Flesh-eating bacteria cases on the rise and we need an urgent response

In Australia, cases of Buruli ulcer have  
been associated with coastal areas – like Victoria’s Bellarine Peninsula. 
Bernard Spragg. NZ/Flickr

Victoria is facing a worsening epidemic of flesh-eating bacteria that cause a disease known internationally as Buruli ulcer – and we don’t know how to prevent it. Also called Bairnsdale ulcer or Daintree ulcer, this disease causes destructive skin lesions that can lead to severe illness and occasionally even death.

Buruli ulcer is caused by the bacteria Mycobacterium ulcerans (M. ulcerans) and often results in long-term disability and cosmetic deformity.

An epidemic, or an outbreak, is when cases of a disease occur more often than expected in a given area over a particular period of time.

In 2016, there were 182 new cases in Victoria, which, at the time was the highest number ever reported. But the number of casesreported in 2017 (275) have further increased by 51%, compared with 2016 (182). The cases are also becoming more severe in nature and occurring in new geographical areas.

In Australia, Buruli ulcer is frequently reported from the Daintree region, and less commonly the Capricorn coast, of Queensland. Occasionally we’ve heard of cases from the NT, NSW and WA. But most reports come from Victoria, where the disease has been recognised since 1948.

Despite this, we still don’t know the exact environmental niche where the organism lives and how it is transmitted to humans.

Our article, published today in the Medical Journal of Australia, calls for an urgent investigation to answer some critical questions. These include finding out the natural source of M. ulcerans; how the infection is transmitted to humans; what role possums, mosquitoes and other species play in transmission; why the disease incidence is increasing and spreading into new areas in Victoria; and why cases are becoming more severe.

Why is Buruli ulcer such a problem?

Buruli ulcer occurs most commonly in the tropical regions of West or Central Africa, and is a significant public health problem there.

Ulcers are the most common form of this disease. But it can also manifest as a small swelling or lump below the skin, a plaque or as a cellulitic form, and can be complicated by bone or joint infection. The disease can affect all age-groups, including young children.

Treatment effectiveness has improved in recent years and cure rates have approached 100% with the use of combination antibiotics (rifampicin and clarithromycin). But these are expensive and not subsidised under Australia’s Pharmaceutical Benefits Scheme (PBS).

The treatments are also powerful and about one-quarter of people have severe side-effectsincluding hepatitis, allergy or a destabilisation of other medical conditions such as heart disease or mental illness.

Buruli ulcer usually requires reconstructive surgery, like in the case of this 76-year-old man. Author provided

Many people require reconstructive plastic surgery – sometimes with prolonged hospital admissions. On average it takes four to five months for the disease to heal, and sometimes a year or more.

All of this results in substantial costs through such things as wound dressings, medical visits, surgery, hospitalisation, and time off work or school.

What do we know about the bacteria?

M. ulcerans disease is concentrated in particular sites, and endemic and non-endemic areas are separated by only a few kilometres. In Africa it’s usually associated with wetlands, especially those with slow-flowing or stagnant waters. But in Australia it’s found mostly in coastal regions, like Victoria’s Mornington Peninsula.

We know the risk of infection is seasonal, with an increased risk in the warmer months. Lesions most commonly occur on areas of the body that have been exposed. This suggests bites, environmental contamination or trauma may play a role in infection, and that clothing is protective.

Human-to-human transmission does not seem to occur, although cases are commonly clustered in families, presumably as a result of similar environmental exposure.

The rest is unclear. Possible sources of infection in the environment include the soil, or dead plant material in water bodies such as lakes or ponds.

It may be transmitted to humans though contamination of skin lesions and minor abrasions – through trauma or via the bite of insects such as mosquitoes.

In Victoria, some possums in Point Lonsdale on the Bellarine Peninsula (an endemic area) were found to have Buruli ulcers and have high levels of M. ulcerans in their faeces. The location, proportion and concentration of M. ulcerans in possum faeces was also strongly correlated with human cases. But no M. ulcerans was found in possum faeces in nearby areas with no human cases.

So, it’s thought possum faeces might increase the risk of infection to humans in contact with that environment, or infection could be potentially transmitted by insects biting possums and then humans.

What should we do?

We need to understand the risk factors for M. ulcerans disease by comprehensively analysing human behaviour and environmental characteristics, combined with information on climate and geography.

It’s especially relevant that over the last two years, the number of cases have been increasing in the Mornington Peninsula, while decreasing in the adjacent Bellarine Peninsula. Studying this could allow us to pinpoint the risk factors that underlie the differing incidence patterns.

Once identified, more specific analysis can be performed to further assess the role of these risk factors. We can then explore targeted interventions such as modifying human behaviour, insect control, changes to water use and informed urban planning. Through this we have the best chance to develop effective public health interventions to prevent the disease, and promote more community education and awareness campaigns to help people protect themselves.

It will also facilitate the development of predictive models for non-affected areas that closely monitor these areas for the emergence of the organism. This knowledge can hopefully also be applied globally to benefit those affected overseas.

We need an urgent response based on robust scientific knowledge. Only then can we hope to halt the devastating impact of this disease. We advocate for local, regional and national governments to urgently commit to funding the research needed to help stop Buruli ulcer.


This article was written by:
Image of Daniel O’BrienDaniel O’Brien – [Associate Professor and specialist advisor with the Manson Unit, MSF-UK focusing on HIV/AIDS, tuberculosis and Buruli ulcer, University of Melbourne]

 

 

 

This article is part of a syndicated news program via

 

Night owls may have 10 percent higher risk of early death, study says

 Night owls, or people who have a hard time waking 
up in the morning, face health risks as a result. aslysun/Shutterstock.com

Do you wake up bright eyed and bushy-tailed, greeting the sunrise with cheer and vigor? Or are you up late into the night and dread the sound of your alarm clock? We call this inherent tendency to prefer certain times of day your “chronotype” (chrono means time). And it may be more than a scheduling issue. It has consequences for your health, well-being and mortality.

