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tag:theconversation.com,2011:/au/health/articles Health + Medicine – The Conversation 2019-08-25T19:54:14Z tag:theconversation.com,2011:article/122190 2019-08-25T19:54:14Z 2019-08-25T19:54:14Z How doctors convinced the world the planet was worth fighting for

International Physicians for the Prevention of Nuclear War, which won the Nobel Peace Prize in 1985, is one example of doctors' involvement on the political stage. Wellcome Images/Wikimedia Commons

Last week, one of the world's leading medical journals declared the medical community must act now to limit the health effects of climate change.

In a stark editorial, readers of the New England Journal of Medicine were reminded that hospitals, even airconditioned and sterilised, are not protected from "the environmental chaos unfolding outside".

The effects of climate change are "frighteningly broad", the editorial continued, including risks to medical supply chains, health infrastructure and all aspects of human health.

The special issue represents an important new focus for the journal and for the medical community: protecting human health in a changing climate calls for urgent, dramatic climate action.

   Read more: Climate explained: will we be less healthy because of climate change?

Our contribution shows how doctors have taken up planetary-scale issues in the past, and helped shift the course of history.

We show how, in the 20th century, doctors learned to apply environmental ethics to medicine, and to apply medicine to politics — and how these developments featured in the New England Journal of Medicine.

Nuclear war, not cardiac arrest, the threat

In the early 1960s, as nuclear arms proliferated, a group of doctors inspired by Nobel Peace Prize Laureate Sir Philip Noel-Baker decided nuclear war, and not cardiac arrest, presented the greatest threat to human health.

Organising as Physicians for Social Responsibility, they published a series of articles in the New England Journal of Medicine describing the likely effects of a 20-megaton blast over Boston: death, injury, ecological damage, and profound disturbance to social structures.

Introducing the articles, the editor declared no group could be more interested in the prospect than physicians, since none were more committed to human health and survival.

Despite the threats to other species and natural systems, these articles emphasised the threat to human health.

 <img alt="" src="https://images.theconversation.com/files/289027/original/file-20190822-170941-c5xlh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/289027/original/file-20190822-170941-c5xlh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=464&fit=crop&dpr=1 600w, https://images.theconversation.com/files/289027/original/file-20190822-170941-c5xlh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=464&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/289027/original/file-20190822-170941-c5xlh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=464&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/289027/original/file-20190822-170941-c5xlh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=583&fit=crop&dpr=1 754w, https://images.theconversation.com/files/289027/original/file-20190822-170941-c5xlh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=583&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/289027/original/file-20190822-170941-c5xlh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=583&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
 Physicians for Social Responsibility wrote a series of articles about the impact of nuclear war, to warn against repeating the horrors of Hiroshima and Nagasaki (pictured here) at the end of WW2. from www.shutterstock.com

Australian paediatrician Helen Caldicott revived the group in 1978 when she was working in Cambridge, Massachusetts. Together with International Physicians for the Prevention of Nuclear War, its leaders helped educate doctors and concerned citizens worldwide about the dangers of nuclear war.

They showed the most significant threats to human health might lie outside the conventional realms of medicine, and to protect it, doctors might need to do more than practise medicine.

And they succeeded. Membership of Physicians for Social Responsibility grew rapidly, and the model was widely exported. Caldicott met with then US-President Ronald Reagan and the International Physicians for the Prevention of Nuclear War won the Nobel Peace Prize in 1985.

 <img alt="" src="https://images.theconversation.com/files/289150/original/file-20190822-170941-ds4dqx.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/289150/original/file-20190822-170941-ds4dqx.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=419&fit=crop&dpr=1 600w, https://images.theconversation.com/files/289150/original/file-20190822-170941-ds4dqx.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=419&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/289150/original/file-20190822-170941-ds4dqx.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=419&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/289150/original/file-20190822-170941-ds4dqx.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=527&fit=crop&dpr=1 754w, https://images.theconversation.com/files/289150/original/file-20190822-170941-ds4dqx.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=527&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/289150/original/file-20190822-170941-ds4dqx.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=527&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
 Australian doctor, Helen Caldicott, is still fighting nuclear power, nuclear war and climate change today. Screenshot/Twitter

The downsides of economic growth

Ecological education deepened across the 20th century, with increased awareness of the environmental impacts of post-war economic growth.

It was the mounting evidence of ozone depletion in the 1980s, however, which brought the lesson home. Humans were altering not only the face of the earth, but the composition of the stratosphere.

In 1987, the World Commission on Environment and Development, chaired by doctor and former Prime Minister of Norway Gro Harlem Brundtland, articulated the threats to the planet's species and systems from human activities.

 <img alt="" src="https://images.theconversation.com/files/289029/original/file-20190822-170927-14c73bl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/289029/original/file-20190822-170927-14c73bl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=561&fit=crop&dpr=1 600w, https://images.theconversation.com/files/289029/original/file-20190822-170927-14c73bl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=561&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/289029/original/file-20190822-170927-14c73bl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=561&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/289029/original/file-20190822-170927-14c73bl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=705&fit=crop&dpr=1 754w, https://images.theconversation.com/files/289029/original/file-20190822-170927-14c73bl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=705&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/289029/original/file-20190822-170927-14c73bl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=705&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
 Doctor and former Prime Minister of Norway, Gro Harlem Brundtland, wrote a landmark report about how human activities were affecting the planet. screenshot/theelders.org

The Brundtland Report regretted the retreat of government and business from social and environmental concerns, and yet called for optimism. It advocated "sustainable development", and concerted work towards a "common future" where ecological and economic issues were addressed together.

Others were less optimistic. As evidence of ecological collapse at a planetary scale gathered like storm clouds, doctors who had had their visions of health expanded by the nuclear threat took up their pens.

Alexander Leaf, a professor of preventive medicine at Harvard University and leading member of the Physicians for Social Responsibility and the International Physicians for the Prevention of Nuclear War, was one. He was deeply concerned by the Brundtland Report and by how little had been written about the health implications of environmental change.

In 1989, encouraged by his friends Arnold Relman, the new editor of the New England Journal of Medicine, and doctor and researcher Marcia Angell, Leaf wrote an article for the journal about the likely effects of ozone depletion, air pollution and global warming.

   Read more: Saving the ozone layer: why the Montreal Protocol worked

If the planet's systems could not support explosive population growth and consumption habits, nor could human bodies, Leaf argued. The actual effects of global environmental changes might prove as catastrophic as the theoretical effects of nuclear war. What was the role of the doctor in dealing with these global environmental challenges, Leaf asked his colleagues.

With the end of the Cold War, Leaf and Harvard psychiatrist Eric Chivian, who founded the Center for Health and the Global Environment at Harvard in 1993, prompted Physicians for Social Responsibility to develop an environmental program.

Yet many doctors proved reluctant to organise against environmental threats as they had against nuclear war.

Re-setting the research agenda

The Brundtland Report also helped produce a new research agenda. The first assessment report of the Intergovernmental Panel on Climate Change addressed health effects, and in 1990, the World Health Organization and Australian National Health and Medical Research Council issued reports on the likely links between greenhouse gases and human health.

Andrew Haines, at the London School of Tropical Medicine, began writing about the health effects of climate change.

   Read more: Heatwaves threaten Australians' health, and our politicians aren't doing enough about it

And in Australia, Anthony McMichael took up the cause. The "bottom line", he suggested, was threats to human health (not deforestation or species extinctions) would drive human responses to environmental degradation.

As evidence grows of ever greater disruptions to natural systems, the broader medical community is once again taking action to protect human health in a planetary crisis.

Shifting the boundaries of medicine

Our research shows how the boundaries of medicine have shifted in the face of emerging threats, expanding to a planetary scale, to political advocacy, to new research directions and efforts to translate scientific evidence into powerful public messages.

It draws attention to the new ethical commitments realised in crises — commitments to current and future generations, other species, and to the planet itself.

Authors of the paper mentioned in the article are James Dunk, Warwick Anderson and Anthony Capon (University of Sydney) and David Jones (Harvard University).

James Dunk 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.
 Doctors have long taken up global issues, from nuclear war to ozone depletion and climate change, and helped shift the course of history. James Dunk, Research Fellow, University of Sydney Licensed as Creative Commons – attribution, no derivatives. tag:theconversation.com,2011:article/119170 2019-08-23T06:51:22Z 2019-08-23T06:51:22Z It's not just athletes who get Achilles tendon pain, but exercising is the answer
Basketball fans around the world were recently sickened by the footage of NBA star Kevin Durant's Achilles tendon rupturing during a game.

But while many think it's only elite athletes who suffer from Achilles tendon issues, a fifth of the over-50 population actually suffers from Achilles tendinopathy (pain). And while very few of these will be ruptures, the pain can be frustratingly persistent and limit our ability to exercise and enjoy life.

What is Achilles tendinopathy?

The Achilles tendon is one of the strongest tendons in the human body. It attaches the calf muscles to the heel bone of the foot, helping you to run fast, jump high, and change direction quickly. During these types of exercises the tendon acts like a spring that propels you forward more efficiently.

Many labels are used to describe what's going on when the tendon is injured. People are often told their tendon is torn and may think of it as a rope hanging on by a thread. These descriptions are unhelpful and inaccurate, often leading to expensive and unnecessary treatments.

We know words are extremely powerful and influence what treatment you think you need. For example, would you do the exercises your physiotherapist gave you if you believed your tendon was hanging on by a thread? Probably not.

Our work has found a painful tendon is not like a torn rope at all. It's more like doughnuts stacked on top of each other. Even though changes in tendon structure are seen as a "hole" in the middle of the tendon, there is still a lot of delicious doughnut (in other words healthy tendon) surrounding the damaged area. The tendon adapts by getting thicker, making it stronger and allowing you to exercise.

Critically, pain poorly reflects damage. Tendon pain is not present because the tendon is damaged, weak or hanging on by a thread. More than 30% of AFL players have a "hole" in their tendon when we scan them but are able to play at the highest level with no pain.

   Read more: Health Check: why do my muscles ache the day after exercise?

Who gets it?

Achilles tendinopathy can affect athletes who participate in sports that involve running or explosive movements (Australian football, track and field). Most players do not miss competition as a result of Achilles tendon pain.

But our research found more than 20% of AFL players report that pain in their Achilles tendon significantly affects their training and performance. That's four or five of your favourite 22 athletes playing this weekend.

 <img alt="" src="https://images.theconversation.com/files/288671/original/file-20190820-170951-11jtxgc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/288671/original/file-20190820-170951-11jtxgc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288671/original/file-20190820-170951-11jtxgc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288671/original/file-20190820-170951-11jtxgc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288671/original/file-20190820-170951-11jtxgc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288671/original/file-20190820-170951-11jtxgc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288671/original/file-20190820-170951-11jtxgc.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">
 Some 20% of AFL players suffer from pain in the Achilles tendon that affects their performance. www.shutterstock.com

But most people who experience this type of pain are aged 40-64 years.

That's because the Achilles tendon bears the brunt of activities like running, playing golf, walking the dog, and stepping off the kerb throughout life. Being overweight, having diabetes, and high cholesterol all increase the risk of developing Achilles tendon pain. Tendon pain can lead to further weight gain and a greater impact on someone's health beyond just their ability to run and exercise.

Overcoming tendon pain

The good news is that painful Achilles tendons rarely rupture. Some 80-90% of people who rupture their tendon have never had Achilles tendon pain. Your brain is clever as it uses pain to protect your Achilles tendon by changing your behaviour. But it's easy to become overprotective.

Completely resting the tendon, either by using crutches or a walking boot, is one thing that should be avoided. This is because of the "use it or lose it" principle. With even two weeks' rest, your tendon and calf muscles become weaker, meaning a longer recovery time.

Just like muscles, tendons get stronger with exercise. Starting exercise that produces no or minimal pain and progressively increasing the intensity of exercise is by far the best option, based on research.

   Read more: How to prevent injury from sport and exercise

In consultation with an experienced physiotherapist, this program should include strength training to help strengthen the tendon and the calf muscles. If you want to get back to running, slowly introduce exercise that requires the tendon to act like a spring, such as skipping and jumping.

It can be tempting to look for a quick fix for your pain. But interventions such as surgery or injections are often ineffective, costly, and can be harmful.

These approaches should be a last resort, and actually all still require exercise to strengthen the tendon. Unfortunately, there are no shortcuts when recovering from a tendon injury.

Unlike Achilles in Greek mythology, your Achilles tendon does not have to be a point of weakness. Consulting with an experienced physiotherapist to develop a progressive exercise program is the best protection you can have against further injury.

Sean Docking receives funding from Australian Football League Research Board, GE Healthcare, and the National Basketball Association.

email@example.com receives funding from NHMRC and holds current grants from NBA-GE and have previously been awarded grants from AFL and the Australian Institute of Sport. She regularly speaks at conferences about tendon pain and runs courses nationally and internationally.

firstname.lastname@example.com receives funding from the National Basketball Association and the International Olympic Committee
 Achilles tendon pain is surprisingly common in people over the age of 50. Strength training can help you recover and protect against future injury. Sean Docking, Post-doctoral researcher, La Trobe University Ebonie Rio, NHMRC Research Fellow, La Trobe University Jill Cook, Professor, Sports Medicine Research, La Trobe University Licensed as Creative Commons – attribution, no derivatives. tag:theconversation.com,2011:article/120889 2019-08-22T20:06:29Z 2019-08-22T20:06:29Z 'What is wrong with me? I'm never happy and I hate school'

Remember, there is always someone to talk to about these things.  Wes Mountain

Hi, I was just wondering if something's wrong with me because I'm never happy and never want to do anything and I'm getting really lazy and I really hate school. Thanks - Anonymous

Everyone experiences down days at times. Feeling flat is a normal reaction to something upsetting happening, tiredness or just being stuck in a rut. Usually our low mood is short-lived and improves fairly quickly as we resolve a problem, catch up on sleep or move on to something else.

There's a difference between temporarily feeling a bit down and what you're describing. The fact you're "never" happy and "never" want to do anything, suggests this is probably more than just a "rough patch". Constantly feeling sad, struggling with motivation and lacking interest or pleasure in anything, are all symptoms often associated with depression.

Are you also struggling with sleep, eating more or less than usual, feeling exhausted or irritable or finding it hard to concentrate? These are other common features of depression.

I feel low… all the time

Depression is much more far reaching than regular sadness. Symptoms are persistent and interfere significantly with daily life. Depression affects how a person thinks, feels and acts. People with depression tend to have negative thoughts about themselves, the world and the future. They often feel helpless:

Nothing I do will improve the situation.

And hopeless:

Things will never get better.

There are things YOU can do to help

While everything feels like a struggle now with your low energy levels and not liking school, why not try some of these things to help you move forward:

identify and challenge any unhelpful thinking which may be contributing to how you're feeling. When we're down, we tend to interpret situations in a biased, negative way. Work on developing more realistic, balanced thinking – this is a helpful sheet to aid you in doing just that

take action to to solve the problems affecting you. For example, if you're hating school, identify specifically what you hate about it, brainstorm and evaluate possible solutions and implement the best ones

plan daily activities, no matter how small, that make you feel you've achieved something. Maybe start an assignment you've been putting of or simply have a bath

practice daily gratitude by thinking of three things you were thankful for, and writing them down. Balance out life's negatives, by identifying the things that went well and the reasons why

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look after yourself physically! Work towards exercising regularly, getting enough sleep and having a balanced diet.

Practical strategies like these are used in the cognitive behaviour therapy (CBT) approach to managing depression. CBT focuses on developing more helpful ways of thinking and behaving. Moodgym is a great place to learn CBT techniques.

There is ALWAYS someone to talk to

During challenging times it's important to speak up and reach out for support. Talk to a trusted adult, maybe a parent or teacher, about what's happening. Consider contacting an online or telephone support service such as Kidshelpline or e-headspace. An open chat with your school counsellor may also be a good starting point.

A GP can help guide you too. You can find a doctor who bulk bills (so you don't have to pay). ReachOut has a great web-page with some simple tips for finding the right doctor to talk to about this – you can find it here.

If you are experiencing depression, the doctor may help you develop a mental health care plan which can give you up to ten Medicare-subsidised sessions with a private psychologist or clinical psychologist per year.

 <img alt="" src="https://images.theconversation.com/files/288106/original/file-20190815-136213-179wztw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/288106/original/file-20190815-136213-179wztw.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=438&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288106/original/file-20190815-136213-179wztw.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=438&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288106/original/file-20190815-136213-179wztw.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=438&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288106/original/file-20190815-136213-179wztw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=550&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288106/original/file-20190815-136213-179wztw.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=550&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288106/original/file-20190815-136213-179wztw.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=550&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
 Based on Medicare Benefits Schedule as of August 2019.

