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Surgery won’t fix my chronic back pain, so what will?

<a href="https://theconversation.com/profiles/christine-lin-346821">Christine Lin</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/christopher-maher-826241">Christopher Maher</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/fiona-blyth-448021">Fiona Blyth</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/james-mcauley-1526139">James Mcauley</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a>, and <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> This week’s ABC Four Corners episode <a href="https://www.abc.net.au/news/2024-04-08/pain-factory/103683180">Pain Factory</a> highlighted that our health system is failing Australians with chronic pain. Patients are receiving costly, ineffective and risky care instead of effective, low-risk treatments for chronic pain. The challenge is considering how we might reimagine health-care delivery so the effective and safe treatments for chronic pain are available to millions of Australians who suffer from chronic pain. <a href="https://www.aihw.gov.au/getmedia/10434b6f-2147-46ab-b654-a90f05592d35/aihw-phe-267.pdf.aspx">One in five</a> Australians aged 45 and over have chronic pain (pain lasting three or more months). This costs an estimated <a href="https://www.aihw.gov.au/getmedia/10434b6f-2147-46ab-b654-a90f05592d35/aihw-phe-267.pdf.aspx">A$139 billion a year</a>, including $12 billion in direct health-care costs. The most common complaint among people with chronic pain is low back pain. So what treatments do – and don’t – work? <h2>Opioids and invasive procedures</h2> Treatments offered to people with chronic pain include strong pain medicines such as <a href="https://pubmed.ncbi.nlm.nih.gov/30561481/">opioids</a> and invasive procedures such as <a href="https://pubmed.ncbi.nlm.nih.gov/36878313/">spinal cord stimulators</a> or <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/imj.14120">spinal fusion surgery</a>. Unfortunately, these treatments have little if any benefit and are associated with a risk of significant harm. <a href="https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-06900-8">Spinal fusion surgery</a> and <a href="https://privatehealthcareaustralia.org.au/consumers-urged-to-be-cautious-about-spinal-cord-stimulators-for-pain/#:%7E:text=Australian%20health%20insurance%20data%20shows,of%20the%20procedure%20is%20%2458%2C377.">spinal cord stimulators</a> are also extremely costly procedures, costing tens of thousands of dollars each to the health system as well as incurring costs to the individual. <h2>Addressing the contributors to pain</h2> Recommendations from the latest <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/low-back-pain-clinical-care-standard">Australian</a> and <a href="https://www.who.int/publications/i/item/9789240081789">World Health Organization</a> clinical guidelines for low back pain focus on alternatives to drug and surgical treatments such as: <ul> <li>education</li> <li>advice</li> <li>structured exercise programs</li> <li>physical, psychological or multidisciplinary interventions that address the physical or psychological contributors to ongoing pain.</li> </ul> Two recent Australian trials support these recommendations and have found that interventions that address each person’s physical and psychological contributors to pain produce large and sustained improvements in pain and function in people with chronic low back pain. The interventions have minimal side effects and are cost-effective. In the <a href="https://jamanetwork.com/journals/jama/fullarticle/2794765">RESOLVE</a> trial, the intervention consists of pain education and graded sensory and movement “retraining” aimed to help people understand that it’s safe to move. In the <a href="https://pubmed.ncbi.nlm.nih.gov/37146623/">RESTORE</a> trial, the intervention (cognitive functional therapy) involves assisting the person to understand the range of physical and psychological contributing factors related to their condition. It guides patients to relearn how to move and to build confidence in their back, without over-protecting it. <h2>Why isn’t everyone with chronic pain getting this care?