or even nothing. But uninsured patients face steep market prices, and as of 2023, there were <a href="https://aspe.hhs.gov/sites/default/files/documents/e06a66dfc6f62afc8bb809038dfaebe4/Uninsured-Record-Low-Q12023.pdf">over 25 million</a> uninsured Americans. <a href="https://www.cdc.gov/asthma/asthma_stats/insurance_coverage.htm">Even insured patients may have trouble</a> affording their asthma meds, the CDC has found. </p>
<p>The same asthma medication for which U.S. patients pay top dollar is available elsewhere at much cheaper prices. Consider the following case for inhalers. The pharmaceutical company Teva sells <a href="https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ccd3aaec-4892-40d0-ad60-3e570178fbe1">QVAR RediHaler</a>, a corticosteroid inhaler, <a href="https://doi.org/10.1016/S2213-2600(24)00012-2">for $286</a> in the U.S.</p>
<p>In Germany, Teva sells that same inhaler for $9.</p>
<h2>Seeking meds from Mexico and Canada</h2>
<p>Some U.S. patients have traveled abroad to obtain cheaper asthma medication. After the 2008 ban on CFCs, it became common for patients to <a href="https://doi.org/10.1177/8755122515595052">visit border towns in Mexico</a> to purchase albuterol inhalers. They were sold for <a href="https://doi.org/10.1177/8755122515595052">as little as $3 to $5</a>. </p>
<p>A study of inhalers available to U.S. patients in Nogales, Mexico – about an hour south of Tucson, Arizona – found that Mexican products were <a href="http://doi.org/10.1177/8755122515595052">generally comparable to U.S. inhalers</a>. But researchers found some differences in performance, suggesting that American patients who use them could be getting a slightly different dose than their usual.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/580250/original/file-20240306-24-xrc96u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Asthma medication is seen on the shelves of a Mexican pharmacy." src="https://images.theconversation.com/files/580250/original/file-20240306-24-xrc96u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580250/original/file-20240306-24-xrc96u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580250/original/file-20240306-24-xrc96u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580250/original/file-20240306-24-xrc96u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580250/original/file-20240306-24-xrc96u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580250/original/file-20240306-24-xrc96u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580250/original/file-20240306-24-xrc96u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Asthma meds are considerably more affordable south of the border.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/the-interior-of-farmacia-san-pablo-news-photo/1041982048">Jeffrey Greenberg/Universal Images Group via Getty Images</a></span>
</figcaption>
</figure>
<p>There have also been reports of Americans turning to Canadian pharmacies to purchase asthma inhalers at much cheaper prices. In one case, a U.S. pharmacy would have charged $857 for a three-month supply. A patient obtained it for <a href="https://www.seattletimes.com/life/wellness/canadian-pharmacy-provided-inhaler-at-a-fraction-of-us-cost/">$134 from a pharmacy in Canada</a>.</p>
<h2>One potential fix: Importing cheaper meds</h2>
<p>U.S. law has long <a href="https://www.fda.gov/about-fda/center-drug-evaluation-and-research-cder/frequently-asked-questions-about-drugs">prohibited</a> personal importation of pharmaceutical drugs. However, a recent development could <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/us-fda-allow-florida-import-cheaper-drugs-canada-2024-01-05">pave the way for states</a> to import cheaper asthma drugs.</p>
<p>In January 2024, the <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/us-fda-allow-florida-import-cheaper-drugs-canada-2024-01-05/">FDA authorized</a> the importation of certain prescription drugs from Canada for the first time. <a href="https://www.kff.org/policy-watch/what-to-know-about-the-fdas-recent-decision-to-allow-florida-to-import-prescription-drugs-from-canada/">For now</a>, this authorization is limited to Florida, and it covers only drugs for HIV/AIDS, prostate cancer and certain mental health conditions.</p>
<p>Should it prove successful, the program could serve as a blueprint for other states.</p>
<h2>Another possible solution: Price-capping</h2>
<p>Policymakers could also try borrowing a page from the insulin playbook. Insulin prices <a href="https://doi.org/10.1001/jamanetworkopen.2023.18074">climbed for almost two decades</a> before Congress acted, capping the cost of insulin for Medicare patients. The 2022 <a href="https://www.congress.gov/bill/117th-congress/house-bill/5376/text">Inflation Reduction Act</a> established an out-of-pocket ceiling of $35 per month for prescription-covered insulin products. </p>
<p>If this cap had been in effect two years earlier, it would have saved 1.5 million Medicare patients about $500 annually, <a href="https://www.hhs.gov/about/news/2023/08/16/first-anniversary-inflation-reduction-act-millions-medicare-enrollees-savings-health-care-costs.html">a recent study estimated</a>. It also would have saved Medicare <a href="https://www.hhs.gov/about/news/2023/08/16/first-anniversary-inflation-reduction-act-millions-medicare-enrollees-savings-health-care-costs.html">$761 million</a>.</p>
<p>A similar approach could be taken for asthma meds.</p>
<p>Congress could create an asthma-specific rule similar to the insulin case. Or it could place provisions for asthma-med prices into a larger piece of legislation.</p>
<p>While this approach depends on the political environment, there are signs the government is becoming more willing to act. In January 2024, the U.S. Department of Health and Human Services <a href="https://www.hhs.gov/about/news/2024/01/29/readout-hhs-officials-meeting-private-sector-patient-advocacy-leaders-improve-national-access-important-asthma-medications.html">hosted a meeting</a> to discuss the problem with manufacturers and other stakeholders.</p>
<p>It’s a start. And – together with other measures – it brings some hope that asthma meds might soon become more affordable to those in need.</p><img src="https://counter.theconversation.com/content/222858/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ana Santos Rutschman does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>An inhaler that costs nearly $300 in the US goes for just $9 in Germany. What gives?Ana Santos Rutschman, Professor of Law, Villanova School of LawLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2219392024-03-08T13:38:13Z2024-03-08T13:38:13ZTeenagers often know when their parents are having money problems − and that knowledge is linked to mental health challenges, new research finds<figure><img src="https://images.theconversation.com/files/576103/original/file-20240216-28-neuioj.jpg?ixlib=rb-1.1.0&rect=120%2C77%2C5609%2C3736&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Teens are more clued in to family finances than many people think.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/single-working-mother-and-her-teenage-girl-talking-royalty-free-image/1457103190">Olga Rolenko/Moment via Getty Images</a></span></figcaption></figure><p>When parents try to shield their kids from financial hardship, they may be doing them a favor: Teens’ views about their families’ economic challenges are <a href="https://doi.org/10.1017/S0954579423001451">connected to their mental health and behavior</a>.</p>
<p>That’s the main finding of a study into household income and child development that I recently conducted with my colleagues.</p>
<p>As a <a href="https://scholar.google.com/citations?hl=en&oi=ao&user=--zcHSQAAAAJ">professor of psychology</a>, I know there’s <a href="https://doi.org/10.1007/s10964-020-01210-4">a good deal of research</a> showing that young people who experience more household economic hardship <a href="https://doi.org/10.1007/s13524-019-00833-y">tend to have more behavioral problems</a>.</p>
<p>But most studies on this issue rely heavily on caregiver reports – that is, what adults say about their kids. Fewer researchers have asked young people themselves. </p>
<p>To fill this gap, my colleagues and I asked more than 100 Pittsburgh-area teenagers, as well as their parents, about their family income, their views about their financial challenges, and their mental health. We checked in with them multiple times over nine months. </p>
<p>Doing this, we found a few important things. First, we found that many families’ economic situations varied over time – they were doing fine with money in some months and struggling during others. And second, we found that when teenagers said they and their family were experiencing hardship, those teens had more behavioral problems.</p>
<p>For example, many teens said that they couldn’t afford school supplies or that their caregivers worried because they lacked money for necessities. In the months when teens reported experiencing these hardships, they were more likely to feel depressed and get in trouble at school.</p>
<h2>Why it matters</h2>
<p>Other researchers have found that economic hardship is related to <a href="https://doi.org/10.1111/j.1467-8624.2007.00986.x">differences in parenting</a>, <a href="https://doi.org/10.3390/children9070981">academic achievement</a> and many <a href="https://doi.org/10.1016/j.childyouth.2022.106400">other developmental outcomes</a> – but prior studies haven’t always captured the complexities and challenges that struggling families face. </p>
<p>For example, researchers studying links between economic hardship and youth behavioral development have historically looked at family income on a yearly basis. But bills come due weekly or monthly. Our work shows that looking at the annual data alone risks missing an important part of the story: Many families experience brief spells of financial instability.</p>
<p>Our work also shows that teens are acutely affected by economic conditions in their daily lives and understand their families’ circumstances. This has important implications for research. Given that adolescence is a time of major emotional and cognitive changes, our team believes that researchers should center on the perspectives of young people directly affected by economic challenges. For example, we have previously found that how young people view stress and support in their lives may have <a href="https://theconversation.com/positive-parenting-can-help-protect-against-the-effects-of-stress-in-childhood-and-adolescence-new-study-shows-208268">implications for their brain development</a>.</p>
<p>This work also has important implications for public policy. For example, lawmakers assume that economic hardship is fairly stable and set anti-poverty policies accordingly. Our research offers fresh evidence that many people see <a href="https://www.nytimes.com/interactive/2017/05/31/business/31-volatility.html">large income swings throughout the year</a>. This kind of economic instability has been found to <a href="https://doi.org/10.1007/s10802-016-0181-5">affect child development</a>, especially when families <a href="https://doi.org/10.1017/S0954579419001494">lose large amounts of income</a>. To lessen the impact of poverty, policymakers may need to think about economic hardship more dynamically.</p>
<h2>What’s next</h2>
<p>Our research team wants to continue putting young people’s voices front and center. We’re also interested in more complex ways to make sense of socioeconomic status. While we know that income matters for families, we’re increasingly focused on household wealth, which is a household’s assets minus its debts. Wealth may influence child development in ways that are different from income. We’re just starting to collect data for a new project examining how both of these factors <a href="https://sanford.duke.edu/story/nichd-awards-grant-sanford-partnership-focused-adolescent-wellness-factors/">affect teen mental health</a>.</p>
<p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take on interesting academic work.</em></p><img src="https://counter.theconversation.com/content/221939/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jamie Hanson and his colleagues receive funding from the National Institutes of Health. Hanson is also a board member of the Pittsburgh Non-Profit, Project Destiny.</span></em></p>A study of more than 100 teens and their caregivers showed a unique link between hardship and behavior problems.Jamie Hanson, Assistant Professor of Psychology, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2211552024-03-07T13:03:45Z2024-03-07T13:03:45ZWhy schools need to take sun safety more seriously – expert explains<figure><img src="https://images.theconversation.com/files/577546/original/file-20240223-16-azytla.jpg?ixlib=rb-1.1.0&rect=37%2C0%2C4195%2C2788&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The World Health Organization recommends formal school programmes as the key to preventing skin cancer.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-boy-having-sunscreen-applied-339150182">Paul Higley/Shutterstock</a></span></figcaption></figure><p>Despite the UK’s rainy climate, there is a one in six <a href="https://onlinelibrary.wiley.com/doi/10.1002/ski2.61">risk</a> of developing skin cancer. Children, especially, should take extra care as severe sunburn as a youngster more than <a href="https://www.skincancer.org/risk-factors/sunburn/">doubles</a> the chance of developing skin cancer later on. </p>
<p>But <a href="https://academic.oup.com/ced/advance-article/doi/10.1093/ced/llad458/7507665">new research</a> my colleagues and I conducted shows that less than half of primary schools in Wales have a formal sun safety policy.</p>
<p>With skin cancer rates continuing to rise by <a href="https://gettingitrightfirsttime.co.uk/medical_specialties/dermatology/">8% annually</a> in England and Wales, it’s a problem that’s not going away and the disease now accounts for half of all cancers. In 2020 alone, the cost of treating skin cancer in England was <a href="https://pubmed.ncbi.nlm.nih.gov/23554510/">estimated</a> to be more than £180 million.</p>
<p>There is hope, though. It is estimated that around <a href="https://www.skincancer.org/skin-cancer-information/skin-cancer-facts">90% of skin cancers</a> are due to ultraviolet (UV) radiation exposure from the sun. This means they can be prevented through safer behaviour. </p>
<p>In the UK, though, many people still <a href="https://academic.oup.com/her/article/20/5/579/611761">underestimate</a> the link between sunburn and skin cancer. Research paints a worrying picture, revealing disparities in sun protection awareness and behaviour across different groups. Notably, <a href="https://academic.oup.com/her/article/20/5/579/611761">men</a>, people living in <a href="https://pubmed.ncbi.nlm.nih.gov/26875569/">low-income neighbourhoods</a>, those belonging to <a href="https://academic.oup.com/her/article/20/5/579/611761">lower socioeconomic groups</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/28125871/">people of colour</a> are often found to be less informed about sun safety and are more likely to put themselves at risk. </p>
<p>With childhood a crucial time for learning healthy behaviour, teaching all children from a young age about sun protection could be one way to reduce future skin cancer rates. And the <a href="https://iris.who.int/bitstream/handle/10665/42678/9241590629_v1.pdf?sequence=1">World Health Organization</a> recommends formal school programmes as the key to prevention. </p>
<p>Overall, school-based interventions have been <a href="https://www.sciencedirect.com/science/article/pii/S0091743521000438">shown</a> to positively influence sun safe knowledge and behaviour. For example, <a href="https://doi.org/10.1093/her/cyt105">schools in Australia</a> with written policies show better sun protection practices than those without.</p>
<p>But in UK schools, the situation varies. The UK government’s Department for Education has issued <a href="https://www.gov.uk/government/publications/relationships-education-relationships-and-sex-education-rse-and-health-education/physical-health-and-mental-wellbeing-primary-and-secondary#by-the-end-of-primary-school">statutory guidance</a> for England that children should leave primary school knowing about sun safety and how to reduce the risk of getting skin cancer. </p>
<p>In Scotland and Northern Ireland, it is not a legal requirement to teach sun safety in schools. And in Wales, while sun safety is recommended as part of the Welsh Network of Healthy Schools scheme, again there is no mandatory requirement to have a sun safety policy or to teach skin cancer prevention. Nor are there central UK resources provided to help schools in this area. </p>
<figure class="align-center ">
<img alt="The red, peeling sunburnt back and shoulders of a young girl." src="https://images.theconversation.com/files/578006/original/file-20240226-21-2xd3jb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/578006/original/file-20240226-21-2xd3jb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/578006/original/file-20240226-21-2xd3jb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/578006/original/file-20240226-21-2xd3jb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/578006/original/file-20240226-21-2xd3jb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/578006/original/file-20240226-21-2xd3jb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/578006/original/file-20240226-21-2xd3jb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Being severely sunburnt as a youngster more than doubles the chance of developing future skin cancer.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/dangerous-sunburn-shoulders-young-girl-601094933">Alonafoto/Shutterstock</a></span>
</figcaption>
</figure>
<p>My colleagues and I wanted to know how many schools have a sun safety policy, a formal document that sets out a school’s position with respect to the education and provision of sun safety. We also wanted to understand whether the existence of a policy varied by area or school characteristic, and what support schools need. </p>
<p>In 2022, we sent a survey to all 1,241 primary schools in Wales. In total, 471 schools responded. </p>
<h2>What we found</h2>
<p>We found that only 39% of responding schools had a formal sun safety policy. And of these, not all enforced them. Schools that had more children receiving free school meals and with lower attendance rates were less likely to have a sun safety policy.</p>
<p>We asked schools that did not have a policy to tell us the reasons why not. Thirty-five per cent of schools were “not aware of the need”, while 27% of schools had “not got around to it just yet”. Thirty schools (13%) said that a sun safety policy was not a priority at this time. Clearly, there is work to be done on raising awareness among schools and school leaders on the role they can play in this area.</p>
<p>Of course, schools are busy places. So, when asked to indicate what would encourage them to create a sun safety policy, 73% of schools said assistance with development, while 56% said resources to aid the teaching of sun safety. </p>
<p>Previously both Cancer Research UK and the Wales-based Tenovus Cancer Care charities have offered support and guidelines for schools but this support is no longer easily available. The England-based charity <a href="https://www.skcin.org/ourWork/sunSafeSchools.htm">Sckin</a> has a comprehensive and free sun-safe schools accreditation scheme. Some schools told us they based their policies on resources supplied by the local authority, but this was not consistent across Wales.</p>
<p>UV levels will soon rise in the UK and now is the time for schools to start thinking about sun protection. Having a formal sun safety school policy sets out the position of the school when it comes to sun safety. When enforced and communicated properly, this makes it clear to everyone (governors, teachers, carers and pupils) their individual responsibilities when it comes to staying safe. </p>
<p>But with fewer than half of schools in Wales having formal policies, and not all enforced, awareness of the importance of this issue and the potential role of schools is lacking. </p>
<p>It is therefore time for sun safety policies to become mandatory for primary schools across the UK. This could help to improve knowledge and behaviour for all age groups. But adequate support and guidance must be also given to schools to help them educate children about sun safety and protect them while they are at school.</p><img src="https://counter.theconversation.com/content/221155/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julie Peconi received funding for the Sunproofed Study from Health and Care Research Wales through a Health Research Grant Award. She is also a volunteer with the charity Skin Care Cymru, a charity working to raise the profile of skin health in Wales. </span></em></p>Being severely sunburnt as a child more than doubles the chance of developing future skin cancer but less than half of primary schools questioned in new research have a sun safety policy.Julie Peconi, Senior Research Officer in Health Data Science, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2228542024-02-29T21:48:23Z2024-02-29T21:48:23ZBetter sleep is a protective factor against dementia<figure><img src="https://images.theconversation.com/files/573581/original/file-20240117-23-vqzz7m.jpg?ixlib=rb-1.1.0&rect=60%2C0%2C6720%2C4456&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Lack of sleep, or poor quality sleep, is one of the risk factors for developing Alzheimer's disease. Fortunately, there are ways to improve sleep.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Dementia is a progressive loss of cognitive abilities, such as memory, that is significant enough to have an impact on a person’s daily activities. </p>
<p>It can be caused by a number of different diseases, including <a href="https://alzheimer.ca/en/about-dementia/what-alzheimers-disease">Alzheimer’s</a>, which is the most common form. Dementia is caused by a loss of neurons over a long period of time. Since, by the time symptoms appear, many changes in the brain have already occurred, many scientists are focusing on studying the risk and protective factors for dementia. </p>
<p>A risk factor, or conversely, a protective factor, is a condition or behaviour that increases or reduces the risk of developing a disease, but does not guarantee either outcome. Some risk factors for Alzheimer’s disease and dementia, such as age or genetics, are not modifiable, but there are several other factors we can influence, <a href="https://www.thelancet.com/article/S0140-6736(20)30367-6/fulltext">specifically lifestyle habits and their impact on our overall health</a>.</p>
<p>These risk factors include depression, lack of physical activity, social isolation, high blood pressure, obesity, diabetes, excessive alcohol consumption and smoking, as well as poor sleep.</p>
<p>We have been focusing our research on the question of sleep for over 10 years, particularly in the context of the <a href="https://www.nhlbi.nih.gov/science/framingham-heart-study-fhs">Framingham Heart Study</a>. In this large community-based cohort study, ongoing since the 1940s, the health of surviving participants has been monitored to the present day. As researchers in sleep medicine and epidemiology, we have expertise in researching the role of sleep and sleep disorders in cognitive and psychiatric brain aging. </p>
<p>As part of our research, we monitored and analyzed the sleep of people aged 60 and over to see who did — or did not — develop dementia. </p>
<h2>Sleep as a risk or protective factor against dementia</h2>
<p>Sleep appears to play an essential role in a number of brain functions, such as memory. Good quality sleep <a href="https://jamanetwork.com/journals/jamaneurology/fullarticle/2793873">could therefore play a vital role in preventing dementia</a>.</p>
<p>Sleep is important for maintaining <a href="https://www.science.org/doi/10.1126/science.1241224">good connections in the brain</a>. Recently, research has revealed that sleep seems to have a function similar to that of a garbage truck for the brain: <a href="https://doi.org/10.1016/j.mad.2023.111899">deep sleep could be crucial for eliminating metabolic waste from the brain</a>, including clearing certain proteins, such as those known to accumulate in the brains of people with Alzheimer’s disease. </p>
<p>However, the links between deep sleep and dementia still have to be clarified.</p>
<h2>What is deep sleep?</h2>
<p>During a night’s sleep, we go through several <a href="http://ceams-carsm.ca/en/a-propos-du-sommeil/">sleep stages</a> that succeed one another and are repeated. </p>
<p>NREM sleep (non-rapid eye movement sleep) is divided into light NREM sleep (NREM1 stage), NREM sleep (NREM2 stage) and deep NREM sleep, also called slow-wave sleep (NREM3 stage). The latter is associated with several restorative functions. Next, REM sleep (rapid eye movement sleep) is the stage generally associated with the most vivid dreams. An adult generally spends around 15 to 20 per cent of each night in deep sleep, if we add up all the periods of NREM3 sleep. </p>
<p>Several sleep changes are common in adults, such as going to bed and waking up earlier, sleeping for shorter periods of time and less deeply, and waking up more frequently during the night.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=279&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=279&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=279&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=350&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=350&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=350&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sleep stages, and the role of deep sleep for brain health.</span>
<span class="attribution"><span class="source">(Andrée-Ann Baril)</span></span>
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<h2>Loss of deep sleep linked to dementia</h2>
<p>Participants in the <a href="https://jamanetwork.com/journals/jamaneurology/fullarticle/2810957">Framingham Heart Study</a> were assessed using a sleep recording — known as polysomnography — on two occasions, approximately five years apart, in 1995-1998 and again in 2001-2003. </p>
<p>Many people showed a reduction in their deep slow-wave sleep over the years, as is to be expected with aging. Conversely, the amount of deep sleep in some people remained stable or even increased. </p>
<p>Our team of researchers from the Framingham Heart Study followed 346 participants aged 60 and over for a further 17 years to observe who developed dementia and who did not. </p>
<p>Progressive loss of deep sleep over time was associated with an increased risk of dementia, whatever the cause, and particularly Alzheimer’s type dementia. These results were independent of many other risk factors for dementia.</p>
<p>Although our results do not prove that loss of deep sleep causes dementia, they do suggest that it could be a risk factor in the elderly. Other aspects of sleep may also be important, such as its duration and quality. </p>
<h2>Strategies to improve deep sleep</h2>
