In a world with no antibiotics, how did doctors treat infections?

The development of antibiotics and other antimicrobial therapies is arguably the greatest achievement of modern medicine. However, overuse and misuse of antimicrobial therapy predictably leads to resistance in microorganisms.

Bloodletting was treatment for infection in the past. Wellcome Library, London, CC BY

The development of antibiotics and other antimicrobial therapies is arguably the greatest achievement of modern medicine. However, overuse and misuse of antimicrobial therapy predictably leads to resistance in microorganisms. Antibiotic-resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus species (VRE) and carbapenem-resistant Enterobacteriaceae (CRE) have emerged. Certain CRE species are resistant to multiple antibiotics, and have been deemed “superbugs” in the news.

Alternative therapies have been used to treat infections since antiquity, but none are as reliably safe and effective as modern antimicrobial therapy.

Unfortunately, due to increasing resistance and lack of development of new agents, the possibility of a return to the pre-antimicrobial era may become a reality.

So how were infections treated before antimicrobials were developed in the early 20th century?

Blood, leeches and knives

Bloodletting was used as a medical therapy for over 3,000 years. It originated in Egypt in 1000 B.C. and was used until the middle of the 20th century.

Medical texts from antiquity all the way up until 1940s recommend bloodletting for a wide variety of conditions, but particularly for infections. As late as 1942, William Osler’s 14th edition of Principles and Practice of Medicine, historically the preeminent textbook of internal medicine, included bloodletting as a treatment for pneumonia.

Bloodletting is based on an ancient medical theory that the four bodily fluids, or “humors” (blood, phlegm, black bile and yellow bile), must remain in balance to preserve health. Infections were thought to be caused by an excess of blood, so blood was removed from the afflicted patient. One method was to make an incision in a vein or artery, but it was not the only one. Cupping was another common method, in which heated glass cups were placed on the skin, creating a vacuum, breaking small blood vessels and resulting in large areas of bleeding under the skin. Most infamously, leeches were also used as a variant of bloodletting.

A man sitting in chair, arms outstretched, streams of blood pouring out as a nun places leeches on his body.
Images from the History of Medicine (NLM)

Interestingly, though bloodletting was recommended by physicians, the practice was actually performed by barbers, or “barber-surgeons.” The red and white striped pole of the barbershop originated as “advertising” their bloodletting services, the red symbolizing blood and the white symbolizing bandages.

There may actually have been some benefit to the practice – at least for certain kinds of bacteria in the early stages of infection. Many bacteria require iron to replicate, and iron is carried on heme, a component of the red blood cell. In theory, fewer red blood cells resulted in less available iron to sustain the bacterial infection.

Some mercury for your syphilis?

Naturally occurring chemical elements and chemical compounds have historically have been used as therapies for a variety of infections, particularly for wound infections and syphilis.

A woodcut from 1689 showing various methods of syphilis treatment including mercury fumigation.
Images from the History of Medicine (NLM)

Topical iodine, bromine and mercury-containing compounds were used to treat infected wounds and gangrene during the American Civil War. Bromine was used most frequently, but was very painful when applied topically or injected into a wound, and could cause tissue damage itself. These treatments inhibited bacterial cell replication, but they could also harm normal human cells.

Mercury compounds were used to treat syphilis from about 1363 to 1910. The compounds could be applied to skin, taken orally or injected. But the side effects could include extensive damage to skin and mucous membranes, kidney and brain damage, and even death. Arsphenamine, an arsenic derivative, was also used in the first half of the 20th century. Though it was effective, side effects included optic neuritis, seizures, fever, kidney injury and rash.

Thankfully, in 1943, penicillin supplanted these treatments and remains the first-line therapy for all stages of syphilis.

Looking in the garden

Over the centuries, a variety of herbal remedies evolved for the treatment of infections, but very few have been evaluated by controlled clinical trials.

One of the more famous herbally derived therapies is quinine, which was used to treat malaria. It was originally isolated from the bark of the cinchona tree, which is native to South America. Today we use a synthetic form of quinine to treat the disease. Before that, cinchona bark was dried, ground into powder, and mixed with water for people to drink. The use of cinchona bark to treat fevers was described by Jesuit missionaries in the 1600s, though it was likely used in native populations much earlier.

An engraving of a Quinine plant, 1880.
Wellcome Library, London, CC BY

Artemisinin, which was synthesized from the Artemisia annua (sweet wormwood) plant is another effective malaria treatment. A Chinese scientist, Dr. Tu Youyou, and her team analyzed ancient Chinese medical texts and folk remedies, identifying extracts from Artemisia annua as effectively inhibiting the replication of the malaria parasite in animals. Tu Youyou was coawarded the 2015 Nobel Prize in Physiology or Medicine for the discovery of artemisinin.

You probably have botantically derived therapy against wound infection in your kitchen cupboard. The use of honey in wound healing dates back to the Sumerians in 2000 B.C.. The high sugar content can dehydrate bacterial cells, while acidity can inhibit growth and division of many bacteria. Honey also has an enzyme, glucose oxidase, that reduces oxygen to hydrogen peroxide, which kills bacteria.

The most potent naturally occurring honey is thought to be Manuka honey. It is derived from the flower of the tea tree bush, which has additional antibacterial properties.

Like other botanically derived therapies, honey has inspired the creation of pharmaceuticals. MEDIHONEY®, a medical grade product developed by Derma Sciences, is used to promote healing in burns as well as other types of wounds.

Combating antimicrobial resistance

While some of these ancient therapies proved effective enough that they are still used in some form today, on the whole they just aren’t as good modern antimicrobials at treating infections. Sadly, thanks to overuse and misuse, antibiotics are becoming less effective.