Being a night owl has been associated with a range of health problems. For example, night owls have higher rates of obesity, high blood pressure and cardiovascular disease. Night owls are also more likely to have unhealthy behaviors, such as smoking, alcohol and drug use, and physical inactivity.

We study the health effects of being a night owl. In our recent study published in Chronobiology International, we found even worse news for the owls of the world: a higher risk of early death.

Your very own biological clock

Our bodies have their own internal time-keeping system, or clock. This clock would keep running even if a person were removed from the world and hidden away in a dark cave (which some dedicated researchers did to themselves years ago!). We believe these internal clocks play an important role in health by anticipating the time of day and preparing the body accordingly.

For example, as humans, we typically sleep at night, and our bodies start preparing for our habitual bedtime even before we try to fall asleep. Similarly, we eat during the day, so our body is prepared to process the food and nutrients efficiently during the daytime.

Our chronotype is also related to our biological clock. Morning larks’ biological clocks are set earlier. Their habitual bedtimes and wake times occur earlier in the day. Night owls have internal clocks set for later times. But are there any problems related to being a lark or owl, other than scheduling difficulties? Research suggests that there are; night owls tend to have worse health.

And, in our new study, we compared risk of dying between night owls and morning larks. In this study, death certificates were collected for an average of 6.5 years after the initial study visit to identify those who died. We found that night owls had a 10 percent increased risk of death over this six-and-a-half year period compared to larks. We also found that owls are more likely to have a variety of health problems compared to larks, particularly psychiatric disorders like depression, diabetes and neurological disorders.

The switch to daylight saving time in the U.S. (or summer time in the U.K.) only makes things more difficult for night owls. There are higher rates of heart attacks following the switch to daylight savings, and we have to wonder if more night owls are at risk.

Why do night owls have more health problems?

Night owls’ health risks could be related to drinking, but they also could be due to loneliness. Jacob Lund/Shutterstock.com

We researchers do not fully understand why we see more health problems in night owls. It could be that being awake at night offers greater opportunity to consume alcohol and drugs. For some, being awake when everyone else is sleeping may lead to feelings of loneliness and increased risk of depression. It could also be related to our biological clocks.

As explained above, an important function of internal biological clocks is to anticipate when certain things, like sunrise, sleep and eating, will occur. Ideally, our behavior will match both our internal clock and our environment. What happens when it doesn’t? We suspect that “misalignment” between the timing of our internal clock and the timing of our behaviors could be detrimental over the long run.

A night owl trying to live in a morning lark world will struggle. Their job may require early hours, or their friends may want to have an early dinner, but they themselves prefer later times for waking, eating, socializing and sleep. This mismatch could lead to health problems in the long run.

What can owls do?

It is true that someone’s “chronotype” is (approximately) half determined by their genes, but it is not entirely preordained. Many experts believe that there are behavioral strategies that may help an individual who prefers evening. For example, gradually advancing your bedtime – going to bed a little earlier each night – may help to move someone out of the “night owl zone.”

Going to bed early is part of getting a good night’s sleep. fizkes/Shutterstock.com

A gradual advance is important because if you try to go to bed two to three hours earlier tonight, it won’t work, and you may give up. Once you achieve an earlier bedtime, maintain a regular schedule. Avoid shifting to later nights on weekends or free days because then you’ll be drifting back into night owl habits. Also, avoiding light at night will help, and this includes not staring into smartphones or tablets before bed.

On a broader scale, flexibility in work hours would help to improve the health of night owls. Night owls who can schedule their day to match their chronotype may be better off.

It is important to make night owls aware about the risks associated with their chronotype and to provide them with this guidance on how to cope. We researchers need to identify which strategies will work best at alleviating the health risks and to understand exactly why they are at increased risk of these health problems in the first place.


RThis article was co-authored by:

Image of Kristen KnutsonKristen Knutson – [Associate Professor of Neurology, Northwestern University]

and

Image of Malcolm von SchantzMalcolm von Schantz – [Professor of Chronobiology, University of Surrey]

 

 

 

This article is part of a syndicated news program via

 

Health check: why do we get muscle cramps?

 Some people experience cramps frequently after 
vigorous, high-intensity exercise. from shutterstock.com

Many of us know the feeling of a cramp – whether you’ve been struck down on the sports field or woken with a start in excruciating pain in the middle of the night. A cramp is the involuntary contraction of our skeletal muscle, and it hurts.

Some people often experience cramps after vigorous, high-intensity exercise, but there are also many who experience them with no exercise at all – mostly at night. These “nocturnal” cramps occur with increasing frequency as we age, and are common in pregnancy.

Interestingly, these cramps are usually restricted to the lower limb. This is generally the same as athletes experiencing exercise-associated muscle cramps. So, are the causes the same?

What causes cramps?

Actually, we don’t really know, but there are several theories.

We know cramps are rarely seen at the start of a sporting contest, but regularly seen at the end. So fatigue seems to be the defining factor in exercise. Some researchers have long suggested dehydration and electrolyte imbalance (such as decreased salt content) as a cause.

But recent reviews have downplayed this theory, as the evidence is mostly observational. This means while there may be an association between dehydration, salt depletion and cramps, we can’t prove one caused the other.