<p>Knowing the impact of a lack of deep sleep on cognitive health, what strategies can be used to improve it? </p>
<p>First and foremost, if you’re experiencing sleep problems, it’s worth talking to your doctor. Many sleep disorders are underdiagnosed and treatable, particularly through behavioural (i.e. non-medicinal) approaches. </p>
<p>Adopting good sleep habits can help, such as going to bed and getting up at consistent times or avoiding bright or blue light in bed, like that of screens. </p>
<p>You can also avoid caffeine, limit your alcohol intake, maintain a healthy weight, be physically active during the day, and sleep in a comfortable, dark and quiet environment.</p>
<p>The role of deep sleep in preventing dementia remains to be explored and studied. Encouraging sleep with good lifestyle habits could have the potential to help us age in a healthier way.</p><img src="https://counter.theconversation.com/content/222854/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrée-Ann Baril received funding from the Sleep Research Society Foundation, the Alzheimer Society of Canada, the Canadian Institutes of Health Research, Banting Postdoctoral Fellowships, the Fondation de l'Hôpital du Sacré-Coeur de Montréal, the Université de Montréal and speaking fees from Eisai.</span></em></p><p class="fine-print"><em><span>Matthew Pase received funding from the National Health and Medical Research Council of Australia, National Institute on Aging, Dementia Australia, Alzheimer's Association, National Heart Foundation of Australia, Australian Research Council, Stroke Foundation, Brain Foundation, Alzheimer's Drug Discovery Foundation, Rebecca L Cooper Medical Research Foundation, and Bethlehem Griffiths Research Foundation.</span></em></p>Sleep appears to play an essential role in a number of brain functions, such as memory. So good quality sleep could play a vital role in preventing dementia.Andrée-Ann Baril, Professeure-chercheure adjointe au Département de médecine, Université de MontréalMatthew Pase, Associate Professor of Neurology and Epidemiology, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2121142024-02-26T19:00:52Z2024-02-26T19:00:52ZI want to eat healthily. So why do I crave sugar, salt and carbs?<figure><img src="https://images.theconversation.com/files/567024/original/file-20231221-29-wxqo9t.jpg?ixlib=rb-1.1.0&rect=17%2C565%2C5973%2C3422&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/donut-with-sprinkles-1785852/">Lisa Fotios/Pexels</a></span></figcaption></figure><p>We all want to eat healthily, especially as we reset our health goals at the start of a new year. But sometimes these plans are sabotaged by powerful cravings for sweet, salty or carb-heavy foods. </p>
<p>So why do you crave these foods when you’re trying to improve your diet or lose weight? And what can you do about it?</p>
<p>There are many reasons for craving specific foods, but let’s focus on four common ones:</p>
<h2>1. Blood sugar crashes</h2>
<p>Sugar is a key energy source for all animals, and its taste is one of the most basic sensory experiences. Even without specific sweet taste receptors on the tongue, a strong preference for sugar can develop, indicating a mechanism beyond taste alone.</p>
<p>Neurons <a href="https://www.nature.com/articles/s41593-021-00982-7">responding to sugar</a> are activated when sugar is delivered to the gut. This can increase appetite and make you want to consume more. Giving into cravings also drives an appetite for more sugar. </p>
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Read more:
<a href="https://theconversation.com/im-trying-to-lose-weight-and-eat-healthily-why-do-i-feel-so-hungry-all-the-time-what-can-i-do-about-it-215808">I’m trying to lose weight and eat healthily. Why do I feel so hungry all the time? What can I do about it?</a>
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<p>In the long term, research suggests a high-sugar diet can affect <a href="https://www.bmj.com/content/369/bmj.m2382">mood</a>, digestion and <a href="https://pubmed.ncbi.nlm.nih.gov/33339337/">inflammation</a> in the <a href="https://www.science.org/doi/10.1126/scitranslmed.aay6218?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">gut</a>.</p>
<p>While there’s a lot of <a href="https://www.sciencedirect.com/science/article/pii/S0149763402000040?via%3Dihub#aep-section-id23">variation between individuals</a>, regularly eating sugary and high-carb foods can lead to <a href="https://pubmed.ncbi.nlm.nih.gov/30951762/">rapid spikes and crashes</a> in blood sugar levels. When your blood sugar drops, your body can respond by craving quick sources of energy, often in the form of sugar and carbs because these deliver the fastest, most easily accessible form of energy. </p>
<h2>2. Drops in dopamine and serotonin</h2>
<p>Certain neurotransmitters, such as <a href="https://pubmed.ncbi.nlm.nih.gov/30595479/">dopamine</a>, are involved in the reward and pleasure centres of the brain. Eating sugary and carb-rich foods can trigger the release of dopamine, creating a pleasurable experience and reinforcing the craving. </p>
<p>Serotonin, the feel-good hormone, suppresses <a href="https://www.sciencedirect.com/science/article/pii/S1569733910700886">appetite</a>. Natural changes in serotonin can influence daily fluctuations in mood, energy levels and attention. It’s also associated with eating more <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5829131/">carb-rich snacks in the afternoon</a>. </p>
<figure class="align-center ">
<img alt="Woman sits at her desk, tired" src="https://images.theconversation.com/files/567025/original/file-20231221-27-ljdcvp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/567025/original/file-20231221-27-ljdcvp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/567025/original/file-20231221-27-ljdcvp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/567025/original/file-20231221-27-ljdcvp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/567025/original/file-20231221-27-ljdcvp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/567025/original/file-20231221-27-ljdcvp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/567025/original/file-20231221-27-ljdcvp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Do you get 3pm sugar cravings? Serotonin could play a role.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/photo-of-woman-holding-her-head-4064177/">Marcus Aurelius/Pexels</a></span>
</figcaption>
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<p><a href="https://pubmed.ncbi.nlm.nih.gov/21985780/">Low carb diets</a> may reduce serotonin and lower mood. However, a recent systematic review suggests little association between these diets and risk for <a href="https://www.sciencedirect.com/science/article/pii/S0165032722013933?via%3Dihub">anxiety and depression</a>. </p>
<p>Compared to men, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4189179/">women tend to crave more carb rich foods</a>. Feeling irritable, tired, depressed or experiencing carb cravings are part of premenstrual <a href="https://pubmed.ncbi.nlm.nih.gov/29218451/">symptoms</a> and could be <a href="https://www.ncbi.nlm.nih.gov/books/NBK560698/">linked to</a> reduced <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9928757/">serotonin levels</a>. </p>
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Read more:
<a href="https://theconversation.com/got-period-pain-or-cramps-what-to-eat-and-avoid-according-to-science-218344">Got period pain or cramps? What to eat and avoid, according to science</a>
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<h2>3. Loss of fluids and drops in blood sugar and salt</h2>
<p>Sometimes our bodies crave the things they’re missing, such as hydration or even salt. A low-carb diet, for example, <a href="https://www.ncbi.nlm.nih.gov/books/NBK537084/">depletes</a> insulin levels, decreasing sodium and water retention. </p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S1933287419302673">Very low-carb diets</a>, like ketogenic diets, induce “ketosis”, a metabolic state where the body switches to using fat as its primary energy source, moving away from the usual dependence on carbohydrates. </p>
<p>Ketosis is often associated with increased urine production, further contributing to potential fluid loss, electrolyte imbalances and salt cravings.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-do-we-crave-the-food-our-bodies-need-53218">Health Check: do we crave the food our bodies need?</a>
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<h2>4. High levels of stress or emotional turmoil</h2>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4214609/">Stress</a>, boredom and emotional turmoil can lead to cravings for comfort foods. This is because stress-related hormones can impact our appetite, satiety (feeling full) and food preferences. </p>
<p>The stress hormone <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3425607/">cortisol</a>, in particular, can drive cravings for <a href="https://www.sciencedirect.com/science/article/abs/pii/S0306453000000354">sweet comfort foods</a>. </p>
<p>A <a href="https://www.sciencedirect.com/science/article/abs/pii/S0306453000000354">2001 study</a> of 59 premenopausal women subjected to stress revealed that the stress led to higher calorie consumption. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/37295418/">A more recent study</a> found chronic stress, when paired with high-calorie diet, increases food intake and a preference for sweet foods. This shows the importance of a healthy diet during stress to prevent weight gain.</p>
<h2>What can you do about cravings?</h2>
<p>Here are four tips to curb cravings:</p>
<p><strong>1) don’t cut out whole food groups.</strong> Aim for a well-balanced diet and make sure you include:</p>
<ul>
<li><p><em>sufficient protein</em> in your meals to help you feel full and reduce the urge to snack on sugary and carb-rich foods. Older adults should aim for 20–40g protein per meal with a particular focus on <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/jhn.12838">breakfast and lunch</a> and an overall daily protein intake of at least <a href="https://apps.who.int/iris/handle/10665/43411">0.8g</a> per kg of body weight for <a href="https://pubmed.ncbi.nlm.nih.gov/35187864/">muscle health</a></p></li>
<li><p><em>fibre-rich foods</em>, such as vegetables and whole grains. These make you feel full and <a href="https://pubmed.ncbi.nlm.nih.gov/32142510/">stabilise your blood sugar</a> levels. Examples include broccoli, quinoa, brown rice, oats, beans, lentils and bran cereals. Substitute refined carbs high in sugar like processed snack bars, soft drink or baked goods for more complex ones like whole grain bread or wholewheat muffins, or nut and seed bars or energy bites made with chia seeds and oats</p></li>
</ul>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/how-much-protein-do-i-need-as-i-get-older-and-do-i-need-supplements-to-get-enough-215695">How much protein do I need as I get older? And do I need supplements to get enough?</a>
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<p><strong>2) manage your stress levels.</strong> Practise stress-reduction techniques like meditation, deep breathing, or yoga to manage emotional triggers for cravings. Practising <a href="https://pubmed.ncbi.nlm.nih.gov/30570305/">mindful eating</a>, by eating slowly and tuning into bodily sensations, can also reduce daily calorie intake and curb cravings and stress-driven eating </p>
<p><strong>3) get enough sleep.</strong> Aim for <a href="https://pubmed.ncbi.nlm.nih.gov/33054337/">seven to eight</a> hours of quality sleep per night, with a minimum of seven hours. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9031614/">Lack of sleep</a> can disrupt hormones that regulate hunger and cravings</p>
<p><strong>4) control your portions.</strong> If you decide to indulge in a treat, control your portion size to avoid overindulging.</p>
<p>Overcoming cravings for sugar, salt and carbs when trying to eat healthily or lose weight is undoubtedly a formidable challenge. Remember, it’s a journey, and setbacks may occur. Be patient with yourself – your success is not defined by occasional cravings but by your ability to manage and overcome them.</p><img src="https://counter.theconversation.com/content/212114/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hayley O'Neill is a wellness coach for Hayley M O'Neill Enterprises.</span></em></p>We all want to eat healthily, especially as we reset our health goals at the start of a new year. But sometimes these plans are sabotaged by powerful cravings for sweet, salty or carb-heavy foods.Hayley O'Neill, Assistant Professor, Faculty of Health Sciences and Medicine, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2239952024-02-23T17:16:46Z2024-02-23T17:16:46ZYour smart watch isn’t a medical device – but it is tracking all your health data<figure><img src="https://images.theconversation.com/files/577550/original/file-20240223-16-alopfu.jpg?ixlib=rb-1.1.0&rect=26%2C0%2C8648%2C5774&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/fit-female-runner-using-smart-watch-1037615245">Jacob Lund / Shutterstock</a></span></figcaption></figure><p>For millions of people, smartwatches aren’t just a piece of technology. They can use them to take control of their health in ways never thought possible.</p>
<p>As you go on your morning run, a smartwatch can monitor the rhythmic pounding of your feet and your heart’s steady beat. The watch can record the <a href="https://www.which.co.uk/news/article/can-you-trust-fitness-tracking-stats-ajJf85J6C42l">distance covered and the intensity of your workout</a>, guiding you towards your fitness goals.</p>
<p>During lunch, you can use it to <a href="https://blog.fitbit.com/fitbit-calories-in-vs-out/">log calories for a BLT sandwich</a>. As deadlines loom, they can offer gentle reminders to take a moment for yourself. And as you doze off, they <a href="https://www.zdnet.com/article/samsung-galaxy-watch-gets-first-ever-fda-clearance-for-sleep-apnea-detection/">might pick up instances of apnoea</a> or other sleep disturbances.</p>
<p>But some users could also conflate health tips with medical advice. Device and app developers have <a href="https://www.cnet.com/tech/mobile/features/fitbit-apple-know-smartwatches-arent-medical-devices-but-do-you/">consistently made it clear</a> that their products cannot replace a professional medical doctor’s advice or treatment. </p>
<p>A smartwatch is not a medical device as defined by law. In the UK, medical devices are strictly regulated in a way that other devices such as smartwatches are not. These regulations provide users with better legal protections and clarity as well as providing for resolution in the event of a mishap.</p>
<h2>What qualifies</h2>
<p>The key legal framework in the UK is <a href="https://www.legislation.gov.uk/uksi/2002/618/regulation/2/made">the Medical Devices Regulations 2002 (UK MDR)</a>. Once a product has been identified as a medical device under UK MDR, further classification of it takes place, ranging from low risk (stethoscopes and wheelchairs) to high risk (pacemakers, heart valves, implanted cerebral simulators).</p>
<p>If a device is designed to go inside the body, or if it contains medicinal substances, it is more likely it is treated as high risk. Depending on the risk classification, the law then imposes stringent standards to protect users from harm. These include obligations on the manufacturers and developers to ensure their devices are safe, through conducting risk impact assessments, periodic audits and other actions.</p>
<p>All matters relating to medical devices in the UK <a href="https://www.gov.uk/government/organisations/medicines-and-healthcare-products-regulatory-agency">fall under the responsibility</a> of the Medicines and Healthcare Products Regulatory Agency (MHRA). The MHRA conducts surveillance of medical devices available in the UK and has the authority to make decisions regarding their marketing and distribution. It is also the MHRA’s duty to ensure that manufacturers and developers are complying with the regulations. </p>
<h2>Pursuit of wellness?</h2>
<p>An important question is how one distinguishes a device, digital tool or app as one used for a medical purpose – which is how the UK MDR defines a medical device – versus one that is used for general health and wellness. The latter would include, for example, meditation apps or step counters. </p>
<p>Traditionally, smart watches have been <a href="https://www.insiderintelligence.com/insights/wearable-technology-healthcare-medical-devices/">treated as smart, wearable technology</a>. On the face of it, they offer users insight into their general health and wellness, helping them make necessary lifestyle adjustments to improve their health or fitness goals. </p>
<p>In recent years, however, such technologies have become increasingly advanced. Tens of thousands of digital tools and applications have flooded app stores. These include monitoring apps for mental health, symptom checkers based on information entered by patient users, or medical calculators for drug dosing.</p>
<figure class="align-center ">
<img alt="ECG" src="https://images.theconversation.com/files/577593/original/file-20240223-28-zkojeb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/577593/original/file-20240223-28-zkojeb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/577593/original/file-20240223-28-zkojeb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/577593/original/file-20240223-28-zkojeb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/577593/original/file-20240223-28-zkojeb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/577593/original/file-20240223-28-zkojeb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/577593/original/file-20240223-28-zkojeb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Electrocardiogram functions can now be incorporated into smartwatches.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/ekg-monitor-intra-aortic-balloon-pump-1936321450">Pitchyfoto/Shutterstock</a></span>
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<p>Smartwatches may have <a href="https://support.apple.com/en-us/HT208955">electrocardiogram (ECG) functions</a>. An ECG is a test used to check a person’s heart’s rhythm and electrical activity. Medical professionals have traditionally used ECGs to look for signs of coronary heart disease or other cardiovascular conditions. The same functions on a watch may not have the right sensitivity to pick up on medical conditions.</p>
<p>The latest version of the <a href="https://www.apple.com/healthcare/docs/site/Apple_Watch_Arrhythmia_Detection.pdf">Apple watch has embedded sensors</a> that may be able to <a href="https://www.nhs.uk/conditions/atrial-fibrillation/">detect atrial fibrillation</a>, a type of irregular heart rhythm. In the US, <a href="https://www.apple.com/newsroom/2022/06/watchos-9-delivers-new-ways-to-stay-connected-active-and-healthy/">Apple has obtained clearance</a> from the Food and Drug Administration (FDA) <a href="https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K213971">allowing it to be used</a> for this purpose, marking a bold move into the regulated medicine and healthcare space.</p>
<p>Biosensors, previously thought of as devices that were <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4986445/">administered only in clinical settings</a> have now evolved by design into slim patches for consumer use. Take the <a href="https://nixbiosensors.com/">Nix Biosensor device</a>. When paired with Apple Watches, it is designed to measure a user’s optimal <a href="https://www.theverge.com/23582865/nix-hydration-biosensor-review-wearables-hydration">hydration level</a> in real time by identifying molecular markers in sweat and determining the loss of fluid and electrolytes (substances that maintain a balance of fluids inside and outside cells). </p>
<p>Finally, emerging trends also indicate that more and more women are relying on fertility and cycle trackers in smartwatches and sophisticated apps. However, there have been concerns that users might use the information <a href="https://www.wired.com/story/apple-watch-fertility-features-not-birth-control/">in place of actual birth control</a>.</p>
<p>Hence, as smartwatches and trackers evolve, it’s possible that they may approach the threshold for what authorities could consider a medical device.</p>
<h2>Privacy protections</h2>
<p>There’s something else to consider too. Users of devices and digital tools regularly hand over their personal data. Businesses must ensure compliance with the <a href="https://ico.org.uk/for-organisations/data-protection-and-the-eu/data-protection-and-the-eu-in-detail/the-uk-gdpr/">UK General Data Protection Regulation (UK GDPR)</a> and the <a href="https://www.legislation.gov.uk/ukpga/2018/12/contents/enacted">Data Protection Act 2018 (DPA)</a>.</p>
<p>Personal health data is a “special category of data”. This would fall under the application of Articles 6 and 9 of the UK GDPR and Schedule 1 of the DPA. This means that more stringent standards are imposed for the collection and use of such data (in its processing), including potentially an obligation to conduct an extensive data impact assessment. </p>
<p>Indeed, the UK’s privacy watchdog, the Information Commissioner’s Office (ICO) <a href="https://ico.org.uk/about-the-ico/media-centre/news-and-blogs/2024/02/ico-urges-all-app-developers-to-prioritise-privacy/">issued a statement</a> on February 8 2024 reminding all app developers to ensure they protect users’ privacy following the regulator’s review of period and fertility apps. </p>
<p>Other potential safeguards for users’ privacy could come from the <a href="https://www.legislation.gov.uk/ukpga/2021/3/contents">Medicines and Medical Devices Act 2021 (MMDA)</a>, from the appointment of the <a href="https://www.patientsafetycommissioner.org.uk/">Patient Safety Commissioner</a> and from the National Health Service (NHS), which can now evaluate digital tools using the <a href="https://transform.england.nhs.uk/key-tools-and-info/digital-technology-assessment-criteria-dtac/">digital technology assessment criteria (DTAC)</a>.</p>
<p>Clear guidelines in this area are not just necessary, they’re imperative. Without them, we potentially risk both stifling innovation and compromising user care.</p><img src="https://counter.theconversation.com/content/223995/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Pin Lean Lau does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Medical devices have a legal definition, but the lines might become blurred in future.Pin Lean Lau, Senior Lecturer (Associate Professor) in Bio-Law, Brunel University LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2230082024-02-21T03:45:57Z2024-02-21T03:45:57ZWhy do I keep getting urinary tract infections? And why are chronic UTIs so hard to treat?<figure><img src="https://images.theconversation.com/files/576612/original/file-20240219-26-qkb5eg.jpg?ixlib=rb-1.1.0&rect=209%2C473%2C7139%2C4429&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-tired-young-tattooed-business-woman-1703410366">BAZA Productions/Shutterstock</a></span></figcaption></figure><p>Dealing with chronic urinary tract infections (UTIs) means facing more than the occasional discomfort. It’s like being on a never ending battlefield against an unseen adversary, making simple daily activities a trial.</p>
<p>UTIs happen when bacteria sneak into the urinary system, causing pain and frequent trips to the bathroom. </p>
<p>Chronic UTIs take this to the next level, coming back repeatedly or never fully going away despite treatment. <a href="https://www.ncbi.nlm.nih.gov/books/NBK557479/">Chronic UTIs</a> are typically diagnosed when a person experiences two or more infections within six months or three or more within a year.</p>
<p>They can happen to anyone, but some are more prone due to their <a href="https://www.urologyhealth.org/urology-a-z/u/urinary-tract-infections-in-adults">body’s makeup or habits</a>. Women are more likely to get UTIs than men, due to their shorter urethra and hormonal changes during menopause that can decrease the protective lining of the urinary tract. Sexually active people are also at greater risk, as bacteria can be transferred around the area.</p>
<p>Up to <a href="https://www.urologyhealth.org/urology-a-z/u/urinary-tract-infections-in-adults#Related%20Resources">60% of women</a> will have at least one UTI in their lifetime. While effective treatments exist, <a href="https://www.health.harvard.edu/bladder-and-bowel/when-urinary-tract-infections-keep-coming-back#:%7E:text=Your%20urine%20might%20be%20cloudy,they%20take%20on%20your%20life.">about 25%</a> of women face recurrent infections within six months. Around <a href="https://sciendo.com/article/10.33073/pjm-2019-048?tab=article">20–30%</a> of UTIs don’t respond to standard antibiotic. The challenge of chronic UTIs lies in bacteria’s ability to shield themselves against treatments.</p>
<h2>Why are chronic UTIs so hard to treat?</h2>
<p>Once thought of as straightforward infections cured by antibiotics, we now know chronic UTIs are complex. The cunning nature of the bacteria responsible for the condition allows them to hide in bladder walls, out of antibiotics’ reach. </p>
<p>The bacteria form biofilms, a kind of protective barrier that makes them nearly impervious to standard antibiotic treatments. </p>
<p>This ability to evade treatment has led to a troubling <a href="https://theconversation.com/rising-antibiotic-resistance-in-utis-could-cost-australia-1-6-billion-a-year-by-2030-heres-how-to-curb-it-149543">increase in antibiotic resistance</a>, a global health concern that renders some of the conventional treatments ineffective.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-do-bacteria-actually-become-resistant-to-antibiotics-213451">How do bacteria actually become resistant to antibiotics?</a>
</strong>
</em>
</p>
<hr>
<figure class="align-center ">
<img alt="Underpants hanging on a clothesline" src="https://images.theconversation.com/files/576616/original/file-20240219-28-iawpj7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/576616/original/file-20240219-28-iawpj7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/576616/original/file-20240219-28-iawpj7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/576616/original/file-20240219-28-iawpj7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/576616/original/file-20240219-28-iawpj7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/576616/original/file-20240219-28-iawpj7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/576616/original/file-20240219-28-iawpj7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some antibiotics no longer work against UTIs.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/womens-underwear-hangs-on-clothesline-687500683">Michael Ebardt/Shutterstock</a></span>
</figcaption>
</figure>
<p>Antibiotics need to be advanced to keep up with evolving bacteria, in a similar way to the flu vaccine, which is updated annually to combat the latest strains of the flu virus. If we used the same flu vaccine year after year, its effectiveness would wane, just as overused antibiotics lose their power against bacteria that have adapted. </p>
