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No, antibiotics aren’t always needed. Here’s how GPs can avoid overprescribing

<p><em><a href="https://theconversation.com/profiles/mina-bakhit-826292">Mina Bakhit</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> and <a href="https://theconversation.com/profiles/paul-glasziou-13533">Paul Glasziou</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a></em></p> <p>The growth in antibiotic resistance threatens to return the world to the pre-antibiotic era – with deaths from now-treatable infections, and some elective surgery being restricted because of the risks of infection.</p> <p>Antibiotic resistance is a major problem worldwide and should be the concern of everyone, including you.</p> <p>We need to develop new antibiotics that can fight the resistant bacteria or antibiotics that bacteria would not be quickly resistant to. This is like finding new weapons to help the immune system fight the bacteria.</p> <p>More importantly, we need to use our current antibiotics – our existing weapons against the bacteria – more wisely.</p> <h2>Giving GPs the tools to say no</h2> <p>In 2022, more than <a href="https://www.safetyandquality.gov.au/publications-and-resources/resource-library/aura-2023-fifth-australian-report-antimicrobial-use-and-resistance-human-health">one-third of Australians</a> had least one antibiotic prescription, with <a href="https://www.safetyandquality.gov.au/publications-and-resources/resource-library/analysis-2015-2022-pbs-and-rpbs-antimicrobial-dispensing-data">88%</a> of antibiotics prescribed by GPs.</p> <p>Many people <a href="https://pubmed.ncbi.nlm.nih.gov/28289114/">mistakenly think</a> antibiotics are necessary for treating any infection and that infections won’t improve unless treated with antibiotics. This misconception is found in studies involving patients with various conditions, including respiratory infections and conjunctivitis.</p> <p>In reality, not all infections require antibiotics, and this belief drives patients requesting antibiotics from GPs.</p> <p>Other times, GPs give antibiotics because they think patients want them, even when they might not be necessary. Although, in reality they are <a href="https://pubmed.ncbi.nlm.nih.gov/17148626/">after symptom relief</a>.</p> <p>For GPs, there are ways to target antibiotics for only when they are clearly needed, even with short appointments with patients perceived to want antibiotics. This includes:</p> <ul> <li> <p>using <a href="https://pubmed.ncbi.nlm.nih.gov/32357226/">decision guides</a> or tests to decide if antibiotics are really necessary</p> </li> <li> <p>giving <a href="https://www.safetyandquality.gov.au/our-work/partnering-consumers/shared-decision-making/decision-support-tools-specific-conditions">patients information sheets</a> when antibiotics aren’t needed</p> </li> <li> <p>giving a “<a href="https://pubmed.ncbi.nlm.nih.gov/33910882/">delayed prescription</a>” – only to be used after the patient waits to see if they get better on their own.</p> </li> </ul> <p>All these strategies need some <a href="https://www.nps.org.au/assets/NPS/pdf/NPS-MedicineWise-Economic-evaluation-report-Reducing-Antibiotic-Resistance-2012-17.pdf">training</a> and practice, but they can help GPs prescribe antibiotics more responsibly. GPs can also learn from each other and use tools like <a href="https://pubmed.ncbi.nlm.nih.gov/24474434/">posters</a> as reminders.</p> <p>To help with patients’ expectations, public campaigns have been run periodically to educate people about antibiotics. These campaigns <a href="https://pubmed.ncbi.nlm.nih.gov/35098267/">explain why</a> using antibiotics too much can be harmful and when it’s essential to take them.</p> <h2>Giving doctors feedback on their prescribing</h2> <p>National programs and interventions can help GPs use antibiotics more wisely</p> <p>One successful way they do this is by <a href="https://pubmed.ncbi.nlm.nih.gov/34356788/">giving GPs feedback</a> about how they prescribe antibiotics. This works better when it’s provided by organisations that GPs trust, it happens more than once and clear goals are set for improvement.</p> <p>The NPS (formerly National Prescribing Service) MedicineWise program, for example, had been giving feedback to GPs on how their antibiotic prescriptions compared to others. This reduced the number of antibiotics prescribed.</p> <p>However, <a href="https://australianprescriber.tg.org.au/articles/the-end-of-nps-medicinewise.html">NPS no longer exists</a>.</p> <p>In 2017, the Australian health department did something similar by sending <a href="https://behaviouraleconomics.pmc.gov.au/projects/nudge-vs-superbugs-behavioural-economics-trial-reduce-overprescribing-antibiotics">feedback letters</a>, randomly using different formats, to the GPs who prescribed the most antibiotics, showing them how they were prescribing compared to others.</p> <p>The most effective letter, which used pictures to show this comparison, reduced the number of antibiotics GPs prescribed by <a href="https://behaviouraleconomics.pmc.gov.au/sites/default/files/projects/nudge-vs-superbugs-12-months-on-report.pdf">9% in a year</a>.</p> <h2>Clearer rules and regulations</h2> <p>Rules and regulations are crucial in the fight against antibiotic resistance.</p> <p>Before April 2020, many GPs’ computer systems made it easy to get multiple repeat prescriptions for the same condition, which could encourage their overuse.</p> <p>However, in April 2020, the Pharmaceutical Benefits Scheme (PBS) <a href="https://www.pbs.gov.au/pbs/industry/listing/elements/pbac-meetings/psd/2019-08/antibiotic-repeats-on-the-pharmaceutical-benefits-scheme">changed the rules</a> to ensure GPs had to think more carefully about whether patients actually needed repeat antibiotics. This meant the amount of medicine prescribed better matched the days it was needed for.</p> <p>Other regulations or policy targets could include:</p> <ul> <li> <p>ensuring all GPs have access to antibiotic prescribing guidelines, such as <a href="https://www.tg.org.au/">Therapeutic Guidelines</a>, which is well accepted and widely available in Australia</p> </li> <li> <p>ensuring GPs are only prescribing antibiotics when needed. Many of the conditions antibiotics are currently prescribed for (such as sore throat, cough and middle ear infections) are self-limiting, meaning they will get better without antibiotics</p> </li> <li> <p>encouraging GP working with antibiotics manufacturers to align pack sizes to the recommended treatment duration. The recommended first-line treatments for uncomplicated urinary tract infections in non-pregnant women, for example, are either three days of trimethoprim 300 mg per night or five days of nitrofurantoin 100 mg every six hours. However, the packs contain enough for seven days. This can mean patients take it for longer or use leftovers later.</p> </li> </ul> <h2>Australia lags behind Sweden</h2> <p>Australia has some good strategies for antibiotic prescribing, but we have not had a sustained long-term plan to ensure wise use.</p> <p>Although Australian GPs have been doing well in <a href="https://www.safetyandquality.gov.au/our-work/antimicrobial-resistance/antimicrobial-use-and-resistance-australia-surveillance-system/aura-2021">reducing antibiotic prescribing</a> since 2015, <a href="https://pubmed.ncbi.nlm.nih.gov/35098269/">more</a> could be done.</p> <p>In the 1990s, Sweden’s antibiotic use was similar to Australia’s, but is now less than half. For more than two decades, Sweden has had a national strategy that reduces antibiotic use by about <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5677604/">7% annually</a>.</p> <p>It is vital Australia invests in a similar long-term national strategy – to have a centrally funded program, but with regional groups working on the implementation. This could be funded directly by the Commonwealth Department of Health and Ageing, or with earmarked funds via another body such as the Australian Centre for Disease Control.</p> <p>In the meantime, individual GPs can do their part to prescribe antibiotics better, and patients can join the national effort to combat antibiotic resistance by asking their GP: “what would happen if I don’t take an antibiotic?”.</p> <p><em><a href="https://theconversation.com/profiles/mina-bakhit-826292">Mina Bakhit</a>, Assistant Professor of Public Health, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> and <a href="https://theconversation.com/profiles/paul-glasziou-13533">Paul Glasziou</a>, Professor of Medicine, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/no-antibiotics-arent-always-needed-heres-how-gps-can-avoid-overprescribing-213981">original article</a>.</em></p>