Also, in these studies, people who were prone to cramps didn’t have differences in hydration or electrolyte content compared to people who were not prone to cramps.

And if electrolyte imbalance was implicated, then all the muscles in the body would be affected. But only muscles actively being used tend to cramp, particularly those that cross more than one joint, such as the calf muscle and hamstrings. These may be contracting from a shortened position when the knee is bent.

Mismatched reflexes

Muscles have an inbuilt reflex mechanism. When the muscle is tensed, or contracts, a reflexive message is sent to the spinal cord for the muscle to lengthen and relax. This protects the muscle from injury.

The recent reviews suggest what is called the altered neuromuscular control hypothesis to explain cramps. Here, the protective reflex action is disrupted, which usually happens when the muscle is tired. So, in this instance, the muscle contracts, but the usual signal to the spinal cord for it to relax is inhibited. There is now no protective relaxing of the muscle that follows, meaning it contracts for longer than you want it to.

When we tense our muscles a message is sent to the spinal cord for the muscles to relax. From shutterstock.com

But the reason for neuromuscular fatigue, and why this inhibits the reflex, is not well understood. Cramps are also more common at the start of a sports season, when muscles are less conditioned. This is most likely due to higher levels of fatigue occurring in less trained muscles.

The altered neuromuscular control could also explain nocturnal cramps, as older muscles of inactive people are generally shorter. Whether this is the case in pregnancy is still debated.

Hot conditions have also been associated with increased cramping, but this likely relates to higher rates of fatigue when it’s hot. Despite what people may think, cold doesn’t increase the incidence of cramps, but may be likely to make the severity of cramps worse as reflexes are stronger in cold, stiff muscles.

Are certain people more susceptible?

Some people seem to experience cramps more often than others, which may be related to the sensitivity of their muscle reflexes.

Fatigue is a clear risk factor, both in long-term endurance athletes and in those participating in high-intensity activities. This is because high-intensity activities require the use of our powerful, fast-contracting fibres (fast fibres), as opposed to lower-intensity activities that use our slower fibres. Fast fibres are more susceptible to fatigue.

Cramps are more prevalent in males, which may be because males have more fast fibres, or because females demonstrate less fatigue when exercising at similar relative intensities.

Cramps may occur during the night, including commonly in pregnant women. from shutterstock.com

Nocturnal cramps are more commonly reported in older age. There is also a particularly high prevalence of cramps in pregnancy, generally beginning in the second trimester and often worsening in the third.

No one really knows exactly why this occurs. It may be due to increased fatigue from carrying the extra body weight, or increased pressure on the leg muscles due to slowed return of blood to the heart.

Hormones could play a role too, and there have been suggestions that women taking the contraceptive pill could be more prone to cramping. Connective tissue stiffness is altered by sex hormones.

But, while reflex sensitivity does change with the phases of the menstrual cycle, the muscle stretch reflex is actually lowest at ovulation, and there is limited evidence that the pill affects this.

How do we treat cramps?

Salt tablets and magnesium have been commonly used for cramps, but because electrolyte imbalance and dehydration don’t appear to be the cause, their usefulness is debatable.

Stretching is generally the best way to get rid of a cramp. From shutterstock.com

The best way to get rid of a cramp is by stretching the muscle, since the reflex to do this is likely being inhibited. However, stretching a severely cramping muscle might cause a degree of damage to the muscle.

So, contracting the opposite muscle in the muscle pair (usually on the other side) may be a better approach. This involves, for example, contracting the quadriceps (at the front of the leg) when the hamstrings (at the back of the leg) are cramping.

Given the overall lack of understanding of exactly how cramps occur, evidence-based prevention strategies are few and far between. If fatigue is one of the main causes of increased susceptibility to cramps, then methods to delay fatigue – such as fluid intake and salt replacement during exercise – may help prevent them. This can also aid performance.

Massage (due to reduced nerve sensitivity) and stretching may also help decrease the incidence of cramps in older people and during pregnancy.


This article was written by:
Image of Alan HayesAlan Hayes – [Assistant Dean, Western Centre for Health Research and Education, Victoria University]
 
 
 
This article is part of a syndicated news program via

 

 

What is hepatitis A and how can you get it from eating frozen fruit?

 Imported frozen pomegranate seeds have been linked 
to hepatitis A infections in NSW. from www.shutterstock.com

Seven people in New South Wales have been diagnosed with hepatitis A after eating imported frozen pomegranate seeds from Coles. Although still under investigation, the company responsible for production recalled the implicated product as a precaution.

Around 40,000 packs of Creative Gourmet Frozen Pomegranate Arils have been sold since hitting the shelves in September 2017. NSW Health is advising consumers to immediately dispose of any in their possession.

What is hepatitis A?

Hepatitis A is a virus that infects the liver. Symptoms usually take 15-50 days to develop after initial infection and typically last for several weeks or sometimes longer.

Symptoms can range from fever, weakness, tiredness, loss of appetite, nausea, muscle aches, vomiting and jaundice (yellow discolouration of the eyes and skin). Sometimes there are no symptoms, particularly among young children.

Liver failure and death from hepatitis A are very rare but occasionally occur among those with existing chronic health conditions, especially those that affect the liver. Hepatitis A vaccination is recommended for those living with hepatitis B and C.

How does it spread?

Hepatitis A is spread when a person ingests faecal matter from an infected person. This can occur through person-to-person contact (including through sexual or even seemingly trivial household contact), or consumption of contaminated food and water.

Hepatitis A is quite an infectious virus. Only microscopic amounts of poo are needed to infect people and cause symptoms. People living in the same house with a person with hepatitis A have an increased risk of acquiring hepatitis A unless receiving preventive interventions.