<p>But fighting bacteria that resist antibiotics is much tougher than updating the flu vaccine. Bacteria change in ways that are harder to predict, making it more challenging to create new, effective antibiotics. It’s like a never-ending game where the bacteria are always one step ahead.</p>
<p>Treating chronic UTIs still relies heavily on antibiotics, but doctors are getting crafty, changing up medications or prescribing low doses over a longer time to outwit the bacteria. </p>
<p>Doctors are also placing a greater emphasis on thorough diagnostics to accurately identify chronic UTIs from the outset. By asking detailed questions about the duration and frequency of symptoms, health-care providers can better distinguish between isolated UTI episodes and chronic conditions. </p>
<p>The approach to initial treatment can significantly influence the likelihood of a UTI becoming chronic. Early, targeted therapy, based on the specific bacteria causing the infection and its antibiotic sensitivity, may reduce the risk of recurrence. </p>
<p>For post-menopausal women, <a href="https://link.springer.com/article/10.1007/s00192-020-04397-z">estrogen therapy</a> has shown promise in reducing the risk of recurrent UTIs. After menopause, the decrease in estrogen levels can lead to changes in the urinary tract that makes it more susceptible to infections. This treatment restores the balance of the vaginal and urinary tract environments, making it less likely for UTIs to occur.</p>
<p>Lifestyle changes, such as <a href="https://journals.lww.com/co-nephrolhypertens/FullText/2013/05001/Impact_of_fluid_intake_in_the_prevention_of.1.aspx">drinking more water</a> and practising good hygiene like washing hands with soap after going to the toilet and the recommended front-to-back wiping for women, also play a big role. </p>
<p>Some swear by cranberry juice or supplements, though researchers are still figuring out <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001322.pub2/full">how effective these remedies truly are</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cranberry-juice-can-prevent-recurrent-utis-but-only-for-some-people-203926">Cranberry juice can prevent recurrent UTIs, but only for some people</a>
</strong>
</em>
</p>
<hr>
<h2>What treatments might we see in the future?</h2>
<p>Scientists are currently working on new treatments for chronic UTIs. One promising avenue is the development of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10052183/pdf/pathogens-12-00359.pdf">vaccines</a> aimed at preventing UTIs altogether, much like flu shots prepare our immune system to fend off the flu. </p>
<figure class="align-center ">
<img alt="Gynaecologist talks to patient" src="https://images.theconversation.com/files/576617/original/file-20240219-16-qgkamv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/576617/original/file-20240219-16-qgkamv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/576617/original/file-20240219-16-qgkamv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/576617/original/file-20240219-16-qgkamv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/576617/original/file-20240219-16-qgkamv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/576617/original/file-20240219-16-qgkamv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/576617/original/file-20240219-16-qgkamv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Emerging treatments could help clear chronic UTIs.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/gynecologist-talks-patient-during-medical-consultation-2298674535">guys_who_shoot/Shutterstock</a></span>
</figcaption>
</figure>
<p>Another new method being looked at is called <a href="https://link.springer.com/article/10.1007/s12223-019-00750-y">phage therapy</a>. It uses special viruses called bacteriophages that go after and kill only the bad bacteria causing UTIs, while leaving the good bacteria in our body alone. This way, it doesn’t make the bacteria resistant to treatment, which is a big plus. </p>
<p>Researchers are also exploring the potential of <a href="https://www.mdpi.com/2079-6382/12/1/167">probiotics</a>. Probiotics introduce beneficial bacteria into the urinary tract to out-compete harmful pathogens. These good bacteria work by occupying space and resources in the urinary tract, making it harder for harmful pathogens to establish themselves. </p>
<p>Probiotics can also produce substances that inhibit the growth of harmful bacteria and enhance the body’s immune response.</p>
<p>Chronic UTIs represent a stubborn challenge, but with a mix of current treatments and promising research, we’re getting closer to a day when chronic UTIs are a thing of the past.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/phage-therapy-could-treat-some-drug-resistant-superbug-infections-but-comes-with-unique-challenges-207025">'Phage therapy' could treat some drug-resistant superbug infections, but comes with unique challenges</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/223008/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Iris Lim does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Chronic UTIs come back repeatedly or never fully go away despite treatment.Iris Lim, Assistant Professor, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2225132024-02-19T19:04:30Z2024-02-19T19:04:30ZHow long does back pain last? And how can learning about pain increase the chance of recovery?<figure><img src="https://images.theconversation.com/files/576603/original/file-20240219-18-edti6b.jpg?ixlib=rb-1.1.0&rect=60%2C60%2C6639%2C4406&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/upset-mature-woman-suffering-backache-after-1504807832">fizkes/Shutterstock</a></span></figcaption></figure><p>Back pain is common. One in thirteen people have it right now and worldwide a staggering 619 million people will <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186678/">have it this year</a>.</p>
<p>Chronic pain, of which back pain is the most common, is the world’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186678/">most disabling</a> health problem. Its economic impact <a href="https://www.ncbi.nlm.nih.gov/books/NBK92510/">dwarfs other health conditions</a>. </p>
<p>If you get back pain, how long will it take to go away? We scoured the scientific literature to <a href="https://www.cmaj.ca/content/cmaj/196/2/E29.full.pdf">find out</a>. We found data on almost 20,000 people, from 95 different studies and split them into three groups: </p>
<ul>
<li>acute – those with back pain that started less than six weeks ago</li>
<li>subacute – where it started between six and 12 weeks ago</li>
<li>chronic – where it started between three months and one year ago. </li>
</ul>
<p>We found 70%–95% of people with acute back pain were likely to recover within six months. This dropped to 40%–70% for subacute back pain and to 12%–16% for chronic back pain.</p>
<p>Clinical guidelines point to graded return to activity and pain education under the guidance of a health professional as the best ways to promote recovery. Yet these effective interventions are underfunded and hard to access.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-cognitive-functional-therapy-how-can-it-reduce-low-back-pain-and-get-you-moving-207009">What is cognitive functional therapy? How can it reduce low back pain and get you moving?</a>
</strong>
</em>
</p>
<hr>
<h2>More pain doesn’t mean a more serious injury</h2>
<p>Most acute back pain episodes are <a href="https://www.racgp.org.au/getattachment/75af0cfd-6182-4328-ad23-04ad8618920f/attachment.aspx">not caused</a> by serious injury or disease.</p>
<p>There are rare exceptions, which is why it’s wise to see your doctor or physio, who can check for signs and symptoms that warrant further investigation. But unless you have been in a significant accident or sustained a large blow, you are unlikely to have caused much damage to your spine. </p>
<figure class="align-center ">
<img alt="Factory worker deep-breathes with a sore back" src="https://images.theconversation.com/files/575505/original/file-20240214-24-yvwksc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575505/original/file-20240214-24-yvwksc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575505/original/file-20240214-24-yvwksc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575505/original/file-20240214-24-yvwksc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575505/original/file-20240214-24-yvwksc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575505/original/file-20240214-24-yvwksc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575505/original/file-20240214-24-yvwksc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Your doctor or physio can rule out serious damage.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/asian-man-worker-warehouse-have-accident-2181811499">DG fotostock/Shutterstock</a></span>
</figcaption>
</figure>
<p>Even very minor back injuries can be brutally painful. This is, in part, because of how we are made. If you think of your spinal cord as a very precious asset (which it is), worthy of great protection (which it is), a bit like the crown jewels, then what would be the best way to keep it safe? Lots of protection and a highly sensitive alarm system.</p>
<p>The spinal cord is protected by strong bones, thick ligaments, powerful muscles and a highly effective alarm system (your nervous system). This alarm system can trigger pain that is so unpleasant that you cannot possibly think of, let alone do, anything other than seek care or avoid movement. </p>
<p>The messy truth is that when pain persists, the pain system becomes more sensitive, so a widening array of things contribute to pain. This pain system hypersensitivity is a result of neuroplasticity – your nervous system is becoming better at making pain. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-pain-and-what-is-happening-when-we-feel-it-49040">Explainer: what is pain and what is happening when we feel it?</a>
</strong>
</em>
</p>
<hr>
<h2>Reduce your chance of lasting pain</h2>
<p>Whether or not your pain resolves is not determined by the extent of injury to your back. We don’t know all the factors involved, but we do know there are things that you can do to reduce chronic back pain:</p>
<ul>
<li><p>understand how pain really works. This will involve intentionally learning about modern pain science and care. It will be difficult but rewarding. It will help you work out what you can do to change your pain </p></li>
<li><p>reduce your pain system sensitivity. With guidance, patience and persistence, you can learn how to gradually retrain your pain system back towards normal.</p></li>
</ul>
<h2>How to reduce your pain sensitivity and learn about pain</h2>
<p>Learning about “how pain works” provides the most sustainable <a href="https://www.bmj.com/content/376/bmj-2021-067718">improvements in chronic back pain</a>. Programs that combine pain education with graded brain and body exercises (gradual increases in movement) can reduce pain system sensitivity and help you return to the life you want. </p>
<figure class="align-center ">
<img alt="Physio helps patient use an exercise strap" src="https://images.theconversation.com/files/575501/original/file-20240214-22-gzb0hs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575501/original/file-20240214-22-gzb0hs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575501/original/file-20240214-22-gzb0hs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575501/original/file-20240214-22-gzb0hs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575501/original/file-20240214-22-gzb0hs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=506&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575501/original/file-20240214-22-gzb0hs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=506&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575501/original/file-20240214-22-gzb0hs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=506&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some programs combine education with gradual increases in movement.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-physiotherapist-exercising-senior-patient-physic-2130321380">Halfpoint/Shutterstock</a></span>
</figcaption>
</figure>
<p>These programs have been in development for years, but high-quality clinical trials <a href="https://jamanetwork.com/journals/jama/fullarticle/2794765">are now emerging</a> and it’s good news: they show most people with chronic back pain improve and many completely recover.</p>
<p>But most clinicians aren’t equipped to deliver these effective programs – <a href="https://www.jpain.org/article/S1526-5900(23)00618-1/fulltext">good pain education</a> is not taught in most medical and health training degrees. Many patients still receive ineffective and often risky and expensive treatments, or keep seeking temporary pain relief, hoping for a cure. </p>
<p>When health professionals don’t have adequate pain education training, they can deliver bad pain education, which leaves patients feeling like they’ve just <a href="https://www.jpain.org/article/S1526-5900(23)00618-1/fulltext">been told it’s all in their head</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/opioids-dont-relieve-acute-low-back-or-neck-pain-and-can-result-in-worse-pain-new-study-finds-203244">Opioids don't relieve acute low back or neck pain – and can result in worse pain, new study finds</a>
</strong>
</em>
</p>
<hr>
<p>Community-driven not-for-profit organisations such as <a href="https://www.painrevolution.org/">Pain Revolution</a> are training health professionals to be good pain educators and raising awareness among the general public about the modern science of pain and the best treatments. Pain Revolution has partnered with dozens of health services and community agencies to train more than <a href="https://www.painrevolution.org/find-a-lpe">80 local pain educators</a> and supported them to bring greater understanding and improved care to their colleagues and community. </p>
<p>But a broader system-wide approach, with government, industry and philanthropic support, is needed to expand these programs and fund good pain education. To solve the massive problem of chronic back pain, effective interventions need to be part of standard care, not as a last resort after years of increasing pain, suffering and disability.</p><img src="https://counter.theconversation.com/content/222513/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Wallwork receives payments for lectures on pain and rehabilitation. Sarah was funded by an NHMRC Investigator Grant awarded to GL Moseley (ID 1178444).</span></em></p><p class="fine-print"><em><span>Lorimer Moseley has received support from: Reality Health, ConnectHealth UK, Institutes of Health California, AIA Australia, Workers’ Compensation Boards and professional sporting organisations in Australia, Europe, South and North America. Professional and scientific bodies have reimbursed him for travel costs related to presentation of research on pain and pain education at scientific conferences/symposia. He has received speaker fees for lectures on pain, pain education and rehabilitation. He receives royalties for books on pain and pain education. He is non-paid CEO of the non-profit Pain Revolution, an unpaid Director of Painaustralia and an unpaid Director of Australian Pain Solutions Research Alliance.</span></em></p>Back pain is common. One in thirteen people have it right now and worldwide a staggering 619 million people will have it this year. Chronic pain, of which back pain is the most common, is the world’s most…Sarah Wallwork, Post-doctoral Researcher, University of South AustraliaLorimer Moseley, Professor of Clinical Neurosciences and Foundation Chair in Physiotherapy, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2235282024-02-19T13:44:01Z2024-02-19T13:44:01ZLung cancer: Predicting which patients are at high risk of recurrence to improve outcomes<figure><img src="https://images.theconversation.com/files/575433/original/file-20240205-29-abkjt8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Chemotherapy is used to treat all lung cancer patients. Yet many would not need such invasive treatment if diagnosis of the risk of recurrence were more refined. A new technology could change all that.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Lung cancer <a href="https://cancer.ca/en/research/cancer-statistics/cancer-statistics-at-a-glance">is responsible for more deaths than breast, colon and prostate cancer combined</a>. </p>
<p>With advancements in lung cancer screening, it is expected that more patients will be diagnosed at earlier stages, enabling them to undergo surgery, the primary treatment modality for early-stage patients.</p>
<p>However, a significant proportion of patients will have a recurrence of their cancer after resection (surgery to remove the tumour). Unfortunately, current clinical guidelines cannot help predict which patients are at risk. Better knowledge of who is at risk has significant implications for systemic therapy selection such as chemotherapy for early-stage lung cancer patients after surgery. </p>
<p>To find solutions to this problem, our research group at McGill University launched a project in collaboration with Université Laval. <a href="https://www.nature.com/articles/s41586-022-05672-3#MOESM1">Preliminary results were published in <em>Nature</em></a>. In our work we discovered that the use of a new imaging technology, along with artificial intelligence, could improve outcomes for cancer patients.</p>
<h2>Too much or too little intervention</h2>
<p>This clinical dilemma has important implications for the choice of treatment, such as chemotherapy. For example, lung cancer patients who are cured by surgery could be spared the toxicity of chemotherapy. Patients at risk of their cancer recurring could benefit from additional therapeutic interventions.</p>
<p>The challenge of predicting recurrence for patients with early-stage lung cancer has important implications for the 31,000 Canadians who are diagnosed with this terrible disease every year.</p>
<h2>Mass cytometry imaging</h2>
<p>To address this clinical problem, we used <a href="https://www.mcgill.ca/gci/facilities/single-cell-imaging-and-mass-cytometry-analysis-platform-scimap">imaging mass cytometry</a> (IMC), a new technology that allows for a comprehensive characterization of the tumour microenvironment. </p>
<p>The tumour microenvironment is a complex ecosystem composed of interactions between tumour cells, immune cells, and various structural cells. IMC can be used to visualize up to 50 markers at the cell surface, significantly more than was previously possible. </p>
<p>This technology makes it possible to identify different types of cells and determine their spatial organization, i.e. how they interact. IMC produces images that can be analyzed to determine the frequency of cell subpopulations, their activation states, the other cell types with which they interact and their organization in cellular communities. </p>
<p>The results of our study, published in <em>Nature</em>, reveal that various cell types can interact in cellular communities, and that communities composed of B cells were strongly associated with prolonged survival in lung cancer patients. Our study highlights that beyond cellular frequency, cellular interactions and spatial organization also correlate strongly with important clinical outcomes such as survival.</p>
<h2>Using artificial intelligence to make better predictions</h2>
<p>Based on our initial results, we hypothesized that important spatial features embedded within IMC images, such as cellular interactions, could be important in predicting clinical outcomes. </p>
<p>Our dataset of 416 patients and over 1.6 million cells provided sufficient power to make predictions using artificial intelligence. We sought to predict which patients with early-stage lung cancer would have a recurrence of their cancer after surgery. </p>
<p>Using 1 mm2 tumour samples, material readily available from surgical resections or biopsies, we used artificial intelligence algorithms together with IMC images to make our predictions. Our algorithm was able to predict with 95 per cent accuracy which patients would experience a cancer recurrence by using the spatial information contained within the images. </p>
<h2>Six markers can make all the difference</h2>
<p>One of the challenges in applying our results in a clinical setting is that IMC is not readily available. Clinical pathologists typically use less complex technologies such as immunofluorescence, which are often limited to three or fewer markers. </p>
<figure class="align-center ">
<img alt="image obtained using immunofluorescence" src="https://images.theconversation.com/files/573537/original/file-20240205-17-2oj4zm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/573537/original/file-20240205-17-2oj4zm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/573537/original/file-20240205-17-2oj4zm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/573537/original/file-20240205-17-2oj4zm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/573537/original/file-20240205-17-2oj4zm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/573537/original/file-20240205-17-2oj4zm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/573537/original/file-20240205-17-2oj4zm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Immunofluorescence image of a tumour treated with immunotherapy. This technology is often limited to the use of three or fewer markers at a time.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>To address this challenge, we sought to identify the minimum number of markers needed to make meaningful predictions about recurrence in lung cancer patients after surgery. By using six markers, we obtained an accuracy rate of 93 per cent, a result that is close to the 95 per cent accuracy rate obtained by using 35 markers. </p>
<p>These results suggest that by harnessing the power of artificial intelligence with existing technologies available in hospitals, we may be able to improve the post-surgical clinical management of patients with early-stage lung cancer. Our ultimate goal is to increase cure rates for those at high risk of cancer recurrence, while minimizing toxicity for those who can be cured by surgery.</p><img src="https://counter.theconversation.com/content/223528/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark Sorin has received funding from the Fonds de recherche du Québec and Vanier Canada Graduate Scholarships.</span></em></p><p class="fine-print"><em><span>Logan Walsh has received funding from McGill University's Interdisciplinary Infection and Immunity Initiative, the Brain Tumour Funders' Collaborative, the Canadian Institutes of Health Research (CIHR; PJT-162137), the Canada Foundation for Innovation and holds the Rosalind Goodman Research Chair in Lung Cancer.</span></em></p>Treatment for lung cancer patients is the same for everyone, regardless of the risk of recurrence. The use of a new technology could refine diagnosis.Mark Sorin, Étudiant au MD-PhD, chercheur en cancer du poumon, McGill UniversityLogan Walsh, Assistant Professor, Department of Human Genetics, McGill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2196132024-02-18T22:46:53Z2024-02-18T22:46:53ZNZ is bound by international mental health agreements – statistics for Māori show we’re failing to uphold them<p>Aotearoa New Zealand ranks among the highest in youth suicide rates among <a href="https://www.oecd.org/els/family/CO_4_4_Teenage-Suicide.pdf">OECD countries</a> – and it is Māori youth at the <a href="https://theconversation.com/maori-suicide-rates-remain-too-high-involving-whanau-more-in-coronial-inquiries-should-be-a-priority-217254">forefront of this national crisis</a>. </p>
<p><a href="https://www.tewhatuora.govt.nz/our-health-system/data-and-statistics/suicide-web-tool">Recent statistics</a> show the number of suspected self-inflicted deaths for Māori males is nearly double the rate for non-Māori males. The rate for Māori females is around 1.8 times higher than the rate for non-Māori females. </p>
<p>The alarming discrepancy is most notable in the 15-24 age group, where the rate for Māori is about 2.6 times higher than for non-Māori.</p>
<p>Despite these concerning figures, there is no express right to health in New Zealand law, creating a gap in accountability. And by failing to ensure the health and wellbeing of young Māori, Aotearoa New Zealand is falling short of its international obligations.</p>
<h2>Progress and retreat</h2>
<p>Over the past five years, the government has taken some steps to tackle the country’s mental health crisis. But the priorities of the new government could threaten this already limited progress.</p>
<p>In 2019, NZ$2 billion was <a href="https://www.beehive.govt.nz/release/taking-mental-health-seriously">injected into the mental health system</a> by the then Labour government. And the <a href="https://www.mhwc.govt.nz/">Mental Health Commission</a> was established in 2021 with the aim of contributing to better and equitable mental health and wellbeing outcomes for all people. </p>
<p>Te Aka Whai Ora, the Māori Health Authority, was established under the <a href="https://www.legislation.govt.nz/act/public/2022/0030/latest/LMS575405.html">Pae Ora (Healthy Futures) Act 2022</a>. But while the new coalition government has announced the country’s first ever <a href="https://www.beehive.govt.nz/minister/biography/matt-doocey">minister for mental health</a>, it has also announced plans to <a href="https://www.rnz.co.nz/news/political/507330/reti-confirms-transfer-of-decision-making-to-regions-is-among-health-priorities">scrap the authority</a>.</p>
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Read more:
<a href="https://theconversation.com/have-you-been-feeling-your-spirit-was-sad-culture-is-key-when-assessing-indigenous-australians-mental-health-119463">'Have you been feeling your spirit was sad?' Culture is key when assessing Indigenous Australians' mental health</a>
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<p>The <a href="https://www.platform.org.nz/assets/WorkDetail/Cross-Party-Report-Under-One-Umbrella-MHAC-Web-Accessible-FINALv.pdf">Under One Umbrella</a> report, published by the cross-party <a href="https://www.mhwc.govt.nz/news-and-resources/priority-on-youth-mental-health-strikes-a-chord/">Mental Health and Addiction Wellbeing Group</a>, presents a comprehensive, integrated approach to mental health, alcohol and addiction for young people. Significantly, it advocates for a holistic “all-of-government” approach. </p>
<p>Submissions from a <a href="https://www.health.govt.nz/our-work/mental-health-and-addiction/mental-health-legislation/repealing-and-replacing-mental-health-act">recent review</a> of the Mental Health Act show strong support for the new legislation to uphold rights in alignment with international conventions, with more focus on tangata whaiora (someone seeking health) and whānau (extended family). </p>
<p>Although these initiatives and pending legislative reform represent a step in the right direction, the statistics related to <a href="https://www.unicef.org.nz/media-releases/poor-mental-health-in-children-and-young-people-cannot-be-ignored-unicef">youth mental health</a> are still cause for concern. </p>