When you use a mental health care plan you, or your parents, will be charged the full amount for the psychology session, then the rebate will be refunded back into the bank account. It's a good idea to ask what the appointment fees are before booking. Private psychologist rates can vary significantly, from bulk billing to A$300 an hour.

Depending on what is available in your area, a GP might recommend other support options such as:

a group therapy program, which again might attract a different Medicare rebate level

counselling at a community health service which is usually free of charge

Have a read of this ReachOut page to understand more, including how to find a psychologist who "gets" you.

For more ideas, check out Reachout and Youth Beyondblue.

If you'd like to learn more, here are some helpful links

Depression and Young People

A Guide to what works for depression in young people

Modifying CBT for Depression in Young People

If you or anyone you know needs help or is having suicidal thoughts, contact Lifeline on 131 114 or beyondblue on 1300 22 46 36.

I Need to Know is an ongoing series for teens in search of reliable, confidential advice about life's tricky questions.

If you're a teenager and have a question you'd like answered by an expert, you can:

submit your question anonymously through Incogneato, or

DM us on Instagram.

Please tell us your name (you can use a fake name if you don't want to be identified), age and which city you live in. Send as many questions as you like! We won't be able to answer every question, but we will do our best.

Louise Remond 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.
 There's a difference between having low days and feeling bad all the time. The latter is a common feature of depression. Louise Remond, Clinical Psychologist, University of Technology Sydney Licensed as Creative Commons – attribution, no derivatives. tag:theconversation.com,2011:article/122184 2019-08-22T03:08:42Z 2019-08-22T03:08:42Z Why full-fat milk is now OK if you're healthy, but reduced-fat dairy is still best if you're not

The Heart Foundation now backs full-fat milk if you're healthy. But it still recommends reduced-fat milk if you have high blood pressure or heart disease. from www.shutterstock.com

The Heart Foundation now recommends full-fat milk, cheese and yoghurt or reduced-fat options as part of its updated dietary advice released yesterday.

This moves away from earlier advice that recommended only reduced-fat dairy when it comes to heart health.

So, what's behind the latest change? And what does this mean for people with high blood pressure or existing heart disease?

   Read more: According to TV, heart attack victims are rich, white men who clutch their hearts and collapse. Here's why that's a worry

What's new if you're healthy?

For healthy Australians, the Heart Foundation now recommends unflavoured full-fat milk, yoghurt and cheese, as well as the reduced-fat options previously recommended.

The change comes after reviewing research from systematic reviews and meta-analyses published since 2009. These pooled results come from mostly long-term observational studies.

This is where researchers assess people's dietary patterns and follow them for many years to look at health differences between people who eat and drink a lot of dairy products and those who consume small amounts.

Researchers run these studies because it is not practical or ethical to put people on experimental diets for 20 or more years and wait to see who gets heart disease.

   Read more: Are light dairy products better? We asked five experts

So when results of the recent studies were grouped together, the Heart Foundation reported no consistent relationship between full-fat or reduced-fat milk, cheese and yoghurt consumption and the risk of heart disease. The risk was neither increased nor decreased.

Put simply, for people who do not have any risk factors for heart disease, including those in the healthy weight range, choosing reduced-fat or low-fat options for milk, yoghurt and cheese does not confer extra health benefits or risks compared to choosing the higher fat options, as part of a varied healthy eating pattern.

   Read more: Health Check: is cheese good for you?

Before you think about having a dairy binge, the review noted the studies on full-fat milk, yoghurt and cheese can't be extrapolated to butter, cream, ice cream and dairy-based desserts.

This is why the Heart Foundation still doesn't recommend those other full-fat dairy options, even if you're currently healthy.

What about people with heart disease?

However, for people with heart disease, high blood pressure or some other conditions, the advice is different.

The review found dairy fat in butter seems to raise LDL or "bad" cholesterol levels more than full-fat milk, cheese and yogurt. And for people with raised LDL cholesterol there is a bigger increase in LDL after consuming fat from dairy products.

   Read more: Got high cholesterol? Here are five foods to eat and avoid

So, for people with high blood cholesterol or existing heart disease, the Heart Foundation recommends unflavoured reduced-fat milk, yoghurt and cheese to help lower their total risk of heart disease, which is consistent with previous recommendations.

Unflavoured, reduced-fat versions are lower in total kilojoules than the full-fat options. So, this will also help lower total energy intakes, a key strategy for managing weight.

 <img alt="" src="https://images.theconversation.com/files/289010/original/file-20190822-170935-msabhr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/289010/original/file-20190822-170935-msabhr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/289010/original/file-20190822-170935-msabhr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/289010/original/file-20190822-170935-msabhr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/289010/original/file-20190822-170935-msabhr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/289010/original/file-20190822-170935-msabhr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/289010/original/file-20190822-170935-msabhr.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">
 Reduced-fat yoghurt and other dairy products are still recommended for people with high cholesterol or existing heart disease. from www.shutterstock.com

How does this compare with other advice?

The 2013 National Health and Medical Research Council's Dietary Guidelines for Australians recommends a variety of healthy foods from the key healthy food groups to achieve a range of measures of good health and well-being, not just heart health.

Based on evidence until 2009, the guidelines generally recommend people aged over two years mostly consume reduced-fat versions of milk, yoghurt, cheese and/or their alternatives, recognising most Australians are overweight or obese.

   Read more: Plain, Greek, low-fat? How to choose a healthy yoghurt

This advice still holds for people with heart disease. However, the new Heart Foundation advice for healthy people means less emphasis is now on using reduced-fat versions, in light of more recent evidence.

The Australian Dietary Guidelines have a further recommendation to limit eating and drinking foods containing saturated fat. The guidelines recommend replacing high-fat foods which contain mainly saturated fats such as butter and cream, with foods which contain mainly polyunsaturated and monounsaturated fats such as oils, spreads, avocado, nut butters and nut pastes.

This advice is still consistent with the Heart Foundation recommendations.

Australians eat a lot of 'junk' food

The most recent (2011-12) National Nutrition Survey of Australians found over one-third (35%) of what we eat comes from energy-dense, nutrient-poor, discretionary foods, or, junk foods.

Poor dietary patterns are the third largest contributor to Australia's current burden of disease. Being overweight or obese is the second largest contributor, after smoking.

If Australians followed current dietary guidelines, whether using full- or reduced-fat milk, yoghurt and cheese, the national burden of disease due to heart disease would drop by 62%, stroke by 34% and type 2 diabetes by 41%.

What's the take home message?

See your GP for a heart health check. If you do not have heart disease and prefer full-fat milk, cheese and yoghurt then choose them, or a mix of full and reduced-fat versions.

If you have heart disease or are trying to manage your weight then choose mostly reduced-fat versions.

Focus on making healthy choices across all food groups. If you need personalised advice, ask your GP to refer you to an accredited practising dietitian.

Clare Collins is affiliated with the Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, NSW. She is an NHMRC Senior Research and Gladys M Brawn Research Fellow. She has received research grants from NHMRC, ARC, Hunter Medical Research Institute, Meat and Livestock Australia, Diabetes Australia, Heart Foundation, Bill and Melinda Gates Foundation, nib foundation, Rijk Zwaan Australia and Greater Charitable Foundation. She has consulted to SHINE Australia, Novo Nordisk, Quality Bakers, the Sax Institute and the ABC.. She was a team member conducting systematic reviews to inform the Australian Dietary Guidelines update and the Heart Foundation 2017 evidence review on dietary patterns and 2019 evidence review on meat intake for the Heart Foundation. She served in a viluntary capacity on the health Foundation Food and Nutrition Advisory Committee from 2015-2017.
 Low-fat milk provides no extra benefit for your heart over full-fat milk, if you're healthy. But it's too soon to pour the low-fat options down the sink. Clare Collins, Professor in Nutrition and Dietetics, University of Newcastle Licensed as Creative Commons – attribution, no derivatives. tag:theconversation.com,2011:article/120664 2019-08-21T19:54:02Z 2019-08-21T19:54:02Z Should I get my DNA tested? We asked five experts

Is it worthwhile to know you're 25% Irish?  from www.shutterstock.com

With the advent of online ancestry DNA testing, and advancements in genetic screening for various medical aliments, we're able to know more than ever about the genes that make us who we are.

But is there a point to knowing we're 25% Irish? And is there a point to knowing we could one day be struck down with a disease we're unable to prevent?

We asked five experts if we should consider a DNA test.

Four out of five experts said yes

 <img alt="" src="https://images.theconversation.com/files/259889/original/file-20190220-148520-121cdzg.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/259889/original/file-20190220-148520-121cdzg.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=99&fit=crop&dpr=1 600w, https://images.theconversation.com/files/259889/original/file-20190220-148520-121cdzg.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=99&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/259889/original/file-20190220-148520-121cdzg.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=99&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/259889/original/file-20190220-148520-121cdzg.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=125&fit=crop&dpr=1 754w, https://images.theconversation.com/files/259889/original/file-20190220-148520-121cdzg.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=125&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/259889/original/file-20190220-148520-121cdzg.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=125&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">

Here are their detailed responses:

If you have a "yes or no" health question you'd like posed to Five Experts, email your suggestion to: firstname.lastname@example.com

 <img alt="" src="https://images.theconversation.com/files/210303/original/file-20180314-113452-h7un11.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/210303/original/file-20180314-113452-h7un11.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/210303/original/file-20180314-113452-h7un11.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/210303/original/file-20180314-113452-h7un11.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/210303/original/file-20180314-113452-h7un11.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/210303/original/file-20180314-113452-h7un11.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/210303/original/file-20180314-113452-h7un11.png?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">

None of the authors have any interests or affiliations to declare.
 We asked five experts if DNA testing was worthwhile. Four out of five said yes. Alexandra Hansen, Chief of Staff, The Conversation Licensed as Creative Commons – attribution, no derivatives. tag:theconversation.com,2011:article/110700 2019-08-21T03:55:34Z 2019-08-21T03:55:34Z Time out shouldn't be your go-to parenting tool but can be useful if it's well planned

A parent's attention is gold to a child, and even negative attention is better than none. pathompong24/Shutterstock

Parenting young children is one of the most stressful times in a parent's life. Toddlers and preschoolers are learning how to independently regulate their emotions. And parents are developing their ability to be both warm and firm – the ideal parenting combination.

It's no wonder so many parents are uncertain about how to best respond to their child's challenging behaviour.

Time out is a parenting strategy that is often misunderstood and misused, with a plethora of conflicting information online, often highlighting the potential harms.

   Read more: Evidence-based parenting: how to deal with aggression, tantrums and defiance

Yet the evidence shows it can be effective for children aged two to eight years – when used occasionally, calmly, briefly and when the process is pre-planned and understood by both parent and child.

Even UCLA professor of psychiatry Dan Siegel, the author of No Drama Discipline who is widely believed to be anti-time out, supports the technique.

What's the theory behind time out?

A parent's attention is everything to a child. Whether this attention involves loving gazes or that glare they get at Grandma's house, it's all attention.

Any human behaviour that is reinforced or rewarded will usually increase in frequency. If you wear a particular pair of shoes, and these are admired or commented on by people you respect, you'll probably wear them again.

Often when a child acts up, parents accidentally reward this by providing more attention: "I told you not to do that! Stop! Come on, you know not to do that to your sister …"

 <img alt="" src="https://images.theconversation.com/files/288645/original/file-20190820-123716-1mtrvn2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/288645/original/file-20190820-123716-1mtrvn2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288645/original/file-20190820-123716-1mtrvn2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288645/original/file-20190820-123716-1mtrvn2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288645/original/file-20190820-123716-1mtrvn2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288645/original/file-20190820-123716-1mtrvn2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288645/original/file-20190820-123716-1mtrvn2.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">
 Parents are more likely to intervene when something goes wrong than praise good behaviour. KK Tan/Shutterstock

Yet children may receive less attention for "positive" behaviours that warrant praise ("Great sharing with your sister", "Thanks for asking nicely").

Time out can turn this pattern of interaction on its head.

How do you do time out?

Time out involves the deliberate, brief and pre-arranged withdrawal of parent attention when the child hasn't complied with a clear and reasonable instruction.

This withdrawal of attention should have been pre-planned, with the child and parent both knowing what's happening ahead of time.

Parents need to first make sure their instruction is clear and developmentally appropriate. ("Please put the Lego in the box"). Give the child a chance to comply, perhaps count to five (internally).

Then repeat the instruction, calmly telling the child what the consequence will be. This isn't a threat, it's stating what will happen and giving the child another chance to comply – they may not have heard the first time. ("If you don't put the Lego in the box you will need to go to the time out chair".)

 <img alt="" src="https://images.theconversation.com/files/288489/original/file-20190819-123727-68t28m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/288489/original/file-20190819-123727-68t28m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=806&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288489/original/file-20190819-123727-68t28m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=806&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288489/original/file-20190819-123727-68t28m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=806&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288489/original/file-20190819-123727-68t28m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1013&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288489/original/file-20190819-123727-68t28m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1013&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288489/original/file-20190819-123727-68t28m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1013&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
 You can expect a bit of push back, so be prepared. Wendy Riseborough/Shutterstock

Give the child another few seconds to comply after this warning. Then, calmly move them to the pre-arranged spot, which can be a chair or a cushion or similar.

Say something clear like, "stay on the chair until I say you can get off". The time period should be three to five minutes for young children.

When they are reasonably calm, go over and say "you're sitting quietly, are you ready to put the Lego in the box?"

If yes, they do it and the time out is over – time for re-connection!

If no, "stay on the chair until I say you can get off" and the time out starts again. The parent, not the child, decides when time out finishes.

Parents need a plan for what they're going to do if the child gets off the chair, such as using the child's bedroom as a "back up" time out spot. And both parent and child need to have talked about this ahead of time.

Similarly, if the child refuses to go to time out, decide ahead of time on the response. With children under about seven, parents can gently move them to the chair.

Children over about seven need another, hands-off approach such as loss of privileges like screen time until they have completed the time out.

 <img alt="" src="https://images.theconversation.com/files/288644/original/file-20190820-123745-19f429t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/288644/original/file-20190820-123745-19f429t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=422&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288644/original/file-20190820-123745-19f429t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=422&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288644/original/file-20190820-123745-19f429t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=422&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288644/original/file-20190820-123745-19f429t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=531&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288644/original/file-20190820-123745-19f429t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=531&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288644/original/file-20190820-123745-19f429t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=531&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
 Older children who refuse to go to time out might lose their screen privileges. Bloomicon/Shutterstock

What not to do

If you're thinking about using time out there are some important traps to avoid and situations where it's not appropriate:

don't use time out for children under two (or those who have a developmental level under this age) – the strongest evidence base is for children two to eight

don't threaten time out and fail to follow through – this makes it less effective

keep things calm, fair and predictable, and limit time outs to three to five minutes. Prolonged time out is not necessary for learning

try to avoid statements that conflate judgements of the child and their behaviour. What they did (or didn't do) is not OK, but the child isn't "bad". They're loved and lovable. Statements like "you're angry, I can't be with you right now, get out of my sight" aren't helpful

don't overuse time out as a parenting strategy – it should only be used very occasionally. Parents should first opt for strategies that help children understand and work through their feelings, or redirect the child's attention.

   Read more: 'Making up games is more important than you think': why Bluey is a font of parenting wisdom

What's going on with your child?

Children often push back when a limit is set. If they're calmly told to sit on a time out chair, for example, it's unlikely they'll pleasantly thank their parent for the fair and reasonable consequence.

Instead, they'll protest. Shouting, threatening, pleading ("but I was going to do it!") and defiance are all possibilities.

It's important to remain silent, even if what they say while they're on the chair is rude, hurtful or humorous – again, your attention is likely to reinforce this, and it will escalate.

Don't enter into any discussion about how fair or unfair the consequence was. The child needs to know ahead of time that the parent is going to stay silent until the time out is finished.

   Read more: Reward or punishment: finding the best match for your child's personality

But once it's over, have all the discussion in the world. You might say something like, "That felt really unfair to you – you wanted to finish the Lego and I asked you to clean up".

This can serve several functions: the child feels understood by their parent, it validates their feelings (though not their actions), and models how to calmly articulate and express when something feels unfair.