The virus can survive on hands and other surfaces such as cooking utensils and plates for hours. So it’s important to ensure that infected people properly wash their hands after using the toilet, and completely avoid handling food.

Hepatitis A infections occur infrequently in Australia, with the number of cases detected dropping profoundly in the last 20 years. Most infections are in people who have travelled in countries where hepatitis A transmission is common due to poor sanitation and lack of access to safe water.

When outbreaks occur, they are due to contaminated foods, as we saw with the frozen pomegranate seeds, or person-to-person transmission. This is the case for the currentoutbreak in Victoria, which has predominantly been spread between sexual partners, although other routes of transmission have also occurred.

Hepatitis A can survive on your hands for hours, so it’s important to wash thoroughly to prevent transmission. from www.shutterstock.com

How is it treated?

Although hepatitis A can cause significant illness, the body usually recovers without treatment and becomes immune to future infections.

A highly effective hepatitis A vaccine has been available for decades, and once fully vaccinated (two vaccinations spaced at least six months apart), you’re protected for life.

Has this happened before?

Pomegranates have been linked to outbreaks internationally but not in Australia.

Past food-related outbreaks in Australia have occurred in oysters, lettuce, semi-dried tomatoes and frozen berries.

Imported frozen berries from the same producer implicated in the pomegranate associated outbreak were recalled due to linked cases of hepatitis A in 2015 and again in 2017.

These outbreaks led to some questions regarding the screening and regulations of imported food coming into Australia and prompted new regulations by the Department of Agriculture, requiring the producer of imported berries to be declared. The Department of Agriculture and Food Standards Australia New Zealand (AFANZ) also issued guidance and recommendations to ensure industry producers are compliant with Australia’s food standards.

Microbiological screening tests for imported berries currently only involves testing for the intestinal bacterium E.Coli.

Why is this happening again?

Contamination of pomegranates, berries and other food products with hepatitis A can occur at several points of production, through:

  • the use of contaminated water during irrigation
  • the processing and cleaning stages, or
  • handling by people infected with hepatitis A who may not have washed their hands prior to processing and packaging the fresh product.

Both pomegranates and berries require large amounts of water and handling for processing, so it’s not surprising these types of outbreaks have occurred in Australia and across the world.

These outbreaks tend to be reported in countries such as Australia with low rates of hepatitis A. This is because there are more susceptible people in the population who aren’t immune from natural infections earlier in life. Also, these countries tend to have better functioning surveillance systems and relatively good access to health care.

Freezing fruit does not inactivate the hepatitis A virus, which remains stable and able to cause human infections when consumed. Heat can kill the virus, however the berries need to stay heated at 85 degrees Celsius for at least one minute.

Should I be worried?

Although this imported frozen pomegranate product has been linked to hepatitis A, no fresh (or Australian-produced) pomegranate has been connected with the recent hepatitis A cases.

If you have eaten any of the implicated pomegranate seeds within the last few weeks and are experiencing any symptoms, see your doctor for a blood test and don’t forget to wash your hands.


This article was co-authored by:
Image of Benjamin CowieBenjamin Cowie – [Director, WHO Collaborating Centre for Viral Hepatitis, The Peter Doherty Institute for Infection and Immunity]
and
Image of Nicole RomeroNicole Romero – [Epidemiologist, WHO Collaborating Centre for Viral Hepatitis, The Peter Doherty Institute for Infection and Immunity]

 

 

 

This article is part of a syndicated news program via

 

A brief history of fake doctors, and how they get away with it

 Impersonation of doctors is a modern phenomenon 
that grew out of Western medicine’s drive towards professionalism. 
from shutterstock.com

Melbourne man Raffaele Di Paolo pleaded guilty last week to a number of charges related to practising as a medical specialist when he wasn’t qualified to do so. Di Paolo is in jail awaiting his sentence after being found guilty of fraud, indecent assault and sexual penetration.

This case follows that of another so-called “fake doctor” in New South Wales. Sarang Chitale worked in the state’s public health service as a junior doctor from 2003 until 2014. It was only in 2016, after his last employer – the research firm Novotech – reported him to the Australian Health Practitioner Regulation Agency (AHPRA), that his qualifications were investigated.

“Dr” Chitale turned out to be Shyam Acharya, who had stolen the real Dr Chitale’s identity and obtained Australian citizenship and employment at a six-figure salary. Acharya had no medical qualifications at all.

Cases of impersonation, identity theft and fraudulent practice happen across a range of disciplines. There have been instances of fake pilotsveterinarians and priests. It’s especially confronting when it happens in medicine, because of the immense trust we place in those looking after our health.

So what drives people to go to such extremes, and how do they get away with?

A modern phenomenon

Impersonation of doctors is a modern phenomenon. It grew out of Western medicine’s drive towards professionalism in the 19th century, which ran alongside the explosion of scientific medical research.

Before this, doctors would be trained by an apprentice-type system, and there was little recourse for damages. A person hired a doctor if they could afford it, and if the treatment was poor, or killed the patient, it was a case of caveat emptor – buyer beware.

But as science made medicine more reliable, the title of “doctor” really began to mean something – especially as the fees began to rise. By the end of the 19th century in the British Empire, becoming a doctor was a complex process. It required long university training, an independent income and the right social connections. Legislation backed this up, with medical registration acts controlling who could and couldn’t use medical titles.

Given the present social status and salaries of medical professionals, it’s easy to see why people would aspire to be doctors. And when the road ahead looks too hard and expensive, it may be tempting to take short cuts.