Caring

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I think I have the flu. Should I ask my GP for antivirals?

<p><em><a href="https://theconversation.com/profiles/lara-herrero-1166059">Lara Herrero</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a>; <a href="https://theconversation.com/profiles/wesley-freppel-1408971">Wesley Freppel</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a>, and <a href="https://theconversation.com/profiles/yong-qian-koo-1457640">Yong Qian Koo</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a></em></p> <p>If you test positive for COVID and you’re eligible for antivirals, you’ll likely ask your GP for a script to protect you from severe disease.</p> <p><a href="https://healthdispatch.com.au/news/immunisation-coalition-urging-people-with-flu-like-symptoms-to-g">Antivirals</a> are also available to fight influenza viruses, via a doctor’s prescription. But they have a mixed history, with their benefits at times <a href="https://theconversation.com/controversies-in-medicine-the-rise-and-fall-of-the-challenge-to-tamiflu-38287">overstated</a>.</p> <p>It can be difficult to get an appointment to see your GP. So when should you make the effort to see a GP for a prescription for influenza antivirals? And how effective are they?</p> <h2>What exactly is influenza?</h2> <p>The flu is primarily a viral infection of the respiratory system that can spread through sneezing, coughing, or touching contaminated objects then touching your nose or mouth.</p> <p>Common symptoms include headache, sore throat, fever, runny or blocked nose and body aches that last a week or more.</p> <p>Influenza is actually a group of viruses, divided into several <a href="https://www.cdc.gov/flu/about/viruses/types.htm#:%7E:text=There%20are%20four%20types%20of,global%20epidemics%20of%20flu%20disease,%20https://www.cdc.gov/flu/professionals/acip/background-epidemiology.htm">sub-groups</a>. Flu A and B are the <a href="https://www.health.gov.au/resources/collections/aisr?language=en,%20https://www.health.gov.au/resources/collections/australian-influenza-surveillance-reports-2023?language=en">most common groups</a> that circulate in humans.</p> <h2>What are flu antivirals?</h2> <p>Influenza antivirals, target specific parts of the viral life cycle, which prevents the virus replicating and spreading.</p> <p>Most flu antivirals <a href="https://www.nejm.org/doi/full/10.1056/NEJMra050740">target</a> neuraminidase, an important enzyme the virus uses to release itself from cells.</p> <p>On the other hand, COVID antivirals work by inhibiting other parts of the viral life cycle involved in the <a href="https://www.tga.gov.au/news/media-releases/tga-provisionally-approves-two-oral-covid-19-treatments-molnupiravir-lagevrio-and-nirmatrelvir-ritonavir-paxlovid">virus replicating itself</a>.</p> <p>Three influenza antivirals are <a href="https://australianprescriber.tg.org.au/articles/influenza-overview-on-prevention-and-therapy.html#r20">used in Australia</a>. Relenza (zanamivir) is an inhaled powder and Tamiflu (oseltamivir) is a capsule; both are five-day treatments. Rapivab (peramivir) is a single injection.</p> <p>These antivirals may also come with <a href="https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm">side effects</a>, such as a headache, vomiting, cough, or <a href="https://www.immunisationcoalition.org.au/resources/antiviral-treatments-for-influenza/">fever</a>.</p> <p>Tamiflu and Relenza generally cost A$40-50 in Australia, plus the cost of the consultation fee with your doctor, if applicable.</p> <h2>How effective are antivirals for the flu?</h2> <p>Antivirals have the greatest effect if started 24-72 hours after symptoms. This is to prevent the virus from reaching <a href="https://www.mdpi.com/1660-4601/19/5/3018">high levels in the body</a>.</p> <p>Among healthy adults, if Relenza or Tamiflu are started within 48 hours from your first symptoms, they can <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008965.pub4/full">reduce the duration</a> of symptoms such as cough, blocked nose, sore throat, fatigue, headache, muscle pain and fever by just under a day.</p> <p>For people who have developed severe flu symptoms or who have existing health conditions such as heart disease or chronic obstructive pulmonary disease (COPD), antivirals that start later (but still before day five of symptoms) can still reduce the <a href="https://academic.oup.com/cid/article/52/4/457/378776?login=true">severity of infection</a> and reduce the <a href="https://thorax.bmj.com/content/thoraxjnl/65/6/510.full.pdf?frbrVersion=3">chance of</a> <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/215903">hospitalisation</a> and <a href="https://academic.oup.com/jac/article/72/11/2990/4091484?login=false">death</a>.</p> <p>In a study from the 2009 swine flu (H1N1) pandemic in the United States, treatment with antivirals (Tamiflu and Relenza) <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3358088/">reduced</a> the chance of needing to be hospitalised. Around 60% of hospitalisations prevented were among 18-64 years olds, around 20% in children 0-17 years, and 20% in adults aged over 65.</p> <p>The research is less clear about whether antivirals prevent the development of flu complications such as secondary bacterial pneumonia. They might, but so far the data aren’t clear.