</h2> While these trials provide new hope for people with chronic low back pain, and effective alternatives to spinal surgery and opioids, a barrier for implementation is the out-of-pocket costs. The interventions take up to 12 sessions, lasting up to 26 weeks. One physiotherapy session <a href="https://www.sira.nsw.gov.au/__data/assets/pdf_file/0005/1122674/Physiotherapy-chiropractic-and-osteopathy-fees-practice-requirements-effective-1-February-2023.pdf">can cost</a> $90–$150. In contrast, <a href="https://www.servicesaustralia.gov.au/chronic-disease-individual-allied-health-services-medicare-items">Medicare</a> provides rebates for just five allied health visits (such as physiotherapists or exercise physiologists) for eligible patients per year, to be used for all chronic conditions. Private health insurers also limit access to reimbursement for these services by typically only covering a proportion of the cost and providing a cap on annual benefits. So even those with private health insurance would usually have substantial out-of-pocket costs. Access to trained clinicians is another barrier. This problem is particularly evident in <a href="https://www.ruralhealth.org.au/15nrhc/sites/default/files/B2-1_Bennett.pdf">regional and rural Australia</a>, where access to allied health services, pain specialists and multidisciplinary pain clinics is limited. Higher costs and lack of access are associated with the increased use of available and subsidised treatments, such as pain medicines, even if they are ineffective and harmful. The <a href="https://www.safetyandquality.gov.au/publications-and-resources/resource-library/data-file-57-opioid-medicines-dispensing-2016-17-third-atlas-healthcare-variation-2018">rate of opioid use</a>, for example, is higher in regional Australia and in areas of socioeconomic disadvantage than metropolitan centres and affluent areas. <h2>So what can we do about it?</h2> We need to reform Australia’s health system, private and <a href="https://www.health.gov.au/sites/default/files/documents/2020/12/taskforce-final-report-pain-management-mbs-items-final-report-on-the-review-of-pain-management-mbs-items.docx">public</a>, to improve access to effective treatments for chronic pain, while removing access to ineffective, costly and high-risk treatments. Better training of the clinical workforce, and using technology such as telehealth and artificial intelligence to train clinicians or deliver treatment may also improve access to effective treatments. A recent Australian <a href="https://pubmed.ncbi.nlm.nih.gov/38461844/">trial</a>, for example, found telehealth delivered via video conferencing was as effective as in-person physiotherapy consultations for improving pain and function in people with chronic knee pain. Advocacy and <a href="https://pubmed.ncbi.nlm.nih.gov/37918470/">improving the public’s understanding</a> of effective treatments for chronic pain may also be helpful. Our hope is that coordinated efforts will promote the uptake of effective treatments and improve the care of patients with chronic pain.<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/227450/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/christine-lin-346821">Christine Lin</a>, Professor, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/christopher-maher-826241">Christopher Maher</a>, Professor, Sydney School of Public Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/fiona-blyth-448021">Fiona Blyth</a>, Professor, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/james-mcauley-1526139">James Mcauley</a>, Professor of Psychology, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a>, and <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, Professor of Physiotherapy, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> Image credits: Getty Images 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/surgery-wont-fix-my-chronic-back-pain-so-what-will-227450">original article</a>.