Today, there are four common elements that point to weaknesses in our health-care systems, which allow fraudsters to slip through the cracks and practise medicine.

Shyam Acharya stole Dr Chitale’s identity to practise medicine. AAP Images

1. Misplaced trust

Everyone believes someone, somewhere, has checked and verified a person’s credentials. But sometimes this hasn’t been done, or it takes a long time.

Fake psychiatrist Mohamed Shakeel Siddiqui – a qualified doctor who stole a real psychiatrist’s identity and worked in New Zealand for six months in 2015 – left a complicated trail of identity theft that required the assistance of the FBI to unravel.

Last year, in Germany, a man was found to have forged foreign qualifications that he presented to the registering body in early 2016. He was issued with a temporary licence while these were checked. When the qualifications turned out to be fraudulent, he was fired from his job as a junior doctor in a psychiatric ward. But this wasn’t until June 2017.

2. Foreign credentials

Credentials from a foreign university, issued in a different language, are another common element among medical fraudsters. Verifying these can be time-consuming, so a health system desperate for staff may cut corners.

Ioannis Kastanis was appointed as head of medicine at Skyros Regional Hospital in Greece in 1999 with fake degrees from Sapienza University of Rome. The degrees were recognised and the certificates translated, but their authenticity was never checked.

Dusan Milosevic, who practised as a psychologist for ten years, registered in Victoria in 1998. He held bogus degrees from the University of Belgrade in Serbia – at the time a war-torn corner of Europe, which made verification difficult.

3. Regional and remote practice

It’s easier to get away with faking in regional or remote areas where there is less scrutiny. Desperation to retain staff may also silence complaints.

“Dr” Balaji Varatharaju fraudulently gained employment in remote Alice Springs, where he worked as a junior doctor for nine months.

Ioannis Kastanis had worked on a distant Greek island with a population of only around 3,000 people.

4. It’s not easy to dob

Finally, there are two unnerving questions. How do you tell a poorly trained but legally qualified practitioner from a faker? And who do you tell if you suspect something is off?

The people best placed to spot the fakes – other hospital and health-care staff – work in often stressful conditions where complaints about colleagues can lead to reprisals. If the practitioner is from another ethnicity or culture, this adds an extra layer of sensitivity. It was only after “Dr Chitale” was exposed that staff were willing to say his practice had been “shabby”, “unsavoury” and “poor”.

Qualified doctors, like former Bundaberg surgeon Jayant Patel, have also caused problems. DAN PELED/AAP Image

So, why do they do it?

The reasons for fakery are as diverse as the fakers. “Dr Nick Delaney”, at Lady Cilento Children’s Hospital in Brisbane, reportedly pretended to be a doctor to “make friends” and keep a fling going with a security guard at the same hospital.

On a more sinister level, there are possible sexually predatory reasons, like those of bogus gynaecologist Raffale Di Paolo. Fake psychiatrist Mohamed Shakeel Siddiqui said he only did it to help people.

There are also the less easily understood fakers, like “Dr” Adam Litwin, who worked as a resident in surgery at UCLA Medical Center in California for six months in 1999. Questions only began to be asked when he turned up to work in his white coat with a picture of himself silk-screened on it: even by Californian standards, this was going too far.

So how do we stop this happening?

Part of the problem is our cultural dependence on qualifications as the passkey to higher income and social status, making them an easy target for fraudsters. Qualifications only reduce risk, but they can’t eliminate it. Qualified doctors can also cause havoc: think Jayant Patel and other bona fide qualified practitioners who have been struck off for malpractice, mutilation and manslaughter.

Conversely, no one complained about “Dr Chitale” in 11 years. The only complaints Kastanis received in 14 years were from people who thought his Ferrari was vulgar. The German junior doctor had an excellent knowledge of mental health-care procedures and language – obtained from his time as a psychiatric patient.

Most of these loopholes can be closed with time and patience. What would help is if hospital and health-care staff felt sufficiently supported to report their suspicions to their employer, rather than to their colleagues. This would foster a more open culture of flagging concerns about fellow practitioners without fear of formal or informal punishment. It might also uncover more “Dr Chitales” before anyone is seriously harmed.


This article was written by:
Image of Philippa MartyrPhilippa Martyr – [Lecturer, Pharmacology, University of Western Australia]

 

 

 

This article is part of a syndicated news program via

 

Six things you can do to reduce your risk of dementia

 Challenging and training your brain is important 
to prevent dementia risk. Photo by rawpixel.com on Unsplash

An ageing population is leading to a growing number of people living with dementia. Dementia is an umbrella term for a group of symptoms including memory impairment, confusion, and loss of ability to carry out everyday activities.

Alzheimer’s disease is the most common form of dementia, and causes a progressive decline in brain health.

Dementia affects more than 425,000 Australians. It is the second-ranked cause of deathoverall, and the leading cause in women.

The main risk factor for dementia is older age. Around 30% of people aged over 85 live with dementia. Genetic influences also play a role in the onset of the disease, but these are stronger for rarer types of dementia such as early-onset Alzheimer’s disease.


Read more: What causes Alzheimer’s disease? What we know, don’t know and suspect


Although we can’t change our age or genetic profile, there are nevertheless several lifestyle changes we can make that will reduce our dementia risk.

1. Engage in mentally stimulating activities

Education is an important determinant of dementia risk. Having less than ten years of formal education can increase the chances of developing dementia. People who don’t complete any secondary school have the greatest risk.

The good news is that we can still strengthen our brain at any age, through workplace achievement and leisure activities such as reading newspapers, playing card games, or learning a new language or skill.