Each year in the United States, at least two million people become infected with bacteria that are resistant to antibiotics, and at least 23,000 people die each year as a direct result of these infections.

While resistant bacteria are most commonly reported, resistance also can arise in other microorganisms, including fungi, viruses and parasites. Increasing resistance has raised the possibility that certain infections may eventually be untreatable with the antimicrobials we currently have.

The race is on to find new treatments for these infections, and researchers are exploring new therapies and new sources for antibiotics.

Besides using antibiotics as directed and only when necessary, you can avoid infections in the first place with appropriate immunization, safe food-handling practices and washing your hands.

Tracking resistant infections so we can learn more about them and their risk factors, as well as limiting the use of antibiotics in humans and animals, glasgow chauffeur, could also help curb the risk of resistant bacteria.

Cristie Columbus 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 the academic appointment above.

Read the Original Article at TheConservation.com

Explainer: Where did Zika virus come from and why is it a problem in Brazil?

From October 2015 to January 2016, there were almost 4,000 cases of babies born with microcephaly in Brazil. Before then, there were just 150 cases per year.

From October 2015 to January 2016, there were almost 4,000 cases of babies born with microcephaly in Brazil. Before then, there were just 150 cases per year.

The suspected culprit is a mosquito-borne virus called Zika. Officials in Colombia, Ecuador, El Salvador and Jamaica have suggested that women delay becoming pregnant. And the Centers for Disease Control and Prevention has advised pregnant women to postpone travel to countries where Zika is active.

Countries and territories with active Zika virus transmission.
Centers for Disease Control and Prevention

The World Health Organization says it is likely that the virus will spread, as the mosquitoes that carry the virus are found in almost every country in the Americas.

Zika virus was discovered almost 70 years ago, but wasn’t associated with outbreaks until 2007. So how did this formerly obscure virus wind up causing so much trouble in Brazil and other nations in South America?

Where did Zika come from?

Zika virus was first detected in Zika Forest in Uganda in 1947 in a rhesus monkey, and again in 1948 in the mosquito Aedes africanus, which is the forest relative of Aedes aegypti. Aedes aegypti and Aedes albopictus can both spread Zika. Sexual transmission between people has also been reported.

Aedes aegypti. Emil August Goeldi (1859-1917).
via Wikimedia Commons.

Zika has a lot in common with dengue and chikungunya, another emergent virus. All three originated from West and central Africa and Southeast Asia, but have recently expanded their range to include much of the tropics and subtropics globally. And they are all spread by the same species of mosquitoes.

Until 2007 very few cases of Zika in humans were reported. Then an outbreak occurred on Yap Island of Micronesia, infecting approximately 75 percent of the population. Six years later, the virus appeared in French Polynesia, along with outbreaks of dengue and chikungunya viruses.

How did Zika get to the Americas?

Genetic analysis of the virus revealed that the strain in Brazil was most similar to one that had been circulating in the Pacific.

Brazil had been on alert for an introduction of a new virus following the 2014 FIFA World Cup, because the event concentrated people from all over the world. However, no Pacific island nation with Zika transmission had competed at this event, making it less likely to be the source.

There is another theory that Zika virus may have been introduced following an international canoe event held in Rio de Janeiro in August of 2014, which hosted competitors from various Pacific islands.

Another possible route of introduction was overland from Chile, since that country had detected a case of Zika disease in a returning traveler from Easter Island.

Most people with Zika don’t know they have it

According to research after the Yap Island outbreak, the vast majority of people (80 percent) infected with Zika virus will never know it – they do not develop any symptoms at all. A minority who do become ill tend to have fever, rash, joint pains, red eyes, headache and muscle pain lasting up to a week. And no deaths had been reported.

However, in the aftermath of the Polynesian outbreak it became evident that Zika was associated with Guillain-Barré syndrome, a life-threatening neurological paralyzing condition.

In early 2015, Brazilian public health officials sounded the alert that Zika virus had been detected in patients with fevers in northeast Brazil. Then there was a similar uptick in the number of cases of Guillain-Barré in Brazil and El Salvador. And in late 2015 in Brazil, cases of microcephaly started to emerge.

At present, the link between Zika virus infection and microcephaly isn’t confirmed, but the virus has been found in amniotic fluid and brain tissue of a handful of cases.

How Zika might affect the brain is unclear, but a study from the 1970s revealed that the virus could replicate in neurons of young mice, causing neuronal destruction. Recent genetic analyses suggest that strains of Zika virus may be undergoing mutations, possibly accounting for changes in virulence and its ability to infect mosquitoes or hosts.

The Swiss cheese model for system failure

The Swiss cheese model of accident causation.
Davidmack via Wikimedia Commons, CC BY-SA

One way to understand how Zika spread is to use something called the Swiss cheese model. Imagine a stack of Swiss cheese slices. The holes in each slice are a weakness, and throughout the stack, these holes aren’t the same size or the same shape. Problems arise when the holes align.

With any disease outbreak, multiple factors are at play, and each may be necessary but not sufficient on its own to cause it. Applying this model to our mosquito-borne mystery makes it easier to see how many different factors, or layers, coincided to create the current Zika outbreak.

A hole through the layers

The first layer is a fertile environment for mosquitoes. That’s something my colleagues and I have studied in the Amazon rain forest. We found that deforestation followed by agriculture and regrowth of low-lying vegetation provided a much more suitable environment for the malaria mosquito carrier than pristine forest.

Increasing urbanization and poverty create a fertile environment for the mosquitoes that spread dengue by creating ample breeding sites. In addition, climate change may raise the temperature and/or humidity in areas that previously have been below the threshold required for the mosquitoes to thrive.