It also invites the child to draw close for a cuddle or a time of closeness, and this is important after a time out. Learning happens when children are calm.

Some parents need extra help

Most children show age-appropriate (and developmentally normal) defiance. But some children may have long-running challenging behaviour that's impacting on their own safety, or the family's well-being.

 <img alt="" src="https://images.theconversation.com/files/288646/original/file-20190820-123736-ddp48v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/288646/original/file-20190820-123736-ddp48v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288646/original/file-20190820-123736-ddp48v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288646/original/file-20190820-123736-ddp48v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288646/original/file-20190820-123736-ddp48v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288646/original/file-20190820-123736-ddp48v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288646/original/file-20190820-123736-ddp48v.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">
 Some families have additional challenges and need external support. Monkey Business Images/Shutterstock

This may be due to the child's developmental needs, temperament, experiences, or complex factors within their relationships with loved ones. Or perhaps their parent or caregiver is themselves experiencing depression, anxiety, or another factor that makes parenting more challenging.

In these situations, parents may need need the support of a professional or a structured parenting program such as Incredible Years, Triple P or Parent-Child Interaction Therapy. Reassuringly, my recent study suggests even where parents have a significant mental health issues, parent training programs can remain effective.

Parents and caregivers aren't robots, rationally computing the best strategy to use in the moment and calmly dispensing a technique. How they think and feel – both generally and in the moment – impacts on their parenting decisions and effectiveness.

Thankfully, we don't need to aim for perfection. We just need to be good enough.

   Read more: Stop worrying about screen 'time'. It's your child's screen experience that matters

Melanie J Woodfield receives funding from the Health Research Council of New Zealand.
 Research shows if time out is used occasionally, briefly and the child understands the process, it can be a useful parenting tool for kids aged two to eight. Melanie Woodfield, Clinical Psychologist and Health Research Council Foxley Fellow, University of Auckland Licensed as Creative Commons – attribution, no derivatives. tag:theconversation.com,2011:article/121628 2019-08-20T20:04:57Z 2019-08-20T20:04:57Z Will eating chicken reduce your risk of breast cancer?

While this research has merit, it doesn't exactly tell us eating chicken reduces risk of breast cancer.  From shutterstock.com

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

You might have seen headlines recently claiming eating chicken reduces a person's risk of breast cancer.

These reports were based on a new study published in the International Journal of Cancer this month which examined the links between breast cancer and consumption of red meat and poultry.

It found women who ate chicken had a lower risk of developing breast cancer than those who ate red meat.

As with all observational studies, this research cannot show cause and effect. The correlation between eating chicken and a lower risk of breast cancer may have more to do with consuming large quantities of red meat than it does with chicken having any protective qualities.

The study

Over almost eight years, researchers followed 42,000 women aged 35-74 involved in the Sister Study in Puerto Rico and the United States. The Sister Study, funded by the US National Institutes of Health, is currently tracking a large cohort of women with view to better understanding the causes of breast cancer.

Some 1,536 cases of invasive breast cancer were diagnosed among the cohort over the eight-year period. The researchers considered this alongside information on participants' meat consumption habits, gathered through a series of standardised questionnaires.

An analysis of the women's diets showed those who consumed the most red meat (beef, veal, pork, lamb, game meats) had a 23% higher risk of being diagnosed with invasive breast cancer than those who consumed small amounts.

By contrast, the women who consumed the most poultry (lean chicken, turkey, duck, goose, quail and pheasant) had a 15% lower risk than those who consumed the least poultry.

The effects were particularly striking in post-menopausal women.

   Read more: Research Check: is white meat as bad for your cholesterol levels as red meat?

Notably, neither the red meat group nor the poultry group necessarily ate only one or the other. So it's likely women eating a lot of poultry were eating less red meat, while women who ate less poultry included more red meat in their diets.

The researchers predicted breast cancer risk would be reduced even further if the women who ate a large amount of red meat switched to poultry.

They accounted for many confounding factors including obesity, age, income, education level, total energy intake, percentage of energy from fat, consumption of vegetables, fruit and dairy products, how long the women breast-fed their infants and their use of hormone therapy.

Even considering all these factors, there was still a significant relationship between invasive breast cancer and a high consumption of red meat.

Limitations

The Sister Study involves women with no previous diagnosis of breast cancer themselves, but all have sisters who have had breast cancer. Since some cases of breast cancer have a genetic component, we should remember this group may have greater susceptibility to breast cancer than the general population.

Unfortunately, the study did not identify any women who avoided all meat, so it doesn't tell us if a vegetarian diet would have further reduced the risk of breast cancer.

   Read more: Three charts on: Australia's declining taste for beef and growing appetite for chicken

Red meat and cancer

Previous studies looking at red meat and breast cancer have reported conflicting results.

One large British report found a small increase in breast cancer with processed meat, but not fresh red meat.

Another major review confirmed the processed meat results and found only a very small increase in breast cancer related to fresh red meat.

Other studies have looked at poultry consumption and breast cancer. None have found significant correlations with breast or other cancers. Several have found inverse relationships similar to those seen in this study.

 <img alt="" src="https://images.theconversation.com/files/288495/original/file-20190819-123754-t54hcf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/288495/original/file-20190819-123754-t54hcf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288495/original/file-20190819-123754-t54hcf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288495/original/file-20190819-123754-t54hcf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288495/original/file-20190819-123754-t54hcf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288495/original/file-20190819-123754-t54hcf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288495/original/file-20190819-123754-t54hcf.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 high consumption of red meat, particularly processed red meat, has been associated with increased cancer risk. From shutterstock.com

Red meat has more definite links with the risk of certain cancers. The World Cancer Research Foundation recommends limiting red meat (beef, lamb, pork, goat) to reduce the risk of colorectal cancer. At this stage, it has not extended this advice to breast cancer.

Health concerns about red meat intake also lie in its links to heart disease, which are supported by research evidence.

It's about quantity

It is useful to look at the quantity of meat consumed by those with the lowest incidence of breast cancer in this study. It was small – no more than 340g of red meat a week, or equivalent to about two average-sized red meat portions a week.

By contrast, the highest incidence of breast cancer occurred in those with a weekly consumption of 775g or more.

The greatest benefit, according to the researchers' modelling, appeared in women who substituted lean poultry for red meat.

   Read more: Confused about your cancer risk from eating meat? Here's what the figures mean

Adding a small amount of red meat to a plant-based diet is unlikely to cause health problems. In modest quantities, red meat can actually make a valuable nutritional contribution, adding iron, protein and vitamin B12.

But problems with red meat relate to the quantity consumed – more is not better.

Sustainability concerns around the methods of red meat production also relate to the quantities consumed. Earlier this year, the Eat-Lancet Commission's healthy reference diet for sustainable food systems recommended a 50% reduction in global consumption of red meat.

So while this new research doesn't provide enough evidence to suggest eating chicken is protective against breast cancer, women who currently consume a lot of red meat may find it useful to know poultry is an acceptable alternative.

Blind peer review

The analysis presents a fair, balanced and accurate assessment of the study. In this study, the researchers looked at the impact of consumption of different types of red meat and white meat, and the way the meats were cooked, on the rates of breast cancer.

The researchers showed red meat consumption (which in this study included beef, lamb, veal, pork and game meat) increased the risk of invasive breast cancer, while consuming poultry (including chicken, turkey, ducks, goose, quail, pheasant/game birds) reduced the risk of invasive breast cancer. There was no association shown between the way the meat was cooked and breast cancer risk. – Evangeline Mantzioris

   Read more: How to get the nutrients you need without eating as much red meat

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.
 Recent reports suggested eating chicken could reduce the risk of breast cancer. In the study, those who ate chicken were at lower risk – when compared to women who ate large quantities of red meat. Rosemary Stanton, Visiting Fellow, School of Medical Sciences, UNSW Licensed as Creative Commons – attribution, no derivatives. tag:theconversation.com,2011:article/121803 2019-08-20T05:17:45Z 2019-08-20T05:17:45Z Youth discounts fail to keep young people in private health insurance

Many young people see private health insurance as an unnecessary expense. Yuricazac/Shutterstock

It was a key plank of what was dubbed the most significant package of private health insurance reforms in more than a decade. From April 1 this year, private health insurers have been permitted to offer a youth discount – lower premiums for people under 30.

But the early signs are not good. New data released today by the private health insurance regulator show 7,000 fewer young people (25 to 29 year olds) were insured on June 30, 2019 than three months earlier when the new discount regime started.

In the three years to June 30, 2018, an average of about 2,100 young people dropped private health insurance every month. For the first six months of this year, the decline was 1,700 a month.

   Read more: Premiums up, rebates down, and a new tiered system – what the private health insurance changes mean

So the new policy may have stemmed the bleeding, but young people are still leaving private health insurance. This does not augur well for the future of private health insurance.

It's time to consider a bold option to encourage young people to stay in private health insurance, which reduces their premium costs based on their likelihood of getting sick.

Lower health risks but the same costs

As we pointed out in a recent Grattan Institute working paper, the industry fears a death spiral where young and healthy people drop out of insurance, forcing up premiums for everyone left, then more young and healthy people drop out, premiums go up again, and the cycle continues.

Australian private health insurance is based on community rating. This means insurers must charge all consumers the same premium for the same product: they are not permitted to discriminate based on health risk (such as age, gender, health status, or claims history); and they cannot refuse to insure an individual.

 <img alt="" src="https://images.theconversation.com/files/288655/original/file-20190820-123716-lnf43n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/288655/original/file-20190820-123716-lnf43n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288655/original/file-20190820-123716-lnf43n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288655/original/file-20190820-123716-lnf43n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288655/original/file-20190820-123716-lnf43n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288655/original/file-20190820-123716-lnf43n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288655/original/file-20190820-123716-lnf43n.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">
 Older people are much more likely to use private health insurance yet everyone pays the same premiums. Rawpixel.com/Shutterstock

Community rating is designed to enable higher-risk people to take out private health insurance, by forcing lower-risk people to cross-subsidise them. It means lower-risk people have to contribute more than what their expected use would require.

But faced with a higher-than-fair premium, low-risk people – typically the young and the healthy – make an economically rational decision to drop their private insurance. Hence the death spiral.

Discounts don't cut it

Australia already has a so-called lifetime community ranking, under which people who take out private health insurance after their 31st birthday pay higher premiums – an additional 2% per year for each year they defer taking out insurance.

The April 1 changes introduced a reverse scheme, under which people can get a discount of 2% for each year they join before they turn 30, up to a maximum discount of 10%.

But even with the full 10% discount, a 25 year old will still be paying significantly more than they would with a risk-rated premium.

   Read more: Going to the naturopath or a yoga class? Your private health won't cover it

So the relentless downward trend continues. In the year to June 2019, the number of 25 to 29 year olds with private health insurance dropped 28,000, about 6%. The previous year it was also 6%. The year before that it was 5%.

In fact, for every quarter for the last four years there has been fewer 25 to 29 year olds insured at the end of each quarter than at the beginning of the quarter.

Although it may be too early to declare the new youth discount policy a complete failure, the government and industry need to consider bolder policies.

A better way to attract young people

Community rating may have had its day, given that under Medicare, everyone who needs health insurance automatically has it through the public system.

It's time to consider shifting to risk rating, starting with people under 30. A risk rating based on age could halve young people's private health insurance premiums and encourage more Australians to stay in private health insurance.

People aged 25 to 29 use health care much less than the rest of the insured population. In 2018-19, the average benefit payments for that group were A$708 per member compared to A$1,363 per member for the whole population.

If there were no cross-subsidies from 25 to 29 year olds, their premiums would be 52% of the average, community-rated premium.

This would dramatically reduce premiums for young people and increase the attractiveness of private health insurance.

As 25 to 29 year olds only comprise 4% of the insured population, adjusting premiums for this group is unlikely to have a measurable impact on premiums for other people with insurance in the short run, and may have a long run benefit if it attracts people aged 30 to 39 into insurance.

 <img alt="" src="https://images.theconversation.com/files/288656/original/file-20190820-123720-10r01n3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/288656/original/file-20190820-123720-10r01n3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288656/original/file-20190820-123720-10r01n3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288656/original/file-20190820-123720-10r01n3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288656/original/file-20190820-123720-10r01n3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288656/original/file-20190820-123720-10r01n3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288656/original/file-20190820-123720-10r01n3.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">
 Moving from a community rating to a risk rating could halve private health insurance premiums for young people. GaudiLab/Shutterstock

Under this reform, funds would have to manage the transition from a risk-rated premium for a 29 year old to a community-rated premium for a 30 year old.

This might involve full risk rating for 25 year olds and a blended approach – partial risk rating – for people over 25, so that the rate for 29 year olds does not involve too big a jump to a community rated premium at age 30.

But if developing a phasing-in plan is beyond insurers' skill set, then private health insurance is in even more dire straits than the trend data reveals.

   Read more: Do you really need private health insurance? Here's what you need to know before deciding

Grattan Institute began with contributions to its endowment of $15 million from each of the Federal and Victorian Governments, $4 million from BHP Billiton, and $1 million from NAB. In order to safeguard its independence, Grattan Institute's board controls this endowment. The funds are invested and contribute to funding Grattan Institute's activities. Grattan Institute also receives funding from corporates, foundations, and individuals to support its general activities, as disclosed on its website.
 Young people continue to cancel their private health insurance despite discounts to entice them to stay. Instead, we should reduce their premiums based on their likelihood of needing health care. Stephen Duckett, Director, Health Program, Grattan Institute Licensed as Creative Commons – attribution, no derivatives. tag:theconversation.com,2011:article/119394 2019-08-19T20:01:36Z 2019-08-19T20:01:36Z Curious Kids: how does our blood fight viruses like chicken pox and colds?

When you're feeling sick, your immune system is fighting to get you well again. www.shuttershock.com , CC BY

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If you have a question you'd like an expert to answer, send it to firstname.lastname@example.com.

How does our blood fight viruses like chicken pox, sickness and colds? - Teddy, 5, Oxfordshire, England.

Our bodies are made up of building blocks called cells. They are different sizes and colours and join together to become organs like the skin, brain and lungs.

Some cells travel around our body and work to move food and waste.

Other cells work for the immune system, which is the body's protection system. The mucous (or snot) and the tiny hairs in your nose and throat are a part of your immune system. Snot traps germs before they get too far into your body. The tiny hairs in your nose and throat tickle when they feel a germ, making your body cough or sneeze the germ out.

But if a germ makes it past the first layers of protection and into your blood, they will meet an army of special immune system cells that have one job: to fight germs.

   Read more: Curious Kids: How does pain medicine work in the body?

Red and white blood cells

It helps to think of our blood like a soup, a mixture of different ingredients. The main ingredients are red blood cells and white blood cells.

The red cells give our blood its colour. They carry a thing called oxygen from our lungs to the rest of the body.

 <img alt="" src="https://images.theconversation.com/files/286886/original/file-20190805-36367-uj4k53.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/286886/original/file-20190805-36367-uj4k53.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=300&fit=crop&dpr=1 600w, https://images.theconversation.com/files/286886/original/file-20190805-36367-uj4k53.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=300&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/286886/original/file-20190805-36367-uj4k53.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=300&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/286886/original/file-20190805-36367-uj4k53.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=377&fit=crop&dpr=1 754w, https://images.theconversation.com/files/286886/original/file-20190805-36367-uj4k53.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=377&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/286886/original/file-20190805-36367-uj4k53.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=377&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
 It's best to think our our blood like soup. The main ingredients are red and white cells. www.shuttershock.com, CC BY

The white blood cells act as an army of fighting soldier cells that attack germs. They are fast, strong and smart.

They can squeeze out of the blood and travel into the nose or throat cells, capture germs and even swallow them.

White blood cells have a cool trick to help them recognise and fight germs: they "wear" the broken parts of germs like a badge. This helps other white cells know what the bad cells look like, so they can stop the bad cells if they come back.

Do you remember going to the doctor and getting a needle in your arm? The doctor was probably injecting a vaccine into your blood. The vaccine has a germ that's been changed so it won't hurt you – like a tiger with no teeth. The vaccine helps your immune system learn to recognise that germ if the real, more dangerous version came along.

Some viruses are smart and can change their appearance so white cells can't remember them. This is why you can get the cold or the flu more than once.

Sometimes the white cells will eat the viruses. Other times they will shoot powerful balls called antibodies at the bad cells. These balls stick to the bad cells and make them very weak, which stops them moving around your body.