Body

Why do I keep getting urinary tract infections? And why are chronic UTIs so hard to treat?

<a href="https://theconversation.com/profiles/iris-lim-1204657">Iris Lim</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Dealing with chronic urinary tract infections (UTIs) means facing more than the occasional discomfort. It’s like being on a never ending battlefield against an unseen adversary, making simple daily activities a trial. UTIs happen when bacteria sneak into the urinary system, causing pain and frequent trips to the bathroom. Chronic UTIs take this to the next level, coming back repeatedly or never fully going away despite treatment. <a href="https://www.ncbi.nlm.nih.gov/books/NBK557479/">Chronic UTIs</a> are typically diagnosed when a person experiences two or more infections within six months or three or more within a year. They can happen to anyone, but some are more prone due to their <a href="https://www.urologyhealth.org/urology-a-z/u/urinary-tract-infections-in-adults">body’s makeup or habits</a>. Women are more likely to get UTIs than men, due to their shorter urethra and hormonal changes during menopause that can decrease the protective lining of the urinary tract. Sexually active people are also at greater risk, as bacteria can be transferred around the area. Up to <a href="https://www.urologyhealth.org/urology-a-z/u/urinary-tract-infections-in-adults#Related%20Resources">60% of women</a> will have at least one UTI in their lifetime. While effective treatments exist, <a href="https://www.health.harvard.edu/bladder-and-bowel/when-urinary-tract-infections-keep-coming-back#:%7E:text=Your%20urine%20might%20be%20cloudy,they%20take%20on%20your%20life.">about 25%</a> of women face recurrent infections within six months. Around <a href="https://sciendo.com/article/10.33073/pjm-2019-048?tab=article">20–30%</a> of UTIs don’t respond to standard antibiotic. The challenge of chronic UTIs lies in bacteria’s ability to shield themselves against treatments. <h2>Why are chronic UTIs so hard to treat?</h2> Once thought of as straightforward infections cured by antibiotics, we now know chronic UTIs are complex. The cunning nature of the bacteria responsible for the condition allows them to hide in bladder walls, out of antibiotics’ reach. The bacteria form biofilms, a kind of protective barrier that makes them nearly impervious to standard antibiotic treatments. This ability to evade treatment has led to a troubling <a href="https://theconversation.com/rising-antibiotic-resistance-in-utis-could-cost-australia-1-6-billion-a-year-by-2030-heres-how-to-curb-it-149543">increase in antibiotic resistance</a>, a global health concern that renders some of the conventional treatments ineffective. Antibiotics need to be advanced to keep up with evolving bacteria, in a similar way to the flu vaccine, which is updated annually to combat the latest strains of the flu virus. If we used the same flu vaccine year after year, its effectiveness would wane, just as overused antibiotics lose their power against bacteria that have adapted. But fighting bacteria that resist antibiotics is much tougher than updating the flu vaccine. Bacteria change in ways that are harder to predict, making it more challenging to create new, effective antibiotics. It’s like a never-ending game where the bacteria are always one step ahead. Treating chronic UTIs still relies heavily on antibiotics, but doctors are getting crafty, changing up medications or prescribing low doses over a longer time to outwit the bacteria. Doctors are also placing a greater emphasis on thorough diagnostics to accurately identify chronic UTIs from the outset. By asking detailed questions about the duration and frequency of symptoms, health-care providers can better distinguish between isolated UTI episodes and chronic conditions. The approach to initial treatment can significantly influence the likelihood of a UTI becoming chronic. Early, targeted therapy, based on the specific bacteria causing the infection and its antibiotic sensitivity, may reduce the risk of recurrence. For post-menopausal women, <a href="https://link.springer.com/article/10.1007/s00192-020-04397-z">estrogen therapy</a> has shown promise in reducing the risk of recurrent UTIs. After menopause, the decrease in estrogen levels can lead to changes in the urinary tract that makes it more susceptible to infections. This treatment restores the balance of the vaginal and urinary tract environments, making it less likely for UTIs to occur. Lifestyle changes, such as <a href="https://journals.lww.com/co-nephrolhypertens/FullText/2013/05001/Impact_of_fluid_intake_in_the_prevention_of.1.aspx">drinking more water</a> and practising good hygiene like washing hands with soap after going to the toilet and the recommended front-to-back wiping for women, also play a big role. Some swear by cranberry juice or supplements, though researchers are still figuring out <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001322.pub2/full">how effective these remedies truly are</a>. <h2>What treatments might we see in the future?</h2> Scientists are currently working on new treatments for chronic UTIs. One promising avenue is the development of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10052183/pdf/pathogens-12-00359.pdf">vaccines</a> aimed at preventing UTIs altogether, much like flu shots prepare our immune system to fend off the flu. Another new method being looked at is called <a href="https://link.springer.com/article/10.1007/s12223-019-00750-y">phage therapy</a>. It uses special viruses called bacteriophages that go after and kill only the bad bacteria causing UTIs, while leaving the good bacteria in our body alone. This way, it doesn’t make the bacteria resistant to treatment, which is a big plus. Researchers are also exploring the potential of <a href="https://www.mdpi.com/2079-6382/12/1/167">probiotics</a>. Probiotics introduce beneficial bacteria into the urinary tract to out-compete harmful pathogens. These good bacteria work by occupying space and resources in the urinary tract, making it harder for harmful pathogens to establish themselves. Probiotics can also produce substances that inhibit the growth of harmful bacteria and enhance the body’s immune response. Chronic UTIs represent a stubborn challenge, but with a mix of current treatments and promising research, we’re getting closer to a day when chronic UTIs are a thing of the past.<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/223008/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/iris-lim-1204657">Iris Lim</a>, Assistant Professor, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Image credits: Getty Images 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/why-do-i-keep-getting-urinary-tract-infections-and-why-are-chronic-utis-so-hard-to-treat-223008">original article</a>.