The second layer is the introduction of the mosquito vector. Aedes aegypti and Aedes albopictus have expanded their geographic range in the past few decades. Urbanization, changing climate, air travel and transportation, and waxing and waning control efforts that are at the mercy of economic and political factors have led to these mosquitoes spreading to new areas and coming back in areas where they had previously been eradicated.

For instance, in Latin America, continental mosquito eradication campaigns in the 1950s and 1960s led by the Pan American Health Organization conducted to battle yellow fever dramatically shrunk the range of Aedes aegypti. Following this success, however, interest in maintaining these mosquito control programs waned, and between 1980 and the 2000s the mosquito had made a full comeback.

The third layer, susceptible hosts, is critical as well. For instance, chikungunya virus has a tendency to infect very large portions of a population when it first invades an area. But once it blows through a small island, the virus may vanish because there are very few susceptible hosts remaining.

Since Zika is new to the Americas, there is a large population of susceptible hosts who haven’t previously been exposed. In a large country, Brazil for instance, the virus can continue circulating without running out of susceptible hosts for a long time.

The fourth layer is the introduction of the virus. It can be very difficult to pinpoint exactly when a virus is introduced in a particular setting. However, studies have associated increasing air travel with the spread of certain viruses such as dengue.

When these multiple factors are in alignment, it creates the conditions needed for an outbreak to start.

Putting the layers together

My colleagues and I are studying the role of these “layers” as they relate to the outbreak of yet another mosquito-borne virus, Madariaga virus (formerly known as Central/South American eastern equine encephalitis virus), which has caused numerous cases of encephalitis in the Darien jungle region of Panama.

There, we are examining the association between deforestation, mosquito vector factors, and the susceptibility of migrants compared to indigenous people in the affected area.

In our highly interconnected world which is being subjected to massive ecological change, we can expect ongoing outbreaks of viruses originating in far-flung regions with names we can barely pronounce – yet.

Amy Y. Vittor has received funding from the Institute for Social and Environmental Transition International, NIH Fogarty International Center, NIH NIAID Global Health training grant, New York Community Trust Fund, and the University of Florida.

Read the Original Article at TheConservation.com

Not all psychopaths are criminals – some psychopathic traits are actually linked to success

Tom Skeyhill was an acclaimed Australian war hero, known as “the blind solider-poet.” During the monumental World War I battle of Gallipoli, he was a flag signaler, among the most dangerous of all positions.

Some psychopathic traits can lead to success, at least in the short term. Man in suit via www.shutterstock.com.

Tom Skeyhill was an acclaimed Australian war hero, known as “the blind solider-poet.” During the monumental World War I battle of Gallipoli, he was a flag signaler, among the most dangerous of all positions. After being blinded when a bomb shell detonated at his feet, he was transferred out.

After the war he penned a popular book of poetry about his combat experience. He toured Australia and the United States, reciting his poetry to rapt audiences. President Theodore Roosevelt appeared on stage with him and said, “I am prouder to be on the stage with Tom Skeyhill than with any other man I know.” His blindness suddenly disappeared following a medical procedure in America.

But, according to biographer Jeff Brownrigg, Skeyhill wasn’t what he seemed. The poet had, in fact, faked his blindness to escape danger.

That’s not all. After a drunken performance, he blamed his slurred speech on an unverifiable war injury. He claimed to have met Lenin and Mussolini (there is no evidence that he did), and spoke of his extensive battle experience at Gallipoli, when he had been there for only eight days.

You have to be pretty bold to spin those kinds of self-aggrandizing lies and to carry it off as long as Skeyhill did. Although he never received a formal psychological examination (at least to our knowledge), we suspect that most contemporary researchers would have little trouble recognizing him as a classic case of psychopathic personality, or psychopathy.

What’s more, Skeyhill embodied many elements of a controversial condition sometimes called successful psychopathy.

Despite the popular perception, most psychopaths aren’t coldblooded or psychotic killers. Many of them live successfully among the rest of us, using their personality traits to get what they want in life, often at the expense of others.

All psychopaths are criminals if you look for them only behind bars

Psychopathy is not easily defined, but most psychologists view it as a personality disorder characterized by superficial charm conjoined with profound dishonesty, callousness, guiltlessness and poor impulse control. According to some estimates, psychopathy is found in about one percent of the general population, and for reasons that are poorly understood, most psychopaths are male.

That number probably doesn’t capture the full number of people with some degree of psychopathy. Data suggest that psychopathic traits lie on a continuum, so some individuals possess marked psychopathic traits but don’t fulfill the criteria for full-blown psychopathy.

Not surprisingly, psychopathic individuals are more likely than other people to commit crimes. They almost always understand that their actions are morally wrong – it just doesn’t bother them. Contrary to popular belief, only a minority are violent.

Because researchers tend to seek out psychopaths where they can locate them in plentiful numbers, much research on the condition has taken place in prisons and jails. That’s why until fairly recently, the lion’s share of theory and research on psychopathy focused on decidedly unsuccessful individuals – such as convicted criminals.

But a lot of people on the psychopathic continuum aren’t in jail or prison. In fact, some individuals may be able to use psychopathic traits, like boldness, to achieve professional success.

A profoundly disturbed core

The very existence of successful psychopathy has been controversial, perhaps in part because many scholars insist they have never seen it. Some say the concept is illogical, with others going so far as to term it an oxymoron.