Even playing cards can strengthen your brain. Photo by Inês Ferreira on Unsplash

The evidence suggests that group-based training for memory and problem-solving strategies could improve long-term cognitive function. But this evidence can’t be generalised to computerised “brain training” programs. Engaging in mentally stimulating activities in a social setting may also contribute to the success of cognitive training.

2. Maintain social contact

More frequent social contact (such as visiting friends and relatives or talking on the phone) has been linked to lower risk of dementia, while loneliness may increase it.

Greater involvement in group or community activities is associated with a lower risk. Interestingly, size of friendship group appears less relevant than having regular contact with others.

3. Manage weight and heart health

There is a strong link between heart and brain health. High blood pressure and obesity, particularly during mid-life, increase the risk of dementia. Combined, these conditions may contribute to more than 12% of dementia cases.

In an analysis of data from more than 40,000 people, those who had type 2 diabetes were up to twice as likely to develop dementia as healthy people.

Managing or reversing these conditions through the use of medication and/or diet and exercise is crucial to reducing dementia risk.

Exercise is protective for heart health and diabetes, as well as against cognitive decline. Photo by chuttersnap on Unsplash

4. Get more exercise

Physical activity has been shown to protect against cognitive decline. In data combined from more than 33,000 people, those who were highly physically active had a 38% lowerrisk of cognitive decline compared with those who were inactive.

Precisely how much exercise is enough to maintain cognition is still under debate. But a recent review of studies looking at the effects of taking exercise for a minimum of four weeks suggested that sessions should last at least 45 minutes and be of moderate to high intensity. This means huffing and puffing and finding it difficult to maintain a conversation.

Australians generally don’t meet the target of 150 minutes of physical activity per week.

5. Don’t smoke

Cigarette smoking is harmful to heart health, and the chemicals found in cigarettes trigger inflammation and vascular changes in the brain. They can also trigger oxidative stress, in which chemicals called free radicals can cause damage to our cells. These processes may contribute to the development of dementia.

The good news is that smoking rates in Australia have dropped from 28% to 16% since 2001.

As dementia risk is higher in current smokers compared with past smokers and non-smokers, this provides yet another incentive to quit once and for all.

6. Seek help for depression

Around one million Australian adults are currently living with depression. In depression, some changes occur in the brain that may affect dementia risk. High levels of the stress hormone cortisol have been linked to shrinkage of brain regions that are important for memory.

High blood pressure can increase the risk of dementia. Photo by rawpixel.com on Unsplash

Vascular disease, which causes damage to blood vessels, has also been observed in both depression and dementia. Researchers suggests that long-term oxidative stress and inflammation may also contribute to both conditions.

28-year study of more than 10,000 people found that dementia risk was only increased in those who had depression in the ten years before diagnosis. One possibility is that late-life depression can reflect an early symptom of dementia.

Other studies have shown that having depression before the age of 60 still increases dementia risk, so seeking treatment for depression is encouraged.

Other things to consider

Reducing dementia risk factors doesn’t guarantee that you will never develop dementia. But it does mean that, at a population level, fewer people will be affected. Recent estimates suggest that up to 35% of all dementia cases may be due to the risk factors outlined above.

This figure also includes management of hearing loss, although the evidence for this is less well established.

The contribution of sleep disturbances and diet to dementia risk are emerging as important, and will likely receive more consideration as the evidence base grows.

Even though dementia may be seen as an older person’s disease, harmful processes can occur in the brain for several decades before dementia appears. This means that now is the best time to take action to reduce your risk.


This article was written by:
Image of Helen MacphersonHelen Macpherson – [Research Fellow, Institute for Physical Activity and Nutrition, Deakin University]

 

 

 

 

This article is part of a syndicated news program via

Do you really need private health insurance? Here’s what you need to know before deciding

 More than half of Australians have private 
 health insurance. l i g h t p o e t/Shutterstock

Every year at the end of March and early in April, the 11 million Australians who have private health insurance receive notification that premiums are increasing.

Premiums will increase by an average of 3.95% from April 1 and will vary with the insurerand the product. The increase is lower than previous years but still higher than any wage growth, leaving consumers wondering if they should give it up or downgrade to save money.

Why go private?

Australia has a universal health care system, Medicare. Health care is available to all and is financed, in part, through a 2% tax on our wages (the Medicare levy). Access to general practitioners and public hospitals are just some of the benefits.

The Commonwealth government encourages Australians to have private health insurance. It imposes penalties for not taking it out (paying more income tax: the Medicare levy surcharge) and offers incentives for those who do (rebates on premiums).

More than 50% of Australians have private health insurance, a rise from 31% in 1999.

Australians have different reasons for taking out private health insurance. For some, it makes financial sense to take out policies to avoid paying the Medicare levy surcharge.

Others choose to take out policies to avoid waiting times for elective treatment (predominantly surgery); to choose their own specialist or hospital; or to have the option of a private room, better food or more attractive facilities.

Some people perceive that private health insurance will give them access to better care in the private system. Many are fearful they won’t get the services they need in the public system.

Shorter waits than the public system

A universal health system is based on people with the most clinical need gaining access to the services required.

Most emergency treatment is provided in public hospitals. The case is different for “non-urgent” or elective surgery, with patients encouraged to use their private health insurance, mainly because of waiting times for such surgery in the public system.

Elective surgery waiting times for public hospitals vary according to whether patients are publicly or privately funded. In 2015-2016, the median waiting time (the time within which 50% of all patients are admitted) was 42 days for public patients, 20 days for patients who used their private health insurance to fund their admission, and 16 days for those who self-funded their treatment.