Body

"I was terrified": Law & Order star reveals traumatic past

Warning: This story contains graphic content. Mariska Hargitay, who plays Olivia Benson, a character that investigate rapists on Law & Order: Special Victims Unit, has revealed that she too is a victim of sexual assault. The actress opened up about her traumatic past in a powerful essay written for <a href="https://people.com/mariska-hargitay-experience-rape-renewal-reckoning-8424247" target="_blank" rel="noopener">People Magazine</a>, where she revealed that she was raped by “a friend" when she was in her thirties. "A man raped me in my thirties," she bravely revealed in the essay. "It wasn’t sexual at all. It was dominance and control. Overpowering control." The actress revealed that he was a friend who "made a unilateral decision" and recalled the fear she felt when the incident occurred. "He grabbed me by the arms and held me down. I was terrified," she said. "I didn’t want it to escalate to violence. I now know it was already sexual violence, but I was afraid he would become physically violent. "I went into freeze mode, a common trauma response when there is no option to escape. I checked out of my body," she recalled. Hargitay, who is the daughter of the late actress Jane Mansfield, said that she never thought of herself as a "survivor", and often "minimised" what happened to her when she talked about it with others. "My husband Peter remembers me saying, “I mean, it wasn’t rape," she wrote. "Then things started shifting in me, and I began talking about it more in earnest with those closest to me. They were the first ones to call it what it was." The actress said that she wants other survivors to feel "no shame" about sexual assault and wants "this violence to end." She added that justice "may look different for each survivor," but for her she wants "an acknowledgment and an apology" after what happened. "This is a painful part of my story. The experience was horrible. But it doesn’t come close to defining me, in the same way that no other single part of my story defines me," she concluded, adding that she feels for all sexual violence survivors. "I’m turning 60, and I’m so deeply grateful for where I am. I’m renewed and I’m flooded with compassion for all of us who have suffered. And I’m still proudly in process." Hargitay started her own foundation, the Joyful Heart Foundation, in 2004 to help survivors of sexual assault. Image: Getty

Caring

90-year-old-with chronic leukaemia skydives for charity

A thrill-seeking 90-year-old has celebrated her birthday - in what some would call an unconventional manner for her age - by skydiving, and raising £5,000 for a homeless charity in the process. Shirley Robinson, from Long Clawson in Leicestershire, jumped out of a plane at 14,000ft for the fundraiser at Skydive Langar in Nottinghamshire. Shirley, who was diagnosed with chronic leukaemia in 2022, raised funds for Crisis, a charity that provides help and support for homeless people. She told BBC News, “It's just wonderful how generous people have been. It's lovely.” Footage of her dive saw Shirley styled in a bright blue jumpsuit as she was cheered on by family and friends before getting on the plane. She smiled and waved at the camera as she was strapped to her skydiving instructor. <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/reel/CsZGxykN0PN/?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/reel/CsZGxykN0PN/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Skydive Langar (@skydivelangar)</a> </div> </blockquote> After Shirley’s adrenaline packed skydive, she landed safely in a field and can be heard in the video exclaiming, “That was wonderful.” When asked about her favourite part of the experience, she responded, “That was lovely, going through the clouds.” She confessed afterwards that the free fall was a “bit breathtaking” but she “loved it” before thanking her instructor for looking after her. Shirley returned to a hero’s welcome with her beaming friends and family congratulating her. A spokesperson for the charity said, “We want to say an enormous thank you to Shirley for the incredible amount of money she has raised. “Shirley's donation will provide vital support for people experiencing or at risk of homelessness. We're so grateful.” Image credit: Instagram

Retirement Life

Could mobile phones revolutionise chronic wound treatment?