Successful psychopathy is a controversial idea, but it’s not a new one. In 1941, American psychiatrist Hervey Cleckley was among the first to highlight this paradoxical condition in his classic book “The Mask of Sanity.” According to Cleckley, the psychopath is a hybrid creature, donning an engaging veil of normalcy that conceals an emotionally impoverished and profoundly disturbed core.

In Cleckley’s eyes, psychopaths are charming, self-centered, dishonest, guiltless and callous people who lead aimless lives devoid of deep interpersonal attachments. But Cleckley also alluded to the possibility that some psychopathic individuals are successful interpersonally and occupationally, at least in the short term.

In a 1946 article, he wrote that the typical psychopath will have often:

outstripped 20 rival salesmen over a period of 6 months, or married the most desirable girl in town, or, in a first venture into politics, got himself elected into the state legislature.

Charming, aggressive and looking out for number one

In 1977, Catherine Widom published a study about “noninstitutionalized psychopaths.” To find these individuals, she placed an advertisement in underground Boston newspapers calling for “charming, aggressive, carefree people who are impulsively irresponsible but are good at handling people and looking out for number one.”

The individuals she recruited exhibited a personality profile similar to those of incarcerated psychopaths, and about two-thirds of them had been arrested.

What’s the difference between the psychopaths who get arrested and the ones who don’t? Research from Adrian Raine, now at the University of Pennsylvania, conducted in the 1990s sheds some light.

Raine and his colleagues recruited men from temporary employment agencies in the Los Angeles area. After first identifying those who met the criteria for psychopathy, they compared the 13 participants who had been convicted of one or more crimes with the 26 who had not. Raine provisionally regarded these 26 men as successful psychopaths.

Each man gave a videotaped speech about his personal flaws. Raine and his colleagues found that the men they considered successful psychopaths displayed significantly greater heart rate increases, suggesting an increase in social anxiety. These men also performed better on a task requiring them to modulate their impulses.

The bottom line: having a modicum of social anxiety and impulse control may explain why some psychopathic people manage to stay out of trouble.

The psychopath at the stock exchange

More recently, some researchers, ourselves included, have speculated that people with pronounced psychopathic traits may be found disproportionately in certain professional niches, such as politics, business, law enforcement, firefighting, special operations military services and high-risk sports. Most of those with psychopathic traits probably aren’t classic “psychopaths,” but nonetheless exhibit many features of the condition.

Perhaps their social poise, charisma, audacity, adventurousness and emotional resilience lends them a performance edge over the rest of us when it comes to high-stakes settings. As Canadian psychologist Robert Hare, the world’s premier psychopathy expert, quipped, “If I weren’t studying psychopaths in prison, I’d do it at the stock exchange.”

Our lab at Emory University, and that of our collaborators at Florida State University, are investigating whether some psychopathic traits, such as boldness, predispose to certain successful behaviors.

What do we mean by boldness? It encompasses poise and charm, physical risk-taking and emotional resilience, and it is a trait that is well-represented in many widely used psychopathy measures.

For instance, in studies on college students and people in the general community, we have found that boldness is modestly tied to impulsive heroic behaviors, such as intervening in emergencies. It’s also linked to a higher likelihood of assuming leadership and management positions, and to certain professions, such as law enforcement, firefighting and dangerous sports.

Want to be president? Having some psychopathic traits could help

There’s one job in particular in which boldness may make a difference: president of the United States.

In a study of the 42 American presidents up to and including George W. Bush, we asked biographers and other experts to complete a detailed set of personality items – including items assessing boldness – about the president of their expertise. Then, we connected these data with independent surveys of presidential performance by prominent historians.

We found that boldness was positively, although modestly, associated with better overall presidential performance. And several specific facets of such performance, such as crisis management, agenda setting and public persuasiveness, were associated with boldness too. This may be something to keep in mind the next time you see presidential candidates talk about how bold they’ll be in the White House.

Theodore Roosevelt, the boldest of them all.
National Archives and Records Administration

In an interesting coincidence, the boldest president in our study was the one who said he was proud to share a stage with Tom Skeyhill. Theodore Roosevelt was described by a recent biographer as possessing a “robust, forceful, naturalistic, bombastic, teeth-clapping, animal-skinning, keen-eyed, avalanche-like persona.”

The boldest presidents were not necessarily extreme or pathological on this dimension, but boldness was markedly elevated relative to the average person.

Although boldness was tied to some successful actions, we generally found that other psychopathic features, such as callousness and poor impulse control, were unrelated or negatively related to professional success.

Boldness may be associated with certain positive life outcomes, but full-fledged psychopathy generally is not.

Where’s the line between success and criminality?

Could psychopathic traits be adaptive? Few investigators have explored this “Goldilocks” hypothesis. Moreover, we know surprisingly little about how psychopathic traits forecast real-world behavior over extended stretches of time.

The charm of the psychopath is shallow and superficial. With that in mind, we would argue that boldness and allied traits may be linked to successful behaviors in the short term, but that their effectiveness almost always fizzles out in the long term. After all, Tom Skeyhill was able to fool people for only so long.

The authors do 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 the academic appointment above.

Read the Original Article at TheConservation.com

Take a chill pill if you want to avoid the flu this year

Along with snow and frigid temperatures, the winter months also bring coughs, colds and the flu. Lower respiratory tract infections, the ones that cause feelings of chest congestion despite the deepest coughs, are one of the top 10 causes of death in the United States and around the world.

Avoiding stress could help stave off the flu. Sick woman via www.shutterstock.com.

Along with snow and frigid temperatures, the winter months also bring coughs, colds and the flu. Lower respiratory tract infections, the ones that cause feelings of chest congestion despite the deepest coughs, are one of the top 10 causes of death in the United States and around the world. In the U.S. the flu alone kills thousands of people each year.