</p> <h2>Are flu antivirals becoming less effective?</h2> <p>Antiviral resistance to Tamiflu has been <a href="https://link.springer.com/article/10.1007/s10096-020-03840-9">reported</a> around the world, mostly in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223162/">immunocompromised people</a>, as they <a href="https://link.springer.com/article/10.1007/s10096-020-03840-9">have</a> a weakened immune system that allows higher viral loads and prolonged viral shedding.</p> <p>The impact of the antiviral resistance is unclear but there is evidence indicating resistant strains can uphold their ability to replicate effectively and spread. So far it’s not clear if these stains cause more severe disease.</p> <p>However, government agencies and surveillance programs are constantly monitoring the spread of antiviral resistance. Currently there is <a href="https://www.cdc.gov/flu/treatment/antiviralresistance.htm">minimal concern</a> for strains that are resistant to Tamiflu or Relenza.</p> <h2>Antivirals can also prevent the flu if you’ve been exposed</h2> <p>Tamiflu and Relenza can also be used to <a href="https://onlinelibrary.wiley.com/doi/10.1111/irv.12046">prevent flu infections</a>, if we’re exposed to the virus or come into contact with infected people.</p> <p>Some studies suggest Tamiflu and Relenza can <a href="https://www.bmj.com/content/326/7401/1235.long">reduce the chance of developing symptomatic influenza</a> by 70-90%.</p> <p>Many health agencies around the world <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8165743/">recommend</a> “prophylactic” treatment for high-risk patients in hospitals or age care setting when people have been in contact with others infected with influenza.</p> <h2>So who should talk to their GP about a prescription?</h2> <p><a href="https://www.health.nsw.gov.au/Infectious/factsheets/Pages/racf-antiviral-treatments-and-prophylaxis.aspx#:%7E:text=The%20Australian%20Therapeutic%20Guidelines*%20recommends,of%20severe%20disease%20from%20influenza.&amp;text=people%20with%20chronic%20conditions%20including,heart%20disease">Australian guidelines recommend</a> doctors offer antivirals to people with influenza who have severe disease or complications.</p> <p>Doctors can also consider treatment for people at higher risk of developing severe disease from influenza. This includes:</p> <ul> <li>adults aged 65 years or older</li> <li>pregnant women</li> <li>people with certain chronic conditions (heart disease, Down syndrome, obesity, chronic respiratory conditions, severe neurological conditions)</li> <li>people with compromised immunity</li> <li>Aboriginal and Torres Strait Islander people</li> <li>children aged five years or younger</li> <li>residents of long-term residential facilities</li> <li>homeless people.</li> </ul> <p>Doctors can prescribe antivirals for the prevention of influenza <a href="https://australianprescriber.tg.org.au/articles/influenza-overview-on-prevention-and-therapy.html#r20">in</a> vulnerable people who have been exposed to the virus.</p> <p>Antiviral treatment also can be <a href="https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm#:%7E:text=Antiviral%20treatment%20also%20can%20be,48%20hours%20of%20illness%20onset">considered</a> for otherwise healthy symptomatic patients who have confirmed or suspected influenza, if they can start treatment within 48 hours of developing symptoms.</p> <p>In some instances a doctors can make a clinical diagnosis of influenza based on the symptoms and known close flu positive contacts of the patient. However, it is preferred to have flu diagnosed by one of the approved diagnostic tests, such as a <a href="https://24-7medcare.com.au/influenza/australian-gp-influenza-2023-guide/">rapid antigen test</a> (RAT) or the more accurate <a href="https://www.health.nsw.gov.au/Infectious/factsheets/Pages/influenza_factsheet.aspx">PCR test</a>, similar to what is perfomed for COVID. There are also now combo tests that can <a href="https://www.tga.gov.au/news/media-releases/first-combination-covid-19-and-influenza-self-tests-approved-australia">distinguish between SARS-CoV-2 and influenza virus</a>.</p> <p>Remember, the flu can cause <a href="https://www.abc.net.au/news/2023-07-23/flu-season-hitting-children-hard-antivirals-may-help/102633722">severe illness or death</a>, particularly among people from the high-risk groups. So if you think you might have the flu, wear a mask and stay away to avoid spreading the virus to others. <img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/210457/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/lara-herrero-1166059">Lara Herrero</a>, Research Leader in Virology and Infectious Disease, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a>; <a href="https://theconversation.com/profiles/wesley-freppel-1408971">Wesley Freppel</a>, Research Fellow, Institute for Glycomics, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a>, and <a href="https://theconversation.com/profiles/yong-qian-koo-1457640">Yong Qian Koo</a>, , <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a></em></p> <p><em>Image </em><em>credits: Shutterstock</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/i-think-i-have-the-flu-should-i-ask-my-gp-for-antivirals-210457">original article</a>.</em></p>