Australian researchers are developing a contactless, thermal imaging system that uses artificial intelligence to help nurses determine the best way to treat leg ulcers without waiting to see if the wound is going to heal properly. It’s estimated that 450,000 thousand Australians currently live with a chronic wound. Being able to predict early on which wounds will become chronic could improve outcomes by enabling nurses to start specialised therapy as soon as possible. But current techniques rely on physically monitoring the wound area over several weeks. New research from RMIT in Melbourne paired thermal imaging with AI. The software was able to accurately identify unhealing ulcers 78% of the time, and healing ulcers 60% of the time, according to the new study <a href="https://www.nature.com/articles/s41598-022-20835-y" target="_blank" rel="noreferrer noopener">published</a> in Scientific Reports. “Our new work that identifies chronic leg wounds during the first visit is a world-first achievement,” says lead researcher Professor Dinesh Kumar, from RMIT’s School of Engineering. “This means specialised treatment for slow-healing leg ulcers can begin up to four weeks earlier than the current gold standard.” How do you normally assess wound healing? The work builds on <a href="https://www.nature.com/articles/s41598-021-92828-2.epdf?sharing_token=7SIEmbOksKOou2TGQ5qPWdRgN0jAjWel9jnR3ZoTv0NntGTf8gfSMhoDjLAz58SefUeGL0aP2A-0mDVnZaiZTcBjNNpA4cvP9FgK6-aoPzyk4oQ0OSbPh83HNS_AwGDQVMg43K4WmG60QDoQohtsdkaRv70YSxfPg4Dn0qa_CUs%3D" target="_blank" rel="noreferrer noopener">previous research</a> by the same team, which found that this method could be used to predict wound healing by week 3 after initial assessment. But they wanted to know whether healing could be predicted from the first wound assessment only, reducing any delay in treatment. If a wound is healing normally it’s area would reduce by 50% within four weeks, but more than 20% of ulcers don’t heal in this expected trajectory and may need specialist interventions. Venous leg ulcers (VLUs) are the <a href="https://treasury.gov.au/sites/default/files/2022-03/258735_wounds_australia.pdf" target="_blank" rel="noreferrer noopener">most common</a> chronic wound seen in Australia and currently, the gold standard for predicting their healing– conventional digital planimetry – requires physical contact. Regular wound photography is also less accurate because there can be variations between images due to lighting, image quality, and differences in camera angle. But a non-contact method like thermal imaging could overcome this. The thermal profile of wounds changes over the healing trajectory, with higher temperatures signalling potential inflammation or infection and lower temperatures indicating a slower healing rate due to decreased oxygen in the region. So, taking thermal images of wounds can provide important information for predicting how they will heal. What did they do? The study collected VLU data from 56 older participants collected over 12 weeks, including thermal images of their wounds at initial assessment and information on their status at the 12th week follow-up. “Our innovation is not sensitive to changes in ambient temperature and light, so it is effective for nurses to use during their regular visits to people’s homes,” says co-author Dr Quoc Cuong Ngo, from RMIT’s School of Engineering. “It is also effective in tropical environments, not just here in Melbourne.” “Clinical care is provided in many different locations, including specialist clinics, general practices and in people’s homes,” says co-author Dr Rajna Ogrin, a Senior Research Fellow at Bolton Clarke Research Institute. “This method provides a quick, objective, non-invasive way to determine the wound-healing potential of chronic leg wounds that can be used by healthcare providers, irrespective of the setting.” So, what’s next? There are a few limitations to this study. First, the number of healed wounds in the dataset was relatively small compared to unhealed wounds, and the study only investigated older people. The authors recommend that “future research should focus on improving the predictive accuracy and customising this method to incorporate this assessment into clinical practice on a wider pool of participants and in a variety of settings.” Kumar says that they are hoping to adapt the method for use with mobile phones. “With the funding we have received from the Medical Research Future Fund, we are now working towards that,” he says. “We are keen to work with prospective partners with different expertise to help us achieve this goal within the next few years.” <img id="cosmos-post-tracker" style="opacity: 0; height: 1px!important; width: 1px!important; border: 0!important; position: absolute!important; z-index: -1!important;" src="https://syndication.cosmosmagazine.com/?id=222978&title=Could+mobile+phones+revolutionise+chronic+wound+treatment%3F" width="1" height="1" /> <div id="contributors"> <a href="https://cosmosmagazine.com/health/revolutionise-chronic-wounds-treatment/" target="_blank" rel="noopener">This article</a> was originally published on Cosmos Magazine and was written by Imma Perfetto. Image: RMIT University </div>