Private patients often have shorter waits. Iakov Filimonov/Shutterstock

Bear in mind, however, that waiting times vary according to clinical urgency. In 2016-17 in New South Wales, 98% of public patients were admitted within the clinically recommended time frame.

Differences in waiting times also vary according to the type of procedure. In 2015-2016, cardiothoracic (heart) surgery had a median waiting time of 18 days for public patients and 16 days for all other patients. In contrast, the median wait for public patients needing total knee replacement was 203 days, and 67 days for all other patients.

The question of choice

Choice of provider is a leading reason people take out private health insurance.

The idea that consumers should have choice in the services they receive has been promoted by government and private health insurance companies for some years, with great success. Many consumers now believe that more choice is better and private health insurance is an “enabler of choice”.

But do people really have choice? Choice is not equally distributed, and not everyone with private health insurance gets the choices they desire.

Private health insurers reserve the right to restrict benefits, or provide maximum benefits for using their “preferred providers”. This, in fact, limits the choices consumers can make.

A recent example of this is the announcement from Bupa that, from August 1, members will face higher out-of-pocket costs in private hospitals that don’t have a special relationship with the company, and some procedures will be excluded from particular policies.

Finding the best policy

If you decide to keep your private health insurance, make sure you’re getting the best deal on a policy that’s right for you. Shop around for a policy that meets your needs.

Take note of what is excluded. If you are thinking about starting a family, you may want to look at whether obstetrics care is covered. For those who are older, inclusions such as hip replacements and cataract removal may be more important.

The Australian government website PrivateHealth.gov.au or the Choice health insurance finder are good places to start. These include all registered health funds in Australia and allow you to compare what is covered in each policy.

Other “free” comparison sites may compare only some health funds and policies, or earn a fee per sale from insurers.


Read more: Here’s what’s actually driving up health insurance premiums (hint: it’s not young people dropping off)


Before taking out extras cover, see whether you are better off to self-insure: setting aside money for if and when you need to pay for extras such as dental or optical care.

Review your policy each year and talk to your health insurance fund about your changing needs. Seek redress if something goes wrong.

If you need a procedure, find out the waiting period in the public system, rather than assuming it will be quicker in the private system. Check the out-of-pocket costs if you choose to use your private health insurance. Then you can assess whether the price tag is worth getting your surgery a few weeks earlier.


Additional reading: Increased private health insurance premiums don’t mean increased value

This article was co-authored by:
Image of Sophie LewisSophie Lewis – [Senior Research Fellow, Centre for Social Research in Health, UNSW]
and
Image of Karen WillisKaren Willis – [Professor, Allied Health Research, Melbourne Health, LaTrobe University, La Trobe University]

 

 

 

 

This article is part of a syndicated news program via

Your asthma puffer is probably contributing to climate change, but there’s a better alternative

 There is an environmentally friendly option. 
from www.shutterstock.com

I breathe all the way out. There’s a quiet puff of gas from my inhaler, and I breathe all the way in. I hold my breath for a few seconds and the medicine is where it needs to be: in my lungs.

Many readers with asthma or other lung disease will recognise this ritual. But I suspect few will connect it with climate change. Until recently, neither did I.

In asthma, there is narrowing of the airways that carry air into and out of our lungs. The lining of the airways becomes swollen, muscles around the airways contract, and mucus is produced. All these changes make it hard to breathe out.

The most commonly used medicines in asthma are delivered by inhalation. Inhaling gets the medicines straight to the airways, speeding and maximising their local effects, and minimising side effects elsewhere compared to, say, swallowing tablets.

Some medicines (“relievers”) work quickly to relax the airway muscles. Others (“preventers”) work more slowly but do more good, preventing asthma’s swelling and inflammation of the airways.

These medicines are available in various sorts of inhaler devices. The devices fall into two broad types: “metered dose inhalers” and “dry powder inhalers” of various shapes and sizes.

In metered dose inhalers, the medicine and a pressurised propellant liquid are mixed together in a little canister, and then sprayed out of the inhaler in a measured puff of fine mist. This is inhaled, often after passing through a “spacer” which allows more of the medicine to reach the lungs. While the medicine is absorbed by the body, the propellant, now a gas, is exhaled unchanged.

In dry powder inhalers, the medicine is in the form of a fine powder which is swept into the lungs as the user breathes in — there is no spray and no spacer.

Powder inhalers don’t release any gases at all. Author provided

It’s feasible for many (but not all) people to use either sort of device. Young children do better with metered dose inhalers and spacers, as do people who struggle to inhale. But most asthmatics can inhale well from dry powder inhalers.

The two types of inhaler seem to work just as well as each other; if anything the dry powder ones might be a little better.

Metered dose inhalers are more often prescribed than dry powder devices in many countries, but this has more to do with history and familiarity than effectiveness.

What about those gases?

You might remember hearing, years ago, about “CFCs” — chlorofluorocarbons — and their dire effect on the ozone layer. A successful international treaty, the Montreal Protocol, led to their phase-out from various uses, including medical inhalers. And with that, I thought, the environmental problems of inhaler gases had ended.


Read more: Explainer: what is thunderstorm asthma?


But CFCs were replaced with “HFCs” — hydrofluorocarbons — which are safe for the ozone layer, but which are potent global warming gases. HFCs are better known in their role as refrigerant gases in air conditioners and refrigerators.

recent amendment to the Montreal Protocol has now planned a phase-out of HFCs, too, but it’s slow, with deadlines decades away. Earlier prudent management of these gases could make a big difference to climate change.

The one most often found in asthma metered dose inhalers, norflurane, is 1,430 times more potent than the best-known warming culprit, carbon dioxide. Another, apaflurane, is 3,220 times more potent than carbon dioxide.