Besides causing poor health, the flu and other respiratory illness also have a huge impact on the economy. A study published in 2007 suggests that flu epidemics account for over US$10 billion per year in direct medical care costs, while lost earnings due to illness account for an additional $16.3 billion per year. And that doesn’t cover run-of-the-mill colds and coughs. The total economic impact of non-influenza viral respiratory tract infections is estimated at another $40 billion per year.

Avoiding the flu or catching a cold in the winter months can be tough, but there is something you can do in addition to getting the flu shot and washing your hands.

Relax. There’s strong evidence that stress affects the immune system and can make you more susceptible to infections.

Big doses of stress can hurt your immune system

Health psychologist Andrew Baum defined stress as “a negative emotional experience accompanied by predictable biochemical, physiological, and behavioral changes that are directed toward adaptation.” Scientists can actually measure the body’s stress response – the actions the body takes to fight through arduous situations ranging from difficult life events to infections.

In most stress responses, the body produces chemicals called pro-inflammatory cytokines. They activate the immune system, and without them the body would not be able to fight off bacteria, viruses or fungi. Normally the stress response is helpful because it preps your body to deal with whatever challenge is coming. When the danger passes, this response is turned off with help from anti-inflammatory cytokines.

However, if the stress response cannot be turned off, or if there is an imbalance between pro-inflammatory and anti-inflammatory cytokines, the body can be damaged. This extra wear and tear due to the inflammation from a heightened stress response has been termed allostatic load. A high allostatic load has been associated with multiple chronic illnesses, such as cardiovascular disease and diabetes. This partly explains the focus on taking anti-inflammatory supplements to prevent or treat disease.

Short-term stress hurts too

An inappropriate stress response can do more than cause chronic illness down the road. It can also make you more susceptible to acute infections by suppressing the immune system.

For example, when mice are subjected to different environmental stressors, there is an increase in a molecule in their blood called corticosterone, which is known to have immunosuppressive effects on the body. This type of response is mirrored in research on humans. In a study of middle-aged and older women, stress from being instructed to complete a mental math or speech test was associated with higher levels of similar immunosuppressive molecules.

A similar response has been documented among medical students. A 1995 study showed that the students who reported “feeling stressed” the most during exam periods also had the highest levels of molecules with immunosuppressant characteristics.

Stress won’t make you healthier.
Stressed out man image via www.shutterstock.com.

Stress makes it easier to get sick

There is also direct evidence that stress can increase risk of infection. For instance, a group of scientists in Spain used surveys to assess stress in 1,149 people for a year and then measured how many colds occurred within the group. They found that every dimension of stress they measured was associated with an increased risk for getting the common cold. While this study’s large sample size and design make it particularly noteworthy, the relationship between colds and stress has been reported since the 1960s.

More recently, we presented a study that calculated allostatic load scores in over 10,000 people that were a part of the National Health and Nutrition Examination Survey between 1999 and 2002. We searched for associations between those allostatic load scores and the likelihood of having reported symptoms of a communicable disease, like the common cold. We found that the higher the score, the more likely an individual was to have reported symptoms of illness.

While causality cannot be completely confirmed in the type of analysis we conducted, our calculations included multiple biological and clinical markers that would not likely have been significantly impacted by short-term illnesses alone. This suggests that the correlation between allostatic load score and disease symptoms was not simply due to the stress of having an illness.

Our results mirror what is generally accepted in the field. There are whole book chapters dedicated to describing the impacts of stress and infection risk. All this evidence seems to suggest that stress reduction might lead to a healthier cold and flu season.

A prescription for relaxation

While there are medications that can treat the flu, the latest evidence suggests they are only marginally effective at relieving symptoms and may have no impact on reducing the rate of hospitalizations. And Vitamin C, which is often touted as an over-the-counter cold remedy, has little impact on the incidence of the common cold according to the latest compilation of studies from the Cochrane Collaboration, an independent network of scientific researchers.

So keeping stress at bay might be a better bet for staying healthy. But besides just remembering to take deep breaths, participating in activities to reduce stress during the winter months has been shown to help reduce the burden of respiratory illnesses. This may include making good on that New Year’s resolution to get to the gym. In fact, a recent randomized controlled trial concluded that those who exercised or meditated had fewer severe acute respiratory illnesses than did a control group that did neither.

It may also help to talk to somebody, such as your physician or a psychologist, about techniques to manage stress. In a clinical trial done with children between the ages of 8-12, those who talked with therapists about relaxation management had improved mood and decreased frequency of colds. On a cellular level, those in the therapist group had increased levels of secretory immunoglobulin A, one of the molecules that is responsible for protecting mucosal surfaces, like the lung, from infection. These types of relaxation techniques are not just for kids. Review articles conclude relaxation techniques are an important therapeutic strategy for stress-related diseases.

Cold and flu season is here, but getting worried about it might only hurt your chances of staying healthy. Instead, consider how stress hurts your immune system, and write yourself a prescription for relaxation.

The authors do 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 the academic appointment above.

Read the Original Article at TheConservation.com

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If you’re going to drink, make it part of your Mediterranean diet

The British government’s new guidelines advise reducing alcohol consumption to 14 units a week for both men and women and bluntly state that, for some cancers of the mouth, throat and breast, “risk increases with any amount you drink”.

It’s not just what you drink, but the way that you drink it. merc67/shutterstock.com

The British government’s new guidelines advise reducing alcohol consumption to 14 units a week for both men and women and bluntly state that, for some cancers of the mouth, throat and breast, “risk increases with any amount you drink”. The message is clear: for the good of our health, the government would rather we not drink at all.