Technology

“It’s not easy”: Michael Klim shares health update

Aussie swimmer Michael Klim has opened up about how his life has changed following his diagnosis with a rare autoimmune disease, including the strategy he uses to cope. In 2020, the world champion was diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP) - a rare neurological disorder where the fatty myelin sheath protecting nerves is damaged and feeling is lost in the arms and legs. The condition has affected Klim’s physical and mental wellbeing, with the father-of-three struggling to perform everyday tasks such as walking and playing with his kids. But, Klim has adopted a new strategy to help him acknowledge the toll the disease has while not letting it get him down. “My counsellor and I have come up with a strategy where I give myself an hour a day to feel sorry for myself,” he told the <a href="https://www.smh.com.au/sport/swimming/i-am-trying-to-not-let-it-consume-me-the-rare-disease-that-turned-michael-klim-s-world-upside-down-20221027-p5bte5.html" target="_blank" rel="noopener">Sydney Morning Herald</a>. “I can whinge as much as I want and feel down, but after that, then there are still a lot of things I can do and be functional and still have responsibilities as a parent and a coach and as a partner, and I can still do them effectively. “I am trying to not let it consume me completely. But it's hard.” <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/Ci1vISQBbPk/?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/Ci1vISQBbPk/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by MICHAEL KLIM (@michaelklim1)</a> </div> </blockquote> Klim said the effect on his body has meant he had to go through a “grieving process”, where he came to grips with the condition and the possibility he may need a wheelchair. “And to a degree the fear is still there. I think I am a bit better, in the sense I have accepted – to a degree – that these are the cards I have been dealt,” he said. “But I am still working through it. When we experience grief, you don't just go one day, 'I am fine, I am better now'. It affects you for much longer, and particularly because it is in my face daily. “There was a fear because I got bad really quickly. I am now in a remission, stable phase. But there is a fear I may go again at the same rate and if I degrade that quickly again, I probably will need assistance with walking and things like that.” Earlier this month, Klim said his mobility has been affected to the point where can no longer leave Bali and make trips to Australia, which he had done several times a year for work and treatment in the past. “I have pulled my focus to the swim academy here in Bali and... we run a bunch of camps and clinics,” he said. “I have sort of simplified my lifestyle just from that point of view. “I mean I did use to do 20 return trips to Australia a year for work and whatever.” “But for now it's just physically... physically actually impossible because (for) myself getting around is not simple.” The 45-year-old revealed he is now facing financial stresses too, after he left his role in sales and marketing at Milk & Co, the skincare company he founded in 2008, due to his inability to travel. “Look it has definitely put a stress on our finances and security because there is a level of investment for me,” Klim told Brett Hawke, the host of the Inside with Brett Hawke podcast, this week. “I stepped back from my role with Milk and Co. because of the demand it had on me physically, flying back and forth and the stress as well. “I was very hands-on doing sales and marketing. (But) unless I could give myself one hundred percent I didn't want to do it.” To make matters worse, Klim’s battle with CIDP has been self-funded because his original health insurance policy doesn’t cover the condition. “Unfortunately unless you have a very good insurance policy, which mine unfortunately didn't cover this disorder, everything is self-funded so it has put a fair bit of stress on everybody I think,” he said. “I have had great support from the family but it's, yeah, it's not easy.” <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/Cf3hl1fhzH6/?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/Cf3hl1fhzH6/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by MICHAEL KLIM (@michaelklim1)</a> </div> </blockquote> After first speaking about his condition on The Project in July, including noticing numbness and other symptoms in his legs and feet in 2019, Klim told Hawke that the disorder had worsened in recent months, with the numbness in his feet now in his calf muscles and knees. “I had a big foot drop...my foot is just really floppy and can't control my foot so I'm having to wear special braces called AFO's (ankle-foot orthoses) which keeps my toes up so I don't trip up over myself when I'm using a walking stick or crutches,” he explained. He admitted that he fears losing all of his physical mobility, but still remains determined to fight CIDP and seek treatment from neurological experts in Australia and the US. “I think there is definitely an element of fear in this because it's the fear of the unknown, which we're always scared of, you know,” an emotional Klim said. “So there is 30 percent of patients (that) end up in a wheelchair and it's just to get around. So that's in the back of my mind.” Despite his worsening condition, Klim said he is still able to regularly swim with the assistance of a pool buoy between his legs. “The thing that gives me so much joy at the moment is I can actually still jump in the pool and have a bit of float around,” Klim said. “I like to put the buoy in and punch out a couple of times and, and yeah, it's kind of my happy place at the moment.” Image: @michaelklim1 (Instagram)