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Should GPs bring up a patient’s weight in consultations about other matters? We asked 5 experts

<p><em><a href="https://theconversation.com/au/team#fron-jackson-webb">Fron Jackson-Webb</a>, <a href="http://www.theconversation.com/">The Conversation</a></em></p> <p>Australian of the Year and body positivity advocate Taryn Brumfitt has <a href="https://www.smh.com.au/healthcare/doctors-should-avoid-discussing-patient-s-weight-australian-of-the-year-says-20230707-p5dmhv.html">called for</a> doctors to avoid discussing a patient’s weight when they seek care for unrelated matters.</p> <p>A 15-minute consultation isn’t long enough to provide support to change behaviours, Brumfitt says, and GPs don’t have enough training and expertise to have these complex discussions.</p> <p>“Many people in larger bodies tell us they have gone to the doctor with something like a sore knee, and come out with a ‘prescription’ for a very restrictive diet, and no ongoing support,” Brumfitt <a href="https://www.smh.com.au/healthcare/doctors-should-avoid-discussing-patient-s-weight-australian-of-the-year-says-20230707-p5dmhv.html">told the Nine newspapers</a>.</p> <p>By raising the issue of weight, Brumfitt says, GPs also risk turning patients off seeking care for other health concerns.</p> <p>So should GPs bring up a patient’s weight in consultations about other matters? We asked 5 experts.</p> <p><strong>Brett Montgomery - GP academic</strong></p> <p>Yes, sometimes – but with great care.</p> <p>I agree that weight stigma is damaging, and insensitively raising weight in consultations can <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251566" target="_blank" rel="noopener">hurt people's feelings and create barriers</a>to other aspects of health care.</p> <p>I also agree people can sometimes be “overweight” yet <a href="https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0287218" target="_blank" rel="noopener">quite healthy</a>, and that common measures and categories of weight are <a href="https://theconversation.com/bmi-alone-will-no-longer-be-treated-as-the-go-to-measure-for-weight-management-an-obesity-medicine-physician-explains-the-seismic-shift-taking-place-208174">questionable</a>.</p> <p>On the other hand, I know obesity <a href="https://www.racgp.org.au/FSDEDEV/media/documents/RACGP/Position%20statements/Obesity-prevention-and-management.pdf" target="_blank" rel="noopener">is associated with</a> heart disease, joint problems, diabetes and cancers.</p> <p>GPs should be ready to help people with their weight when they want help. <a href="https://www.bmj.com/content/377/bmj-2021-069719.full?ijkey=FnARkmvxLOMFvlb&amp;keytype=ref">Our assistance somewhat effective</a>, though sadly dietary efforts often have minimal effect on weight in the long term. Meanwhile, treatments causing larger weight changes (<a href="https://insightplus.mja.com.au/2021/10/bariatric-surgery-public-system-access-still-terrible/">surgery</a> and <a href="https://www.nature.com/articles/s41366-022-01176-2">some medicines</a> are often financially inaccessible.</p> <p>I feel safe discussing weight when my patient raises the issue. Fearing hurting people, I often avoid raising it myself. I focus instead on health rather than weight, discussing physical activity and healthy diet – these are good things for people of any size.</p> <p><strong>Emma Beckett - Nutrition scientist</strong></p> <p>No. It’s not likely to succeed. Large systematic reviews bringing together multiple studies of multiple weight-loss diets show weight loss is not generally maintained long term (<a href="https://pubmed.ncbi.nlm.nih.gov/32238384/">12 months</a> to <a href="https://www.nature.com/articles/0802982">four years</a>).</p> <p>The idea that weight is about willpower is outdated. The current body of evidence <a href="https://theconversation.com/whats-the-weight-set-point-and-why-does-it-make-it-so-hard-to-keep-weight-off-195724">suggests</a> we each have a weight set point that our body defends. This is determined by genetics and environment more so than education.</p> <p>There may be associations between weight and health outcomes, but losing weight <a href="https://theconversation.com/just-because-youre-thin-doesnt-mean-youre-healthy-101185">does not necessarily equate</a> with improving health.</p> <p>Fat stigma and fatphobia are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866597/">harmful too</a> and can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381543/">compromise access to health care</a>.</p> <p>Instead, consider asking a better question. Healthy eating reduces disease risk <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935663/">regardless of weight</a>. So maybe ask how many vegetables are your patients eating. Would they like to see a dietitian to discuss strategies for a better-quality diet?