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<h2>International responsibilities to ensure health</h2>
<p>One strategy to address the national mental health crisis for Māori youth would be to embed the human right to health in local policy and law. This would also bring Aotearoa New Zealand’s legislation into line with its international obligations. </p>
<p>In 1946, the <a href="https://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf?ua=1">World Health Organization</a> adopted a broad definition of health:</p>
<blockquote>
<p>Health is a state of complete physical, mental, cultural and social wellbeing and not merely the absence of disease or infirmity. </p>
</blockquote>
<p>Over the course of the next two decades, health was conceived as a human right (in the <a href="https://www.un.org/en/about-us/universal-declaration-of-human-rights">Universal Declaration of Human Rights</a> and later in the <a href="https://www.ohchr.org/en/instruments-mechanisms/instruments/international-covenant-economic-social-and-cultural-rights">International Covenant on Economic Social and Cultural Rights</a>). </p>
<p>The <a href="https://www.ohchr.org/en/instruments-mechanisms/instruments/international-convention-elimination-all-forms-racial">International Convention on the Elimination of Racial Discrimination</a> also obliged countries to eliminate race discrimination in public health and medical care. </p>
<p>For children, the right to health is further recognised in the <a href="https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-rights-child">Convention on the Rights of the Child 1989</a>. And, specifically for Indigenous communities, in the <a href="https://www.un.org/development/desa/indigenouspeoples/wp-content/uploads/sites/19/2018/11/UNDRIP_E_web.pdf">United Nations Declaration on the Rights of Indigenous Peoples 2007</a>. </p>
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Read more:
<a href="https://theconversation.com/equity-in-health-care-improves-peoples-health-114910">Equity in health care improves people's health</a>
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<p>It is well established within <a href="https://www.un.org/development/desa/indigenouspeoples/wp-content/uploads/sites/19/2018/11/UNDRIP_E_web.pdf">international law</a> that the right to health for Indigenous children and youth is linked to their distinct cultural, social and customary practices. </p>
<p>And various UN groups have <a href="https://www.ohchr.org/en/resources/educators/human-rights-education-training/e-general-comment-no-14-right-highest-attainable-standard-health-article-12-2000">repeatedly</a> <a href="https://documents-dds-ny.un.org/doc/UNDOC/GEN/G16/177/09/PDF/G1617709.pdf?OpenElement">emphasised</a> that Indigenous people have the right to receive culturally appropriate healthcare services that respect their traditional practices and medicines. </p>
<p>These groups have also urged countries to provide Indigenous communities with the necessary resources to design, deliver and control their own healthcare services. </p>
<h2>The need for a legal framework</h2>
<p><a href="https://www.justice.govt.nz/justice-sector-policy/constitutional-issues-and-human-rights/human-rights/international-human-rights/">Aotearoa New Zealand is bound</a> by these international agreements, and the rights and obligations that flow from them. Yet the right to health <a href="https://tikatangata.org.nz/human-rights-in-aotearoa/right-to-health">does not appear in our laws</a>, which leaves a void in accountability and enforcement. </p>
<p>This hinders the implementation of effective health policies for tamariki and rangatahi Māori (children and young people), particularly as it limits the legal avenues available for recourse when the system fails. </p>
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<strong>
Read more:
<a href="https://theconversation.com/its-despair-not-depression-thats-responsible-for-indigenous-suicide-108497">It's despair, not depression, that's responsible for Indigenous suicide</a>
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<p>The disparities in mental health outcomes point to an immediate national challenge facing Aotearoa New Zealand, which is to formulate an effective mental healthcare framework. </p>
<p>The most appropriate starting point is to include the right to health in national policy and legislation. This would align New Zealand’s national policies and laws with international norms. </p>
<p>It would also mandate the government to take active steps to ensure that the highest attainable standards of mental health and wellbeing for tamariki and rangtahi Māori are met.</p><img src="https://counter.theconversation.com/content/219613/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There is no express right to health in New Zealand law. But international agreements protecting Indigenous rights to health and wellbeing set the standard New Zealand should follow.Claire Breen, Professor of Law, University of WaikatoRobert Joseph, Associate Professor of Law, University of WaikatoThilini Karunaratne, PhD candidate/ Lawyer, University of WaikatoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2222442024-02-15T13:33:58Z2024-02-15T13:33:58ZNitazenes are a powerful class of street drugs emerging across the US<figure><img src="https://images.theconversation.com/files/574223/original/file-20240207-20-k3tcfe.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C7790%2C5217&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Nitazenes, like this powder sample, are a class of synthetic opioids more potent than morphine and fentanyl.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/alex-krotulski-associate-director-and-forensic-toxicologist-news-photo/1836064649">Joe Lamberti/The Washington Post via Getty Images</a></span></figcaption></figure><p><em><a href="https://bouldercounty.gov/news/emerging-drug-information-nitazenes/">Two deaths in Boulder County, Colorado, in 2023</a> are the latest in the U.S. to be blamed on the powerful class of synthetic opioids called nitazenes. Most health systems cannot detect nitazenes, so the exact number of overdoses is unknown, but they’re implicated in <a href="https://doi.org/10.7759/cureus.40736">more than 200 deaths</a> in Europe and North America since 2019, including <a href="https://cdn.theconversation.com/static_files/files/3058/Colorado_nitazenes.pdf?1707842742">11 in Colorado since 2021</a>. One of the two Boulder County deaths is linked to a new formulation called N-Desethyl etonitazene, which was <a href="https://www.cfsre.org/nps-discovery/monographs/n-desethyl-etonitazene">identified by a national laboratory</a>, and is thought to be the first related death.</em></p>
<p><em>The Conversation interviewed <a href="https://scholar.google.com/citations?hl=en&user=Ne94jgIAAAAJ">Dr. Christopher Holstege</a>, professor of emergency medicine and pediatrics at the University of Virginia School of Medicine and director of the Blue Ridge Poison Center, where opioid overdoses are increasing. He explains why nitazenes are so potent and deadly.</em></p>
<h2>What are nitazenes?</h2>
<p>Nitazenes are a class of synthetic opioids that contains more than 20 unique compounds, <a href="https://www.dea.gov/stories/2022/2022-06/2022-06-01/new-dangerous-synthetic-opioid-dc-emerging-tri-state-area">including isotonitazene</a>, which was first identified in 2019 and is known on the streets as ISO. It also includes protonitazene, metonitazene and etonitazene.</p>
<p>Nitazenes are psychoactive substances, or <a href="https://doi.org/10.1177%2F2045125320967197">“designer drugs,”</a> that aren’t controlled by any laws or conventions but <a href="https://www.unodc.org/LSS/Page/NPS">pose significant health risk</a> to the public. These substances have recently surfaced as illegal street drugs. </p>
<p>Researchers have relatively little information on how the human body reacts to nitazenes because the drugs have never gone through clinical trials. But lab tests show certain nitazenes could be <a href="https://doi.org/10.7759/cureus.40736">hundreds to thousands of times more potent</a> than morphine and 10 to 40 times stronger than fentanyl.</p>
<p>The U.S. Drug Enforcement Agency has classified many formulations of nitazenes as <a href="https://www.federalregister.gov/documents/2021/12/07/2021-26263/schedules-of-controlled-substances-temporary-placement-of-butonitazene-etodesnitazene-flunitazene">Schedule 1 drugs under the Controlled Substances Act</a>, meaning they have no medical use and have a high risk of abuse.</p>
<h2>When were nitazenes first developed?</h2>
<p>Nitazenes were initially <a href="https://www.deadiversion.usdoj.gov/drug_chem_info/benzimidazole-opioids.pdf">developed in the 1950s</a> by the pharmaceutical research laboratories of the Swiss chemical company CIBA Aktiengesellschaft. It synthesized numerous substances in the drug class to be used as painkillers. </p>
<p>However, nitazenes were never approved by the U.S. Food and Drug Administration <a href="https://doi.org/10.7759/cureus.40736">for medical use in humans</a>. They were nearly forgotten outside of specialized research circles until they reemerged as street drugs in 2019. As law enforcement has cracked down on other drugs such as fentanyl, illegal labs have used <a href="https://doi.org/10.7759/cureus.40736">historical pharmacology research</a> to formulate analogs of nitazenes as street drugs. </p>
<p>Since 2019, <a href="https://doi.org/10.1093%2Fjat%2Fbkab117">at least six formulas</a> have come from the original patent, but others, like the one detected in Boulder, are brand new. <a href="https://doi.org/10.1093%2Fjat%2Fbkab117">Specialized lab testing</a> is required to identify nitazenes in toxicology samples, and <a href="https://www.ccsa.ca/sites/default/files/2022-03/CCSA-CCENDU-Drug-Alert-Nitazenes-2022-en_0.pdf">fentanyl test strips can’t detect nitazene analogs</a>.</p>
<p>But since <a href="https://doi.org/10.1016/j.forsciint.2021.110686">first being detected</a>, nitazenes have been blamed for <a href="https://doi.org/10.7759/cureus.40736">200 drug-related overdose deaths</a> in Europe and the United States. Although nitazenes are now identified as illegal street drugs in numerous countries, many medical providers aren’t <a href="https://doi.org/10.7759/cureus.40736">even aware they exist</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/574225/original/file-20240207-21-5ih0d9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Blue pills on a black background" src="https://images.theconversation.com/files/574225/original/file-20240207-21-5ih0d9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/574225/original/file-20240207-21-5ih0d9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/574225/original/file-20240207-21-5ih0d9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/574225/original/file-20240207-21-5ih0d9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/574225/original/file-20240207-21-5ih0d9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/574225/original/file-20240207-21-5ih0d9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/574225/original/file-20240207-21-5ih0d9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Isotonitazene has shown up in pill form mixed with other drugs such as oxycodone.</span>
<span class="attribution"><a class="source" href="https://www.dea.gov/onepill/images">DEA</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>What types of nitazenes are showing up on the streets?</h2>
<p>Nitazene first appeared in 2019 in the Midwest as a <a href="https://www.federalregister.gov/documents/2023/08/18/2023-17778/schedules-of-controlled-substances-placement-of-metonitazene-in-schedule-i">white powdery substance</a> similar to cocaine. <a href="https://www.dea.gov/stories/2022/2022-06/2022-06-01/new-dangerous-synthetic-opioid-dc-emerging-tri-state-area">It later appeared</a> on the streets of Washington, D.C., as yellow, brown and white powders. Since 2022, the DEA has found other types of nitazenes in both <a href="https://www.federalregister.gov/documents/2023/10/25/2023-23379/schedules-of-controlled-substances-temporary-placement-of-n-desethyl-isotonitazene-and-n-piperidinyl">powder and blue tablet forms</a>.</p>
<p>Nitazenes are also <a href="https://www.federalregister.gov/documents/2023/10/25/2023-23379/schedules-of-controlled-substances-temporary-placement-of-n-desethyl-isotonitazene-and-n-piperidinyl">mixed with other street drugs</a> such as heroin and fentanyl and with fake oxycodone pills, without users knowing it. </p>
<p>The Justice Department has indicted several <a href="https://www.justice.gov/opa/pr/justice-department-announces-eight-indictments-against-china-based-chemical-manufacturing">companies in China</a>, alleging that they ship the raw chemicals to make nitazenes to Mexico and the U.S., where they get mixed by cartels and traffickers, then distributed on the streets.</p>
<h2>What are signs of a nitazene overdose?</h2>
<p>The toxic effects of nitazene resemble those associated with other classic opioids such as morphine and fentanyl and include small pupils and slowing of the respiratory and central nervous systems, which can lead to death.</p>
<p>Because of the potency of the nitazenes, symptoms can develop rapidly after someone is exposed, killing them before they can get medical care.</p>
<h2>Does naloxone counteract the effects of overdose?</h2>
<p>Naloxone, commonly <a href="https://theconversation.com/fda-approval-of-over-the-counter-narcan-is-an-important-step-in-the-effort-to-combat-the-us-opioid-crisis-198497">known as Narcan</a>, is <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7137a5.htm">reportedly effective</a> in reversing overdoses due to nitazene, but larger and <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7137a5.htm">multiple doses might be required</a>.</p><img src="https://counter.theconversation.com/content/222244/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christopher P. Holstege does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>An overdose death in Boulder County, Colorado, was linked to a powerful new formulation of a designer drug never approved for use in humans.Christopher P. Holstege, Professor of Emergency Medicine and Pediatrics, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2183062024-02-14T16:55:05Z2024-02-14T16:55:05ZNew study reveals four critical barriers to building healthier Canadian cities<p>Many streets around the globe are becoming increasingly inhospitable to children and the elderly due to compounding traffic and road safety concerns which <a href="https://doi.org/10.1080/15568318.2020.1858376">deter these groups from active transport, like walking or cycling</a>. The recent emphasis on designing cities that cater to the well-being of individuals from ages <a href="https://www.880cities.org/">eight to 80 isn’t just a catchy phrase, but a vital requirement to accommodate evolving demographic realities</a>.</p>
<p>Similarly, the concept of the <a href="https://doi.org/10.1007/s11524-023-00749-4">15-minute city</a> has garnered significant attention in recent years — <a href="https://theconversation.com/forget-the-conspiracies-15-minute-cities-will-free-us-to-improve-our-mental-health-and-wellbeing-200823">despite baseless conspiracies accusing local authorities of plotting to limit residents to a small radius around their homes</a>. </p>
<p>The 15-minute city is all about accessibility, time efficiency and expanding options for everyone, not just the most well-off. Achieving this goal, and designing healthier spaces, begins with a comprehensive understanding of how urban environments impact our health and well-being — along with a realistic look at the current barriers to healthier urban design. </p>
<p>Our <a href="https://www.medrxiv.org/content/10.1101/2023.12.05.23299446v1">recent research</a> — conducted with the help of research assistants Shanzey Ali and Agnes Fung and the City of Regina and Saskatchewan Health Authority and currently awaiting peer review — set out to understand these barriers.</p>
<h2>Designing better spaces</h2>
<p>Research shows that the layout of streets, access to grocery stores, choice of construction materials in dwelling design, and the distribution of public services <a href="https://doi.org/10.1016/S0140-6736(16)30066-6">all play pivotal roles in influencing our health and well-being</a>. </p>
<p>Neighbourhoods with accessible public and community spaces and social events have been shown to improve mental health, increase happiness, and offer a <a href="https://doi.org/10.1111/issj.12472">sense of belonging and community</a>. At the same time, readily accessible grocery stores, community gardens and farmers’ markets have been shown to <a href="https://doi.org/10.3390/ijerph18041943">enhance mental, social and physical health</a>. </p>
<p>So, how do we create built environments that are more beneficial? This is where urban planning comes in as municipal policy-makers develop and implement policies, which can alter the structure, use and regulations of public spaces in cities.</p>
<p>The intricate dance between urban planning and health has <a href="https://doi.org/10.1177/1078087406296390">deep historical roots</a>. The <a href="https://www.bbvaopenmind.com/en/science/leading-figures/john-snow-the-origin-new-medicine-time-of-cholera/">early use of sanitation and segregated zoning to control infectious disease outbreaks in the 19th century</a> is well established <a href="https://doi.org/10.1016/S0140-6736(16)30066-6">and these efforts continue to this day</a>. </p>
<p>Meanwhile, global agencies like the World Health Organization (WHO) and the United Nations (UN) have championed the integration of health and equity into urban governance. Indeed, the <a href="https://sdgs.un.org/goals/goal11">UN Sustainable Development Goal 11</a> aims for inclusive, resilient, safe and sustainable cities. Accordingly, cities are well positioned to safeguard population health and reduce health inequities in a changing climate.</p>
<h2>Day-to-day challenges</h2>
<p>So, why are we not seeing more urban design policies focused on residents’ health and well-being? Our findings shed light on four key issues.</p>
<p><strong>1 – A lack of shared understanding of health equity</strong></p>
<p>Policy makers lacked a shared understanding of health and equity which highlights the complexity of addressing health inequities and implementing effective policies. While the importance of physical and mental health was widely acknowledged, a glaring gap exists in the recognition of the <a href="https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1">social dimension of health</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/it-is-not-just-heat-waves-climate-change-is-also-a-crisis-of-disconnection-210594">It is not just heat waves — climate change is also a crisis of disconnection</a>
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<p>Policy-makers often struggled to find common ground on what constitutes health and equity, which hindered meaningful action. As one policy-maker noted: “I don’t think our (design) standards have ever really been looked at from that health perspective.”</p>
<p><strong>2 – The evidence is usually inaccessible</strong></p>
<p>While policy-makers acknowledged evidence (data) as an essential building block of policy making, they explained there are significant barriers to accessing it. Administrative roadblocks, such as a lack of co-ordination between, and within, provincial and municipal governments, can prevent access to crucial data needed for policy making. </p>
<p>Financial barriers, such as paywalls, can lock access to scientific studies. Meanwhile, technical barriers — including the use of jargon and overly-technical language by the academic community — can interfere with the accessibility of academic literature. </p>
<figure class="align-center ">
<img alt="A large building stands in the background with a field and flower beds in the foregound." src="https://images.theconversation.com/files/575443/original/file-20240213-20-uh97si.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575443/original/file-20240213-20-uh97si.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575443/original/file-20240213-20-uh97si.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575443/original/file-20240213-20-uh97si.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575443/original/file-20240213-20-uh97si.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575443/original/file-20240213-20-uh97si.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575443/original/file-20240213-20-uh97si.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The Legislative Assembly of Saskatchewan in the City of Regina, Sask. A lack of inter- and intra-governmental communication can inhibit free access to vital evidence and data across provincial and municipal governments.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>As one policy-maker put it: “There’s a lot of academic acumen that’s used and terminology, and it can be overwhelming, and nobody wants to walk out of a room and feel stupid.” As a result, sometimes the best approach is also not well understood by the municipal actors, creating greater need for knowledge translation and accessible research. </p>
<p><strong>3 – Government structures are fragmented</strong></p>
<p><a href="https://doi.org/10.1002/hpm.2846">A fragmented governance structure, marked by silo-ing, is another stumbling block</a>. This lack of co-ordination among different branches and divisions within a municipality can result in missed opportunities for collaboration. Differences in the use of terminology can exacerbate the problem, causing confusion and impeding cross-sectoral work. </p>
<p>Conflicts between the objectives of various divisions, such as those between active transportation planners and traffic engineers, underscore the challenges posed by siloed governance. As one policy-maker noted: “There were lots of policies that we seem to put in place that very much favour the movement of vehicles over the movement of pedestrians, cyclists”.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/how-arctic-landscapes-and-canadian-cityscapes-share-a-similar-pattern-213707">How Arctic landscapes and Canadian cityscapes share a similar pattern</a>
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<p>Adding complexity to the mix is the <a href="https://doi.org/10.1177/1078087416684380">limited legal power of local governments in Canada</a>. Deemed “creatures of the province,” municipalities can only exercise powers delegated to them by provincial governments – meaning municipal powers can be modified or revoked theoretically at will. </p>
<p>The ambiguity surrounding the roles and responsibilities of municipalities versus the provincial government creates tension and incurs costs, as municipalities grapple with disagreements over whose jurisdiction certain issues fall under. Most often, this results in funding decisions that impact healthy urban design. </p>
<p><strong>4 – Political ideologies get in the way</strong></p>
<p>Beyond bureaucratic challenges, differing political ideologies present a formidable barrier.</p>
<p>The integration of health in urban design is rooted in the idea of collectivism, which aims to maximize benefits to the community as a whole. While the current favouring of car-centric roads in most areas reflects a libertarian individualism at odds with collective ideals in urban design.</p>
<p>This imbalance is especially striking when one considers the <a href="https://thediscourse.ca/scarborough/full-cost-commute">considerably higher costs to society of driving over walking or biking</a>.</p>
<p>Policy-makers noted that these political ideologies permeate public perception, resulting in resistance to policies perceived as infringing on individual liberties — while policies benefiting only a minority face opposition if they entail personal drawbacks. </p>
<p>We found this issue was exemplified by a fierce resistance to proposals for safer conditions for sex workers by those who wanted them to remain in out-of-sight areas.</p>
<h2>Overcoming these barriers</h2>
<p>The journey towards creating healthier and more equitable cities is riddled with challenges. From a lack of shared understanding, to inaccessible evidence, fragmented governance and legal limitations of municipalities and differing political ideologies, the barriers are multifaceted. However, understanding these challenges is the first step towards meaningful change. </p>
<p>By fostering collaboration, restructuring governance, empowering local governments, and promoting a collective mindset, we can pave the way for more effective integration of health into urban policies that truly support the well-being of communities at large.</p><img src="https://counter.theconversation.com/content/218306/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Akram Mahani holds funding from SHRF (Saskatchewan Health Research Foundation) and CIHR (Canadian Institutes of Health Research). This project was funded by SHRF Align program. </span></em></p><p class="fine-print"><em><span>Nazeem Muhajarine receives funding from the Canadian Institutes of Health Research and the Social Sciences and Humanities Research Council of Canada. He is affiliated with the Saskatchewan Population Health and Evaluation Research Unit and is a fellow of the Canadian Academy of Health Sciences. </span></em></p><p class="fine-print"><em><span>Joonsoo Sean Lyeo does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Canada’s cities must be planned around resident
health and well-being, our research reveals the key barriers to developing truly healthy cities.Akram Mahani, Assistant Professor at Johnson Shoyama Graduate School of Public Policy, University of ReginaJoonsoo Sean Lyeo, Research Associate, Dalla Lana School of Public Health, University of TorontoNazeem Muhajarine, Professor, Department of Community Health and Epidemiology and Director, Saskatchewan Population Health and Evaluation Research Unit, University of SaskatchewanLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2222802024-02-13T19:08:35Z2024-02-13T19:08:35ZA patch a day? Why the vitamin skin patches spruiked on social media might not be for you<figure><img src="https://images.theconversation.com/files/573945/original/file-20240207-18-9hjka6.jpg?ixlib=rb-1.1.0&rect=26%2C26%2C5824%2C4149&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/capsules-on-light-beige-top-view-2193561733">Shutterstock</a></span></figcaption></figure><p>Vitamin patches are <a href="https://www.tiktok.com/search?lang=en&q=vitamin%20patch&t=1707260917256">trending on social media</a> and advertised in <a href="https://www.instagram.com/reel/C0VBXJOrObo/">posts</a> and podcasts. </p>
<p>With patches marketed for sleep, detox, immunity and hangovers, they are being talked up as near magical fix-all stickers. Manufacturers claim they are easy-to-use, convenient and ethical when compared with other types of vitamin products. Some even come with <a href="https://www.vogue.com/article/barriere-vitamin-patches">cute floral designs</a>.</p>