Caring

Paul Green’s brain donated to science

Paul Green’s brain has been donated to the Australian Sports Brain Bank to help with science. The legendary coach and former player Paul Green was just 49 when he <a href="https://oversixty.com.au/news/news/rugby-league-icon-dead-at-49" target="_blank" rel="noopener">was found dead</a> at his home in Brisbane on August 11. It is confirmed that the father-of-two died from suicide. His family has now confirmed that his brain will be donated to the <a href="https://www.mycause.com.au/page/290298/in-memory-of-paul-green" target="_blank" rel="noopener">Australian Sports Brain Bank</a> to help aid research into concussion-related condition chronic traumatic encephalopathy (CTE) - a common injury amongst NRL players due to the nature of the game. "In memory of our beloved Paul, we ask that you support the pioneering work of the Australian Sports Brain Bank,” their post read. "Paul was known for always looking out for others. We are proud that part of his legacy will be looking out for the brain health of all others involved in the game that he loved. "Amanda, Emerson and Jed." They are hoping to raise $150,000 to help with the research. Michael Buckland, the director of the Australian Sports Brain Bank, thanked Green’s family for their donation. "This is an incredibly generous donation and will be an invaluable part of our research into the long-term effects of repetitive head impacts in sport and elsewhere," he said. "We at the Australian Sports Brain Bank are blown away by the fact that in their time of grief, Amanda and the rest of the family thought of how they could help others." Green had an incredible NRL career, playing 162 first grade matches between 1994-2004 and winning the prestigious Rothmans Medal in 1995 as the game's best and fairest. He played for several different clubs including Cronulla-Sutherland Sharks, North Queensland Cowboys, Sydney Roosters, Parramatta Eels and the Brisbane Broncos. Green eventually swapped his playing boots to coaching ones as he took on the North Queensland Cowboys from 2014-2020. If you would like to donate to the research, click <a href="https://www.mycause.com.au/page/290298/in-memory-of-paul-green" target="_blank" rel="noopener">here</a>. If you are experiencing a personal crisis or thinking about suicide, you can call Lifeline 131 114 or beyondblue 1300 224 636 or visit <a href="https://www.lifeline.org.au/">lifeline.org.au</a> or <a href="https://www.beyondblue.org.au/">beyondblue.org.au</a>. Image: Australian Sports Brain Bank