Such warming power explains why even the small amounts in an inhaler are significant. Globally, tens of millions of tons of carbon dioxide equivalent are attributable annually to these inhaler gases.

How much pollution are inhaler gases responsible for in Australia? I wrote to several companies marketing asthma inhalers in Australia, asking them how much of these gases are present in their products. Some gave straight answers, but some hedged on grounds of commercial confidentiality. This makes it hard for me to be exact.

But based on some reasonable assumptions, and multiplying these by the number of inhalers dispensed on our Pharmaceutical Benefits Scheme last year, I tallied nearly 116,000 tonnes of carbon dioxide-equivalent pollution.

That’s equivalent to the emissions of about 25,000 cars annually. And this is surely an underestimate, as it doesn’t account for reliever inhalers sold over the counter. A person using a preventer inhaler monthly, plus the odd reliever inhaler, could easily release the annual equivalent of a quarter of a ton of carbon dioxide — that’s like burning 100 litres of petrol.


Read more: Common products, like perfume, paint and printer ink, are polluting the atmosphere


How to change

The good news is, for many people with asthma, there’s an easy solution: shifting from metered dose inhalers to dry powder inhalers. As above, this won’t suit everyone, but will be possible for many.

I am both a doctor and a person with asthma. As an asthmatic, I’ve found changing inhalers to be easy — if anything, my dry powder inhalers are simpler to use. And as a doctor, I’ve been pleasantly surprised by how open my patients have been to this topic. I worried people might find it weird their GP was raising environmental issues at their appointment, but my fears were unfounded.

If you have asthma, a chat with your doctor or pharmacist would be a good way to gauge whether a dry powder inhaler is feasible for you. Don’t be surprised if they haven’t heard of this gas issue — awareness still seems limited.

If metered dose inhalers are a better choice for you, please don’t panic or quit your medicines. These gases probably won’t be the biggest contributor to your personal carbon footprint. Asthma control is really important, and these medicines work really well. But consider changing if it’s an option for you — when it comes to reducing our footprint, every little bit counts.


This article was written by:
Image of Brett MontgomeryBrett Montgomery – [Senior Lecturer in General Practice, University of Western Australia]

 

 

 

This article is part of a syndicated news program via

 

Beauty is skin-deep: why our complexion is so important to us

 Skin is seen as a marker of health, and thus beauty. 
Noah Buscher/Unsplash

We’re all attracted to a beautiful face. We like to look at them, we feel drawn to them and we aspire to have one. Many researchers and others have investigated what we humans identify as “beautiful”: symmetry, large evenly spaced eyes, white teeth, a well-proportioned nose and of course, a flawless complexion. The skin is of utmost importance when people judge someone as beautiful.

When choosing a mate, men rank female beauty more highly than women rate male appearance. Female beauty is thought to signal youth, fertility and health.

Beauty can also signal high status. People with “plain looks” earn about 10% less than people who are average-looking, who in turn earn around 5% less than people who are good-looking.


Read more: The skin is a very important (and our largest) organ: what does it do?


Skin as a marker of health and beauty

Even the best facial structure can be unbalanced by skin that is flawed.

There are many skin conditions that are perfectly natural, yet because of our beliefs around skin and health, these can cause the sufferers extreme self-consciousness.

Examples include: chloasma, the facial pigmentation that often occurs during pregnancy; starburst telangiectasias, the broken capillaries that appear on the lower thighs and calves of many women as they age; and dermatosis papulosa nigra, the brown marks that accumulate on the upper cheeks and temples, especially in people of Asian or African descent.

Chloasma (pigmentation) often affects pregnant women. from www.shutterstock.com

Teenagers with acne are more likely to withdraw socially. It may impair school performance and result in severe depression and even suicide.

There are hundreds of skin diseases that can change facial appearance, including rashes such as rosacea and skin cancers. Surgery for skin cancer can leave noticeable marks and scars that make the survivor self-conscious.

Industries built on our self-consciousness

Perhaps alongside the greying of the hair, skin is the most visible sign of ageing. As we age the skin changes. These changes are most pronounced in the areas exposed daily to the sun, such as the face, neck and the backs of our hands.

There the skin thins, loses volume and elasticity and becomes dull. Dark rings develop under the eyes. Wrinkles appear. The skin sags and blemishes and scars accumulate.

Despite having no negative physical health effects, acne can cause major self-esteem problems in youth. from www.shutterstock.com

People spend a lot of money in attempts to regain their youthful appearance. The global cosmetics industry is worth about US$500 billion. Sales of skin and sun care products, make-up and colour cosmetics generate over 36% of the worldwide cosmetic market.

We use foundation makeup to conceal freckles and blemishes, moisturisers and fillers to hide dryness, concealers to disguise broken capillaries and pimples. And increasingly people are using botox to remove wrinkles, fillers to replace volume, and laser to remove flaws from the top layer of skin.


Read more: Common skin rashes and what to do about them


We should all use sunscreen to protect the skin from sun damage and prescription medications to cure the skin of diseases when necessary.

In 2018, we find ourselves living longer, working later and remarrying more. We’re having to trade on our beauty much later in life.

In a better world, beauty would be irrelevant. Unfortunately in our world it’s one of our most valuable assets. The best we can do is to protect our skin from sunburn, seek advice from a dermatologist when we notice any skin problems, and accept we weren’t born with the skin of Beyonce.


Read more: Four of the most life-threatening skin conditions and what you should know about them  


This article was written by:

Rodney Sinclair – [Professor of Dermatology, University of Melbourne]

 

 

 

This article is part of a syndicated news program via