</p> <p><strong>Liz Sturgiss - GP/researcher </strong></p> <p>No. A <a href="https://pubmed.ncbi.nlm.nih.gov/33211585/">US study</a> estimates it would take a family doctor 131% of their work hours to implement all preventive health-care recommendations. It's impossible to address every recommendation for preventative care at every consultation. One of the key skills of a GP is balancing the patient and doctor agenda.</p> <p><a href="https://www.obesityevidencehub.org.au/collections/treatment/weight-bias-and-stigma-in-health-care">Weight stigma</a> can deter people from seeking health care, so raising weight when a patient doesn't have it on their agenda can be harmful. A strong <a href="https://academic.oup.com/fampra/article/38/5/644/6244494?login=false">therapeutic relationship</a> is critical for safe and effective health care to address weight. </p> <p>Weight is always on my agenda when there is unexpected weight loss. If a patient has rapid weight loss, I am concerned about an undetected <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7283307/">cancer</a> or infection. Additionally, I am increasingly seeing patients who are unable to afford food, who often have <a href="https://www.aihw.gov.au/reports/dental-oral-health/oral-health-and-dental-care-in-australia/contents/introduction">poor oral health</a>, who lose weight due to <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/1747-0080.12580">poverty</a>. Weight loss for the wrong reasons is also a very concerning part of general practice.</p> <p><strong>Nick Fuller - Obesity researcher </strong></p> <p>Yes. GPs should play a role in the early detection of weight issues and direct patients to evidence-based care to slow this progression. <a href="https://pubmed.ncbi.nlm.nih.gov/31032548/">Research</a> shows many people with obesity are motivated to lose weight (48%). <a href="https://pubmed.ncbi.nlm.nih.gov/31032548/">Most</a> want their clinician to initiate a conversation about weight management and treatment options.</p> <p>However, this conversation <a href="https://pubmed.ncbi.nlm.nih.gov/32385580/">rarely occurs</a>, resulting in <a href="https://pubmed.ncbi.nlm.nih.gov/33621413/">significant delays to treatment</a>.</p> <p>Starting the conversation presents challenges. Although obesity is a complex disease related to multiple factors, it's still <a href="https://pubmed.ncbi.nlm.nih.gov/25752756/">highly stigmatised</a>in our society and even in the <a href="https://pubmed.ncbi.nlm.nih.gov/23144885/">clinical setting</a>. Sensitivity is required and the wording the clinician uses is important to make the patient feel safe and avoid placing blame on them. Patients often <a href="https://pubmed.ncbi.nlm.nih.gov/20823355/">prefer terms</a> such as “weight” and “BMI” (body mass index) over “fatness,” “size” or “obesity”, <a href="https://pubmed.ncbi.nlm.nih.gov/27354290/">particularly women</a>.</p> <p>Measuring weight, height and waist circumference should be <a href="https://pubmed.ncbi.nlm.nih.gov/33621413/">considered routine in primary care</a>. But this needs to be done without judgement, and in collaboration with the patient.</p> <p><strong>Helen Truby - Nutrition scientist </strong></p> <p>Yes. A high body weight contributes to many chronic conditions that negatively impact the <a href="https://www.aihw.gov.au/australias-health/summaries">quality of life and mental health</a> of millions of Australians.</p> <p>Not all GPs feel confident having weight conversations, given the sensitive nature of weight and its stigma. GPs' words matter – they are a <a href="https://doi.org/10.1111/nbu.12320">trusted source</a> of health information. It’s critical GPs gain the skills to know when and how to have <a href="https://doi.org/10.1186/s12875-019-1026-4">positive weight conversations</a>.</p> <p>GPs need to offer supportive and affordable solutions. But effective specialist weight management programs are few and far between. More equitable access to programs is essential so GPs have referral pathways after conversations about weight.</p> <p>GPs' time is valuable. Activating this critical workforce is essential to meet the <a href="https://www.health.gov.au/resources/publications/national-obesity-strategy-2022-2032?language=en">National Obesity Strategy.</a></p> <p><em><a href="https://theconversation.com/au/team#fron-jackson-webb">Fron Jackson-Webb</a>, Deputy Editor and Senior Health Editor, <a href="http://www.theconversation.com/">The Conversation</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/should-gps-bring-up-a-patients-weight-in-consultations-about-other-matters-we-asked-5-experts-209681">original article</a>.</em></p>

Body

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Gastro or endometriosis? How your GP discusses uncertainty can harm your health