<p>So do they work, are they safe, and why would you use one instead of just taking a vitamin tablet? </p>
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Read more:
<a href="https://theconversation.com/should-i-be-getting-my-vitamin-d-levels-checked-211268">Should I be getting my vitamin D levels checked?</a>
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<h2>What are vitamin patches?</h2>
<p>Vitamin patches are adhesives designed to deliver vitamins or nutrients to your bloodstream directly through the skin.</p>
<p>You peel away the backing, place it on a hairless area of skin where it is less likely to be bumped, and then the patches release their vitamins over a period of 12 to 24 hours.</p>
<p>Two dominant <a href="https://thepatchremedy.com/">brands</a> that <a href="https://www.ultimatepatch.com.au/">market</a> in Australia sell patches that contain various chemical and plant ingredients. </p>
<p>There are patches for <a href="https://thepatchremedy.com/products/menopause">menopause symptoms</a> that claim to include plant extracts of gotu kola, damiana, black cohosh, valerian, skull cap, oat seed and ginger. Patches promising an <a href="https://www.ultimatepatch.com.au/products/energy-patch-vitamin-patches">energy boost</a> offer caffeine, taurine, gluconolactone, green tea extract and vitamins B3, B5 and B6. </p>
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Read more:
<a href="https://theconversation.com/can-taking-vitamins-and-supplements-help-you-recover-from-covid-182220">Can taking vitamins and supplements help you recover from COVID?</a>
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<h2>Do they work and are they safe?</h2>
<p>In Australia, vitamins are considered pharmaceutical products and are regulated by the Therapeutic Goods Administration. Vitamins are generally approved as listed medicines, meaning the ingredients have been assessed for safety but not for efficacy (whether they do what they promise).</p>
<p>Being a listed medicine also means vitamins are manufactured in a factory with <a href="https://www.tga.gov.au/how-we-regulate/manufacturing/manufacture-medicine/good-manufacturing-practice-gmp#:%7E:text=Good%20Manufacturing%20Practice%20(GMP)%20describes,into%20a%20batch%20of%20product">good manufacturing practices</a>, so you can be assured the ingredients listed on the packaging have been sourced properly and are provided at the correct concentration.</p>
<p>However, there are no items listed as vitamin patches on the Australian Register of Therapeutic Goods. This means they currently can not <a href="https://www.tga.gov.au/news/blog/how-are-vitamins-regulated-australia#:%7E:text=Depending%20on%20the%20vitamin%20and,their%20safety%20and%20quality%20only.">legally be supplied or purchased in Australia</a>. It doesn’t matter if they are being sold from a physical store or online within the country. The TGA won’t <a href="https://www.tga.gov.au/sites/default/files/australian-regulatory-guidelines-complementary-medicines-argcm.pdf">stop you from buying them from overseas</a>, but they advise you not to do so because you can’t be assured of quality and safety.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/573949/original/file-20240207-30-751n5r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="clear capsules being produced by machine" src="https://images.theconversation.com/files/573949/original/file-20240207-30-751n5r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/573949/original/file-20240207-30-751n5r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/573949/original/file-20240207-30-751n5r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/573949/original/file-20240207-30-751n5r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/573949/original/file-20240207-30-751n5r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/573949/original/file-20240207-30-751n5r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/573949/original/file-20240207-30-751n5r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Vitamins and supplements listed by the TGA are produced in factories with stringent quality standards.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/fish-oil-gelatin-capsules-production-vitamins-2299877737">Shutterstock</a></span>
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</figure>
<p>There is also insufficient evidence that vitamins delivered in this way work. Not all drugs and chemicals can be delivered through the skin. Ordinarily, to be absorbed through the skin a chemical needs to be <a href="https://www.merriam-webster.com/dictionary/lipophilic">lipophilic</a>, meaning it likes fats and oils more than water. </p>
<p>So, the form in which the vitamins have been produced and supplied will dictate whether they will get into the skin. For example, a water extract of a plant is less likely to be absorbed when compared with an oil-based extract.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/31302845/">A small 2019 study</a> of patients at risk of nutrient deficiencies after bariatric (weight-loss) surgery gave some of them a daily multivitamin patch for a year. Those patients had lower blood concentrations of several vitamins and were more likely to have vitamin D deficiency when compared with patients given oral vitamins. The study concluded transdermal vitamin patches were not as effective as oral supplements. </p>
<p>Another issue with vitamin patches is that they contain very low concentrations of ingredients and you may therefore get an ineffective dose, even if all the vitamin in the patch is 100% absorbed through the skin. </p>
<p>For example, one particular patch that is marketed for immunity states that it contains 3 milligrams of vitamin C, which is likely insufficient if taken to supplement a low vitamin C diet. The health condition called <a href="https://www.ncbi.nlm.nih.gov/books/NBK493187/">scurvy</a> is thought to occur when daily vitamin C intake drops lower than <a href="https://www.healthdirect.gov.au/vitamin-c-and-your-health">7 milligrams per day</a>. </p>
<p>In contrast, a typical vitamin C tablet contains 500 milligrams. The recommended daily intake of vitamin C is around <a href="https://www.healthdirect.gov.au/vitamin-c-and-your-health">45 milligrams per day</a> – more if a woman is breastfeeding. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/573947/original/file-20240207-22-3nunzy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="person puts clear patch on skin of upper arm" src="https://images.theconversation.com/files/573947/original/file-20240207-22-3nunzy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/573947/original/file-20240207-22-3nunzy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/573947/original/file-20240207-22-3nunzy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/573947/original/file-20240207-22-3nunzy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/573947/original/file-20240207-22-3nunzy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/573947/original/file-20240207-22-3nunzy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/573947/original/file-20240207-22-3nunzy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Nicotine patches work by providing a sustained release of the drug into the skin.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/nicotine-patch-on-skin-quitting-smoking-438277147">Shutterstock</a></span>
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Read more:
<a href="https://theconversation.com/is-tiktok-right-will-eating-three-carrots-a-day-really-give-me-a-natural-tan-214270">Is TikTok right – will eating three carrots a day really give me a natural tan?</a>
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<h2>Why not just take a tablet?</h2>
<p>When other medicines are supplied in a patch formulation it is usually because a constant supply of the drug is needed in the body; think smoking replacement nicotine patches, <a href="https://www.healthdirect.gov.au/hormone-replacement-therapy">menopausal hormone therapy</a> and some types of <a href="https://www.nps.org.au/radar/articles/fentanyl-patches-durogesic-for-chronic-pain">pain relief</a>.</p>
<p>There is no reason why you would need the slow release, continuous supply of vitamins that patches promise – but there may be other reasons to choose them over tablets and gummy products.</p>
<p>One selling point used by the marketers is that patches are a “cleaner” form of vitamins. A vitamin in tablet or gummy form will contain inactive ingredients called <a href="https://australianprescriber.tg.org.au/articles/pharmaceutical-excipients-where-do-we-begin.html">excipients</a>. Excipients do various tasks in medicines from binding ingredients together, making the medicine look and smell nice, to ensuring drugs don’t break down during storage. The presumption is that patches don’t contain and release any, or very few, excipients into your body. </p>
<p>But many patches don’t list all their ingredients – just the active vitamins – so this claim can not be tested. Some patches may still contain a large number of excipients, some of which may irritate the skin.</p>
<p>For example, one type of <a href="https://www.ebs.tga.gov.au/servlet/xmlmillr6?dbid=ebs/PublicHTML/pdfStore.nsf&docid=203285&agid=%28PrintDetailsPublic%29&actionid=1">nicotine patch</a> contains 12 excipients including acrylic acid and vinyl acetate, which are chemicals used to help stick the patch to the skin.</p>
<p>A patch may be worth investigating for people who have trouble swallowing or chewing. In this instance it could be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7810703/">difficult to take a solid tablet</a> or gummy to get your vitamins. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/paracetamol-versus-ibuprofen-which-works-best-and-when-207921">Paracetamol versus ibuprofen – which works best and when?</a>
</strong>
</em>
</p>
<hr>
<h2>Should you buy them?</h2>
<p>As there are no vitamin patches approved by the TGA in Australia, you should not buy them. </p>
<p>If at some point in the future they become listed medicines, it will be important to remember that they may not have been assessed for efficacy. </p>
<p>If you remain curious about vitamin patches, you should discuss them with your doctor or local pharmacist.</p><img src="https://counter.theconversation.com/content/222280/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nial Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is a Fellow of the Royal Australian Chemical Institute, a member of the Australasian Pharmaceutical Science Association, and a member of the Australian Institute of Company Directors. Nial is the chief scientific officer of Vaihea Skincare LLC, a director of SetDose Pty Ltd a medical device company, and a Standards Australia panel member for sunscreen agents. Nial regularly consults to industry on issues to do with medicine risk assessments, manufacturing, design, and testing.</span></em></p><p class="fine-print"><em><span>Jasmine Lee does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There are no vitamin patches listed on the Australian Register of Therapeutic Goods and there’s not enough evidence to show they work better than tablets.Nial Wheate, Associate Professor of the School of Pharmacy, University of SydneyJasmine Lee, Pharmacist and PhD Candidate, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2230042024-02-11T19:07:40Z2024-02-11T19:07:40ZHILDA survey at a glance: 7 charts reveal we’re smoking less, taking more drugs and still binge drinking<p>Australians’ vices, including drinking, smoking and illicit drugs, have been revealed in the latest <a href="https://melbourneinstitute.unimelb.edu.au/hilda/publications/hilda-statistical-reports">HILDA survey</a>.</p>
<p>The <a href="https://melbourneinstitute.unimelb.edu.au/hilda">Household, Income and Labour Dynamics in Australia survey tracks</a> the same 17,000 Australians each year, with participants followed over the course of their lifetime. The survey collects information on many facets of life and is the only study of its kind in Australia.</p>
<h2>Smoking is declining, but young people are more likely to vape</h2>
<p>There has been substantial progress in reducing smoking rates since 2001, when 25% of males and 20% of females aged 15 and over reported being smokers. In 2021, these rates had dropped to 16% for males and 12% for females. This likely reflects the effects of tobacco control measures, as well as increased public awareness of the harmful health effects of smoking.</p>
<p>Declines have been biggest for young people, which reflects the fact that it is easier to prevent the take-up of smoking than it is to get smokers to quit. Indeed, HILDA shows that over 60% of people who quit smoking take it up again within three years.</p>
<p><iframe id="QZYJ2" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/QZYJ2/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>The progress on reducing smoking appears to have been somewhat offset by the rise in vaping or using e-cigarettes. In 2021, 14.1% of people aged 15 and over reported having tried vaping, and 16% of these people vaped daily.</p>
<p>Vaping is very much a young person’s activity. It is most common among people aged 15 to 24, and also relatively common among people aged 25 to 29. Many people who report vaping also report being smokers.</p>
<p><iframe id="zHKVU" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/zHKVU/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<hr>
<h2>Binge drinking remains common, especially for young men</h2>
<p>Risky drinking, here defined as usually consuming five or more standard drinks on each occasion, is relatively common, applying to over 20% of males and about 10% of females who ever drink alcohol. </p>
<p>After rising slightly between 2003 and 2009, there has since been a small decline in this measure of risky drinking for males. There has been little change in this measure for females. </p>
<p>Another measure of risky drinking, presented in the figure, is “excessive binge drinking”, defined as drinking at least five (if female) or seven (if male) drinks per occasion at least twice per month. This measure of risky drinking is more prevalent, but it has declined for both males and females since 2007.</p>
<p><iframe id="hOh4n" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/hOh4n/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Risky drinking is most common among men aged 20 to 24, followed by men aged 25 to 29. However, for both males and females, <em>regular</em> (but not necessarily “risky”) consumption of alcohol (drinking on five or more days per week) is more common in older age groups, and highest among people aged 60 and over.</p>
<p><iframe id="ORe6u" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/ORe6u/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<hr>
<h2>30 to 34 year-olds had the largest increase in using drugs</h2>
<p>The HILDA survey shows use of illicit drugs, such as marijuana, methamphetamine and cocaine, increased between 2017 and 2021, with annual use increasing from 15.7% to 17.6% for males and from 8.6% to 11% for females.</p>
<p><iframe id="R1Byp" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/R1Byp/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>People aged 20 to 24 are the most likely to use illicit drugs, but the increase in use was greatest for people aged 30 to 34.</p>
<p><iframe id="fTNBL" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/fTNBL/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>The use of multiple types of illicit drugs, known as polydrug use, is common for users of methamphetamine, cocaine and ecstasy, but much less common for users of marijuana.</p>
<p><iframe id="sUmMT" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/sUmMT/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/hilda-data-show-womens-job-prospects-improving-relative-to-mens-and-the-covid-changes-might-have-helped-222897">HILDA data show women's job prospects improving relative to men's, and the COVID changes might have helped</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/223004/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Roger Wilkins receives funding from the Australian Research Council.</span></em></p>Some 17,000 people told us exactly how much they drank, smoked and used illicit drugs. Here’s a unique snapshot of Australians’ vices.Roger Wilkins, Professorial Fellow and Deputy Director (Research), HILDA Survey, Melbourne Institute of Applied Economic and Social Research, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2172872024-02-04T19:09:37Z2024-02-04T19:09:37ZHow much weight do you actually need to lose? It might be a lot less than you think<figure><img src="https://images.theconversation.com/files/572339/original/file-20240131-15-eetcro.jpg?ixlib=rb-1.1.0&rect=81%2C0%2C5381%2C3260&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/overweight-woman-drink-water-during-morning-1079331911">Flotsam/Shutterstock</a></span></figcaption></figure><p>If you’re one of the <a href="https://www.finder.com.au/new-years-resolutions-statistics">one in three</a> Australians whose New Year’s resolution involved losing weight, it’s likely you’re now contemplating what weight-loss goal you should actually be working towards. </p>
<p>But type “setting a weight loss goal” into any online search engine and you’ll likely be left with more questions than answers.</p>
<p>Sure, the many weight-loss apps and calculators available will make setting this goal seem easy. They’ll typically use a body mass index (BMI) calculator to confirm a “healthy” weight and provide a goal weight based on this range.</p>
<p>Your screen will fill with trim-looking influencers touting diets that will help you drop ten kilos in a month, or ads for diets, pills and exercise regimens promising to help you effortlessly and rapidly lose weight. </p>
<p>Most sales pitches will suggest you need to lose substantial amounts of weight to be healthy – making weight loss seem an impossible task. But the research shows you don’t need to lose a lot of weight to achieve health benefits. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/can-you-be-overweight-and-healthy-182219">Can you be overweight and healthy?</a>
</strong>
</em>
</p>
<hr>
<h2>Using BMI to define our target weight is flawed</h2>
<p>We’re a society fixated on numbers. So it’s no surprise we use measurements and equations to score our weight. The most popular is BMI, a measure of our body weight-to-height ratio. </p>
<p>BMI classifies bodies as underweight, normal (healthy) weight, overweight or obese and can be a useful tool for weight and health screening. </p>
<p>But it shouldn’t be used as the single measure of what it means to be a healthy weight when we set our weight-loss goals. This is <a href="https://theconversation.com/using-bmi-to-measure-your-health-is-nonsense-heres-why-180412">because</a> it: </p>
<ul>
<li><p>fails to consider two critical factors related to body weight and health – body fat percentage and distribution</p></li>
<li><p>does not account for significant differences in body composition based on gender, ethnicity and age.</p></li>
</ul>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1520959736476274690"}"></div></p>
<h2>How does losing weight benefit our health?</h2>
<p>Losing just 5–10% of our body weight – between 6 and 12kg for someone weighing 120kg – can significantly improve our health in four key ways.</p>
<p><strong>1. Reducing cholesterol</strong></p>
<p>Obesity increases the chances of having too much low-density lipoprotein (LDL) cholesterol – also known as bad cholesterol – because carrying excess weight changes how our bodies produce and manage lipoproteins and triglycerides, another fat molecule we use for energy.</p>
<p>Having too much bad cholesterol and high triglyceride levels is not good, narrowing our arteries and limiting blood flow, which increases the risk of heart disease, heart attack and stroke.</p>
<p>But <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4987606/">research</a> shows improvements in total cholesterol, LDL cholesterol and triglyceride levels are evident with just 5% weight loss.</p>
<p><strong>2. Lowering blood pressure</strong></p>
<p>Our blood pressure is considered high if it reads more than 140/90 on at least two occasions. </p>
<p>Excess weight is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082272/">linked to</a> high blood pressure in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082272/">several ways</a>, including changing how our sympathetic nervous system, blood vessels and hormones regulate our blood pressure.</p>
<p>Essentially, high blood pressure makes our heart and blood vessels work harder and less efficiently, damaging our arteries over time and increasing our risk of heart disease, heart attack and stroke. </p>
<figure class="align-center ">
<img alt="Older man takes his blood pressure at home" src="https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Losing weight can lower your blood pressure.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hypertension-older-age-senior-black-man-2066841269">Prostock-studio/Shutterstock</a></span>
</figcaption>
</figure>
<p>Like the improvements in cholesterol, a 5% weight loss <a href="https://onlinelibrary.wiley.com/doi/10.1002/oby.21358">improves</a> both systolic blood pressure (the first number in the reading) and diastolic blood pressure (the second number). </p>
<p>A <a href="https://www.ahajournals.org/doi/10.1161/01.hyp.0000094221.86888.ae">meta-analysis of 25 trials</a> on the influence of weight reduction on blood pressure also found every kilo of weight loss improved blood pressure by one point.</p>
<p><strong>3. Reducing risk for type 2 diabetes</strong></p>
<p>Excess body weight is the primary manageable risk factor for type 2 diabetes, particularly for people carrying a lot of visceral fat around the abdomen (belly fat).</p>
<p>Carrying this excess weight can cause fat cells to release pro-inflammatory chemicals that disrupt how our bodies regulate and use the insulin produced by our pancreas, leading to high blood sugar levels. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/can-i-actually-target-areas-to-lose-fat-like-my-belly-205203">Can I actually target areas to lose fat, like my belly?</a>
</strong>
</em>
</p>
<hr>
<p>Type 2 diabetes can lead to serious medical conditions if it’s not carefully managed, including damaging our heart, blood vessels, major organs, eyes and nervous system.</p>
<p><a href="https://www.nejm.org/doi/full/10.1056/nejmoa012512">Research</a> shows just 7% weight loss reduces risk of developing type 2 diabetes by 58%.</p>
<p><strong>4. Reducing joint pain and the risk of osteoarthritis</strong></p>
<p>Carrying excess weight can cause our joints to become inflamed and damaged, making us more prone to osteoarthritis. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/21425246/">Observational studies</a> show being overweight doubles a person’s risk of developing osteoarthritis, while obesity increases the risk fourfold.</p>
<p>Small amounts of weight loss alleviate this stress on our joints. <a href="https://pubmed.ncbi.nlm.nih.gov/15986358/">In one study</a> each kilogram of weight loss resulted in a fourfold decrease in the load exerted on the knee in each step taken during daily activities.</p>
<figure class="align-center ">
<img alt="Man on bathroom scales" src="https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Losing weight eases stress on joints.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/male-feet-on-scale-bathroom-1030174888">Shutterstock/Rostislav_Sedlacek</a></span>
</figcaption>
</figure>
<h2>Focus on long-term habits</h2>
<p>If you’ve ever tried to lose weight but found the kilos return almost as quickly as they left, you’re not alone.</p>
<p>An <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/">analysis</a> of 29 long-term weight-loss studies found participants regained more than half of the weight lost within two years. Within five years, they regained more than 80%.</p>
<p>When we lose weight, we take our body out of its comfort zone and trigger its survival response. It then counteracts weight loss, triggering several <a href="https://pubmed.ncbi.nlm.nih.gov/25896063/">physiological responses</a> to defend our body weight and “survive” starvation. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whats-the-weight-set-point-and-why-does-it-make-it-so-hard-to-keep-weight-off-195724">What's the 'weight set point', and why does it make it so hard to keep weight off?</a>
</strong>
</em>
</p>
<hr>
<p>Just as the problem is evolutionary, the solution is evolutionary too. Successfully losing weight long-term comes down to:</p>
<ul>
<li><p>losing weight in small manageable chunks you can sustain, specifically periods of weight loss, followed by periods of weight maintenance, and so on, until you achieve your goal weight </p></li>
<li><p>making gradual changes to your lifestyle to ensure you form habits that last a lifetime.</p></li>
</ul>
<p>Setting a goal to reach a healthy weight can feel daunting. But it doesn’t have to be a pre-defined weight according to a “healthy” BMI range. Losing 5–10% of our body weight will result in immediate health benefits.</p>
<p><em>At the Boden Group, Charles Perkins Centre, we are studying the science of obesity and running clinical trials for weight loss. You can <a href="https://redcap.sydney.edu.au/surveys/?s=RKTXPPPHKY">register here</a> to express your interest.</em></p><img src="https://counter.theconversation.com/content/217287/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Nick Fuller works for the University of Sydney and has received external funding for projects relating to the treatment of overweight and obesity. He is the author and founder of the Interval Weight Loss program.</span></em></p>Weight loss can seem like an impossible, unachievable task. But you don’t need to lose a lot of weight to start noticing the health benefits.Nick Fuller, Charles Perkins Centre Research Program Leader, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2217092024-01-30T13:35:00Z2024-01-30T13:35:00ZDog care below freezing − how to keep your pet warm and safe from cold weather, road salt and more this winter<figure><img src="https://images.theconversation.com/files/571552/original/file-20240125-22431-dyxkh4.jpg?ixlib=rb-1.1.0&rect=21%2C0%2C4715%2C3067&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Dogs get cold in the winter too, but there are things pet owners can do to help them feel comfortable. </span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/NYColdWeather/de8019836ce9475e91bf816b1401fa3b/photo?Query=dog%20in%20snow&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=310&digitizationType=Digitized&currentItemNo=NaN&vs=true&vs=true">AP Photo/David Duprey</a></span></figcaption></figure><p>Time outside with your dog in the spring, summer and fall can be lovely. Visiting your favorite downtown café on a cool spring morning, going to a favorite dog park on a clear summer evening or going on walks along a river when the leaves are changing color are all wonderful when the weather is favorable. But in much of the country, when winter rolls around, previously hospitable conditions can <a href="https://theconversation.com/is-winter-miserable-for-wildlife-108734">quickly turn chilly and dangerous</a> for people and pups alike. </p>