 <img alt="" src="https://images.theconversation.com/files/284253/original/file-20190716-173325-eugxo0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/284253/original/file-20190716-173325-eugxo0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/284253/original/file-20190716-173325-eugxo0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/284253/original/file-20190716-173325-eugxo0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/284253/original/file-20190716-173325-eugxo0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/284253/original/file-20190716-173325-eugxo0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/284253/original/file-20190716-173325-eugxo0.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">
 You might get a fever when you are sick. White cells work better when your body temperature is a bit higher than normal. www.shuttershock.com, CC BY

How to help your body fight a virus

Fighting bad cells can cause your body to get very hot and you can get a fever. This is because white cells work better when your body temperature is higher than normal.

You might also get rashes, aches and pains and feel really unwell. It is important to drink lots of water (or warm soup) and rest. Resting helps your body recover from all the fighting that the soldiers in your body have done.

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

Hello, curious kids! Have you got a question you'd like an expert to answer? Ask an adult to send your question to email@example.com

Archana Koirala has received funding in the past from the Australian Society of Infectious Diseases.
 The white blood cells act as an army of fighting cells, protecting your body from bad cells known as germs. White blood cells can capture germs and even swallow them. Archana Koirala, Paediatrician and Infectious Diseases Specialist, University of Sydney Licensed as Creative Commons – attribution, no derivatives. tag:theconversation.com,2011:article/121630 2019-08-19T02:33:43Z 2019-08-19T02:33:43Z Why do I dwell on the past?

Dwelling on the past, like writing in a diary, is part of being human and helps us form our identity. But not all memories are helpful. from www.shutterstock.com

Many of us enjoy writing in a diary, reading autobiographies or nostalgically reflecting with others about past times.

Why is remembering our past so important? Are there downsides? And what can we do if dwelling on the past bothers us?

   Read more: Explainer: what is memory?

Memories make us human

Over several decades, researchers have shown remembering your past is fundamental to being human, and has four important roles.

1. Memories help form our identity

Our personal memories give us a sense of continuity — the same person (or sense of self) moving through time. They provide important details of who we are and who we would like to be.

   Read more: Why we remember our youth as one big hedonistic party

2. Memories help us solve problems

Memories offer us potential solutions to current problems and help guide and direct us when solving them.

   Read more: Most people think playing chess makes you 'smarter', but the evidence isn't clear on that

3. Memories make us social

Personal memories are essential for social interactions. Being able to recall personal memories provides important material when making new friends, forming relationships and maintaining ones we already have.

   Read more: The power of 'our song', the musical glue that binds friends and lovers across the ages

4. Memories help us regulate our emotions

Our memories provide examples of similar situations we've been in before. This allows us to reflect on how we managed that emotion before and what we can learn from that experience.

Such memories can also help us manage strong negative emotions. For example, when someone is feeling sad they can take time to dwell on a positive memory to improve their mood.

   Read more: Health Check: how food affects mood and mood affects food

Memories help us function in our wider society

Dwelling on our personal memories not only helps us as individuals. It also allows us to operate in our socio-cultural context; society and culture influence the way we remember our past.

For instance, in Western individualistic cultures people tend to recall memories that are long, specific, detailed and focus on the individual.

In contrast, in East Asian cultures people tend to recall more general memories focusing on social interactions and significant others. Researchers have seen these differences in children and adults.

   Read more: 'Remember when we...?' Why sharing memories is soul food

Indeed, the way parents discuss past events with their children differs culturally.

Parents from Western cultures focus more on the child and the child's thoughts and emotions than East Asian parents. So, there are even cultural differences in the ways we teach our children to dwell on the past.

People from Western individualistic cultures tend to recollect specific unique memories that reaffirm someone's uniqueness, a value emphasised in Western cultures. In contrast, in East Asian cultures memories function to assist with relatedness and social connection, a value emphasised in East Asian cultures.

Memories and ill health

As dwelling on the past plays such a crucial role in how we function as humans, it is unsurprising that disruptions in how we remember arise in several psychological disorders.

People with depression, for instance, tend to remember more negative personal memories and fewer positive personal memories than those without depression. For example, someone with depression may remember failing an exam rather than remembering their academic successes.

 <img alt="" src="https://images.theconversation.com/files/288254/original/file-20190816-136199-rbg65b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/288254/original/file-20190816-136199-rbg65b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288254/original/file-20190816-136199-rbg65b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288254/original/file-20190816-136199-rbg65b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288254/original/file-20190816-136199-rbg65b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288254/original/file-20190816-136199-rbg65b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288254/original/file-20190816-136199-rbg65b.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">
 People with depression are more likely to remember the bad times rather than the good. from www.shutterstock.com

People with depression also have great difficulty remembering something from a specific time and place, for instance "I really enjoyed going to Sam's party last Thursday". Instead they provide memories of general experiences, for instance, "I like going to parties".

We have found people with depression also tend to structure their life story differently and report more negative life stories. They also tend to remember periods of their life, such as going to university, as either distinctly positive or negative (rather than a combination of both).

Disturbances in memory are also the hallmarks of post-traumatic stress disorder. This is when unwanted, distressing personal memories of the trauma spontaneously pop into the mind.

   Read more: Explainer: what is post-traumatic stress disorder?

People with anxiety disorders also tend to have biases when remembering their personal past. For instance, all of us, unfortunately, experience social blunders from time to time, such as tripping getting onto a bus or spilling a drink at a party. However, people with social anxiety are more likely to be consumed with feelings of embarrassment and shame when remembering these experiences.

   Read more: Explainer: what is social anxiety disorder?

Finally, an excessive, repetitive dwelling on your past, without generating solutions, can be unhelpful. It can result in emotional distress and in extreme instances, emotional disorders, such as depression, anxiety and post-traumatic stress disorder.

I don't want to dwell on the past. What can I do?

If dwelling on the past bothers you, these practical tips can help.

Set aside a certain time of the day for your memories. You could write in a diary or write down your worries. Writing about important personal experiences in an emotional way for as little as 15 minutes a day can improve your mental and physical health.

Practice remembering specific positive memories from your past. This can allow you to engage differently with your memories and gain a new perspective on your memories.

Learn and practise mindfulness strategies. Instead of dwelling on painful memories, a focus on the present moment (such as attending to your breath, focusing on what you can currently see, smell or hear) can help break a negative cycle

When dwelling on past memories try being proactive and generate ideas to solve problems rather than just being passive.

See your GP or health practitioner if you're distressed about dwelling on your past.

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

Laura Jobson has previously received funding from NIHR.
 Remembering past events, experiences or emotions is a big part of being human. But if dwelling on the past is distressing, here's what you can do to help. Laura Jobson, Senior Lecturer in Clinical Psychology, Monash University Licensed as Creative Commons – attribution, no derivatives. tag:theconversation.com,2011:article/121938 2019-08-18T20:01:44Z 2019-08-18T20:01:44Z How many people have eating disorders? We don't really know, and that's a worry

Eating disorders disproportionately affect females and young people. From shutterstock.com

Last week, federal health minister Greg Hunt announced that more than 60,000 Australians will be asked about their mental health and well-being as part of the Intergenerational Health and Mental Health Study.

The mental health survey will be run in 2020, with new data on how common mental illness is due the year after. This is a welcome announcement for the mental health sector, because information gathered in a survey like this can be used to shape policy reform.

   Read more: If we're to have another inquiry into mental health, it should look at why the others have been ignored

But eating disorders, a major category of mental illnesses, have been neglected by all previous important data collection initiatives in Australia so far. Notably, they were missing from the last national mental health surveys in 1997 and 2007.

Eating disorders are not yet an official part of this new survey, but we understand they are being considered.

If people with eating disorders are not counted, they don't count. In other words, we need to know who has these severe and debilitating conditions, and then work towards improving the treatment and supports available for them.

   Read more: FactCheck Q&A: do eating disorders have the highest mortality rate of all mental illnesses?

Surveys are important

National surveys ask the public if they have experienced symptoms of various mental illnesses, either in their lifetime or during the past 12 months.

People who answer "yes" to particular clusters of symptoms are "diagnosed", or assumed to have had the illness.

Asking the public about their symptoms is the best way to understand how common mental illnesses are. This is because most people with a mental illness don't seek treatment and may never have had a diagnosis. So collecting data from health services or based on reported diagnoses doesn't provide a full picture.

Also, for some mental illnesses, such as anorexia nervosa or psychosis, people might not realise they have a diagnosable illness. But they are likely to respond "yes" to direct questions about their experiences with body dissatisfaction or thinking difficulties.

Eating disorders are more than just anorexia

A person with anorexia nervosa engages in dangerous behaviours to maintain a very low body weight, or to lose more weight. Although most people have heard of it, anorexia is not common. We know this from other countries who have previously studied the prevalence of anorexia in community surveys.

That being said, it's very serious and can be fatal. It has the highest mortality of all non-substance use mental disorders, and one in five of those deaths is by suicide.

   Read more: Disease evolution: the origins of anorexia and how it's shaped by culture and time

Other eating disorders include bulimia nervosa, binge-eating disorder, and "other specified feeding and eating disorders" (OSFED), a catch-all group for those who don't fit anywhere else.

People with bulimia nervosa or binge-eating disorder experience cycles of binge-eating, often after periods of restricting foods, which cause shame, guilt and discomfort.

Those with bulimia compensate for binge-eating through vomiting, fasting, exercise or other methods, while those with binge-eating disorder do not.

Binge-eating disorder is the most common of all eating disorders and occurs more equally across men and women than other eating disorders.

As well as continued weight gain, people with binge-eating disorder are more likely to experience depression and anxiety, and other significant health problems (such as asthma, diabetes, and arthritis) than people with a high BMI (body-mass index) but no binge-eating disorder.

 <img alt="" src="https://images.theconversation.com/files/288279/original/file-20190816-136208-kruapg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/288279/original/file-20190816-136208-kruapg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288279/original/file-20190816-136208-kruapg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288279/original/file-20190816-136208-kruapg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288279/original/file-20190816-136208-kruapg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288279/original/file-20190816-136208-kruapg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288279/original/file-20190816-136208-kruapg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
 Binge-eating disorder is the most common eating disorder. From shutterstock.com

One example of OSFED is atypical anorexia nervosa – when someone shows all the symptoms of anorexia and has lost a significant amount of weight but their BMI is in the "normal" or "high" range.

Eating disorders disproportionately affect females, young people, LGBTIQ individuals, and those with a high BMI.

People with eating disorders often have a negative body image, and a strong perception their self-worth is tied to their appearance or body weight.

Burden of disease

Every year in Australia, millions of years of healthy life are lost because of injury, illness or premature deaths in the population. This is known as "burden of disease".

Like national surveys, burden of disease studies are extremely important for planning and funding health services. They use prevalence statistics, or how many people per 100,000 Australians are assumed to have a particular illness. Given we don't have good data on how prevalent eating disorders are, we likely underestimate their burden of disease.

   Read more: To the Bone: creating eating disorder awareness or doing harm?

The recently released Australian Burden of Disease Study 2015 lists eating disorders among the most burdensome illnesses for Australian females, being the tenth leading cause of total burden of disease for females aged 5-14 and women aged 25-44.

Importantly, the most common eating disorder – binge-eating disorder – is not included in burden of disease studies, meaning all these figures miscalculate the impact of eating disorders by a long way.

Eating disorders are on the rise

Despite our lack of prevalence data, there is evidence showing eating disorders are an increasing problem and should be regarded as a national priority.

Consecutive population surveys in South Australia showed the numbers of people with eating disorders climbed over a ten-year period.

Annual youth surveys demonstrate body image, the most potent risk factor for eating disorders, is year after year among the top concerns for young people.

A recent study on adolescents in the Hunter Valley region of NSW found one in five had experienced an eating disorder.

Treatment and prevention

People with eating disorders use more health services than people with all other forms of mental illness, but often don't receive appropriate and effective treatment. They typically receive treatment for weight loss, depression or anxiety, but are rarely treated for their disordered eating.

Eating disorders were estimated to cost the health system A$99.9 million in the year 2012 alone.

Better treatment and prevention of eating disorders would reduce the cost and the burden of disease. But we need the data to show where the treatment gaps are and how to fund better services.

There are many promising elements of the proposed Intergenerational Health and Mental Health Study. These include surveying multiple people in a family, gathering physical and mental health data, and a target of more than 60,000 Australians. But it's time eating disorders were included.

   Read more: Therapy for life-threatening eating disorders works, so why can't people access it?

Laura Hart receives funding from Australian Rotary Health for research in eating disorders prevention and is a member of the Australia and New Zealand Academy for Eating Disorders.
 As Australia considers its next national mental health survey, it's crucial to include eating disorders. If we don't have good data on how many people are suffering, we can't come up with solutions. Laura Hart, Senior Research Fellow, University of Melbourne Licensed as Creative Commons – attribution, no derivatives. tag:theconversation.com,2011:article/121504 2019-08-16T04:14:43Z 2019-08-16T04:14:43Z No, eating chocolate won't cure depression

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

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

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

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

   Read more: What causes depression? What we know, don't know and suspect

What did the researchers do?

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

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

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

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

   Read more: Explainer: what is memory?

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

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

   Read more: Monday's medical myth: chocolate is an aphrodisiac

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

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

What did the researchers find?

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

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

 <img alt="" src="https://images.theconversation.com/files/288094/original/file-20190815-136186-kvk3wj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/288094/original/file-20190815-136186-kvk3wj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288094/original/file-20190815-136186-kvk3wj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288094/original/file-20190815-136186-kvk3wj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288094/original/file-20190815-136186-kvk3wj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288094/original/file-20190815-136186-kvk3wj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288094/original/file-20190815-136186-kvk3wj.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">
 Few people said they'd eaten any chocolate in the past 24 hours. Were they telling the truth? from www.shutterstock.com

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

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

What are the study's limitations?

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

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

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

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

   Read more: These 5 foods are claimed to improve our health. But the amount we'd need to consume to benefit is... a lot

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

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

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

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

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

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

Blind peer review

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

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

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

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

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

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

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

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

The 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.
 Depression is a serious, common and sometimes debilitating condition. And no, chocolate won't help, whatever the headlines tell you. Ben Desbrow, Associate Professor, Nutrition and Dietetics, Griffith University Licensed as Creative Commons – attribution, no derivatives. tag:theconversation.com,2011:article/121808 2019-08-15T20:04:25Z 2019-08-15T20:04:25Z Supermarkets put junk food on special twice as often as healthy food, and that's a problem

Supermarkets may discount junk foods to capitalise on the 'impulse buy'. From shutterstock.com

Half-price chips, "two for one" chocolates, "buy one get one free" soft drinks: Australian supermarkets make it very easy for us to fill our trolleys with junk food.

Add in the bonus of an Ooshie or a Little Shop collectable and you're likely going home with a pile of products that will fill out both your pantry and your waistline.

We looked at supermarket specials over a year to see how healthy they were. The results of our research, published today, show junk foods are discounted, on average, twice as often as healthy foods.

   Read more: How we get sucked in by junk food specials in supermarkets

Australians buy about two-thirds of their food and drink at the supermarket, and 40% of their foods on special. We know environments dominated by heavily promoted junk foods are a key driver of unhealthy diets.

Where unhealthy diets are one of the leading contributors to poor health in Australia, the way supermarkets apply discounts needs to change. We all love a bargain, but we may be paying the real price with our health.

Junks foods attract more specials, and bigger discounts

In our research, junk foods included chocolate, chips, confectionery, ice cream and high-sugar breakfast cereals. We found these sorts of products were on special twice as often as healthy foods – 29% versus 15% of the time.

We also looked at how discounts varied according to the healthiness of the products. We assessed the "healthiness" of foods using the Health Star Rating system – an Australian government-endorsed scheme that gives each product a score out of five.

We found the more stars a food product had, the less often it was on special, and the smaller the discount when it was. Discounts applied to junk foods were, on average, almost twice as large as discounts on healthier options (26% off versus 15% off).

A similar recent study of drink specials in supermarkets over a year found almost half of all drink specials were for sugar-sweetened beverages (soft drinks, sports and energy drinks, and cordials). Within drink categories, twice as many sugar-sweetened beverages were on special compared to specials for milk and water (34% versus 15% of the time).

   Read more: Big supermarkets, big on junk food: how to make healthier food environments

How do supermarkets decide what to discount?

The way supermarkets choose what products are on special each week is complex.

Food manufacturers pay large premiums to have their products featured in supermarket catalogues, at end-of-aisle displays or near the checkout. The arrangements between food manufacturers and supermarkets are often governed by contracts that specify the way products are to be promoted.