<p>You wake with stomach pain that worsens during the day and decide to see your doctor. You describe your symptoms and your doctor examines you. Then the doctor says, “From what I hear, I think you could just have a stomach bug. Rest and come back in three days.”</p> <p>This might be a less definitive answer than you’re after. But doctors can’t always be sure of a diagnosis straight away. As <a href="https://link.springer.com/article/10.1007/s11606-022-07768-y">my review</a> shows, doctors use various ways of communicating such uncertainty.</p> <p>Sometimes there is a mismatch between what doctors say when they’re uncertain and how patients interpret what they say, which can have harmful consequences.</p> <h2>Why does uncertainty matter?</h2> <p>Doctors <a href="https://link.springer.com/article/10.1007/s11606-017-4164-1">cannot always explain</a> what your health problem is or what caused it. Such diagnostic uncertainty is a normal and <a href="https://doi.org/10.1001/jama.2022.2141">ever-present part</a> of the processes leading to a diagnosis. For instance, doctors often have to rule out other possible diagnoses before settling on one that’s most likely.</p> <p>While doctors ultimately get the diagnosis right <a href="http://dx.doi.org/10.1136/bmjqs-2012-001615">in 85-90%</a> of cases, diagnostic uncertainty can lead to diagnostic delays and is a huge contributor to harmful or even deadly misdiagnoses.</p> <p>Every year, <a href="https://www.mja.com.au/system/files/issues/213_07/mja250771.pdf">an estimated</a> 21,000 people are seriously harmed and 2,000-4,000 people die in Australia because their diagnosis was delayed, missed or wrong. That could be because the wrong treatment was provided and caused harm, or the right treatment was not started or given after the condition had already considerably progressed. More than <a href="https://www.mja.com.au/system/files/issues/213_07/mja250771.pdf">80% of diagnostic errors</a> could have been prevented.</p> <p>Three medical conditions – infections, cancer and major vascular events (such as strokes or heart attacks) – are the so-called “<a href="https://doi.org/10.1515/dx-2019-0019">Big Three</a>” and cause devastating harm if misdiagnosed.</p> <p>In my review, the top three symptoms – fever, chest pain and abdominal pain – were most often linked to diagnostic uncertainty. In other words, most of us will have had at least one of these very common symptoms and thus been at risk of uncertainty and misdiagnosis.</p> <p>Some groups are less likely to be diagnosed correctly or without inappropriate delay than others, leading to <a href="https://doi.org/10.1001/jama.2022.7252">diagnostic inequities</a>. This may be the case for <a href="https://www.liebertpub.com/doi/10.1089/whr.2022.0052">women</a>, and other groups marginalised because of their <a href="https://onlinelibrary.wiley.com/doi/10.1111/acem.14142">race or ethnicity</a>, <a href="https://doi.org/10.1016/j.socscimed.2020.113609">sexual orientation or gender identity</a>, or <a href="https://doi.org/10.1001/jama.2022.7252">language proficiency</a>.</p> <h2>How often do you hear ‘I don’t know’?</h2> <p>My research showed doctors often make diagnostic uncertainty clear to patients by using explicit phrases such as: “I don’t know.”</p> <p>But doctors can also keep quiet about any uncertainty or signal they’re uncertain in more subtle ways.</p> <p>When doctors believe patients prefer clear answers, they may only share the most likely diagnosis. They say: “It’s a stomach bug” but leave out, “it could also be constipation, appendicitis or endometriosis”. </p> <p>Patients leave thinking the doctor is confident about the (potentially correct or incorrect) diagnosis, and remain uninformed about possible other causes. </p> <p>This can be especially frustrating for patients with chronic symptoms, where such knowledge gaps can lead to lengthy diagnostic delays, as reported for <a href="https://doi.org/10.1016/j.ajog.2018.12.039">endometriosis</a>.</p> <p>Subtle ways of communicating uncertainty include hedging with certain words (could, maybe) or using introductory phrases (my guess, I think). Other implicit ways are consulting a colleague or the Internet, or making follow-up appointments.</p> <p>If patients hear “I think this could be a stomach bug” they may think there’s some uncertainty. But when they hear “come back in three days” the uncertainty may not be so obvious.</p> <p>Sharing uncertainty implicitly (rather than more directly), can leave patients unaware of new symptoms signalling a dangerous change in their condition.</p> <h2>What can you do about it?</h2> <p><strong>1. Ask about uncertainty</strong></p> <p>Ask your doctor to share any <a href="http://dx.doi.org/10.1515/dx-2021-0086">uncertainty and other diagnostic reasoning</a>. Ask about alternative diagnoses they’re considering. If you’re armed with such knowledge, you can better engage in your care, for example asking for a review when your symptoms worsen.</p> <p><strong>2. Manage expectations together</strong></p> <p>Making a diagnosis can be an evolving process rather than a single event. So ask your doctor to outline the diagnostic process to help manage any <a href="http://dx.doi.org/10.1136/ebm.14.3.66">mismatched expectations</a> about how long it might take, or what might be involved, to reach a diagnosis. Some conditions need time for symptoms to evolve, or further tests to exclude or confirm.</p> <p><strong>3. Book a long appointment</strong></p> <p>When we feel sick, we might get anxious or find we experience heightened levels of fear and other emotions. When we hear our doctor isn’t certain about what’s causing our symptoms, we may get even more anxious or fearful.</p> <p>In these cases, it can take time to discuss uncertainty and to learn about our options. So book a long appointment to give your doctor enough time to explain and for you to ask questions. If you feel you’d like some support, you can ask a close friend or family member to attend the appointment with you and to take notes for you.</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a href="https://theconversation.com/gastro-or-endometriosis-how-your-gp-discusses-uncertainty-can-harm-your-health-196943" target="_blank" rel="noopener">The Conversation</a>. </em></p>

Caring

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Couple ‘draw’ 7,237 kilometre bicycle in name of climate change