<p>Winter brings some unique challenges for dog owners, since dogs still need activity and socialization during colder seasons. Studies have shown that dog owners are almost 50% less likely to walk their dogs <a href="https://doi.org/10.3390/ani11113302">when the weather gets cold</a>. Knowing the basics of winter safety is critical to maintaining a healthy lifestyle for your dog. </p>
<p>I am an <a href="https://www.vetmed.ucdavis.edu/faculty/erik-olstad">assistant professor</a> at the University of California Davis School of Veterinary Medicine who weathered polar vortexes with my dog while living in Michigan early in my career. While I’ve since moved to sunny California, I’ve seen how quickly frigid temperatures can turn dangerous for pets.</p>
<h2>Breed and age differences</h2>
<p>Not all dogs have the same abilities to deal with cold weather. A short-coated dog like a Chihuahua is much more susceptible to the dangers of cold weather than a thick-coated husky. When the weather dips below 40 degrees Fahrenheit (4 degrees Celsius), the well-acclimated husky may be comfortable, whereas the Chihuahua would shiver and be at risk of hypothermia. </p>
<p>Additionally, if your dog is used to warm weather, but you decide to move to a colder region, the dog will need time to acclimate to that colder weather, even if they have a thick coat. </p>
<p>Age also affects cold-weather resilience. Puppies and elderly dogs can’t withstand the chill as well as other dogs, but every dog is unique – each may have individual health conditions or physical attributes that make them more or less resilient to cold weather. </p>
<h2>When is my dog too cold?</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/571548/original/file-20240125-29-dudlyh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A small dog wearing a thick, fluffy red coat." src="https://images.theconversation.com/files/571548/original/file-20240125-29-dudlyh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/571548/original/file-20240125-29-dudlyh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=441&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571548/original/file-20240125-29-dudlyh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=441&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571548/original/file-20240125-29-dudlyh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=441&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571548/original/file-20240125-29-dudlyh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=554&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571548/original/file-20240125-29-dudlyh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=554&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571548/original/file-20240125-29-dudlyh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=554&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Dog jackets can keep pets warm in the cold.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/WinterWeatherTexas/b82392611da74eb69750dd2a12c73817/photo?Query=dog%20jacket&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=320&digitizationType=Digitized&currentItemNo=1&vs=true&vs=true">AP Photo/David J. Phillip</a></span>
</figcaption>
</figure>
<p>Pet owners should be able to recognize the symptoms of a dog that is getting too cold. Dogs will shiver, and some may vocalize or whine. Dogs may resist putting their feet down on the cold ground, or burrow, or try to find warmth in their environment when they are uncomfortable. </p>
<p>Just like people, <a href="https://vcahospitals.com/know-your-pet/frostbite-in-dogs">dogs can get frostbite</a>. And just like people, the signs can take days to appear, making it hard to assess them in the moment. The most common sites for frostbite in dogs are their ears and the tips of their tails. Some of the initial signs of frostbite are skin discoloring, turning paler than normal, or purple, gray or even black; red, blistered skin; swelling; pain at the site; <a href="https://www.britannica.com/science/ulcer">or ulceration</a>.</p>
<p>Other <a href="https://vcahospitals.com/know-your-pet/frostbite-in-dogs">serious signs of hypothermia</a> include sluggishness or lethargy, and if you observe them, please visit your veterinarian immediately. A good rule to live by is if it is too cold for you, it is too cold for your dog. </p>
<p>Getting your dog a <a href="https://www.cnn.com/cnn-underscored/pets/best-winter-dog-coats-jackets">sweater or jacket</a> and <a href="https://www.akc.org/expert-advice/vets-corner/protect-dogs-paws-snow-ice-salt/">paw covers</a> can provide them with protection from the elements and keep them comfortable. Veterinarians also recommend closely monitoring your dog and limiting their time outside when the temperature nears the freezing point or drops below it.</p>
<h2>Road salt dangers</h2>
<p>Road salt that treats ice on streets and sidewalks <a href="https://www.cbc.ca/news/canada/kitchener-waterloo/ice-salt-toxic-for-pets-1.5020088">can also harm dogs</a>. When dogs walk on the salt, the sharp, rough edges of the salt crystals can irritate the sensitive skin on their paws. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/571542/original/file-20240125-19-4pvz2g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A fluffy dog sits in the snow wearing two cloth, polka dot paw covers." src="https://images.theconversation.com/files/571542/original/file-20240125-19-4pvz2g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/571542/original/file-20240125-19-4pvz2g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=559&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571542/original/file-20240125-19-4pvz2g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=559&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571542/original/file-20240125-19-4pvz2g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=559&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571542/original/file-20240125-19-4pvz2g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=703&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571542/original/file-20240125-19-4pvz2g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=703&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571542/original/file-20240125-19-4pvz2g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=703&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Paw covers for dogs can keep their feet warm and protected from road salt.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/PetsColdFeet/711807120a854c5787e5dfdaba307a44/photo?Query=dog%20boots&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=379&digitizationType=Digitized&currentItemNo=12&vs=true&vs=true">AP Photo/Jim Cole</a></span>
</figcaption>
</figure>
<p>Dogs will often lick their feet when they’re dirty, wet or irritated, and if they ingest any salt doing that, they may face GI upset, dehydration, kidney failure, seizures or even death. Even small amounts of pure salt can <a href="https://www.petpoisonhelpline.com/pet-tips/my-dog-ate-road-salt-will-they-be-okay/">disrupt critical body functions</a> in dogs.</p>
<p>Some companies make pet-safe salt, but in public it can be hard to tell what type of salt is on the ground. After walking your dog, wash off their feet or boots. You can also keep their paw fur trimmed to prevent snow from balling up or salt collecting in the fur. Applying a thin layer of petroleum jelly or <a href="https://www.akc.org/expert-advice/lifestyle/how-to-make-your-own-paw-balm-for-winter/">paw pad balm</a> to the skin of the paw pads can also help protect your pet’s paws from irritation.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/571553/original/file-20240125-28-o148ri.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A snowy sidewalk covered in tiny chunks of salt." src="https://images.theconversation.com/files/571553/original/file-20240125-28-o148ri.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571553/original/file-20240125-28-o148ri.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=376&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571553/original/file-20240125-28-o148ri.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=376&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571553/original/file-20240125-28-o148ri.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=376&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571553/original/file-20240125-28-o148ri.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=473&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571553/original/file-20240125-28-o148ri.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=473&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571553/original/file-20240125-28-o148ri.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=473&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Road salt can be harmful to dogs’ sensitive paws.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Road_salt_in_Moscow_01.jpg">Stolbovsky/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>Antifreeze risks</h2>
<p><a href="https://www.britannica.com/science/antifreeze-chemical-substance">Antifreeze, or ethylene glycol</a>, is in most vehicles to prevent the fluids from freezing when it gets cold out. Some people pour antifreeze into their toilets when away from their home to prevent the water in the toilet from freezing.</p>
<p>Antifreeze is an exceptionally dangerous chemical to dogs and cats, as it tastes sweet but can be deadly when ingested. If a pet ingests even a small amount of antifreeze, the substance causes a chemical cascade in their body that results in severe kidney damage. If left untreated, the pet may have <a href="https://www.petpoisonhelpline.com/pet-owner-blog/antifreeze-poisoning/">permanent kidney damage or die</a>.</p>
<p>There are safer antifreeze options on the market that use ingredients other than ethylene glycol. If your dog ingests antifreeze, please see your veterinarian immediately for treatment.</p>
<p>When temperatures dip below freezing, the best thing pet owners can do is keep the time spent outside as minimal as possible. Try some <a href="https://www.akc.org/expert-advice/lifestyle/great-indoor-games-to-play-with-your-dog/">indoor activities</a>, like hide-and-seek with low-calorie treats, fetch or even an interactive obstacle course. Food puzzles can also keep your dog mentally engaged during indoor time.</p>
<p>Although winter presents some unique challenges, it can still be an enjoyable and healthy time for you and your canine companion.</p><img src="https://counter.theconversation.com/content/221709/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Erik Christian Olstad does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Dogs might have furry coats, but they can still get cold when the temperature drops.Erik Christian Olstad, Health Sciences Assistant Professor of Clinical Veterinary Medicine, University of California, DavisLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2214092024-01-29T19:05:48Z2024-01-29T19:05:48ZThis salt alternative could help reduce blood pressure. So why are so few people using it?<figure><img src="https://images.theconversation.com/files/571786/original/file-20240128-19-x7pm9f.jpg?ixlib=rb-1.1.0&rect=1207%2C421%2C4190%2C3185&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/shallow-focus-photo-of-elderly-woman-buying-groceries-8422682/">Kampus Production/Pexels</a></span></figcaption></figure><p><a href="https://www.aihw.gov.au/reports/risk-factors/high-blood-pressure/contents/summary">One in three</a> Australian adults has high blood pressure (hypertension). Excess salt (sodium) increases the risk of high blood pressure so everyone with hypertension is advised to reduce salt in their diet.</p>
<p>But despite decades of strong recommendations we have <a href="https://www.who.int/publications/i/item/9789240081062">failed</a> to get Australians to cut their intake. It’s hard for people to change the way they cook, season their food differently, pick low-salt foods off the supermarket shelves and accept a less salty taste. </p>
<p>Now there is a simple and effective solution: potassium-enriched salt. It can be used just like regular salt and most people don’t notice any important difference in taste. </p>
<p>Switching to potassium-enriched salt is feasible in a way that cutting salt intake is not. Our <a href="https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.123.21343">new research concludes</a> clinical guidelines for hypertension should give patients clear recommendations to switch.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-how-much-salt-is-ok-to-eat-58594">Health Check: how much salt is OK to eat?</a>
</strong>
</em>
</p>
<hr>
<h2>What is potassium-enriched salt?</h2>
<p>Potassium-enriched salts replace some of the sodium chloride that makes up regular salt with potassium chloride. They’re also called low-sodium salt, potassium salt, heart salt, mineral salt, or sodium-reduced salt. </p>
<p>Potassium chloride looks the same as sodium chloride and tastes very similar.</p>
<p>Potassium-enriched salt works to lower blood pressure not only because it reduces sodium intake but also because it <a href="https://www.ahajournals.org/doi/10.1161/CIR.0b013e318279acbf?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">increases</a> potassium intake. Insufficient potassium, which mostly comes from fruit and vegetables, is another big cause of high blood pressure.</p>
<h2>What is the evidence?</h2>
<p>We have strong evidence from a <a href="https://www.nejm.org/doi/full/10.1056/nejmoa2105675">randomised trial</a> of 20,995 people that switching to potassium-enriched salt lowers blood pressure and reduces the risks of stroke, heart attacks and early death. The participants had a history of stroke or were 60 years of age or older and had high blood pressure.</p>
<figure class="align-right ">
<img alt="Adding salt to avocado toast" src="https://images.theconversation.com/files/571788/original/file-20240128-29-z46ahg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/571788/original/file-20240128-29-z46ahg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571788/original/file-20240128-29-z46ahg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571788/original/file-20240128-29-z46ahg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571788/original/file-20240128-29-z46ahg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571788/original/file-20240128-29-z46ahg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571788/original/file-20240128-29-z46ahg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Too much salt increases the risk of high blood pressure.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/dash-of-salt-over-avocado-toasts-7936678/">Nicola Barts/Pexels</a></span>
</figcaption>
</figure>
<p><a href="https://heart.bmj.com/content/108/20/1608">An overview</a> of 21 other studies suggests much of the world’s population could benefit from potassium-enriched salt. </p>
<p>The World Health Organisation’s 2023 <a href="https://www.who.int/publications/i/item/9789240081062">global report on hypertension</a> highlighted potassium-enriched salt as an “affordable strategy” to reduce blood pressure and prevent cardiovascular events such as strokes.</p>
<h2>What should clinical guidelines say?</h2>
<p>We teamed up with researchers from the United States, Australia, Japan, South Africa and India to review 32 clinical guidelines for managing high blood pressure across the world. Our findings are <a href="https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.123.21343">published today</a> in the American Heart Association’s journal, Hypertension.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/slashing-salt-can-save-lives-and-it-wont-hurt-your-hip-pocket-or-tastebuds-213980">Slashing salt can save lives – and it won’t hurt your hip pocket or tastebuds</a>
</strong>
</em>
</p>
<hr>
<p>We found current guidelines don’t give clear and consistent advice on using potassium-enriched salt. </p>
<p>While many guidelines recommend increasing dietary potassium intake, and all refer to reducing sodium intake, only two guidelines – the Chinese and European – recommend using potassium-enriched salt.</p>
<p>To help guidelines reflect the latest evidence, we suggested specific wording which could be adopted in Australia and around the world:</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/571334/original/file-20240125-27-fx7wob.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/571334/original/file-20240125-27-fx7wob.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571334/original/file-20240125-27-fx7wob.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=175&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571334/original/file-20240125-27-fx7wob.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=175&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571334/original/file-20240125-27-fx7wob.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=175&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571334/original/file-20240125-27-fx7wob.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=220&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571334/original/file-20240125-27-fx7wob.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=220&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571334/original/file-20240125-27-fx7wob.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=220&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Recommended wording for guidance about the use of potassium-enriched salt in clinical management guidelines.</span>
</figcaption>
</figure>
<h2>Why do so few people use it?</h2>
<p>Most people are unaware of how much salt they eat or the health issues it can cause. Few people know a simple switch to potassium-enriched salt can help lower blood pressure and reduce the risk of a stroke and heart disease.</p>
<p>Limited availability is another challenge. Several Australian retailers stock potassium-enriched salt but there is usually only one brand available, and it is often on the bottom shelf or in a special food aisle. </p>
<p>Potassium-enriched salts also cost more than regular salt, though it’s still low cost compared to most other foods, and not as expensive as many fancy salts now available.</p>
<figure class="align-center ">
<img alt="Woman gets man to try her cooking" src="https://images.theconversation.com/files/571789/original/file-20240128-15-i200b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571789/original/file-20240128-15-i200b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571789/original/file-20240128-15-i200b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571789/original/file-20240128-15-i200b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571789/original/file-20240128-15-i200b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571789/original/file-20240128-15-i200b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571789/original/file-20240128-15-i200b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It looks and tastes like normal salt.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/man-in-white-and-orange-long-sleeve-shirt-holding-chopsticks-TYQ6fyF3Amc">Jimmy Dean/Unsplash</a></span>
</figcaption>
</figure>
<p>A 2021 review found potassium-enriched salts were marketed in only <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8319774/">47 countries</a> and those were mostly high-income countries. Prices ranged from the same as regular salt to almost 15 times greater. </p>
<p>Even though generally more expensive, potassium-enriched salt has the potential to be <a href="https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.122.059573">highly cost effective</a> for disease prevention.</p>
<h2>Preventing harm</h2>
<p>A frequently raised concern about using potassium-enriched salt is the risk of high blood potassium levels (hyperkalemia) in the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8177747/">approximately 2% of the population</a> with serious kidney disease.</p>
<p>People with serious kidney disease are already advised to avoid regular salt and to avoid foods high in potassium. </p>
<p>No harm from potassium-enriched salt has been recorded in any trial done to date, but all studies were done in a clinical setting with specific guidance for people with kidney disease. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-salt-good-for-you-after-all-the-evidence-says-no-168743">Is salt good for you after all? The evidence says no</a>
</strong>
</em>
</p>
<hr>
<p>Our current priority is to get people being managed for hypertension to use potassium-enriched salt because health-care providers can advise against its use in people at risk of hyperkalemia. </p>
<p>In some countries, potassium-enriched salt is recommended to the entire community because the potential benefits are so large. <a href="https://www.bmj.com/content/369/bmj.m824">A modelling study</a> showed almost half a million strokes and heart attacks would be averted every year in China if the population switched to potassium-enriched salt. </p>
<h2>What will happen next?</h2>
<p>In 2022, the health minister launched the <a href="https://ozheart.org/the-national-hypertension-taskforce-is-launched-by-the-honourable-mark-butler-mp-minister-for-health-and-aged-care/">National Hypertension Taskforce</a>, which aims to improve blood pressure control rates from 32% to 70% by 2030 in Australia. </p>
<p>Potassium-enriched salt can play a key role in achieving this. We are working with the taskforce to update Australian hypertension management guidelines, and to promote the new guidelines to health professionals. </p>
<p>In parallel, we need potassium-enriched salt to be more accessible. We are engaging stakeholders to <a href="https://thehill.com/opinion/healthcare/474835-pass-less-salt-and-when-you-pass-it-make-it-potassium-salt/">increase the availability</a> of these products nationwide. </p>
<p>The world has already changed its salt supply once: from regular salt to iodised salt. Iodisation efforts began in the 1920s and took the best part of 100 years to achieve traction. <a href="https://www.who.int/publications/i/item/9789240053717">Salt iodisation</a> is a key public health achievement of the last century preventing <a href="https://www.racgp.org.au/afp/2012/august/goitre">goitre</a> (a condition where your thyroid gland grows larger) and enhancing educational outcomes for millions of the poorest children in the world, as iodine is <a href="https://www.healthdirect.gov.au/iodine">essential for</a> normal growth and brain development.</p>
<p>The next switch to iodised and potassium-enriched salt offers at least the same potential for global health gains. But we need to make it happen in a fraction of the time.</p><img src="https://counter.theconversation.com/content/221409/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alta Schutte receives funding from the National Health and Medical Research Council of Australia, the Medical Research Future Fund, and NSW Health. She is Company Secretary of the Australian Cardiovascular Alliance, Board Member of Hypertension Australia, and Co-Chair of the National Hypertension Taskforce of Australia.</span></em></p><p class="fine-print"><em><span>Bruce Neal receives salary support from the National Health and Medical Research Council of Australia, The George Institute for Global and Imperial College London. He receives research funding from multiple other national and international agencies but from none that represent a conflict of interest with this work.</span></em></p><p class="fine-print"><em><span>Xiaoyue Xu (Luna) does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Potassium-enriched salt tastes like regular salt and you don’t need to change how you cook or season your food. You just need to switch the type of salt you buy.Xiaoyue Xu (Luna), Scientia Lecturer, UNSW SydneyAlta Schutte, SHARP Professor of Cardiovascular Medicine, UNSW SydneyBruce Neal, Executive Director, George Institute Australia, George Institute for Global HealthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2209812024-01-29T16:38:15Z2024-01-29T16:38:15ZHow simple changes can open up Britain’s green spaces so everyone can benefit from them<figure><img src="https://images.theconversation.com/files/571631/original/file-20240126-19-bgcjee.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The Catbells route in the Lake District is just one of many accessible Miles Without Stiles trails. </span> </figcaption></figure><p>A typical British countryside walk may conjure up images of vast green fields, heather-topped moorlands, and of course, countless stiles providing access throughout the right-of-way network. However, while stiles connect trails and public pathways, they are a physical barrier to accessible green spaces for all. </p>
<p>Over the last two decades, national parks across England have been removing stiles as part of a programme of measures to create more easy-to-navigate walking routes. Research by us and others shows how opening up natural spaces in such ways can particularly benefit young and disabled people. If such schemes were adopted more widely, the benefits could be spread even further.</p>
<p>Disabled people access natural and rural green spaces, including national parks, much <a href="https://www.tandfonline.com/doi/pdf/10.1080/02614360903071704">less frequently</a> than non-disabled people. And the physical barriers that stiles and other aspects of the landscape present are not the only issue. Rural green spaces can simply feel daunting for some people, often requiring skilful navigation, specialist equipment and confidence. </p>
<p>These things can also act as barriers for <a href="https://www.sciencedirect.com/science/article/pii/S0743016713000132">young people</a>, who reportedly spend <a href="https://www.gov.uk/government/statistics/the-childrens-people-and-nature-survey-for-england-summer-holidays-2021-official-statistics/the-childrens-people-and-nature-survey-for-england-summer-holidays-2021-official-statistics">less time outside</a> now than ever before. Many children and young people in the UK, particularly those with <a href="https://era.ed.ac.uk/handle/1842/9443">special educational needs or disabilities</a>, do not regularly access natural, wilder green spaces for play and recreation, despite the <a href="https://extremephysiolmed.biomedcentral.com/articles/10.1186/2046-7648-2-3">broad-ranging benefits</a> doing so can offer.</p>
<p>As a result, schools are often tasked with introducing young people to these spaces through outdoor and adventure education. This can be beneficial, but the short-term nature of these programmes leads to short-term <a href="https://www.tandfonline.com/doi/abs/10.1080/14729679.2013.867813">gains</a>, such as improved social skills. </p>
<p>That said, our latest independent evaluation reports of Nottinghamshire YMCA’s <a href="https://www.nottsymca.com/news/access-to-nature-a-positive-first-day/">access to nature programme</a> with marginalised and vulnerable young people show it can improve confidence, increase connection to nature and improve environmental awareness. It can also enhance physical, social and mental health. </p>