So what about the many millions of people of the Mediterranean, whose diet is one of the healthiest in the world and which includes a drink or two as an integral part? The answer may lie not just in the amount of alcohol consumed, as the UK government’s guidelines would have it, but the manner in which it is drunk and what it is drunk with.

There is now good evidence that many foods in the Mediterranean diet including vegetables, pulses, whole grains and olive oil contain protective substances that help counter alcohol’s harmful effects.

For example, a number of studies suggest that even low amounts of alcohol increase the risk of breast cancer. But a recent trial, part of the highly regarded Predimed Study, found that women who ate a Mediterranean diet had a reduced risk of breast cancer, even though almost half were drinking up to two units of alcohol (a 175ml glass of wine) a day.

The extra virgin olive oil in their diet was thought to have played a role. Alcohol increases breast cancer risk by raising oestrogen levels, but extra virgin olive oil contains various anti-oestrogens that block the carcinogenic actions of oestrogens. In another large European study involving 368,000 women, it was convincingly shown that folates – found in large quantities in the green, leafy vegetables and pulses of the Mediterranean diet – also provide a protective action against the effects of alcohol.

Although these are important findings, women with a family history of breast cancer are still advised to avoid drinking.

The link between mouth and throat cancers and low alcohol consumption, which the guidelines declare to hold true “for any amount you drink”, also deserves closer scrutiny. Again, the Mediterranean diet comes up trumps: even when low to moderate alcohol is consumed as part of the diet, the risk of these cancers decreases.

How we drink matters

Food and wine: the ancient Greeks knew what they were doing.
Caravaggio/Uffizi Gallery

It’s well established that combining smoking with drinking dramatically increases the risk of causing mouth and throat cancers. Some studies such as the Million Women Study (which really did involve well over a million women) found no increased risk of these cancers for women drinking up to two units a day, so long as they were non-smokers. It’s thought that alcohol acts as a solvent that increases the absorption of carcinogens in cigarette smoke. If most drinking occurs during a meal, the hazards from smoking become less likely.

So it’s clear that the way we drink is very important. Drinking with food is the typical pattern in Mediterranean countries, whereas in the UK binge drinking is far more common – where alcohol is not just drunk excessively, but also without food. A full stomach of food slows the rate of alcohol absorption, limiting dangerous spikes in blood alcohol levels that are linked to high blood pressure and strokes. In Mediterranean countries, even alcohol consumed without a meal is usually accompanied with some food: a few olives with an ouzo in Greece, tapas or a piece of tortilla to accompany a beer in a Spanish bar. What a shame that so few pubs in the UK provide these protective mouthfuls.

A scoring system was developed to capture the Mediterranean way of drinking: moderate alcohol intake spread out over the week, a preference for red wine drunk with meals, little intake of spirits, and an avoidance of binge drinking. Scoring highly on these criteria correlated with significantly reduced mortality.

Of course there are many other benefits to a Mediterranean diet: it is the leading diet for risk reduction of cardiovascular disease, with many studies confirming the cardio-protective effects of moderate drinking, especially as part of a Mediterranean diet, and increasing evidence that links the Mediterranean diet with a decreased risk of dementia. Considering how few other options there are to counter this devastating disease, these are important findings.

Just as eating guidelines now recognise that diet must be considered as a whole, rather than isolating individual foods or nutrients such as sugar or saturated fat, there is good reason to apply the same thinking to weighing up the risks and benefits of drinking alcohol. Heavy drinking increases the risk of various cancers, of this there is no doubt – and even low alcohol consumption may do so with certain diets such as those high in processed foods. But the evidence suggests that one or two glasses of wine, so long as they are accompanied by a tasty Mediterranean meal, won’t hurt you – whatever the government guidelines say.

Richard Hoffman 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 the academic appointment above.

Read the Original Article at TheConservation.com

We can avoid weight creep – here’s how

Many of us enter a new year reflecting on where we have been and our plans for the future. For some, this will mean acknowledging that a couple more kilos have crept on over the past year.

Walking briskly for at least 30 minutes on most days of the week is a good start. etorres/Shutterstock

Many of us enter a new year reflecting on where we have been and our plans for the future. For some, this will mean acknowledging that a couple more kilos have crept on over the past year. Others will have health on their hit list for 2016; resolving to eat better and lose weight could be part of that.

It can be difficult to lose weight and keep it off in the long term. So how can we support communities to avoid weight gain over time?

New research published today in PLOS Medicine suggests that simple lifestyle programs can help prevent weight gain. But GPs, communities and individuals also have a role to play.

It’s OK to aim low

Even a small weight loss can result in positive health impacts. It has been estimated that a 1% reduction in body mass index (BMI) – the equivalent to approximately 1kg for an average adult – across the United States population would avoid 2 million cases of diabetes, 1.5 million cardiovascular diseases, and more than 73,000 cases of cancer.

It is the norm to be overweight or obese in Australia. Figures released last month showed 63% of adults (71% men, 56% women) and 27% of children were in this category in 2014/15. Further, rates of obesity in women in Australasia are growing faster than anywhere else in the world.

Challenging the accepted dogma that we will gain weight as we age was put to a recent meeting of the Queensland Clinical Senate, which helps set the agenda for long-term health strategies. The resolution of the meeting, convened with Health Consumers Queensland, was to focus on preventing weight gain in the community, rather than weight loss, particularly given the problems faced in achieving the latter.

Lifestyle programs

In today’s study, the researchers randomly assigned 649 women in 41 rural Australian towns to either the intervention group or the control group.