<p dir="ltr">A couple has taken a stand against climate change that can be seen from the skies, having cycled more than 7,000 kilometres to create the image of a bike to encourage others to ditch their cars.</p> <p><span id="docs-internal-guid-2924358c-7fff-a56b-b348-0a24954f55ca">UK-based couple Arianna Casiraghi and Daniel Rayneau-Kirkhope first took it upon themselves to “draw” a 956-kilometre-wide bicycle across Europe in 2019, telling the <em>Guardian </em>they did it to “draw attention to the scale of climate breakdown” and get others to think about choosing bikes over cars for shorter trips.</span></p> <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-captioned="" data-instgrm-permalink="https://www.instagram.com/p/ChRmUTSM9j8/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/ChRmUTSM9j8/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Arianna🇮🇹 - Daniel🇬🇧 - Zola🐶🇫🇮 (@bicycleswillsavetheworld_)</a></p> </div> </blockquote> <p dir="ltr">Though a pandemic, injuries, and poor weather made their short trip anything but, the Italian-British duo eventually finished the task.</p> <p dir="ltr">After quitting their jobs in 2019 to start the ride, Casiraghi suffered a knee injury that put a hold on their journey until November, when the cold and rain made it so miserable they had to stop again.</p> <p dir="ltr">Plans to restart the ride in March 2020 were derailed, but Casiraghi said finishing what they had started was both for a sense of accomplishment and so they didn’t let down the people who had been following their progress.</p> <p dir="ltr">Their trip, which totalled 131 days of cycling, finally came to an end on August 15 and the couple took to Instagram to share the news.</p> <p dir="ltr">“We have completed our gps-trace drawing! And what a drawing it is!” they wrote.</p> <p dir="ltr">“We cycled 7237 km through 7 countries to draw our massive bicycle and hopefully encourage one or two people to use their bike instead of the car.”</p> <p dir="ltr">The pair revealed they had also beaten several records, including the Guinness World Record for the largest GPS drawing, the unofficial record for the largest one completed by a bicycle, and “we have definitely drawn the biggest bicycle ever!”</p> <p><span id="docs-internal-guid-59646a05-7fff-caea-4913-328d6ab06308"></span></p> <p dir="ltr">As if their feat wasn’t impressive enough, the duo also took their Italian water dog, Zola, along for the ride, using custom-built bikes that had a compartment for the pooch to sit in whenever she wasn’t running alongside.</p> <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-permalink="https://www.instagram.com/p/CeWkHS1s06U/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/CeWkHS1s06U/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Arianna🇮🇹 - Daniel🇬🇧 - Zola🐶🇫🇮 (@bicycleswillsavetheworld_)</a></p> </div> </blockquote> <p dir="ltr">"We tried to go on small roads where possible, or off-road, so Zola could walk a bit," Rayneau-Kirkhope said.</p> <p dir="ltr">The planning of their drawing was also a complex task, with their first draft route taking them directly through Charles de Gaulle Airport.</p> <p dir="ltr">Reflecting on their trip, the couple said Casiraghi’s injury proved to be “really quite demoralising”.</p> <p dir="ltr">"We had to stop travelling in order to rest and undertake dedicated</p> <p dir="ltr">physiotherapy sessions, which unfortunately meant that our project got delayed," they said.</p> <p dir="ltr">But, people’s reactions to their journey far outshone the harder moments.</p> <p dir="ltr">"The highlight of the trip has been the incredible support that we have received from</p> <p dir="ltr">people along the road," they said.</p> <p dir="ltr">"Without them, cycling through the cold and rainy winter months would simply not have been possible with our tight budget.</p> <p dir="ltr">"We still are amazed about how open-minded and selfless people can be."</p> <p dir="ltr">As for what’s next, the pair said they would be heading home for a rest before hitting the pedals again - though their next trip won’t be so artistic.</p> <p dir="ltr">"Now, we will go home and rest before going for another cycling trip," they said.</p> <p dir="ltr">"No drawing, just pedalling in whichever direction we bloody well please!"</p> <p dir="ltr"><span id="docs-internal-guid-81fc3562-7fff-e4d9-0b25-1e07cd6bb981"></span></p> <p dir="ltr"><em>Image: @bicycleswilsavetheworld_ (Instagram)</em></p>

International Travel

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22-year-old dies of cervical cancer after GPs turned her away 15 times

<p>A 22-year-old woman died of cervical cancer after GPs turned her away 15 times and told her not to worry about the “Jade Goody effect”.</p> <p>Emma Swain pleaded with her GP for a smear test as she was experiencing symptoms, but was told she was too young by medical professionals.</p> <p>Instead, doctors had placed the blame on her contraceptive pill for her symptoms and told her what happened to Jade Goody was unlikely to happen to her.</p> <p>In 2009, TV personality Jade Goody died from cervical cancer at the age of 27.</p> <p>Emma first approached her doctor about a smear test in May 2013 after experiencing back pain and bleeding after sex.</p> <p>But her request was refused because the cervical screening is only offered to women over the age of 25.</p> <p>Her GP has since admitted that if the 22-year-old had been given the smear test, she may still be alive.</p> <p>Devastated at the loss of his daughter, Darren Swain <a rel="noopener" href="https://www.mirror.co.uk/news/uk-news/woman-22-cervical-cancer-told-23084319" target="_blank">told the Mirror</a>: “To have watched one of your children go through that and to know it could have been ­prevented is ­incredibly hard to ­accept.</p> <p>“We trusted these people – the professionals – to know what they were doing. I’ll never forgive them.”</p> <p>Darren, 51, said: “Basically, he told her she was worrying over nothing. He couldn’t have been more wrong. It cost Emma her life.”</p> <p>Over the course of four months, Emma contacted her doctor 14 times but was advised to swap her brand of contraceptive pill.</p> <p>She changed her pill five times during those four months.</p> <p>Unfortunately, Emma was diagnosed with cervical cancer in December of that year and died the following year in 2014.</p> <p>Emma’s family has since been fighting a six-year legal battle, one that they have recently won.</p> <p>Her family has been awarded compensation for her death.</p> <p>In a letter to the dad-of-three, Dr Stephen Golding, Dr Hendrik Parmentier and practice nurse Maureen Dillon from The Haling Park Partnership in Croydon, South London, apologised for what ­happened to Emma.</p> <p>They wrote: “We admit that if the care and treatment provided to your daughter had been of a reasonable standard, on the balance of probabilities, she would have survived.”</p> <p>A spokesperson for the surgery told the Mirror: “Since Emma’s death, the practice has reviewed its processes to ensure lessons have been learned.”</p>