<p>While outdoor and adventure education programmes offer a glimpse into available opportunities such as climbing or kayaking, regular involvement in these activities is difficult for many families. </p>
<p>More <a href="https://bera-journals.onlinelibrary.wiley.com/doi/full/10.1002/berj.3953">regular access</a> to green spaces for young people can benefit them over the longer term by enabling more creative play, opportunity to experience risk and direct hands-on interaction with nature. </p>
<h2>Removing barriers</h2>
<p>Improving accessibility could be one step towards young people spending more time outside in natural landscapes, like those found in the UK’s 15 national parks. Launched by the Lake District National Park nearly two decades ago, the Miles Without Stiles initiative improves the accessibility of many public footpaths and trails. </p>
<p>Adopted now by <a href="https://democracy.peakdistrict.gov.uk/documents/s17985/LAFbg170615-Item11-2.pdf">National Parks England</a>, this scheme involves the removal of stiles, resurfacing of pathways, and a clear grading system which rates routes depending on their gradient and surface conditions. Improving accessibility also involves more consistent signposting and waymarking, decent public transport links and carpark provision, plus availability of toilets, cafés and other facilities. </p>
<p>The <a href="https://www.lakedistrict.gov.uk/visiting/things-to-do/walking/mileswithoutstiles">Lake District National Park</a> now boasts 51 Miles Without Stiles routes, the <a href="https://www.peakdistrict.gov.uk/visiting/miles-without-stiles#mwsroutes">Peak District National Park</a> has 20 and <a href="https://www.southdowns.gov.uk/all-abilities/miles-without-stiles/">South Downs National Park</a> has seven. </p>
<p>Miles Without Stiles is endorsed by charities like the <a href="https://disabledramblers.co.uk/">Disabled Ramblers</a> who advocate for a more accessible countryside. And 21% of visitors to the Lake District National Park choose routes because of their accessibility, according to a 2019 Lake District National Park Authority report. </p>
<p>Many of these routes offer a gentler introduction to wild spaces, which may make young people feel more confident in accessing these places easily, either independently or with family members. No specialist equipment is required beyond a sturdy pair of shoes, wheelchair or buggy, and more people can go at their own pace. </p>
<h2>Connecting with nature</h2>
<p>When we interviewed a group of secondary school teachers for our research in 2020, it was clear that <a href="https://journals.sagepub.com/doi/full/10.1177/1356336X20953872">inclusive</a> physical education provision involves differentiating lessons for mixed abilities and offering activities that could be modified accordingly. That relates to nature access too, and is especially relevant for young people with special educational needs and disabilities who experience a range of <a href="https://www.tandfonline.com/doi/full/10.1080/1034912X.2021.1952939">barriers</a> to regular <a href="https://www.tandfonline.com/doi/full/10.1080/10413200.2023.2181464">physical activity</a>. </p>
<p>In the case of Miles Without Stiles, well-surfaced and clearly signposted routes are clearly graded as suitable for all, for many or for some, depending on their gradient.</p>
<p>We believe that schools, sport, and other physical activity providers could learn much from Miles Without Stiles about accessibility. Given the notable benefits of physical activity and of spending time outdoors, if National Parks England were to extend the Miles Without Stiles programme across the country, it would provide more accessible options for more people. </p>
<p>Promoting Miles Without Stiles to local authorities and schools could increase awareness of the initiative, and encourage young people and their families to spend more time being active outdoors. Beyond the countryside, local authorities could even use the Miles Without Stiles model to make urban green spaces more accessible, promoting more active lifestyles for all.</p>
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<img alt="Imagine weekly climate newsletter" src="https://images.theconversation.com/files/434988/original/file-20211201-21-13avx6y.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/434988/original/file-20211201-21-13avx6y.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/434988/original/file-20211201-21-13avx6y.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/434988/original/file-20211201-21-13avx6y.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/434988/original/file-20211201-21-13avx6y.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/434988/original/file-20211201-21-13avx6y.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/434988/original/file-20211201-21-13avx6y.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><strong><em>Don’t have time to read about climate change as much as you’d like?</em></strong>
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<hr><img src="https://counter.theconversation.com/content/220981/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anthony Maher works for Leeds Beckett University.</span></em></p><p class="fine-print"><em><span>Janine Coates does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>This initiative could give more disabled and young people the confidence to explore more of Britain’s wild spaces and build a stronger nature connectionJanine Coates, Senior Lecturer in Qualitative Research Methods, Loughborough UniversityAnthony Maher, Professor of Special Educational Needs, Disability and Inclusion, Leeds Beckett UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2215112024-01-29T14:53:48Z2024-01-29T14:53:48ZFrom mud and vinegar to 3D printing skin, the way we treat wounds still challenges humanity<p>Whether it’s the sting of a paper cut or the trauma of battle injury, wounds are woven into the tapestry of human experience. And since ancient times, we’ve fought the enemy that lurks within them – infection. </p>
<p>The constant threat of injury on the battlefield led to the search for new ways to combat wound infection. But early surgical procedures lacked the sterile instruments available today, meaning that for many years, surgery came with the added risk of post-operative <a href="https://cha.com/wp-content/uploads/2017/11/AJIC-2012-Infection-Control-Through-the-Ages.pdf">wound infection</a>, resulting in high numbers of deaths. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3601883/">Ancient practices</a>, such as using oils, mud, turpentine, or honey to treat wounds, were common around 2000BC. The Greek physician Hippocrates (460-377BC) <a href="https://www.dermatologytimes.com/view/acetic-acid-and-wound-healing">used vinegar</a> to clean wounds, followed by bandaging to keep dirt at bay.</p>
<p>While the first hospitals were <a href="https://scientificsurgery.bjs.co.uk/article/the-surgery-of-theodoric-ca-a-d-1267-translated-from-the-latin-by-eldridge-campbell-m-d-and-james-colton-m-a-volume-i-books-i-and-ii-8-38-x-5-12-in-pp-223-xi-with-coloured-front/">established</a> in Europe in the middle ages, they were dangerous and brutal places. Wound infection rates were high because of unsanitary conditions and the use of cautery, which involved pushing a burning iron into a patient’s wound until it reached the bone.</p>
<figure class="align-center ">
<img alt="A drawing of a pot containing a fire with several medical instruments poking out of it." src="https://images.theconversation.com/files/571587/original/file-20240126-19-5nmbkg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571587/original/file-20240126-19-5nmbkg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=403&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571587/original/file-20240126-19-5nmbkg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=403&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571587/original/file-20240126-19-5nmbkg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=403&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571587/original/file-20240126-19-5nmbkg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=506&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571587/original/file-20240126-19-5nmbkg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=506&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571587/original/file-20240126-19-5nmbkg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=506&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A receptacle for burning coal to heat cautery instruments.</span>
<span class="attribution"><a class="source" href="https://wellcomecollection.org/works/gcg933n2/images?id=jghkdnp4">Wellcome Collection</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>By the 1860s, the pioneering surgeon Joseph Lister had revolutionised wound infection treatment by introducing <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2895849/">carbolic-acid-soaked bandages</a>. And Robert Wood Johnson, who founded Johnson & Johnson, <a href="https://wounds-uk.com/journal-articles/sterilised-gauze-and-baby-powder-robert-wood-johnson-i-and-frederick-barnett-kilmer/">produced</a> the first sterile gauze bandages by 1890. The combination of antiseptic and sterile bandage marked a turning point in the evolution of wound treatment and infection control.</p>
<p>The discovery of penicillin by <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4520913/">Alexander Fleming</a> in 1928 was also a pivotal moment in the treatment of wound infections. By the 1940s, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5369031/">penicillin</a> was being used to treat second world war soldiers who had wound infections that would have been deemed fatal in previous years. For less serious wounds, Lister’s approach of using a dressing and an antiseptic was still used.</p>
<p>Substances like <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6756674/">silver</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/12914356/">iodine</a> have also been recognised for their antimicrobial properties since the 1800s. Iodine, though effective, caused pain and skin discolouration until safer and less painful formulations were developed in 1949. <a href="https://bnf.nice.org.uk/wound-management/antimicrobial-dressings/">These formulations</a> endure in modern wound dressings.</p>
<p>For everyday cuts and scrapes, a simple cleaning with water and application of antiseptic cream is usually enough. This helps to prevent the inadvertent introduction of bacteria into the wound, minimising the risk of additional pain and swelling. </p>
<p>But while most wounds nowadays heal without issue, some become become infected. Research published in 2021 showed that <a href="https://wounds-uk.com/wp-content/uploads/sites/2/2023/02/68803cd147c4d81a02b9cc56823f19a1.pdf">3.8 million</a> people were having their wounds managed by the NHS between 2017 and 2018, up 71% from between 2012 and 2013. They included surgical wounds, leg ulcers and burns. This shows how hard it can be to care for wounds that are difficult to heal and particularly susceptible to infections.</p>
<h2>Modern-day challenges</h2>
<p>One of the biggest challenges in the modern-day treatment of wound infection is <a href="https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance">antibiotic resistance</a>. This happens when bacteria develop the ability to defeat the drugs designed to kill them. Resistant infections can be difficult, and sometimes impossible, to treat. </p>
<p>Many bacteria have also become resistant to the antimicrobial ingredients used in wound dressings. This is the case for <a href="https://www.sciencedirect.com/science/article/pii/S0195670104005201">silver-based</a> wound dressings, which are often used to treat chronic wound infections. This type of wound characteristically <a href="https://www.nature.com/articles/s41572-022-00377-3">fails to heal</a>, and can remain an open, infected wound for many months – or even years. As well as the devastating effect on people’s quality of life, this also places a huge financial burden on the NHS.</p>
<p>The constant fight against wound infections drives extensive research for new, safe and effective treatments. While progress is being made, a crucial hurdle lies in the <a href="https://academic.oup.com/jacamr/article/3/1/dlab027/6186407">limitations</a> of laboratory testing methods. These tests, while necessary for regulatory approval, often fail to capture the nuanced realities of wounds in the human body. </p>
<p>No two people are the same and no two wounds are the same either. This can lead to situations where treatments shine in the lab but ultimately prove ineffective in real patients.</p>
<h2>Creating wound models</h2>
<p>In response to this, scientists are tackling the limitations of lab tests by creating more realistic synthetic wound models. Some are even <a href="https://pubmed.ncbi.nlm.nih.gov/30172300/">3D printing</a> human skin (using leftovers from surgical procedures), or animal skin, complete with artificial body fluids, such as pus. The aim is to create a model environment that mimics real wounds more accurately. </p>
<p>Recently, my own <a href="https://pubmed.ncbi.nlm.nih.gov/36678466/">research group</a> has made strides in developing lab models that act like real chronic wounds when treated with antimicrobial dressings. While not perfect, our models are a step in the right direction, contributing to the development of formulations with promising potential for treating wound infections in the future.</p>
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Read more:
<a href="https://theconversation.com/we-built-a-human-skin-printer-from-lego-and-we-want-every-lab-to-use-our-blueprint-203170">We built a human-skin printer from Lego and we want every lab to use our blueprint</a>
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<p>As we navigate the complexities of wound care, the quest for new, effective and safe treatments continues, driven by the efforts of scientists worldwide. We are working towards a future where the management of difficult-to-heal wounds and infections improves, enhancing both individual wellbeing and the efficiency of health systems.</p><img src="https://counter.theconversation.com/content/221511/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Maddocks does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Keeping wounds clean and infection free has challenged people for thousands of years.Sarah Maddocks, Lecturer in Microbiology, Cardiff Metropolitan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2183172024-01-28T13:53:44Z2024-01-28T13:53:44ZSport and physical activity alone can’t tackle health inequities in Indigenous communities<figure><img src="https://images.theconversation.com/files/571313/original/file-20240124-17-du4die.jpg?ixlib=rb-1.1.0&rect=30%2C40%2C6679%2C4426&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">While there are many benefits to sports participation, overstating those benefits can obscure systemic issues.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/sport-and-physical-activity-alone-cant-tackle-health-inequities-in-indigenous-communities" width="100%" height="400"></iframe>
<p>Organized sport is often positioned as a remedy for the many health issues that Indigenous Peoples face. While there are many benefits to sports participation, overstating those benefits risks obscuring the systemic problems they endure in trying to create their own visions for health.</p>
<p>While <a href="https://doi.org/10.1038/oby.2007.51">research indicates that encouraging youth to be engaged in sport and physical activity</a> is essential for improving health outcomes, the relationship between sport participation and health in Indigenous communities is not so simple.</p>
<p>For instance, a recent literature review by the National Collaborating Centre for Indigenous Health calls attention to a significant policy problem: <a href="https://www.nccih.ca/Publications/lists/Publications/Attachments/ISR/Indigenous_Sports_and_Recreation_EN_Web_2022-01-27.pdf">Indigenous youth are more physically active than non-Indigenous youth, and yet they self-report poorer health outcomes</a>. </p>
<p>This illustrates why using sport participation as a policymaking lodestar for affecting positive health outcomes is troublesome. Sport has historically failed to address the systemic issues that burden Indigenous Peoples and their communities. To address these deep-seated issues, a more comprehensive and culturally grounded approach to sport policy is needed. </p>
<h2>National sport policies</h2>
<p>National sport policies are important because they serve as a guide for how and why the federal government will invest in sport. Canada’s first sport policy, <a href="https://books.openedition.org/uop/699?lang=en">An Act to Encourage Fitness and Amateur Sport</a>, dates back to 1961. It mostly featured cost-sharing agreements with the provinces and territories to get people involved in sport for fitness and competition.</p>
<p>After that, the federal government began to focus increasingly on high performance sport. Since the 1970s, billions of dollars have been invested in athletes to win gold, silver and bronze medals, as if their accolades would stimulate greater physical activity among citizens. </p>
<p>The overall orientation of these policies is captured by the expression “<a href="https://www.canada.ca/en/canadian-heritage/services/role-sport-canada.html">from playground to podium</a>” — a fitting summary of the reach and ambition of most of them. </p>
<p>Now, a new national sport policy is on the immediate horizon, and with it will come a renewed discussion regarding the connection between health and sport in Canada. The <a href="https://sirc.ca/wp-content/uploads/2023/01/SIRC-What-We-Heard-Report-FINAL-1.pdf">consultation report that forms the basis for the new policy</a> refers to sport as an “integral component of health and culture in Canada,” with quotes throughout that describe it as a form of health care. </p>
<h2>Sport and health</h2>
<p>The relationship between sport participation and federal policymaking is longstanding and rooted in the conventional wisdom that <a href="https://www.publicworks.com/doc/physical-activity-sport-recreation-sector-applauds-canadian-sport-policy-0001">encouraging youth to be engaged in sport reliably leads to better health outcomes</a>.</p>
<p>For instance, the first goal of the <a href="https://publications.gc.ca/collections/collection_2016/pch/CH24-46-2002-eng.pdf">2002 Canada Sport Policy aimed to significantly increase the number of Canadians participating in sport</a>, saying sports participation “contributes to healthier, longer, and more productive lives.” </p>
<p>The <a href="https://sirc.ca/wp-content/uploads/files/content/docs/Document/csp2012_en.pdf">2012 Canadian Sport Policy</a> continued to highlight the positive health benefits of sports participation, saying it “strengthens their personal development, provides enjoyment and relaxation, reduces stress, improves physical and mental health, physical fitness and general well-being, and enables them to live more productive and rewarding lives.” </p>
<p>Clearly the 2012 policy meant health in a wide sense. These were grand claims, considering <a href="https://cflri.ca/sites/default/files/node/1135/files/CFLRI-B1.Sport%20Participation_2011_12.pdf">only 34 per cent of Canadians participated in some form of organized sport in 2012</a>. By 2023, <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/231010/dq231010b-eng.htm">that number rose to almost 50 per cent</a>, due in large part to return-to-play initiatives after the COVID-19 pandemic — <a href="https://jumpstart.canadiantire.ca/blogs/news/2023-state-of-sport-report-shows-rising-costs-threatening-access-to-sport">a trend that may be in reverse due to the rising cost of living</a>.</p>
<p>For Indigenous Peoples, there is <a href="http://dx.doi.org/10.5663/aps.v3i1-2.21707">no official survey that tracks Indigenous participation in sport in Canada</a>. This means assumptions about sport being a driver for Indigenous health may not be relevant for many segments of the First Nations, Métis and Inuit populations. It also means sport policy may exacerbate their existing health inequities, instead of addressing them.</p>
<h2>Social determinants of Indigenous health</h2>
<p>Although sport is an important and valued aspect of Canadian life, the relative impact it can have on the overall health of a community is tempered by many external factors — a point illustrated by the federal government’s public health resources.</p>
<p>Approaching sport from a <a href="https://www.nccih.ca/28/Social_Determinants.nccah">social determinants of Indigenous health perspective</a> would shed light on why and how this happens. The Canadian government currently uses <a href="https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html">the 12 social determinants of health and health inequalities</a> to guide its policies.</p>
<p>The social determinants of Indigenous health go beyond the government’s current approach to include assessments of other negative factors like settler colonialism, as well as positive factors like Indigenous culture and spirituality.</p>
<p>Likewise, <a href="https://www.rcaanc-cirnac.gc.ca/eng/1524505883755/1557512006268">Call to Action 89 of the Truth and Reconciliation Commission</a> urges decision-makers to embrace a broader perspective of sport that engages health. It states: </p>
<blockquote>
<p>“We call upon the federal government to amend the Physical Activity and Sport Act to support reconciliation by ensuring that policies to promote physical activity as a fundamental element of health and well-being, reduce barriers to sports participation, increase the pursuit of excellence in sport, and build capacity in the Canadian sport system, are inclusive of Aboriginal peoples.”</p>
</blockquote>
<h2>Dangers of sport evangelism</h2>
<p>Without critically considering how we frame sport’s role in Canadian life, any new policy risks the dangers of sport evangelism: the false belief that sport alone can provide a miraculous fix for social and structural issues. </p>
<p>The long list that makes up the social determinants of Indigenous health is a visible reminder of the need to understand sport in that complex matrix. </p>
<p>In both mainstream and Indigenous communities across Canada, sport is neither inherently good nor bad. Rather, it is a tool that must be used responsibly. This requires us to acknowledge both its potential and limitations for enriching the lives of its participants, especially those who we know face health inequities, as Indigenous Peoples do.</p><img src="https://counter.theconversation.com/content/218317/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Taylor McKee receives funding from the Social Sciences and Humanities Research Council of Canada</span></em></p><p class="fine-print"><em><span>Janice Forsyth is affiliated with the Aboriginal Sport Circle, a national non-profit that focuses on Indigenous sport development in Canada. </span></em></p>In both mainstream and Indigenous communities across Canada, sport is neither inherently good nor bad. Rather, it is a tool that must be used responsibly.Taylor McKee, Assistant Professor, Sport Management, Brock UniversityJanice Forsyth, Professor, School of Kinesiology, University of British ColumbiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2202852024-01-25T20:46:49Z2024-01-25T20:46:49ZThe emergence of JN.1 is an evolutionary ‘step change’ in the COVID pandemic. Why is this significant?<figure><img src="https://images.theconversation.com/files/571359/original/file-20240125-15-2lt45r.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C7667%2C3900&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/evolution-covid19-sarscov2-mutating-coronavirus-virus-2344854903">Lightspring/Shutterstock</a></span></figcaption></figure><p>Since it was detected in <a href="https://www.gavi.org/vaccineswork/seven-things-you-need-know-about-jn1-covid-19-variant">August 2023</a>, the JN.1 variant of COVID has <a href="https://news.un.org/en/story/2023/12/1145012">spread widely</a>. It has become dominant in Australia and <a href="https://outbreak.info/situation-reports?xmin=2023-07-05&xmax=2024-01-05&pango=JN.1">around the world</a>, driving the <a href="https://www.cdc.gov/respiratory-viruses/whats-new/JN.1-update-2024-01-05.html">biggest COVID wave</a> seen in many jurisdictions for at least the past year.</p>
<p>The World Health Organization (WHO) <a href="https://news.un.org/en/story/2023/12/1145012">classified</a> JN.1 as a “variant of interest” in December 2023 and in January <a href="https://x.com/UNGeneva/status/1745782729558348212?s=20">strongly stated</a> COVID was a continuing global health threat causing “far too much” preventable disease with worrying potential for long-term health consequences. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1745782729558348212"}"></div></p>
<p>JN.1 is significant. First as a pathogen – it’s a surprisingly new-look version of SARS-CoV-2 (the virus that causes COVID) and is rapidly displacing other circulating strains (omicron XBB). </p>
<p>It’s also significant because of what it says about COVID’s evolution. Normally, SARS-CoV-2 variants look quite similar to what was there before, accumulating just a few mutations at a time that give the virus a meaningful advantage over its parent. </p>
<p>However, occasionally, as was the case when omicron (B.1.1.529) arose two years ago, variants emerge seemingly out of the blue that have markedly different characteristics to what was there before. This has significant implications for disease and transmission. </p>
<p>Until now, it wasn’t clear this “step-change” evolution would happen again, especially given the ongoing success of the steadily evolving omicron variants. </p>
<p>JN.1 is so distinct and causing such a wave of new infections that many are wondering whether the <a href="https://www.who.int/activities/tracking-SARS-CoV-2-variants">WHO</a> will recognise JN.1 as the next variant of concern with its own Greek letter. In any case, with JN.1 we’ve entered a new phase of the pandemic.</p>
<h2>Where did JN.1 come from?</h2>
<p>The JN.1 (or BA.2.86.1.1) story begins with the emergence of its <a href="https://erictopol.substack.com/p/from-a-detour-to-global-dominance">parent lineage</a> BA.2.86 around mid 2023, which originated from a much earlier (2022) omicron sub-variant BA.2.</p>
<p><a href="https://www.nature.com/articles/d41586-022-01613-2">Chronic infections</a> that may linger unresolved for months (if not years, in some people) likely play a role in the emergence of these step-change variants. </p>