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 Consumers will often make purchasing decisions based on what's on special. From shutterstock.com

Food manufacturers and supermarkets know unhealthy food is often bought on impulse, making price discounts a great way to entice customers to make those impulse choices.

Despite their claims to be healthy places to shop, supermarkets are major culprits in pushing junk food upon us.

Does it have to be this way?

If Australia is serious about addressing its obesity crisis, the way junk food is promoted in our supermarkets needs serious review. There's a real opportunity for both supermarkets and food manufacturers to take the lead in helping to encourage healthier eating.

Big supermarket chains stock more than 30,000 products. Most large food manufacturers have a wide variety of products, ranging from more healthy to less healthy. Supermarkets and food manufacturers could work together to put healthier options on special more often.

   Read more: Fat nation: the rise and fall of obesity on the political agenda

Government regulation may play a role, too. Governments around the world are starting to recognise the role of price discounts in driving unhealthy diets. There are current proposals in the UK and Scotland to use government regulations to restrict price discounts for unhealthy products.

There are several ways governments in Australia could step in to limit the impact of unhealthy discounting, including:

restricting the proportion of unhealthy food allowed to be discounted

restricting multi-buy specials (such as "buy one get one free") on unhealthy products

reducing the size of discounts on unhealthy food

restricting the advertising of price discounts (for example, through signage).

Supermarkets of the future

Imagine what it would be like to shop at a supermarket where healthier food was on special more often, and with bigger discounts. Where customers were enticed by discounted fruit and vegetables instead of half price chips, chocolate and soft drinks.

Australian supermarkets have already taken some positive steps to make their stores healthier, including an increased focus on fresh food. Extending this to improving the healthiness of their discounts could have a real benefit on the health of generations to come.

   Read more: More than one in four Aussie kids are overweight or obese: we're failing them, and we need a plan

Adrian Cameron receives funding from the Australian Research Council, the Australian National Health and Medical Research Council and the Canadian Institutes of Health Research. He is the academic partner on a project to test marketing strategies in supermarkets to encourage healthier purchasing (with VicHealth, the City of Greater Bendigo and IGA supermarkets).

Christina Zorbas receives funding from the Australian Government Research Training Program.

Gary Sacks receives funding from the National Heart Foundation of Australia, the Australian National Health and Medical Research Council and the Canadian Institutes of Health Research. He is an academic partner on a project to test marketing strategies in supermarkets to encourage healthier purchasing (with VicHealth, the City of Greater Bendigo and IGA supermarkets).

Kathryn Backholer receives funding from the Nation Heart Foundation of Australia and VicHealth.

Devorah Riesenberg 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.
 Our new study finds in Australian supermarkets, the lower the health star rating, the higher the discounts. The time is ripe for a national conversation about making discounts healthier. Adrian Cameron, Associate professor, and Associate Director of the Global Obesity Centre, Deakin University Christina Zorbas, PhD Candidate, Deakin University Devorah Riesenberg, Research fellow, Deakin University Gary Sacks, Associate Professor, Deakin University Kathryn Backholer, Senior research fellow, Deakin University Licensed as Creative Commons – attribution, no derivatives. tag:theconversation.com,2011:article/121315 2019-08-15T04:37:39Z 2019-08-15T04:37:39Z How do we identify human remains?

Forensic anthropologists, who analyse skeletal remains, can give us clues to how someone lived and died. from www.shutterstock.com

The recent case of a surgical implant found inside a Queensland crocodile has highlighted the challenges forensic scientists face when trying to identify human remains without much evidence to go on.

Did the crocodile eat a human with a surgical implant? If so, could the implant — a metal plate and some screws — be used to identify the victim? Or did the implant come from a dog?

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 Recovered from the stomach of a crocodile: did this metal plate come from a human or dog? Koorana Crocodile Park

Death by crocodile is reasonably rare. In the past decade, there have been about 67 crocodile attacks in Australia, a quarter of which were fatal.

Victim identification can be impossible in these cases, unless a body part with a unique characteristic is recovered, such as a medical device with a serial number. It's just one of a range of potential techniques to put names and faces to hundreds of unidentified human remains in Australia.

   Read more: Australia has 2,000 missing persons and 500 unidentified human remains – a dedicated lab could find matches

Forensic examination of human remains is crucial to establish the person's identity, and cause and manner of death. This way they can have a proper burial, families can get answers, death certificates can be issued and justice can be served.

It is essential for identifying missing persons, disaster victims and casualties of war.

The big three: fingerprints, teeth, DNA

When human remains are recovered, three primary scientific methods are traditionally used to identify who they belong to:

fingerprint analysis, which looks at the skin patterns on the tips of fingers

dental analysis, which looks at the teeth and any dental work, such as crowns and fillings

DNA analysis, which looks at DNA profiles recovered from soft or hard body tissues.

This information can then be compared to a database of fingerprint, dental or DNA records.

Implants and x-rays can also be useful

The discovery of medical implants during an autopsy can also be informative.

These include prosthetic joints, breast implants, pacemakers or dental implants. Investigators may be able to link these to patient records via their unique markings, including a trade mark, date of manufacture and serial number.

In Australia, the Australian Orthopaedic Association National Joint Replacement Registry and Australian Breast Device Registry collect and store information that can allow people who have had joint or breast surgery to be identified.

But there are no national registers of heart or dental implants. Such mandatory records would allow implants to be easily traced back to recipients or surgeons.

Forensic scientists can also compare medical images, such as x-rays or CT scans, taken before and after death.

For head images, unique features such as the sinuses or the arrangement and condition of the teeth can be compared.

Body scans can also be used to look for rarer skeletal features, such as fractures, amputations or cancer lesions.

 <img alt="" src="https://images.theconversation.com/files/287973/original/file-20190814-136176-1re0y3g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/287973/original/file-20190814-136176-1re0y3g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=361&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287973/original/file-20190814-136176-1re0y3g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=361&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287973/original/file-20190814-136176-1re0y3g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=361&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287973/original/file-20190814-136176-1re0y3g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=453&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287973/original/file-20190814-136176-1re0y3g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=453&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287973/original/file-20190814-136176-1re0y3g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=453&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
 Imaging such as x-rays can reveal fractures and surgical implants. from www.shutterstock.com

These scientific techniques, either individually or in combination, have been successfully used to identify large numbers of missing persons or disaster victims.

Computerisation, digitisation and miniaturisation of forensic technologies have further improved the identification process. Now, fingerprints, teeth, DNA and medical images can be quickly and easily collected and searched in real time using portable instruments at the scenes of mass disasters.

   Read more: How dental records will help identify bodies from MH17

But there are limits

These methods are only as good as the information we have from when the person was alive. So if someone doesn't have their fingerprints on file and hasn't visited a dentist recently, or if close living relatives aren't available to provide a DNA reference sample or they've never had a CT scan, these methods are likely to be useless.

And if a surgical implant doesn't have unique markings (as in the case of the Queensland crocodile), it makes the task extremely difficult.

So forensic scientists need to explore other methods.

Clues from tattoos and bones

Distinctive physical features like scars, birthmarks and body modifications such as tattoos and piercings, could help identify someone.

Custom tattoos helped identify the victim of the famous 1935 "shark arm case" and decomposing bodies following the 2004 Boxing Day tsunami.

A forensic anthropologist can also study a set of skeletal remains to reveal a lot about that person when they were living — including their sex, ancestry, stature, age, disease and any fatal injuries.

Radiocarbon dating of teeth and bone could tell us when that person was born and died. And the sample's chemical signature could indicate the region where they were born, lived for long periods or recently travelled. It can even identify what they ate.

Scientists can also reconstruct a 3D image of someone's face if a skull is found.

New DNA intelligence tools

Beyond routine DNA testing to determine someone's sex or relatives, more novel DNA methods are showing promise for piecing together an image of a missing person.

 <img alt="" src="https://images.theconversation.com/files/288084/original/file-20190814-136217-plubcz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/288084/original/file-20190814-136217-plubcz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=902&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288084/original/file-20190814-136217-plubcz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=902&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288084/original/file-20190814-136217-plubcz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=902&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288084/original/file-20190814-136217-plubcz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1134&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288084/original/file-20190814-136217-plubcz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1134&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288084/original/file-20190814-136217-plubcz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1134&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
 New DNA tools can now predict someone's physical appearance from a single bone. from www.shutterstock.com

DNA can now be used to predict someone's ancestry and hair, eye and skin colour. But using DNA to accurately estimate age and facial features is still some way off.

Forensic genetic genealogy is also growing in popularity for identifying Jane Does (unidentified females). This is where investigators search a public DNA database of ancestry.com results, looking for genetic links to the DNA from the remains.

Other countries may consider adopting this technique for their cases, as long as the database owners allow law enforcement agencies to keep using the data to identify people.

   Read more: Is your genome really your own? The public and forensic value of DNA

The value of 'body farms'

Human taphonomic facilities, such as the Australian Facility for Taphonomic Experimental Research, study the science of how bodies decompose. These facilities, often called "body farms", are important for developing new forensic identification techniques. The techniques can be tested on donated human bodies before being used in forensic cases.

   Read more: 'This is going to affect how we determine time since death': how studying body donors in the bush is changing forensic science

The best and most efficient way to identify the remains of unknown and missing Australians involves combining expertise from a number of different branches of forensic science and coordinating these efforts nationally.

So for cases where fragments of human remains are found in the stomachs of crocodiles, sharks or some other human predator, investigators now have a toolkit of forensic techniques to choose from to identify the victim.

However, in this most recent case, the recovery of only an orthopaedic device has left forensic scientists with more questions than answers.

Jodie Ward 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.
 While forensic scientists mostly use fingerprints, dental records and DNA to identify human remains, they have many other techniques in their forensic toolkit. How many have you heard of? Jodie Ward, Director, Australian Facility for Taphonomic Experimental Research; Forensic DNA Identification Specialist, NSW Health Pathology; Associate Professor, Centre for Forensic Science, University of Technology Sydney Licensed as Creative Commons – attribution, no derivatives. tag:theconversation.com,2011:article/121620 2019-08-14T20:03:09Z 2019-08-14T20:03:09Z Women aren't better multitaskers than men – they're just doing more work

Science doesn't appear to support the modern myth that women are super-human multitaskers. From shutterstock.com

Multitasking has traditionally been perceived as a woman's domain. A woman, particularly one with children, will routinely be juggling a job and running a household – in itself a frantic mix of kids' lunch boxes, housework, and organising appointments and social arrangements.

But a new study, published today in PLOS One, shows women are actually no better at multitasking than men.

The study tested whether women were better at switching between tasks and juggling multiple tasks at the same time. The results showed women's brains are no more efficient at either of these activities than men's.

Using robust data to challenge these sorts of myths is important, especially given women continue to be bombarded with work, family and household tasks.

   Read more: Health Check: can people actually multitask?

No one is good at multitasking

Multitasking is the act of performing several independent tasks within a short time. It requires rapidly and frequently switching attention from one task to another, increasing the cognitive demand, compared to completing single tasks in sequence.

This study builds on an existing body of research showing human brains cannot manage multiple activities at once. Particularly when two tasks are similar, they compete to use the same part of the brain, which makes multitasking very difficult.

But human brains are good at switching between activities quickly, which makes people feel like they're multitasking. The brain, however, is working on one project at a time.

   Read more: Multitasking between devices is associated with poorer attention and memory — expert explains why

In this new study, German researchers compared the abilities of 48 men and 48 women in how well they identified letters and numbers. In some experiments, participants were required to pay attention to two tasks at once (called concurrent multitasking), while in others they needed to switch attention between tasks (called sequential multitasking).

The researchers measured reaction time and accuracy for the multitasking experiments against a control condition (performing one task only). They found multitasking substantially affected the speed and accuracy of completing the tasks for both men and women. There was no difference between the groups.

Domestic duties

My colleagues and I recently busted another relevant myth – that women are better at seeing mess than men. We found men and women equally rated a space as messy. The reason men do less cleaning than women may lie in the fact that women are held to higher standards of cleanliness than men, rather than men's "dirt blindness".

Recent data shows Australian men are spending more time doing domestic work than they used to, but women still do the vast majority of housework.

Working Australian women have seen their total time across work and family activities increase over time, with bread-winning mothers spending four hours more across these activities per week than bread-winning fathers.

 <img alt="" src="https://images.theconversation.com/files/287971/original/file-20190814-136190-1ak9iaq.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/287971/original/file-20190814-136190-1ak9iaq.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=461&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287971/original/file-20190814-136190-1ak9iaq.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=461&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287971/original/file-20190814-136190-1ak9iaq.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=461&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287971/original/file-20190814-136190-1ak9iaq.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=579&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287971/original/file-20190814-136190-1ak9iaq.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=579&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287971/original/file-20190814-136190-1ak9iaq.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=579&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
  HILDA/The Conversation, CC BY-ND

This means working mums are balancing planning birthday parties, childcare drop offs and ballet lessons all on top of their regular jobs, commutes and careers.

Consequences of the myth

If women's brains are equally strained by multitasking, why do we keep asking women to do this work? And, more importantly, what are the consequences?

Our recent study shows mothers are more time pressed and report poorer mental health than fathers. We found the birth of a child increases parents' reports of feeling rushed or pressed for time, but the effect is twice the size for mothers than it is for fathers. Second children double mothers' time pressure again and, as a consequence, lead to a deterioration in their mental health.

   Read more: Men do see the mess – they just aren't judged for it the way women are

Women are also more likely to drop out of paid work when children are born or family demands intensify. They carry a larger mental load tied to organising the needs of the family – who has clean socks, who needs to be picked up from school, whether there is enough Vegemite for lunch. All of this labour is at the expense of time planning for the next day's work, the next promotion, and so on.

Women are also asked to multitask family demands at night. Children are more likely to interrupt their mother's than their father's sleep.

Although gender roles are changing and men are assuming a larger share of the housework and childcare than in the past, gender gaps remain in many important domains of work and family life. These include the allocation of childcare, the division of housework, the wage gap, and the concentration of women in top positions.

So, the multitasking myth means mothers are expected to "do it all". But this obligation can affect women's mental health, as well as their capacity to excel at work.

Challenging misconceptions

Public opinion persists that women have a biological edge as super-efficient multitaskers. But, as this study shows, this myth is not supported by evidence.

This means the extra family work women perform is just that – extra work. And we need to see it as such.

Within the family, this work needs to be catalogued, discussed and then equally divided. More men today are invested in gender equality, equal sharing and co-parenting than ever before.

   Read more: We can we reduce gender inequality in housework – here's how

As well as in the home, we need to dismantle these myths in the workplace. The assumption women are better multitaskers can influence the allocation of administrative tasks. Tasks like taking minutes and organising meetings should not be allocated based on gender.

Finally, governments need to dismantle these myths within their policies. Children add work that cannot be easily multitasked. Women need affordable, high-quality, and widely available childcare.

Men also need access to flexible work, parental leave and childcare to share in this labour, and protections to ensure they aren't penalised for taking time to share in the care.

Debunking these myths that expect women to be superheroes is a good thing, but we need to go further and create policy environments where gender equality can thrive.

Leah Ruppanner receives funding from the Australian Research Council.
 The myth that women are superior multitaskers has just been busted. So, let's divide work in and out of the home so women aren't left running themselves ragged. Leah Ruppanner, Associate Professor in Sociology and Co-Director of The Policy Lab, University of Melbourne Licensed as Creative Commons – attribution, no derivatives. tag:theconversation.com,2011:article/121637 2019-08-14T05:07:59Z 2019-08-14T05:07:59Z Patients have rights. Here's how to use yours

What rights do you have when discussing medical treatments or test results with your doctor? from www.shutterstock.com

Working your way around the health-care system can be overwhelming. This is especially hard when care takes place in health systems under stress.

However as a patient, you have rights about how you're treated. This includes not just your actual therapy, but how you're spoken to, how your records are handled and even whether you wish to be treated at all.

Now, the Australian Commission on Safety and Quality in Health Care has updated its charter of patient rights.

The idea is to promote a more active role in health care for patients (and their carers) by reminding them of their seven rights: access to health care, safety, respect, partnership, information, privacy and giving feedback.

But what do these rights really mean when it comes to day-to-day issues you or your family might face with your GP, in hospital or in a nursing home?

   Read more: Why an Australian charter of rights is a matter of national urgency

Example 1: leaving hospital early

Imagine an elderly patient who has been hospitalised with an infection. After a couple of days of treatment, she wants to go home to live alone. The patient's doctors are worried she won't be able to take care of herself and try to convince her to move into a rehabilitation facility. She refuses.