Caring

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The new device that charges your phone while you’re on the go

<p><span style="font-weight: 400;">Researchers from Queen’s University in Canada have developed an energy-harvesting device that exploits the side to side movement of a backpack that will generate electricity while you walk.</span></p> <p><span style="font-weight: 400;">The trial version would be suitable for people who work or trek to remote areas and the device has enough power to deploy an emergency beacon or a GPS.</span></p> <p><span style="font-weight: 400;">The researchers experimented with seven different conditions for energy harvesting and found that a load of nine kilograms generated the optimum amount of power without any extra effort to the wearer.</span></p> <p><span style="font-weight: 400;">The nine kilograms would be made up of clothes, food, a stove, fuel, a sleeping bag and a tent which was packed for a long trek.</span></p> <p><span style="font-weight: 400;">The weight of the device and the backpack adds another five kilos. The setup in total produces about .22 watts of electricity which is enough to power GPS and emergency beacons.</span></p> <p><a href="https://royalsocietypublishing.org/doi/10.1098/rsos.182021"><span style="font-weight: 400;">In the paper</span></a><span style="font-weight: 400;">, the researchers Jean-Paul Martin and Qingguo Li calculate that adding more weight to the backpack will help it generate more power. </span></p> <p><span style="font-weight: 400;">“Modelling predicts that an increase in electrical power production could be achieved by increasing the weight carried,” they write.</span></p> <p><span style="font-weight: 400;">“If generating over (one Watt) of electrical power was desired for powering higher demand devices, such as talking or browsing the internet with a cell phone, our model indicates that over 20 kilograms of weight would need to be carried.”</span></p> <p><span style="font-weight: 400;">In total, you would be carrying 14 kilograms on your back to generate enough power for your GPS or emergency beacon.</span></p> <p><span style="font-weight: 400;">Although this might seem like too much weight for most people, it’s next to nothing for soldiers who are used to carrying at least 27 kilograms and as much as 45 kilograms on their back for long-haul missions in Iraq and Afghanistan.</span></p>

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5 secrets of Google Maps

<p>Google Maps. It’s one of the most used apps in the world and one which many of us use weekly, if not daily. While Google Maps is primarily used for locating specific addresses, there are a whole host of features that the majority of us don’t even know about but that can make life that little bit easier.</p> <p>Here are 5 of our favourite features hiding below the surface.</p> <ol> <li><strong>Multi-stop trips</strong> – Making a more than one stop on your journey? The new multi-stop feature lets you type in more than one destination so that you can map out your whole trip. Access it by clicking the ‘options’ menu from the direction screen and selecting ‘add stop’.</li> <li><strong>The explore option</strong> – If you’re visiting a new place and want to get an idea of the facilities on offer then the explore function is your new best friend. From the main search screen, click on the three parallel lines on the left-hand side of the search bar. You should see the ‘explore’ option appear. If it doesn’t, you may need to zoom in a little bit more. Once it does appear, you’ll find details on places to eat, local attractions and other relevant facilities.</li> <li><strong>Save and store locations</strong> – If you’re going to be out of internet range but know you’ll need a map you can take advantage of Google Maps ability to download and save a section of map for later use. To do this, tap in the search bar and scroll until you see ‘download a new offline area.’ You can download up to 120,000 square kilometres and though the map won’t be able to make suggestions, you can interact with it and search for directions to places within your downloaded section.</li> <li><strong>Share directions</strong> – If you need to share your location with a friend or show someone how to get to where they’re going, Google Maps makes it possible. All you need to do it find the directions you need, hit the three-dot options menu and tap ‘share directions.’ You can then message or email directions to whoever needs them.</li> <li><strong>Sign in for personalised service</strong> – While some prefer not to share their information with Google Maps, signing into it can improve functionality. If you sign in and turn on your history, maps will remember your past destinations. You can also link your Google contacts with Google Maps making it easy to find places you may want or need to visit. You can sign in to your Google account by clicking on the three parallel lines on the left-hand side of the search bar.</li> </ol> <p>Do you use Google Maps? What’s your favourite feature?</p> <p><strong>Related links:</strong></p> <p><a href="/entertainment/technology/2016/11/common-smartphone-myths/"><span style="text-decoration: underline;"><em><strong>5 common smartphone myths busted</strong></em></span></a></p> <p><a href="/entertainment/technology/2016/11/how-to-make-text-bigger-on-your-smartphone/"><span style="text-decoration: underline;"><em><strong>How to make text bigger on your smartphone</strong></em></span></a></p> <p><a href="/entertainment/technology/2016/11/7-hidden-facebook-settings/"><em><span style="text-decoration: underline;"><strong>7 useful Facebook settings you may not know about</strong></span></em></a></p>

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