Women in the intervention group took part in information sessions, received a personalised self-management plan, were sent monthly text message reminders and undertook a 20-minute phone-based coaching session.

Women in the control group attended a general session on women’s health.

Over 12 months, the women in the towns who received the targeted intervention program lost almost half a kilogram, while those in the control towns gained almost half a kilo.

This shows that delivering programs with community integration, a focus on small changes in behaviour, self-management, and minimal burden on the participants using a mix of personal and electronic modes of delivery, can be feasible, cheap and effective.

Role of GPs

General and nurse practitioners play an important role in providing advice and strategies on healthy and active lifestyles to prevent and manage obesity.

However, a Monash University study, published in The Medical Journal of Australia, found GPs recorded the weight of only 25.8% of a sample of 270,426 patients. Some of the barriers for recording this information are difficulty in approaching the discussion and a perceived lack of available training.

It is important for governments to support all health-care providers to be able to raise the issue of weight control – not just with those who are overweight or obese, but also to encourage those who are a healthy weight to remain in that category.

Guidelines for health professionals already exist, however, better integration with community programs (particularly those which offer social benefits), referral to tailored services and alignment with mass media campaigns are likely to add enormous value at relatively low cost.

There is no single strategy that will address excess weight and obesity in our community. But health professionals are important influencers. Empowering this group with effective, low-intensity strategies and programs is one element of a comprehensive approach to address poor diets and weight issues.

Community response

Another key element is to support communities to create healthy environments, to make the healthy choice the easy choice. Schools, workplaces, sports and community centres are all environments that should support healthy eating and active lifestyles.

If communities are funded and empowered, such as through the OPAL (Obesity prevention and lifestyle) program in South Australia and Healthy Together Victoria, they can link into statewide programs but also develop local solutions to solve the unique issues that exist in their catchment.

Recently we saw the funding removed from the National Partnership Agreement on Preventive Health, which provided valuable investment for the implementation of policies and programs to support healthy lifestyles. Funding to support community based initiatives so local populations can engage this issue is critically important, along with the implementation of policies such as reducing junk food marketing to children, mandatory health star labels and taxing sugary drinks.

Individual action

In the meantime, how can individuals who regularly pledge to get fit and lose weight make sustainable and significant healthy changes, as the women in today’s rural Australia study have done?

Aiming to avoid weight gain is a good starting point, followed by small lifestyle changes, such as:

  • reducing serving sizes
  • aiming for two serves of fruit and five serves of vegetables a day
  • reducing sugary drinks
  • walking briskly for at least 30 minutes on most days of the week.

These changes can make a big difference to your risk of weight gain and developing serious health problems in the future.

Jane Martin 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 the academic appointment above.

Read the Original Article at TheConservation.com

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Four common myths about exercise and weight loss

It’s that time of year when many are trying, and some are failing, to live up to their New Years’ resolution of losing weight.

Exercise isn’t the best way to lose weight, in fact it’s one of the hardest. Nottingham Trent University/Flickr, CC BY-SA

It’s that time of year when many are trying, and some are failing, to live up to their New Years’ resolution of losing weight. Many of these probably include resolutions to be more physically active in striving for this goal. But first, there are some common misconceptions about exercise and weight loss that need to be addressed.

Myth 1. Exercise is the best way to lose weight

While there is plenty of evidence showing people can lose weight just by being physically active, it is also one of the hardest ways to go about it.

Our energy balance is mostly determined by what we eat and our metabolic rate (the energy you burn when you do nothing). Our energy balance is determined only to a small extent by how active we are. That means losing weight just by being active is very hard work.

The American College of Sports Medicine recommends accumulating 250 to 300 minutes of moderate intensity exercise per week for weight loss. That is twice the amount of physical activity recommended for good health (30 minutes on most days), and most Australians don’t even manage that.

The best way to lose weight is through combining a nutritious, low-calorie diet with regular physical activity.

Just exercising is an extremely difficult way to shed kilos.
Nina Hale/Flickr, CC BY

Myth 2. You can’t be fat and fit

Inactive people of healthy weight may look OK, but this isn’t necessarily the case. When you’re not active you have a higher risk of heart disease, diabetes, high blood pressure, osteoporosis, some cancers, depression and anxiety. Several studies have demonstrated the association between premature death and being overweight or obese disappears when fitness is taken into account (although another study disputed this).

This means you can still be metabolically healthy while being overweight, but only if you’re regularly active. Of course, people who are fit and of normal weight have the best health outcomes, so there are still plenty of reasons to try to shed some weight.

Myth 3. No pain, no gain

Or in other words, “no suffering, no weight loss”. As mentioned earlier, if you want to lose weight by being active, you will need to do a lot of it. But while physical activity of a moderate intensity is recommended, guidelines do not say activity needs to be of vigorous intensity.

Moderate intensity physical activity makes you breathe harder and may make it more difficult to talk, but you should still be able to carry on a conversation (such as brisk walking, riding a bicycle at a moderate pace). This is unlike vigorous physical activity, which will make you completely out of breath and will make you sweat profusely regardless of the weather conditions (such as running).

Moderate intensity physical activity is not painful and does not include excessive suffering to meet your goals. A study of weight loss in groups with higher intensity and lower volumes of activity compared to groups of lower intensity and higher volumes of activity did not find significant differences.

Myth 4. Only resistance training will help you lose weight

Resistance or strength training is good for you for several reasons. It increases functional capacity (the ability to perform tasks safely and independently) and lean body mass, and prevents falls and osteoporosis. But the main idea for promoting it to lose weight is that muscle mass needs more energy than fat mass, even when at rest. Therefore the more muscular you are, the higher your metabolic rate, which makes it easier to expend the energy you’re taking on board.