Respect means the patient has the right to make her own choices, even if they could result in harm. But this doesn't mean just abandoning the patient to her rights. A first step is the right to information, to ensure she understands the risks of going home. Partnership requires communication with the patient herself as well as other people she chooses, like family members and friends. This helps support the patient.

   Read more: Hospital discharges to 'no fixed address' – here's a much better way

Example 2: dementia restraints

More than half of all people in permanent residential aged care have dementia.

Sometimes patients become physically aggressive, becoming a danger to themselves and others. Physical and chemical restraints for these people has been widespread, and is being considered by the Royal Commission into Aged Care Quality and Safety.

Restraints won't be the right thing in all cases. Whether it's right for a particular person requires balancing respect for the patient's own views and dignity, with other people's rights to safety. Respect can be facilitated by working in partnership with the patient and their family to identify safe options other than restraint.

   Read more: Physical restraint doesn't protect patients – there are better alternatives

Example 3: health information disclosure

Trips to the emergency department are often scary and sensitive. The visit can be even worse if you feel others can overhear your conversations with doctors or nurses.

More than one in ten people who went to the emergency department of a major Melbourne hospital reported this experience. These people felt the loss of their privacy. It also might fail to show respect, dignity and consideration, as required in the right to respect.

But not every unwanted disclosure of health information will be wrong. Some might even be necessary to meet other health-care rights.

For instance, an emergency department with curtains instead of walled rooms to help people or equipment move more freely might meet the safety right even though it risks a patient's right to privacy. But the charter at least means hospitals and treating teams have to justify any unwanted disclosure of health information. It also means patients who feel uncomfortable can give feedback, another of their rights.

   Read more: Paper tsunami: how the move to digital medical records is leaving us drowning in old paper files

How does Australia stack up?

Other countries have created similar lists of patients' rights, including New Zealand and Scotland.

The most valuable part of the Australian charter is improving patient and carer understanding of existing health-care rights. This makes it easier to know when to complain to a state or territory complaints commission, or the Australian Health Practitioner Regulation Agency.

Although the Australian Commission on Safety and Quality in Health Care is releasing more resources for patients, its charter may not go far enough in protecting groups who experience systemic bias in their health-care interactions. This includes many Aboriginal and Torres Strait Islander people.

   Read more: Ms Dhu coronial findings show importance of teaching doctors and nurses about unconscious bias

Another pitfall of the charter is its non-binding nature. It describes the rights patients should expect but it does little to enforce them. This can leave the charter as something of a toothless tiger, an issue also discussed internationally.

The charter also doesn't deal with potential patient responsibilities. These are the obligations consumers have for their own health, like treating staff considerately and keeping medical appointments.

It's hard to see how one can exist without the other.

Lisa Eckstein is an investigator on two current Australian Research Council Discovery Program Grants - Genomic Data Sharing: Shaping an Optimal Regulatory Framework and Reforming the Regulatory Environment for Innovative Health Technologies: Identifying Congestion and Filling Gaps.

Rebekah McWhirter is on the board of Women's Health Tasmania and has been supported by NHMRC and ARC grants.
 It's all very well having rights. But what do these rights really mean when you're with your GP, in hospital or in a nursing home? Lisa Eckstein, Senior Lecturer in Law and Medicine, University of Tasmania Rebekah McWhirter, Research Fellow, Centre for Law and Genetics, University of Tasmania Licensed as Creative Commons – attribution, no derivatives. tag:theconversation.com,2011:article/121764 2019-08-13T20:01:25Z 2019-08-13T20:01:25Z The sex gene SRY and Parkinson's disease: how genes act differently in male and female brains

Male and female brains are different at every level. Science is continuing to uncover how these differences affect health and disease. From shutterstock.com

Parkinson's disease, a debilitating neurodegenerative disease common in elderly people, is twice as prevalent in men than in women.

A new study published this month suggests the sex gene (SRY on the male-specific Y chromosome) plays a role in the loss of dopamine-making neurons that underlies this disease.

As well as providing a spectacular example of how genes act differently in male and female brains, this discovery may lead to a new treatment option for men suffering from Parkinson's disease.

   Read more: Not just about sex: throughout our bodies, thousands of genes act differently in men and women

Sex and disease

Many diseases are more common in one sex than the other. For example, multiple sclerosis and other immune disorders are more common in women than men. Parkinson's disease, and several mental health conditions such as schizophrenia and autism, are more common in men than women.

Treatments, too, may be differently effective in men and women because of differences in expression of genes important for drug metabolism.

The bases of these sex differences are often unclear. Is it a hormonal difference that makes men and women differently susceptible to diseases, and differently amenable to treatment? For instance, the sex difference in Parkinson's disease was previously attributed solely to the protective effect of the hormone oestrogen in female brains.

But as well as hormonal differences, we now have reason to believe genes on sex chromosomes may directly affect the brain.

Parkinson's disease

Parkinson's disease is a growing problem, particularly with an ageing population. Nearly one in 300 Australians live with Parkinson's disease. It usually appears in later life as problems in starting and maintaining voluntary movements, and may be accompanied by severe tremor.

   Read more: What causes Parkinson's disease? What we know, don't know and suspect

Parkinson's disease is caused by a loss of neurons responsible for making dopamine, a hormone and neurotransmitter that sends messages to other nerve cells. Symptoms appear when 70% of these dopamine-synthesising cells have been depleted. We don't understand how these neurons are lost, but expect the effect of loss on motor function is due to the curtailed dopamine production.

Parkinson's disease is progressive and incurable, but the symptoms may be ameliorated and delayed by medications that boost dopamine or substitute for it.

 <img alt="" src="https://images.theconversation.com/files/287798/original/file-20190813-9425-dc93zl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/287798/original/file-20190813-9425-dc93zl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287798/original/file-20190813-9425-dc93zl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287798/original/file-20190813-9425-dc93zl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287798/original/file-20190813-9425-dc93zl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287798/original/file-20190813-9425-dc93zl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287798/original/file-20190813-9425-dc93zl.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 lack of the neurotransmitter dopamine is known to be associated with Parkinson's disease. From shutterstock.com

SRY and Parkinson's disease

In humans and other mammals, females have two X chromosomes (XX), and males a single X and a male-specific Y chromosome (XY). SRY is the master gene on the Y chromosome that determines the male sex of a baby in the embryo.

But research has found SRY seems to be active in other parts of the body, too. In mice and rats, SRY is active in the brain, and in humans it's expressed in several tissues and organs, including the brain.

   Read more: What makes you a man or a woman? Geneticist Jenny Graves explains

SRY has been found to be expressed at abnormally high levels in the brains of mice and rats mutated to have symptoms of Parkinson's disease, and in animals where the disease was induced by chemical treatment.

Previous work showed overactivity of the SRY gene destroys neurons that synthesise dopamine. We're not entirely sure how this happens, but given the link between dopamine production and Parkinson's disease, it might partly explain why Parkinson's disease affects males more commonly than females.

This new study now shows that interfering with SRY expression in the brains of rodents with Parkinson's disease ameliorates the severity of symptoms. Vince Harley and Joohyung Lee from the Hudson Institute in Melbourne found that quashing SRY action prevented or mitigated the reduced mobility of male animals with Parkinson's disease.

 <img alt="" src="https://images.theconversation.com/files/287800/original/file-20190813-9425-1e5k2st.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/287800/original/file-20190813-9425-1e5k2st.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287800/original/file-20190813-9425-1e5k2st.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287800/original/file-20190813-9425-1e5k2st.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287800/original/file-20190813-9425-1e5k2st.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287800/original/file-20190813-9425-1e5k2st.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287800/original/file-20190813-9425-1e5k2st.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">
 For every woman who has Parkinson's disease, two men have it. From shutterstock.com

So, suppressing the activity of SRY in neurons of Parkinson's disease patients could ameliorate their symptoms.

This sort of a cure may be many years away, but it would have a huge impact on the quality of life of thousands of men in Australia living with Parkinson's disease.

Sex and the brain

Male and female brains really are different at every level; molecular, cellular, and behavioural. For 60 years this has been attributed to sex hormones. But we're beginning to find that genes may also have direct effects.

A recent analysis of the activity of most of the 20,000-odd genes in the bodies of hundreds of men and women showed that more than one-third were expressed much more highly in one sex than the other. This sex bias was not limited to sex organs, but was obvious at many other sites, including the brain.

The effect of SRY in the brain is a strong demonstration that male and female brains are genetically different in health and disease, and a reminder we must take account of sex differences in diagnosing and treating disease in men and women.

   Read more: Differences between men and women are more than the sum of their genes

Jenny Graves receives research grants from the Australian Research Council
 Parkinson's disease is twice as common in men than in women. A sex gene called SRY, found only in men, could go some way to explaining this – and might pave the way for potential treatments. Jenny Graves, Distinguished Professor of Genetics, La Trobe University Licensed as Creative Commons – attribution, no derivatives. tag:theconversation.com,2011:article/119539 2019-08-13T06:45:41Z 2019-08-13T06:45:41Z Memory and attention difficulties are often part of a normal life

Can't remember what you came for? Don't worry – you probably have a lot going on. Andrey_Popov/Shutterstock

From young adults to people in their 60s, everyday functioning in today's world can place high demands on our attention and memory skills.

Memory lapses such as forgetting an appointment, losing our keys, forgetting a distant relative's name or not remembering why you opened the fridge can leave us believing our thinking skills are impaired.

But you might be too hard on yourself. Tiredness, stress and worry, and feeling down or depressed are all common reasons adults experience attention and memory difficulties.

   Read more: What is 'cognitive reserve'? How we can protect our brains from memory loss and dementia

Attention and memory systems

Attention and memory skills are closely connected. Whether we can learn and remember something partly depends on our ability to concentrate on the information at the time.

It also depends on our ability to focus our attention on retrieving that information when it's being recalled at a later time.

This attention system, which is so important for successful memory function, has a limited capacity – we can only make sense of, and learn, a limited amount of information in any given moment.

Being able to learn, and later successfully remember something, also depends on our memory system, which stores the information.

Changes in attention and memory skills

In people who are ageing normally, both attention and memory systems gradually decline. This decline starts in our early 20s and continues slowly until our 60s, when it tends to speed up.

During normal ageing, the number of connections between brain cells slowly reduce and some areas of the brain progressively work less efficiently. These changes particularly occur in the areas of the brain that are important for memory and attention systems.

This normal ageing decline is different from dementia and Alzheimer's disease, which cause progressive changes in thinking skills, emotions and behaviour that are not typical of the normal ageing process. Dementia comes from a group of diseases that affect brain tissue and cause abnormal changes in the way the brain works.

   Read more: Why people with dementia don't all behave the same

If you're concerned your memory difficulties may be a symptom of dementia, talk to your GP, who can refer you to a specialist, if needed, to determine whether these changes are due to normal ageing, dementia or some other cause.

If you experience persistent changes in your thinking skills, which are clearly greater than your friends and acquaintances who are of a similar age and in similar life circumstances, see your GP.

Normal attention and memory difficulties

Broadly, there are two main reasons healthy adults experience difficulties with their memory and/or attention: highly demanding lives and normal age-related changes.

A person can be consistently using their attention and memory skills at high levels without sufficient mental relaxation time and/or sleep to keep their brain working at its best.

Young adults who are working, studying and then consistently using attention-demanding devices as "relaxation" techniques, such as computer games and social media interaction, fall into this group.

Adults juggling the demands of work or study, family and social requirements also fall into this group.

Most adults need around seven to nine hours of sleep per night for their brain to work at its best, with older adults needing seven to eight hours.

 <img alt="" src="https://images.theconversation.com/files/287791/original/file-20190813-9935-hmnt4v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/287791/original/file-20190813-9935-hmnt4v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287791/original/file-20190813-9935-hmnt4v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287791/original/file-20190813-9935-hmnt4v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287791/original/file-20190813-9935-hmnt4v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287791/original/file-20190813-9935-hmnt4v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287791/original/file-20190813-9935-hmnt4v.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">
 Most of us need seven to nine hours of sleep a night. Gorodenkoff/Shutterstock

The second common reason is a combination of ageing-related brain changes and highly demanding work requirements.

For people in jobs that place a high load on thinking skills, the thinking changes that occur with normal ageing can become noticeable at some point around 55 to 70 years of age. It's around this time age-related changes in the ability to carry out complex thinking tasks become large enough to be noticeable. People who are retired or don't have the same mentally demanding jobs generally experience the same changes, but may not notice them as much.

This is also the age many people become more aware of the potential risk of dementia. Consequently, these normal changes can result in high levels of stress and concern, which can result in a person experiencing even greater difficulties day to day.

Emotional distress can take its toll

Feeling down and sad can affect memory and concentration. When a person is feeling worried and/or down regularly, they may become consumed by their thoughts.

It's important to recognise how you're feeling, to make changes or seek help if needed. But thinking a lot about how you're feeling can also take a person's attention away from the task at hand and make it difficult for them to concentrate on what is happening, or remember it clearly in the future.

So feeling worried or down can make it seem there is something wrong with their memory and concentration.

Boosting your attention and memory skills

There are a number of things that can be done to help your day-to-day memory and attention skills.

First, it's important to properly rest your mind on a regular basis. This involves routinely doing something you enjoy that doesn't demand high levels of attention or memory, such as exercising, reading for pleasure, walking the dog, listening to music, relaxed socialising with friends, and so on.

Playing computer games, or having a lengthy and focused session on social media, requires high levels of attention and other thinking skills, so these are not good mental relaxation techniques when you are already mentally tired.

   Read more: Why two people see the same thing but have different memories

It's also important to get enough sleep, so you are not consistently tired – undertaking exercise on a regular basis often helps with getting good quality sleep, as does keeping alcohol consumption within recommended limits.

Looking after your mental health is also important. Noticing how you are feeling and getting support (social and/or professional) during longer periods of high stress or lowered mood will help ensure these things are not affecting your memory or concentration.

Finally, be fair to yourself if you notice difficulties with your thinking. Are the changes you notice any different to those of other people your own age and in similar circumstances, or are you comparing yourself to someone younger or with less demands in their life?

If you have ongoing concerns about your attention and memory, speak with your GP, who can refer you to a specialist, such as a clinical neuropsychologist, if needed.

   Read more: Curious Kids: why do I sometimes forget what I was just going to say?

Jacqueline Anderson 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.
 Do you often forget where you put the keys or what you were looking for in the fridge? It's not necessarily a sign of cognitive decline – it might just come down to being tired, stressed or worried. Jacqueline Anderson, Senior Lecturer in Clinical Neuropsychology, University of Melbourne Licensed as Creative Commons – attribution, no derivatives. tag:theconversation.com,2011:article/121561 2019-08-12T19:59:38Z 2019-08-12T19:59:38Z Red tape in aged care shouldn't force staff to prioritise ticking boxes over residents' outcomes

The aged care royal commission has looked at regulation in aged care. From shutterstock.com

Last week's hearings at the aged care royal commission in Brisbane looked at regulation in aged care. While rules and regulations are designed to safeguard residents, bureaucratic "red tape" also contributes to the failings in aged care.

The fear among nursing home staff of failing a review visit by an Aged Care Quality and Safety Commission surveyor has been known to shift the focus from care for residents to meeting paper trail requirements.

The best outcome for aged care residents and their families would be new reporting requirements centred on outcomes rather than processes. Their primary focus should be on the mediation of critical incidents – that is, looking at what caused them and how they could be prevented in future – and the maintenance of health.

   Read more: Our ailing aged care system shows you can't skimp on nursing care

How did we get here?

The crisis in the aged care sector has emerged over time. At least in part, systemic problems in organisations arise from interactions among its key players. These interactions must be aligned to achieve its common goals.

But the key players in the aged care system pursue divergent agendas. Regulators focus on process adherence, while staff struggle with their limited capacity to manage the complex needs of residents. Meanwhile, proprietors focus on economic viability.

The prevailing approach of dealing with the problem of a particular key player in isolation will not solve the problems of aged care as a whole.

Governance and accountability

Our research suggests the need for a major culture shift in the aged care system.

Around the world, governments are being urged to put less emphasis on process measurement and more on outcome transparency.

   Read more: We've had 20 aged care reviews in 20 years – will the royal commission be any different?

Peter Drucker, a well-known management consultant, educator and author, once said "management is doing things right; leadership is doing the right things".