<p>In chronically infected people, the virus silently tests and eventually retains many mutations that help it avoid immunity and survive in that person. For BA.2.86, this resulted in <a href="https://theconversation.com/how-evasive-and-transmissible-is-the-newest-omicron-offshoot-ba-2-86-that-causes-covid-19-4-questions-answered-212453">more than 30 mutations</a> of the spike protein (a protein on the surface of SARS-CoV-2 that allows it to attach to our cells). </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-is-surging-in-australia-and-only-1-in-5-older-adults-are-up-to-date-with-their-boosters-220839">COVID is surging in Australia – and only 1 in 5 older adults are up to date with their boosters</a>
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</p>
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<p>The sheer volume of infections occurring globally sets the scene for major viral evolution. SARS-CoV-2 continues to have a <a href="https://nextstrain.org/ncov/gisaid/global/all-time?dmin=2021-04-07&l=clock">very high rate of mutation</a>. Accordingly, JN.1 itself is already <a href="https://twitter.com/dfocosi/status/1744982175508771190">mutating and evolving</a> quickly.</p>
<h2>How is JN.1 different to other variants?</h2>
<p>BA.2.86 and now JN.1 are behaving in a manner that looks unique in laboratory studies in two ways.</p>
<p>The first relates to how the virus evades immunity. JN.1 has inherited <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(23)00813-7/fulltext#%20">more than 30 mutations</a> in its spike protein. It also acquired a new mutation, <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(23)00744-2/fulltext">L455S</a>, which further decreases the ability of antibodies (one part of the immune system’s protective response) to bind to the virus and prevent infection.</p>
<p>The second involves changes to the way JN.1 <a href="https://www.nature.com/articles/s41580-021-00418-x">enters</a> and replicates in our cells. Without delving in to the molecular details, recent high-profile lab-based research from the <a href="https://www.cell.com/action/showPdf?pii=S0092-8674%2823%2901400-9">United States</a> and <a href="https://www.cell.com/action/showPdf?pii=S0092-8674%2823%2901399-5">Europe</a> observed BA.2.86 to enter cells from the lung in a similar way to pre-omicron variants like delta. However, in contrast, preliminary work by Australia’s Kirby Institute <a href="https://www.biorxiv.org/content/10.1101/2023.09.22.558930v2">using different techniques</a> finds replication characteristics that are aligned better with omicron lineages. </p>
<p>Further research to resolve these different cell entry findings is important because it has implications for where the virus may prefer to replicate in the body, which could affect disease severity and transmission. </p>
<p>Whatever the case, these findings show JN.1 (and SARS-CoV-2 in general) can not only navigate its way around our immune system, but is finding new ways to infect cells and transmit effectively. We need to further study how this plays out in people and how it affects clinical outcomes.</p>
<h2>Is JN.1 more severe?</h2>
<figure class="align-center ">
<img alt="A woman in a supermarket wearing a mask." src="https://images.theconversation.com/files/571362/original/file-20240125-17-9zn8rj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571362/original/file-20240125-17-9zn8rj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571362/original/file-20240125-17-9zn8rj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571362/original/file-20240125-17-9zn8rj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571362/original/file-20240125-17-9zn8rj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571362/original/file-20240125-17-9zn8rj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571362/original/file-20240125-17-9zn8rj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">JN.1 has some characteristics which distinguish it from other variants.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/alarmed-female-wears-medical-mask-against-1708365295">Elizaveta Galitckaia/Shutterstock</a></span>
</figcaption>
</figure>
<p>The step-change evolution of BA.2.86, combined with the immune-evading features in JN.1, has given the virus a <a href="https://www.who.int/docs/default-source/coronaviruse/18122023_jn.1_ire_clean.pdf?sfvrsn=6103754a_3">global growth advantage</a> well beyond the XBB.1-based lineages we faced in 2023. </p>
<p>Despite these features, evidence suggests our <a href="https://www.news-medical.net/news/20231208/T-cells-can-recognize-and-fight-the-Pirola-variant-new-study-suggests.aspx">adaptive immune system</a> could still recognise and respond to BA.286 and JN.1 effectively. Updated monovalent vaccines, tests and treatments <a href="https://publichealth.jhu.edu/2024/jn1-the-dominant-variant-in-the-covid-surge">remain effective</a> against JN.1. </p>
<p>There are two elements to “severity”: first if it is more “intrinsically” severe (worse illness with an infection in the absence of any immunity) and second if the virus has greater transmission, causing greater illness and deaths, simply because it infects more people. The latter is certainly the case with JN.1. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-long-does-immunity-last-after-a-covid-infection-221398">How long does immunity last after a COVID infection?</a>
</strong>
</em>
</p>
<hr>
<h2>What next?</h2>
<p>We simply don’t know if this virus is on an evolutionary track to becoming the “next common cold” or not, nor have any idea of what that timeframe might be. While <a href="https://www.science.org/content/article/four-cold-causing-coronaviruses-may-provide-clues-covids-future">examining the trajectories</a> of four historic coronaviruses could give us a glimpse of where we may be heading, this should be considered as just one possible path. The emergence of JN.1 underlines that we are experiencing a continuing epidemic with COVID and that looks like the way forward for the foreseeable future. </p>
<p>We are now in a new pandemic phase: post-emergency. Yet COVID remains the major infectious disease causing harm globally, from both acute infections and <a href="https://theconversation.com/long-covid-symptoms-can-improve-but-their-resolution-is-slow-and-imperfect-212015">long COVID</a>. At a societal and an individual level we need to re-think the risks of accepting wave after wave of infection. </p>
<p>Altogether, this underscores the importance of <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01585-9/fulltext">comprehensive strategies to reduce COVID transmission and impacts</a>, with the least imposition (such as <a href="https://www.mja.com.au/journal/2022/217/11/healthy-indoor-air-our-fundamental-need-time-act-now">clean indoor air interventions</a>). </p>
<p>People are <a href="https://www.health.vic.gov.au/health-alerts/increase-in-covid-19-cases">advised</a> to continue to take active steps to protect themselves and those around them. </p>
<p>For better pandemic preparedness for emerging threats and an improved response to the current one it is crucial we <a href="https://www.who.int/publications/m/item/virtual-press-conference-on-global-health-issues-transcript-10-january-2024">continue global surveillance</a>. The low representation of low- and middle- income countries is a concerning blind-spot. Intensified research is also crucial.</p><img src="https://counter.theconversation.com/content/220285/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Suman Majumdar, through the Burnet Institute receives grant funding from the Australian Government via the National Health & Medical Research Council of Australia, the Medical Research Future Fund and DFAT's Centre for Health Security.</span></em></p><p class="fine-print"><em><span>Brendan Crabb and the Institute he leads receives research grant funding from the National Health & Medical Research Council of Australia, the Medical Research Future Fund, DFAT's Centre for Health Security and other Australian federal and Victorian State Government bodies. He is the Chair of The Australian Global Health Alliance and the Pacific Friends of Global Health, both in an honorary capacity. And he serves on the Board of the Telethon Kids Institute, on advisory committees of mRNA Victoria, the Sanger Institute (UK), the Institute for Health Transformation (at Deakin University), The Brain Cancer Centre (Australia), the WHO Malaria Vaccine Advisory Committee; MALVAC, and is a member of OzSAGE and The John Snow Project, all honorary positions.</span></em></p><p class="fine-print"><em><span>Stuart Turville receives funding from NHMRC through an Ideas Grant and MRFF grant related to SARS CoV-2 immunology. </span></em></p><p class="fine-print"><em><span>Emma Pakula does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The JN.1 variant has become dominant in Australia and around the world, causing large waves of infections. Here’s what we know about it so far – and why it’s so important.Suman Majumdar, Associate Professor and Chief Health Officer - COVID and Health Emergencies, Burnet InstituteBrendan Crabb, Director and CEO, Burnet InstituteEmma Pakula, Senior Research and Policy Officer, Burnet InstituteStuart Turville, Associate Professor, Immunovirology and Pathogenesis Program, Kirby Institute, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2175092024-01-22T13:28:26Z2024-01-22T13:28:26ZThink wine is a virtue, not a vice? Nutrition label information surprised many US consumers<figure><img src="https://images.theconversation.com/files/569115/original/file-20240112-21-1bz0bp.jpg?ixlib=rb-1.1.0&rect=56%2C85%2C9247%2C5164&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Decisions, decisions.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/rear-view-of-young-asian-woman-grocery-shopping-for-royalty-free-image/1366189228?phrase=wine+store&adppopup=true">d3sign/Getty Images</a></span></figcaption></figure><p>When you reach for that bottle of wine this Valentine’s Day, do you know how healthy it is? Many people have a too-rosy view of the beverage and are surprised when confronted with the facts about it on a nutrition label, according to a study my co-author <a href="https://www.depts.ttu.edu/hs/hrm/velikova.php">Natalia Velikova</a> <a href="https://www.depts.ttu.edu/rawlsbusiness/people/faculty/marketing/deidre-popovich/index.php">and I</a> recently published in the <a href="https://doi.org/10.1108/JCM-09-2020-4101">Journal of Consumer Marketing</a>. </p>
<p>Our findings could have big implications for the wine industry, particularly as <a href="https://www.fooddive.com/news/alcohol-labeling-lawsuit/633347/">some groups in the U.S. are pushing</a> for wine to have mandatory nutrition labels.</p>
<p>Right now, people usually think of wine as <a href="https://doi.org/10.1287/mksc.17.4.317">a “virtue” rather than a “vice,”</a> thanks to popular beliefs about its <a href="https://www.health.harvard.edu/blog/is-red-wine-good-actually-for-your-heart-2018021913285#">health benefits</a> and news coverage of its antioxidant effects. But requiring nutrition labels, which are currently voluntary, could change those views. </p>
<p>In our experimental research, which included nearly 800 participants, we found that American consumers aren’t used to seeing nutrition information on wine labels, and most are surprised by what they read since they don’t associate wine with calories, carbohydrates and sugar. People who were prompted to read labels viewed wine as less healthy than they did beforehand, and they were less likely to buy it. </p>
<p>We also found that people are more surprised by the sugar content of sweeter wines, such as Moscato, than by the number of calories. Sweet wines, in particular, may contain more sugar than consumers realize.</p>
<h2>Why it matters</h2>
<p>The European Union recently <a href="https://www.wineenthusiast.com/culture/industry-news/new-eu-wine-label-regulations/">mandated nutrition labeling on wine</a>, sometimes in the form of <a href="https://www.decanter.com/learn/eu-wine-labelling-the-changes-explained-507553/">QR codes</a>, and industry analysts expect <a href="https://wineindustryadvisor.com/2023/02/24/ingredient-labels-are-coming-you-need-to-know">the U.S. will eventually follow suit</a>. The Treasury Department’s Alcohol and Tobacco Tax and Trade Bureau, which regulates wine production, has already <a href="https://www.cspinet.org/press-release/consumer-groups-obtain-ttb-commitment-issue-rulemakings-mandatory-alcohol-labeling">agreed to issue some preliminary rules</a> for mandatory ingredient labeling.</p>
<p>Nutrition labels don’t need to be bad news for the wine industry. Wine sales have <a href="https://www.svb.com/globalassets/trendsandinsights/reports/wine/svb-state-of-the-wine-industry-report-2023.pdf">recently declined</a> among those 60 and younger, and greater transparency in labeling could help rekindle young consumers’ interest. </p>
<p><a href="https://doi.org/10.1016/j.wep.2018.11.001">Millennial and Gen Z consumers</a> may especially appreciate clearer labels, since it could help them view wine as less mysterious and more accessible. It may also allow them to fit an occasional glass of wine into their personal health goals. Younger consumers might also be more interested in <a href="https://doi.org/10.1016/j.wep.2019.02.001">eliminating as many highly processed ingredients as possible</a> from their diets. </p>
<p>What’s more, there’s been a recent trend toward wine packaging including labels like “organic,” “biodynamic” and “sustainable,” which may appeal to consumers’ preferences for sustainability. These labels have less to do with nutrition than with manufacturers trying to appear eco-friendly — but makers of natural wine would likely benefit most from offering nutrition information to support their front-of-label claims.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/568090/original/file-20240106-28-sl6le5.jpg?ixlib=rb-1.1.0&rect=98%2C12%2C8120%2C5438&q=45&auto=format&w=1000&fit=clip"><img alt="In an over-the-shoulder photograph, a woman chooses between two bottles of wine at a liquor store." src="https://images.theconversation.com/files/568090/original/file-20240106-28-sl6le5.jpg?ixlib=rb-1.1.0&rect=98%2C12%2C8120%2C5438&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/568090/original/file-20240106-28-sl6le5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/568090/original/file-20240106-28-sl6le5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/568090/original/file-20240106-28-sl6le5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/568090/original/file-20240106-28-sl6le5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/568090/original/file-20240106-28-sl6le5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/568090/original/file-20240106-28-sl6le5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Americans generally view red wines as healthier than whites, research shows.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/over-the-shoulder-view-of-woman-walking-through-royalty-free-image/1308615779">D3sign/Getty Images</a></span>
</figcaption>
</figure>
<h2>What other research is being done</h2>
<p>German researchers have found that most consumers often overestimate calories in wine before viewing nutritional labels, and they <a href="https://doi.org/10.1016/j.wep.2019.02.001">don’t think the information is useful</a>. The researchers found that consumers often feel insecure and confused after reading wine ingredient information. Reviewing ingredient lists also made consumers less likely to view wine as a natural product. </p>
<p>On the manufacturer side, research shows that mandatory nutrition labeling would affect the wine industry in several ways — notably by <a href="https://doi.org/10.1016/j.wep.2019.05.002">increasing overhead costs</a> related to compliance, laboratory analyses and more challenging labeling processes. This could disproportionately hurt smaller wineries with fewer resources. </p>
<h2>What still isn’t known</h2>
<p>We still don’t know who is most likely to read and use nutrition labels on wine, but younger customers <a href="https://doi.org/10.1017/S1368980010003290">seem to be more interested</a> in food labels generally. Millennials report they are <a href="https://doi.org/10.1017/S1368980016002871">eating healthier</a> and <a href="https://www.physicalactivitycouncil.org/_files/ugd/286de6_292481f0e76443d4b0921fbb879f8cfc.pdf">exercising more</a> than previous generations.</p>
<p>And there’s still more to learn about how nutrition labels affect behavior. Studies have shown mixed results, but on the whole, labeling appears to make people <a href="https://doi.org/10.1016/j.amepre.2018.09.024">cut their calorie consumption</a> somewhat. Still, the U.S. put nutrition labels on foods in the 1990s, and that hasn’t stopped the <a href="https://www.cdc.gov/obesity/data/adult.html">obesity rate from rising</a>.</p><img src="https://counter.theconversation.com/content/217509/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deidre Popovich does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>People may be surprised when they read a nutrition label on a bottle of wine. The industry should take note.Deidre Popovich, Associate Professor of Marketing, Texas Tech UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2207532024-01-21T13:00:13Z2024-01-21T13:00:13ZUndergoing cataract surgery when it’s not necessary? Some do it to improve their eyesight, but it’s not without risk<figure><img src="https://images.theconversation.com/files/568296/original/file-20231220-21-m59siq.jpg?ixlib=rb-1.1.0&rect=2%2C0%2C989%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For some years now, it has been possible to have surgery to replace the crystalline lens, the natural lens of the eye, with an implant.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Judy is an accomplished consultant who regularly travels for business meetings. She came to see me because she was finding her contact lenses uncomfortable and wanted to explore other options — notably surgical alternatives.</p>
<p>One option was to replace her lens with an implant. This surgery is similar to cataract surgery, but offered to patients who do not have this condition. However, it is not without risks.</p>
<p>As an optometrist with expertise in contact lenses, dry eye treatment and pre- and post-operative management of eye surgery, I had the experience required to help Judy.</p>
<h2>Dry eyes</h2>
<p>I started by doing a clinical assessment of Judy. When she came to see me, she was about to turn 53, had myopia (can’t see far), astigmatism (images stretched far and near) and presbyopia (can’t see near) caused by age.</p>
<p>She hated glasses and didn’t want to wear them in front of her customers, which is why she had undergone laser surgery to correct her myopia 15 years earlier.</p>
<p>At age 45, when presbyopia appeared, Judy had to be refitted with contact lenses. Around the time of menopause, at age 51, she developed some symptoms of dry eyes, <a href="https://pubmed.ncbi.nlm.nih.gov/28706404/">which had increased in the months before she came to see me</a>.</p>
<p>Changes in lens materials, care solutions or wearing mode (one day) had little effect. The arid environments (car interiors, airplanes, recycled office air) to which she was regularly exposed contributed to her symptoms. She also spent quite a number of hours in front of a computer screen, and as a result, blinked less frequently, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8439964/">which in turn increased her visual discomfort</a>.</p>
<p>Clinical examination showed that she did, indeed, suffer from dry eyes. She had a reduced volume of tears, <a href="https://crstoday.com/articles/2011-may/focus-on-complications-and-complexity-dry-eye-after-lasik">a side effect of her laser surgery</a>. Her cornea showed a dry, altered area, which we attributed to incomplete closure of the eyelids during sleep, no doubt induced by the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7154208/">cosmetic eyelid surgery she had had three years prior</a>. And then there were the consequences of her medication: some antidepressants have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8884704/">drying effects on the eye</a>.</p>
<h2>A step-by-step approach</h2>
<p>Judy’s vision problems were compounded by eye health issues.</p>
<p>All dry eyes have an impact on quality of vision, whatever the method of correction that’s used. So the first thing to do was to restore the balance — and treat her dry eyes.</p>
<p>Past surgery had left its mark, and there is no turning back the clock. So how to proceed in this situation?</p>
<p>As far as the eyes are concerned, the <a href="https://www.tfosdewsreport.org/public/images/TFOS_DEWS_II_Management_ther.pdf">first step</a> is to ensure intensive lubrication (full artificial tears, with no chemical preservatives). An ointment should also be applied at bedtime to protect the cornea during sleep. Topical cyclosporine should be considered because of <a href="https://pubmed.ncbi.nlm.nih.gov/33299295/">its action on tear stability</a>.</p>
<p>Furthermore, soft contact lenses can exacerbate dry eyes. Fortunately, other alternatives exist. <a href="https://sclerallens.org/for-patients-2/what-are-scleral-lenses/">Scleral lenses</a> are large rigid lenses that create a tear reservoir, which helps to <a href="https://healthcare.utah.edu/healthfeed/2022/08/scleral-contact-lenses-might-be-best-solution-youve-never-heard-of-dry-eye">reduce dry eye symptoms</a>. Despite their large diameter, these lenses are very comfortable because they rest on the white of the eye (the sclera) without touching the cornea. Visually, they can compensate for myopia, astigmatism and presbyopia.</p>
<p>I suggested these lenses to Judy. However, from her reaction I understood that she was looking for a surgical alternative instead.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/567134/original/file-20231221-16-qled5m.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="scleral lens" src="https://images.theconversation.com/files/567134/original/file-20231221-16-qled5m.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/567134/original/file-20231221-16-qled5m.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/567134/original/file-20231221-16-qled5m.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/567134/original/file-20231221-16-qled5m.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/567134/original/file-20231221-16-qled5m.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/567134/original/file-20231221-16-qled5m.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/567134/original/file-20231221-16-qled5m.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Scleral lenses are large, rigid lenses that create a reservoir of tears.</span>
<span class="attribution"><span class="source">(Langis Michaud)</span>, <span class="license">Fourni par l'auteur</span></span>
</figcaption>
</figure>
<h2>Lens exchange, with clear crystalline lenses as an option</h2>
<p>Laser enhancement is not an option <a href="https://myvision.org/lasik/how-many-times/">when the cornea becomes too thin</a>.</p>
<p>However, for some years now, it has been possible to have surgery to replace the crystalline lens, the natural lens inside of the eye, with an implant. Similar to cataract surgery, this procedure is carried out in the absence of any pathology of this type, on patients who are generally younger (aged 50-65) and healthy. And it is currently quite popular.</p>
<p>The advantage is that this implant can correct the majority of visual defects — unlike Lasik. In Judy’s case, it would be a multifocal (distance and near vision) and toric (astigmatism) lens implant.</p>
<p>Judy was immediately interested in this option. She assumed that this surgery would permanently free her from the need for contact lenses or glasses.</p>
<h2>A procedure with potential risks</h2>
<p>All surgery carries risks. In the presence of disease or pathology, the ophthalmologist’s decision to operate should, in theory, be based on a rigorous assessment of the level of risk compared to expected benefits.</p>
<p>In the case of a clear lens exchange, where no pathology is present, the question of risks versus benefits must be considered differently. We are essentially talking about non-essential, non-urgent cosmetic surgery. The risk remains, but the benefit is less obvious and more related to the patient’s personal satisfaction, which may vary a lot based on our own perspective.</p>
<p>While cataract surgery is considered to be a safe procedure, the same cannot always be said of <a href="https://www.sciencedirect.com/science/article/abs/pii/B9780323035996500638">clear lens exchange</a>. The younger the patient, the greater the risk of complications. Other factors specific to the patient <a href="https://www.aao.org/eyenet/article/refractive-lens-exchange-debate">may also weigh in the balance</a>. Before proceeding, the condition must be rigorously assessed.</p>
<p>The retina of every myopic person is <a href="https://pubmed.ncbi.nlm.nih.gov/22772022/">at risk of tearing</a>. This is a possible complication of cataract and lens surgeries <a href="https://www.reviewofophthalmology.com/article/a-review-of-refractive-lens-exchange">that should not be underestimated</a>. The high myopic retina is also stretched and <a href="https://pubmed.ncbi.nlm.nih.gov/29265742/">can deteriorate beyond the age of 60</a>, like a cinema screen that becomes cracked. Vision automatically deteriorates.</p>
<p>A multifocal implant requires a perfect retina to ensure good vision. Since Judy was highly myopic, she cannot be guaranteed perfect vision for life following clear lens exchange.</p>
<p>Not to mention that, like her mother and grandmother, she could one day develop macular degeneration. In this case, as well, the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7575463/">vision of the multifocal implant would be greatly affected</a>.</p>
<p>Multifocal implants are often associated with the perception of halos and glare, particularly in the evening. While the majority of patients tolerate these side effects after surgery, they can become very disturbing over the long term, as they <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5747227/">persist over time</a>. It may be worst in the presence of eye dryness. Moreover, the procedure is not entirely reversible — removal of the implants can have significant consequences.</p>
<p>So replacing Judy’s lens didn’t seem to be the best option, at least for the moment. In the meantime, she decided to consider scleral lenses and to optimize the treatment of her dry eyes.</p>
<p>She left satisfied, having explored her options with the person who knows her eyes best — her optometrist!</p><img src="https://counter.theconversation.com/content/220753/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Langis Michaud ne travaille pas, ne conseille pas, ne possède pas de parts, ne reçoit pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'a déclaré aucune autre affiliation que son organisme de recherche.</span></em></p>It is possible to have surgery to replace the crystalline lens, the natural lens of the eye, with an implant — without having a cataract. But surgery has risks.Langis Michaud, Professeur Titulaire. École d'optométrie. Expertise en santé oculaire et usage des lentilles cornéennes spécialisées, Université de MontréalLicensed as Creative Commons – attribution, no derivatives.