However, building muscle mass takes a serious effort, and you need to keep doing resistance training or significant loss of muscle mass will occur within weeks.

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Not everyone enjoys weight lifting, so do what you prefer.
Sherri Abendroth/Flickr, CC BY

More importantly though, aerobic or endurance training is also good to help you lose weight. In fact, a recent study demonstrated that endurance training was more effective in producing weight loss compared to resistance training. It’s also likely many people will get more enjoyment out of a brisk walk than a session of weight-lifting, so the most important thing is to pick an exercise routine you enjoy and thus will actually stick to.

To help you get started on your journey to a more active and potentially leaner lifestyle, you can sign up for free physical activity programs such as www.10000steps.org.au. If you want to take part in our web-based physical activity research study, you can register your interest here.

Corneel Vandelanotte receives funding from Queensland Health (for maintaining the 10,000 Steps Australia program), the National Health and Medical Research Council (project funding) and the National Heart Foundation of Australia (salary support).

Read the Original Article at TheConservation.com

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Why isn’t learning about public health a larger part of becoming a doctor?

Chronic conditions, such as Type II diabetes and hypertension, account for seven in 10 deaths in the United States each year. And by some estimates, public health factors, such as the physical environment we live in, socioeconomic status and ability to access health services, determine 90% of our health.

Public health isn’t a standard part of medical school curricula. Medical school class images via www.shutterstock.com.

Chronic conditions, such as Type II diabetes and hypertension, account for seven in 10 deaths in the United States each year. And by some estimates, public health factors, such as the physical environment we live in, socioeconomic status and ability to access health services, determine 90% of our health. Biomedical sciences and actual medical care – the stuff doctors do – determine the remaining 10%.

Clinical medicine can treat patients when they are sick, but public health provides an opportunity to prevent disease and poor health. But too often, medical students don’t get to learn about public health, or how to use it when they become doctors. That means many of today’s students aren’t learning about health care in a broader context.

Why doctors need to know about public health

What should a physician do if patients are unable to visit a physician because their workplace doesn’t give them sick days? What about an obese individual who has trouble following healthy eating recommendations because their neighborhood doesn’t have a grocery store?

If we want the next generation of medical professionals to understand why some patients have an easier time following a care plan than others, or understand what causes these conditions so we can prevent them, medical schools need to look toward public health.

Epidemiology, a core discipline within public health, emphasizes the study and application of treatment to disease and other health-related issues within a population. It is focused on prevention, which means understanding what makes people sick or unwell.

You might hear about epidemiologists who work on figuring out how infectious diseases spread. But they also study obesity, cancer, how our environments affect our health and more.

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Medical schools recognize that their students should learn more about public health. But according to the Association of American Medical Colleges (AAMC), about one-fourth of 2015 medical school graduates report that they intend to participate in public health-related activities during their career, and nearly one-third of graduates report that training related to community health and social service agencies was inadequate.

Putting public health into medicine

But this is slowly starting to change.

For instance, the Medical College Acceptance Test (MCAT), which all medical school applicants in the US take, used to focus on just physical and biological sciences and verbal reasoning. But in 2014 the MCAT added a new section on the psychological, social and biological foundations of behavior. The idea is to provide students with a foundation learn about what public health scholars call the social determinants of health. These are conditions and environments in which we are born, work, live and interact with others.

Students are expected to know more about public health.
Medical students image via www.shutterstock.com.

Expectations for students transitioning from medical school to their postgraduate residency are also starting to change.

The AAMC has a list of 13 activities that medical school graduates are expected to be able to do on their first day of residency. The activities (called Entrustable Professional Activities, or EPAs) integrate, among other core competencies, principles of public health into everyday practice. They include guidelines for working with individuals who have different belief systems, patient-centered practice and understanding how to access and use information about the needs individuals have and the community resource available to them.

Having students make house calls

At the University of Florida, where I teach, population health-based topics are integrated into our medical school curriculum, and also into curricula for other health professions.

Each fall, 700 first-year health science students studying everything from dentistry to clinical psychology, health administration, pharmacy, nursing and more take part in a service learning project with local families.

Students complete coursework about public health, but they are also assigned to work with a family through the year. Students make a series of home visits, which means that they can see, firsthand, how the family’s home environment shapes their health. Because the project includes students from all the health professions, it helps them understand each other’s roles and responsibilities in providing care.

In these visits, students get a chance to see the myriad factors that can make it easier or harder for a patient to follow the care plan their doctor prescribes. Students may learn that their patients have priorities in life that come before monitoring their own health. And for many students, this may be the only home visit that they make during their entire career.

For instance, a team of our students were humbled to learn that one of the patients they visited, a woman with severe hypertension and Type II diabetes, put her desire to provide Christmas presents for the six grandchildren she was raising over her medication adherence or her glucose monitoring. She was more focused on her grandchildren than spending time on monitoring her health and taking medications.

These home visits show students how complex their patients’ lives really are. And that give these future doctors a perspective on their patients that they may never get in a clinical visit.

Other medical schools putting public health on the agenda

The University of Florida isn’t the only medical school investing time and energy to explore new methods to teach students about public health.

Some are adopting dual-degree models that allow medical students to earn degrees in both public health and medicine. Often, these programs extend students’ training by 12 months, but some institutions, like the University of Miami and the University of Texas Health Science Center at San Antonio, have developed four-year dual-degree programs.

Other institutions, such as the University of Illinois and Florida International University, are integrating population and public health perspectives throughout their curricula, to make sure that all students learn about public health.

Erik Black 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 the academic appointment above.

Read the Original Article at TheConservation.com

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