Ticking the boxes of a protocol to demonstrate "regulatory compliance" – that is, doing things right – is no longer an option on its own. Residents and their families expect staff to be attentive to residents' changing physical, emotional, social and cognitive needs; that is, doing the right things.

These insights tell us the aged care system needs to be redesigned.

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

What would this look like in practice?

Let's consider two common aged care problems – falls and diabetes – whose management is significantly influenced by the chosen accountability framework. The differences between an outcomes-based approach (that is, adapting care to problems in their context) and a process-based approach (adhering to a protocol) are stark.

 <img alt="" src="https://images.theconversation.com/files/287636/original/file-20190812-71921-u53rxr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/287636/original/file-20190812-71921-u53rxr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287636/original/file-20190812-71921-u53rxr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287636/original/file-20190812-71921-u53rxr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287636/original/file-20190812-71921-u53rxr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=425&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287636/original/file-20190812-71921-u53rxr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=425&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287636/original/file-20190812-71921-u53rxr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=425&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
 The extent to which staff in aged care are required to focus on documentation may detract from their capacity to care for residents. From shutterstock.com

The first example: a resident has a fall. Rather than only assessing her for injuries and vital signs (as per protocol), staff would also assess potential reasons for the fall – for example, lack of mobility, pain, low blood pressure, or polypharmacy (taking multiple prescription medications at once) – and involve allied health professionals in preventive and rehabilitative care. This could include muscle strengthening exercises, gait and balance retraining, pain management and medication review. These are measures that could reduce the likelihood of the patient falling again, thereby improving her outcomes.

And let's take a resident with normally stable diabetes, who one day records an elevated blood sugar reading. Rather than just giving him more insulin, staff would also assess potential underlying reasons for the elevated reading. These could include loss of appetite, an infection, or an episode of delirium.

The royal commission should do many things, but adding red tape isn't one of them

Increasing frailty and/or significant memory decline are the main reasons for admission to an aged care facility. These people are particularly vulnerable as their health changes frequently and rapidly.

Being bogged down by regulatory ritualism reduces the time staff have available to spend on residents' physical, social, emotional and cognitive needs.

   Read more: Don't wait for a crisis – start planning your aged care now

True accountability in aged care is achieved by demonstrating how the provided care has impacted a resident's well-being. In that regard, the Aged Care Quality and Safety Commission should provide leadership and primarily act as an educator, helping facilities to become learning organisations. If an aged care facility fails to "learn and improve", then sanctions and penalties become necessary.

More bureaucracy would only serve to perpetuate the current crisis, and would fail those residents and families who have suffered from the current failings in the sector.

Len Gainsford, a former adjunct research fellow in accounting & governance at Swinburne University of Technology, contributed to this article.

Joachim Sturmberg is Foundation President of the International Society for Systems and Complexity Sciences for Health (ISSCSH).
 Bureaucratic 'red tape' has contributed to the current crisis in our aged care system. We need a system of accountability that focuses more on residents' outcomes, and less on processes. Joachim Sturmberg, Conjoint Associate Professor of General Practice, University of Newcastle Licensed as Creative Commons – attribution, no derivatives. tag:theconversation.com,2011:article/121500 2019-08-12T06:27:23Z 2019-08-12T06:27:23Z Here's why there should be no gestational limits for abortion

Half of women seeking second and third-trimester abortions do so because of foetal abnormalities.  Sasha Freemind

Family planning organisation and abortion provider Marie Stopes today warned that Australian women face a confusing patchwork of state-based laws and service shortages that restrict access to abortions, based on where they live.

At the centre of these inconsistent laws is the gestational cut off – the point where the pregnant person is no longer the primary decision-maker and, instead, specific criteria must be met (generally, two doctors must agree that the abortion is necessary on medical and/or social grounds).

Gestational cut-off points vary from state to state. The Australian Capital Territory has no cut off. Others are set at 14 weeks (the Northern Territory), 16 weeks (Tasmania), 22 weeks (Queensland and the bill currently under debate in New South Wales), and 24 weeks (Victoria).

   Read more: After 119 years, NSW is set to decriminalise abortion. Why has reform taken so long?

Around the world, Canada has no cut off, while Ireland's is set at 12 weeks. The bill set to be debated in New Zealand has a gestational limit of 20 weeks.

Around 1-3% of abortions in Australia occur after 20 weeks. About half are performed because of foetal abnormality. The other half are for a number of reasons: women who don't menstruate regularly (because they are young, perimenopausal or on contraceptives, for example) miss early symptoms of pregnancy; abusive partners prevent women from accessing abortion services at an earlier date; relationships break down; socioeconomic circumstances change.

There's no evidence gestational limits result in fewer second and third trimester abortions. But there is evidence that such cut-offs harm women, especially those who are already disadvantaged. They also prevent medical professionals from providing pregnant people with the best possible care.

Cut-offs are often based on foetal viability

The 24-week limit in Victoria was adopted from law in the United Kingdom. It's based on foetal viability: the age at which an extremely premature baby can survive outside the uterus. 22-weeks is commonly considered the "threshold of viability".

But viability is subject to medical technologies that are constantly evolving. 22-26 weeks' gestation is considered a "grey zone", where some foetuses have survived with major medical intervention, mostly with ongoing disabilities.

Attempts to legally differentiate "early" from "later" abortions are arbitrary, and based on the technology of the day. When applied in law, these cut-offs are likely to be subject to judicial review in the future as technology advances.

Life-saving treatment is not generally provided for babies born before 22 weeks' gestation. Parents of babies born before 26 weeks can decide whether or not their babies receive treatment, even when there is a chance of survival.

As bioethicists Lachlan de Crespigny and Julian Savulescu argue, the discrepancy between this practice and gestational limits on abortion grants "the foetus inside a woman's body […] a higher moral status than a newborn infant of the same gestation outside the woman's body".

Most Australians support women's right to choose

Although the inclusion of gestational limits for abortion is commonly viewed as a "middle ground" between pro- and anti-choice positions on abortion, they represent a significant move towards the position of a vocal minority.

The most recent study of public opinion towards abortion in Australia found 73% of respondents believed abortion should be fully decriminalised and 57.9% agreed that "women should be able to obtain an abortion readily when they want one".

Only 5.6% were unequivocally opposed to abortion.

   Read more: One in six Australian women in their 30s have had an abortion – and we're starting to understand why

A study from 2008 similarly concluded "a majority of Australians support laws which enable women to access abortion services after 24 weeks' gestation".

Leading professional health bodies also oppose gestational limits, including the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the Royal Australasian College of Physicians, the Australian Psychological Society, and the Public Health Association of Australia.

Cut-offs don't reduce late-term abortions

There is a fiction circulating that an absence of legal restrictions on abortion would compel doctors to perform abortions "until birth". The claims that, without legal oversight, women would terminate pregnancies they have carried to near term and highly trained doctors would perform such procedures are clearly untrue.

There is no evidence that legal restrictions on second and third trimester abortions reduce the number of abortions that occur later in pregnancy. In fact, based on the most recent statistics, the proportion of abortions performed after 20 weeks in Canada, which has no gestational cut off, is half that in Queensland, which has a 22 week cut off (0.66% compared with 1.34%).

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists states that in some circumstances, it's unreasonable for women to make a decision about termination at an earlier gestation. Second trimester ultrasounds, for example, are generally performed between 19-20 weeks' gestation. Further testing is required when anomalies are detected, and some abnormalities are not diagnosable until much later.

When faced with a diagnosis of major foetal abnormality, even people who consider themselves anti-choice often re-evaluate their opposition to terminating a pregnancy.

Gestational cut-offs compel pregnant people (and often their partners) to make decisions without the necessary time or information that is required to comprehend complex medical conditions. This means women terminate pregnancies they would otherwise keep; they keep pregnancies they would have otherwise terminated; and they terminate pregnancies before they are emotionally and psychologically prepared to end a pregnancy that was, until that time, wanted.

   Read more: It's time to lift the restrictions on medical abortion in Australia

Cut-offs disadvantage the vulnerable

Restrictions on abortion past 20 weeks' gestation disproportionately impact on women who are disadvantaged socially and/or geographically and those experiencing reproductive coercion and other forms of domestic violence.

Women living in rural and regional areas, for example, can experience delays in accessing the medical testing required to diagnose foetal abnormality and then further delays when accessing abortions. At later gestations, this generally involves travel to urban centres. Such delays are more onerous for women who do not have ready access to the financial resources to pay for the abortion, and associated costs such as travel, accomodation and childcare.

Only a handful of providers perform abortion post 16 weeks in Australia. This is due to a combination of factors, including laws that differentiate "early" from "late" abortions, a shortage of doctors trained to provide later gestation abortions, and the privatisation of abortion services (and withdrawal of state responsibility for providing access to abortion).

Restrictions on access to second/third trimester abortions produce a two-tiered system, where women with financial resources have access to abortion services interstate and overseas.

Aware that re-criminalising abortion in all circumstances is politically untenable, anti-abortion campaigners have increasingly focused attention on challenging the upper limit of abortion.

This focus misrepresents the practice of abortion and ignores the fact all foetuses exist within the bodies of pregnant people, and pregnant people always exist within a social space that is particular to them.

Erica Millar is a member of the South Australian Abortion Action Coalition.
 If NSW decriminalises abortion, women will be able to access a termination up to 22 weeks' gestation. But such cut-offs are arbitrary and should be abandoned. Erica Millar, Lecturer, La Trobe University Licensed as Creative Commons – attribution, no derivatives. tag:theconversation.com,2011:article/121363 2019-08-11T20:00:18Z 2019-08-11T20:00:18Z Why women are more likely to have dodgy hip implants or other medical devices

Hip implants and other medical devices are not always designed with women in mind. from www.shutterstock.com

The past year has seen wide concern about the safety of medical implants. Some of the worst scandals have involved devices for women, such as textured breast implants with links to cancer, and transvaginal mesh implants, which were the subject of a senate inquiry.

But women are harmed not only by "women's devices" such as breast implants and vaginal mesh. Women are also more likely to be harmed by apparently gender-neutral devices, like joint replacements and heart implants.

   Read more: We can cut private health insurance costs by fixing how we pay for hip replacements and other implants

In recently published research, I explored the reasons for this. I found gender biases at all stages of design and use of medical implants.

Proposed changes to how devices are regulated, such as introducing a national register of all implants, will make it quicker to identify dodgy devices. But this will not address gender bias in how devices are designed and used.

Bias starts with design, then lab testing

Biological and social factors can affect how women present when injured or ill, and how well treatments work. Often, device designers do not take these differences into account.

The lab tests used to make sure implants are safe often ignore the possibility women could have different reactions to materials, or their activities could place different loads on implants.

   Read more: Medicine's gender revolution: how women stopped being treated as 'small men'

Bias continues with clinical trials

Some medical device companies have exploited regulatory loopholes to get devices to market in the UK without clinical trials. Even when trials take place, women are not always included. Or researchers do not analyse the data for gender differences.

Regulators such as the Food and Drug Administration (FDA) in the United States and Australia's Therapeutic Goods Administration (TGA) often approve devices without data split by gender on how well devices perform or how safe they are.

Then there's the doctor-patient relationship

The gender of the doctor and patient can make a difference to what women learn about their implant. The very low numbers of women in surgery mean female patients often see male surgeons. And there is some evidence male doctors tend to treat female patients in a more paternalistic and less patient-centred way.

Then there's the issue of whether surgeons raise important safety issues with their female patients. For example, some surgeons feel uncomfortable discussing whether it's safe to have sex after a hip implant, especially with female patients. This is important as some sexual positions are safer than others.

   Read more: Women have heart attacks too, but their symptoms are often dismissed as something else

Let's look at one example, a hip implant

The DePuy ASR (articular surface replacement) hip implant caused serious complications for patients around the world, including Australia, such as inflammation, painful growths, dislocations and metal toxicity.

Despite media coverage, few were aware this hip implant was more than twice as likely to fail in women.

In the case of hip implants, the same models are available for women and men, implying these devices are gender neutral. Most models come in a range of sizes, with some having better outcomes for women. But women are not small men, and there are gender differences in basic activities involving the hip, such as walking.

When women stand up from sitting or have sex, the fragile edges of their hip sockets tend to bear greater loads than men's. This "edge loading" increases the risk hip implants will wear down and release dangerous metal particles.

 <img alt="" src="https://images.theconversation.com/files/287282/original/file-20190808-144878-1ins2yv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/287282/original/file-20190808-144878-1ins2yv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=390&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287282/original/file-20190808-144878-1ins2yv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=390&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287282/original/file-20190808-144878-1ins2yv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=390&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287282/original/file-20190808-144878-1ins2yv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=490&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287282/original/file-20190808-144878-1ins2yv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=490&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287282/original/file-20190808-144878-1ins2yv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=490&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
 When women stand up from sitting, their hip sockets tend to bear greater loads than men's. from www.shutterstock.com

These differences would not matter if lab tests showed equal safety of hip implants for men and women. However, evidence is not collected on this. In fact, international standards for lab tests that measure rates of wear in hip implants ignore gender differences, and only test normal walking rather than more stressful activities, such as running or having sex.

The FDA, TGA and other regulators often approve new hip implants based on their similarity to already approved models. This happened with the ASR hip implant. Regulators did not need new data, let alone evidence the hip was equally safe for women and men.

It's a concern internationally

Internationally, there is increasing concern about the regulation and safety of medical implants. An international group of journalists released a damning report late last year. The FDA's 510(k) process, which approves new devices based on their similarity to existing ones, allows approval of some high-risk implants without additional evidence.

The situation is no better in Europe, where commercial agencies do the approvals. This system has been criticised for approving devices without good data and for lacking transparency when it comes to implant recalls.

   Read more: What is the Medical Technology Association and how does it wield its power?

The FDA has taken some steps to address gender bias, issuing guidance for companies to provide data on their devices in women and men. However, this is not binding. A study of devices approved after its introduction found only 17% included data analysis by sex.

How could we improve things?

In Australia, scandals with implants have led to calls for bans and registries. These are good ideas, but will not prompt new devices to be designed with women in mind, nor improve patient communication.

   Read more: The TGA's proposed breast implant ban exposes a litany of failures, and fails to protect women

Surgeons need to raise topics important for their patients to know about surgery, however uncomfortable it makes them feel. Current efforts to improve the culture of surgery, and to attract trainees who better reflect the communities they serve may help. But there is a long way to go.

Regulators like the TGA and FDA can influence device design by requiring data on the safety and performance of all new (and modified) devices in both women and men. The FDA experience shows these requirements must be binding if they are to work.

Katrina Hutchison 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.
 How an implant is designed, tested, regulated and discussed with patients tends to disadvantage women. It's time that changed. Katrina Hutchison, Postdoctoral research fellow, Macquarie University Licensed as Creative Commons – attribution, no derivatives. tag:theconversation.com,2011:article/121508 2019-08-09T06:00:47Z 2019-08-09T06:00:47Z What is sepsis and how can it be treated?

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

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

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

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

   Read more: 1 in 10 patients are infected in hospital, and it's not always with what you think

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

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

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

Sepsis has two phases

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

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

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

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

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

Symptoms and treatments

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

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

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

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

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

 <img alt="" src="https://images.theconversation.com/files/287460/original/file-20190809-144888-tyfe0h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/287460/original/file-20190809-144888-tyfe0h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287460/original/file-20190809-144888-tyfe0h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287460/original/file-20190809-144888-tyfe0h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287460/original/file-20190809-144888-tyfe0h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287460/original/file-20190809-144888-tyfe0h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287460/original/file-20190809-144888-tyfe0h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
 Sepsis can be particularly dangerous in babies. From shutterstock.com

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

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

   Read more: What are septic shock and sepsis? The facts behind these deadly conditions

Where to from here?

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

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

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

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

   Read more: Explainer: how is septicaemia treated?

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

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

Hamsa Puthalakath receives funding from La Trobe University's SIF and RFA (UD) for developing novel antibody-based therapeutics for treating poly-microbial sepsis.
 With an ageing population, and the growing threat of antibiotic resistance, now is the time to be worried about sepsis. Hamsa Puthalakath, Associate Professor, Biochemistry, La Trobe University Licensed as Creative Commons – attribution, no derivatives. tag:theconversation.com,2011:article/121554 2019-08-08T20:05:37Z 2019-08-08T20:05:37Z WA's take on assisted dying has many similarities with the Victorian law – and some important differences

A person wanting to access voluntary assisted dying must meet strict criteria, including having a medical condition that is considered to be advanced and progressive. From shutterstock.com

Western Australia may soon become the second Australian state to permit voluntary assisted dying, with the release on Tuesday of its Voluntary Assisted Dying Bill 2019.

As in Victoria, whose law is now just under two months old, the bill was the product of reviews by a parliamentary committee and ministerial expert panel. It's expected to be debated in the Western Australian parliament in three weeks.

So how does what's being proposed compare to the law in Victoria?

The WA bill draws heavily on the Victorian model. But a few important differences suggest eligible people in WA seeking access to voluntary assisted dying will not have to navigate a process as complex as in Victoria.

   Read more: Want to better understand Victoria's assisted dying laws? These five articles will help

First, what's similar?

The WA bill aligns very closely with the Victorian law, particularly in relation to the eligibility criteria and the request and assessment process.

In both states, a person must have a medical condition that is advanced and progressive, and is expected to cause death within six months (or 12 months for neurodegenerative conditions such as motor neurone disease).

Like Victoria, voluntary assisted dying in WA would be available only to adults whose suffering cannot be tolerably relieved, who can make their own decisions, and who have been residents of the state for at least a year.

The process to access voluntary assisted dying would also be similar to Victoria. A patient must make at least three requests for voluntary assisted dying (two verbal and one written), and two separate doctors must assess their eligibility.

The Voluntary Assisted Dying Board, like its Victorian counterpart, would oversee the system as a whole.

What's different?

One key difference is nurse practitioners will be able to administer the voluntary assisted dying medication in WA. While doctors must undertake the eligibility assessments, the bill permits nurse practitioners with at least two years' experience to administer the medication.

This reflects in part a recommendation of the ministerial expert panel, which determined a role for nurse practitioners was needed to ensure equitable access for all WA residents given the geographically diverse nature of the state.

   Read more: We don't know all the details of how voluntary assisted dying will work yet – but the system is ready

Another key difference is a doctor or nurse practitioner can administer the medication in wider circumstances. Under the Victorian law, self-administration (the person taking the medication themselves) is the default option. Practitioner administration (a doctor administering the medication directly) is only permitted where a person is physically incapable of self-administration or digestion.

The WA bill retains self-administration as the default approach. But, if their doctor advises this would be inappropriate because of, for example, concerns about taking the medication themselves, a person can choose practitioner administration. This approach grants more discretion to the person and their doctor about how voluntary assisted dying is provided.

Conscientious objection is handled differently as well. The Victorian law exempts health practitioners from having to provide any information about voluntary assisted dying if they don't wish to. It also allows doctors up to seven days to respond to a first request for voluntary assisted dying.

The WA bill strikes a different balance between conscience and ensuring a person's access to lawful health care. A doctor can still decline to participate in the process, but they are required to inform a patient asking for voluntary assisted dying about their conscientious objection immediately.

The doctor is also required to give the patient standardised information. That information is yet to be approved by the government, but presumably will be about how to find a doctor who may be willing to assist.

   Read more: FactCheck Q&A: do 80% of Australians and up to 70% of Catholics and Anglicans support euthanasia laws?

The WA bill also omits two significant features of the Victorian law. One is the requirement for the doctor to obtain a voluntary assisted dying permit from the government. The stated rationale for not requiring a permit is to prevent the voluntary assisted dying process being burdened by bureaucratic oversight that may not materially add to the safety of the process.

The other is the prohibition on health practitioners raising voluntary assisted dying with patients in the course of the clinical relationship. In Victoria, the patient must bring the topic up themselves in the first instance.

This has been a troubling part of the Victorian law, arguably impeding open discussions needed for high quality end-of-life care. So it's pleasing to see this limit has not been included the the WA proposal.

What happens next?

We consider the departures outlined above to be both sensible and modest. Some, like the changes around conscientious objection, reflect a desire to ensure equitable access to voluntary assisted dying, rather than to widen the cohort of people who will be eligible.

Appropriately, some changes can be attributed to the vast geographical differences between Victoria and WA.

The question that now remains is a political one. Is there sufficient support on the floor of the WA parliament for the voluntary assisted dying bill to become the law?

We have previously described the politics of assisted dying law reform as "notoriously fickle", so this is difficult to predict.

   Read more: From Oregon to Belgium to Victoria – the different ways suffering patients are allowed to die

Factors in favour of reform are an established legal precedent in Victoria, and the wide and inclusive consultation process.

As in Victoria, we anticipate this will be a topic of heated debate both inside and outside the parliament.

Ben White receives funding from the Australian Research Council, the National Health and Medical Research Council and Commonwealth and State Governments for research and training about the law, policy and practice relating to end-of-life care. In relation to implementation of voluntary assisted dying, he (with colleagues) has been engaged by the Victorian Government to design and provide the legislatively mandated training for doctors involved in voluntary assisted dying.

Lindy Willmott receives funding from the Australian Research Council, the National Health and Medical Research Council and Commonwealth and State Governments for research and training about the law, policy and practice relating to end-of-life care. In relation to implementation of voluntary assisted dying, she (with colleagues) has been engaged by the Victorian Government to design and provide the legislatively mandated training for doctors involved in voluntary assisted dying. Lindy is also a Board member of Palliative Care Australia, but the comments in this article are her own and do not represent those of Palliative Care Australia.

Rebecca Meehan was a member of the team who was engaged by the Victorian Government to design and provide the legislatively mandated training for doctors involved in voluntary assisted dying.

Katrine Del Villar 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.
 Western Australia might soon become the second state in Australia to legalise voluntary assisted dying. Its proposed law draws on the Victorian model, but has some important differences, too. Ben White, Professor of Law, Australian Centre for Health Law Research, Queensland University of Technology Katrine Del Villar, Postdoctoral research fellow, Queensland University of Technology Lindy Willmott, Professor of Law, Australian Centre for Health Law Research, Queensland University of Technology, Queensland University of Technology Rebecca Meehan, Research Assistant Licensed as Creative Commons – attribution, no derivatives. tag:theconversation.com,2011:article/121496 2019-08-08T03:25:57Z 2019-08-08T03:25:57Z Don't count on freezing ovarian tissue to delay menopause or stop your biological clock

The procedure is still experimental and there's so much we don't know about it. Bewakoof.com Official

A company in the United Kingdom is offering women a procedure it says can delay menopause up to 20 years and allow women to delay having babies.

But don't get too excited. The costs and risks are likely to outweigh the potential benefits, plus there's so much we don't know about the process.

What is this procedure?

Ovarian tissue cryopreservation is the technical term for a procedure where a small amount of ovarian tissue is collected, via keyhole surgery, cut into tiny slices and then frozen and stored.

Years later, the tissue slices can be thawed and transplanted back into the woman in the hope they will start to produce hormones and release eggs.

Ovarian tissue freezing is not new. It has been used for many years to help young women who face chemotherapy preserve fertility and allow them to have children if and when they recover from their cancer.

   Read more: Young people with cancer should have affordable options to preserve their fertility

Depending on the type of cancer and its treatment, a woman's fertility may recover, but it could also be temporarily or permanently damaged.

When the procedure was first performed in women, it was not known if the tissue would work when it was transplanted. But a 2017 study reported that while the procedure was still experimental, at least 80 babies had been born after transplantation of thawed ovarian tissue. However, the paper does not state the demographics or ages of the women who had given birth after the procedure.

So what's being offered?

The UK company ProFaM (Protecting Fertility and Menopause) is now offering ovarian tissue freezing to any woman who wants to delay menopause and childbearing.

The company's founders claim having "young" ovarian tissue transplanted at the time of natural menopause, which on average happens around age 51, can delay menopause up to 20 years.

 <img alt="" src="https://images.theconversation.com/files/287281/original/file-20190808-144851-627ywi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/287281/original/file-20190808-144851-627ywi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287281/original/file-20190808-144851-627ywi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287281/original/file-20190808-144851-627ywi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287281/original/file-20190808-144851-627ywi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287281/original/file-20190808-144851-627ywi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287281/original/file-20190808-144851-627ywi.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">
 Young women are being offered keyhole surgery to remove ovarian tissue which they can have transplanted at a later date. freestocks.org

This, they say, would delay the onset of pesky menopausal symptoms such as hot flushes and health problems such as heart disease and osteoporosis, which are more common after menopause.

They also proudly announce this means that menopause no longer has to be a barrier for women who want to build a career before they have children.

Delaying onset of menopausal symptoms

While menopausal symptoms can be disturbing, most women find they decrease with time and don't stop them from leading productive and enjoyable lives.

   Read more: Chemical messengers: how hormones change through menopause

For women who suffer severe menopausal symptoms, menopause replacement therapy (also known as hormone replacement therapy) can offer relief. Menopause replacement therapy has been used for decades and is cost-effective and safe.

There are also proven non-pharmacological methods to relieve menopausal symptoms, such as mindfulness and cognitive behavioural therapy.

If menopausal symptoms are a concern, sticking with methods that are known to be safe would seem a better option than forking out £7,000-11,000 (A$12,500-20,000) for an invasive procedure with unknown risks.

Delaying onset of health problems

Risks of disease, such as cancer and heart disease, increase as people age. That goes for both women and men. Having ovarian tissue transplantation won't change that.

Most women who reach menopause can look forward to many healthy postmenopausal years. The best way to maintain your health and reduce your risk of heart disease and prevent osteoporosis is regular exercise.

Delaying motherhood

The promise that freezing ovarian tissue allows women to have babies later in life fails to mention that pregnancy complications increase significantly as women age and are likely to be even greater for women in their 50s and 60s.

The idea that women prefer to establish a career before they have children is also not supported by evidence. Rather, studies of women who freeze their eggs show that not having a partner is the most common reason they haven't already had children.

 <img alt="" src="https://images.theconversation.com/files/287280/original/file-20190808-144843-iln08x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/287280/original/file-20190808-144843-iln08x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287280/original/file-20190808-144843-iln08x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287280/original/file-20190808-144843-iln08x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287280/original/file-20190808-144843-iln08x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287280/original/file-20190808-144843-iln08x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287280/original/file-20190808-144843-iln08x.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">
 Women most commonly freeze their eggs because they haven't found the right partner. Alexis Brown

Too many unknowns

In addition to the claims of benefit of ovarian tissue freezing not stacking up, there are many other question marks about this procedure.

It is not known, for example, what proportion of tissue slices will survive the thawing and the transplantation processes. Whether the amount of hormone the slices produce is enough to eliminate menopausal symptoms and risk of disease is also unknown.

   Read more: 40 years after the birth of IVF, researchers push boundaries to preserve fertility in women, men and children

If indeed the slices do produce high enough hormone levels, women who still have a uterus will continue to have periods, something most women are glad to see the end of.

Presumably, each slice has a limited life span, so women may need to come back for "top-up" slices every few months which would no doubt add to the £7,000-11,000 (A$12,500-20,000) they have already paid to have the tissue removed and frozen.

So, the idea that a 25-year-old would go through a surgical procedure because she wants to avoid natural menopause a quarter of a century later seems ill advised at best. Rather than a procedure that will improve women's lives, ovarian tissue freezing for non-medical reasons may leave them a lot poorer financially and exposed to unknown risks.

Karin Hammarberg is affiliated with the Victorian Assisted Reproductive Treatment Authority

Professor Luk Rombauts is a minority shareholder in Monash IVF Group. He is affiliated with the Fertility Society of Australia.
 Don't get too excited about the prospect of freezing ovarian tissue to postpone menopause. The costs, risks and unknowns are likely to outweigh the potential benefits. Karin Hammarberg, Senior Research Fellow, Global and Women's Health, School of Public Health & Preventive Medicine, Monash University Luk Rombauts, Adjunct clinical professor, Monash University Licensed as Creative Commons – attribution, no derivatives. tag:theconversation.com,2011:article/117678 2019-08-07T20:02:17Z 2019-08-07T20:02:17Z Viruses aren't all nasty – some can actually protect our health

Bacteriophages are viruses that attack and infect bacteria. From shutterstock.com

Viruses are mostly known for their aggressive and infectious nature.

It's true, most viruses have a pathogenic relationship with their hosts – meaning they cause diseases ranging from a mild cold to serious conditions like severe acute respiratory syndrome (SARS). They work by invading the host cell, taking over its cellular machinery and releasing new viral particles that go on to infect more cells and cause illness.

But they're not all bad. Some viruses can actually kill bacteria, while others can fight against more dangerous viruses. So like protective bacteria (probiotics), we have several protective viruses in our body.

   Read more: Discovered in WWI, bacterial viruses may be our allies in a post-antibiotic age

Protective 'phages'

Bacteriophages (or "phages") are viruses that infect and destroy specific bacteria. They're found in the mucus membrane lining in the digestive, respiratory and reproductive tracts.

Mucus is a thick, jelly-like material that provides a physical barrier against invading bacteria and protects the underlying cells from being infected. Recent research suggests the phages present in the mucus are part of our natural immune system, protecting the human body from invading bacteria.

Phages have actually been used to treat dysentery, sepsis caused by Staphylococcus aureus, salmonella infections and skin infections for nearly a century. Early sources of phages for therapy included local water bodies, dirt, air, sewage and even body fluids from infected patients. The viruses were isolated from these sources, purified, and then used for treatment.

Phages have attracted renewed interest as we continue to see the rise of drug resistant infections. Recently, a teenager in the United Kingdom was reportedly close to death when phages were successfully used to treat a serious infection that had been resistant to antibiotics.

   Read more: Potential treatment for eye cancer using tumor-killing virus

Nowadays, phages are genetically engineered. Individual strains of phages are tested against target bacteria, and the most effective strains are purified into a potent concentration. These are stored as either bacteriophage stocks (cocktails), which contain one or more strains of phages and can target a broad range of bacteria, or as Adapted bacteriophages, which target specific bacteria.

Before treatment, a swab is collected from the infected area of the patient, cultured in the lab to identify the bacterial strain, and tested against the therapeutic phage stocks. Treatment can be safely administered orally, applied directly onto wounds or bacterial lesions, or even spread onto infected surfaces. Clinical trials for intravenous administration of phages are ongoing.

Beneficial viral infections

Viral infections at a young age are important to ensure the proper development of our immune systems. In addition, the immune system is continuously stimulated by systemic viruses at low levels sufficient to develop resistance to other infections.

Some viruses we come across protect humans against infection by other pathogenic viruses.

For example, latent (non-symptomatic) herpes viruses can help human natural killer cells (a specific type of white blood cell) identify cancer cells and cells infected by other pathogenic viruses. They arm the natural killer cells with antigens (a foreign substance that can cause an immune response in the body) that will enable them to identify tumour cells.

This is both a survival tactic by the viruses to last longer within their host, and to get rid of competitive viruses to prevent them from damaging the host. In the future, modified versions of viruses like these could potentially be used to target cancer cells.

 <img alt="" src="https://images.theconversation.com/files/287008/original/file-20190806-84221-1qq8k9s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/287008/original/file-20190806-84221-1qq8k9s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287008/original/file-20190806-84221-1qq8k9s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287008/original/file-20190806-84221-1qq8k9s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287008/original/file-20190806-84221-1qq8k9s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287008/original/file-20190806-84221-1qq8k9s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287008/original/file-20190806-84221-1qq8k9s.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">
 Some viruses are bad news, but others might safeguard our health. From shutterstock.com

Pegivirus C or GBV-C is a virus that does not cause clinical symptoms. Multiple studies have shown HIV patients infected with GBV-C live longer in comparison to patients without it. The virus slows disease progression by blocking the host receptors required for viral entry into the cell, and promotes the release of virus-detecting interferons and cytokines (proteins produced by white blood cells that activate inflammation and removal of infected cells or pathogens).

In another example, noroviruses were shown to protect the gut of mice when they were given antibiotics. The protective gut bacteria that were killed by the antibiotics made the mice susceptible to gut infections. But in the absence of good bacteria, these noroviruses were able to protect their hosts.

The future of therapeutic viruses

Modern technology has enabled us to understand more about the complexities of the microbial communities that are part of the human body. In addition to good bacteria, we now know there are beneficial viruses present in the gut, skin and even blood.

Our understanding of this viral component is largely in its infancy. But it has huge potential in helping us understand viral infections, and importantly, how to fight the bad ones. It could also shed light on the evolution of the human genome, genetic diseases, and the development of gene therapies.

   Read more: Explainer: what is a virus?

Cynthia Mathew 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.
 While some viruses make us sick, others can fight against bacteria, or protect us from more harmful viruses. Cynthia Mathew, Research Assistant, University of Canberra Licensed as Creative Commons – attribution, no derivatives.