Body

Home and Away star opens up on traumatic ordeal

Content warning: This article includes descriptions of mental illness and sexual assault. Home and Away star Mat Stevenson has shared his story about being “drugged and raped” as a teenager in the hope that sharing his experience could help others struggling with their mental health. Stevenson admitted he was “uncomfortable” talking about his experience on Sunday’s episode of <a href="https://7news.com.au/spotlight/former-home-and-away-actor-mat-stevenson-says-he-was-once-drugged-and-raped-in-bombshell-episode-of-spotlight-the-fame-game--c-6702234" target="_blank" rel="noopener">Spotlight: The Fame Game</a>, which tackled the dark side of fame in light of Brummer’s death by suicide in July last year. The actor said he decided to speak out in case his story “helped someone” struggling with their own mental health. “I’m a bit uncomfortable opening up about my life because not many people know about it, but if it’s going to help someone, that whole notion of being vulnerable, then I’m all for it,” Stevenson said. “I was basically drugged and raped and dragged into a spa and I thought I was going to drown, and then woke up naked somewhere. “I was 18. And then I won my role in Neighbours the next day. I was a pretty fit guy back then too, but when you’re paralysed there’s nothing you can do.” The then 18-year-old played Skinner on the show between 1988 and 1989, before landing his breakout role as Adam Cameron in Home and Away. On Sunday’s episode, Stevenson explained that he “suppressed” the traumatic ordeal at the time and “suffered in silence”, with his emotions being expressed as “toxic behaviours” like drinking and gambling. He admitted that, after leaving Home and Away in 1999, he had “wanted to find the bottom” as quickly as he could. “When you’re backing slow racehorses and drinking a lot, they’re two voices that’ll get you where you want to go pretty quickly,” he said. “And when I found the bottom, I rang my brother up to snip him for some cash, and he said, ‘Aren’t you tired of making s**t decisions?’ And I said, ‘Yea. I am, mate. I think I am.” Now, Stevenson describes his life as “bloody good” and that his greatest role has been as a dad to his daughter Grace and her friend Belle Bambi - who he symbolically adopted last year after her father allegedly rejected her for being trans. “My greatest role has been [as] a dad. I’ve come through it. So [Dieter’s] death ripped my heart out and I just don’t want to lose another bloke. So, if you’re suffering, reach out is the message,” he said on the program. If you or anyone you know struggles with topics raised in this article, contact lifeline at any time on 13 11 14 or 1800RESPECT on 1800 737 732. Image: 7News Spotlight

Caring

Tennis legend Pam Shriver opens up on "traumatic" affair

Tennis star Pam Shriver has shared an insight into the “inappropriate” and “traumatic” affair she had with her coach as a teen, hoping her story will prompt tennis organisations to address the “alarmingly common” issue. Shriver wrote about her experience in a column for the <a href="https://www.telegraph.co.uk/tennis/2022/04/20/pam-shriver-exclusive-inappropriate-relationship-50-year-old/" target="_blank" rel="noopener">UK Telegraph</a>, revealing how the relationship she had with her Australian coach Don Candy was “inappropriate and damaging”. <blockquote class="twitter-tweet"> This is not an easy story for me to tell, but it is time. You can listen to my story on the <a href="https://twitter.com/TennisPodcast?ref_src=twsrc%5Etfw">@TennisPodcast</a> - <a href="https://t.co/81m3Ryfwr4">https://t.co/81m3Ryfwr4</a> You can read my story <a href="https://twitter.com/TelegraphSport?ref_src=twsrc%5Etfw">@TelegraphSport</a> - <a href="https://t.co/ckvTF4SSQQ">https://t.co/ckvTF4SSQQ</a> <a href="https://t.co/ZRHJMxPTjg">pic.twitter.com/ZRHJMxPTjg</a> — Pam Shriver (@PHShriver) <a href="https://twitter.com/PHShriver/status/1516753194893778945?ref_src=twsrc%5Etfw">April 20, 2022</a></blockquote> Candy, who passed away in 2020, began working with Shriver when she was just nine years old and coached her when she went through to the final of the US Open at 16. She said she told the 50-year-old she was falling in love with him when she was 17, with the pair going on to have an affair. “My main motivation is to let people know this still goes on - a lot,” she wrote. “I believe abusive coaching relationships are alarmingly common in sport as a whole. My particular experience, though, is in tennis, where I have witnessed dozens of instances in my four-and-a-bit decades as a player and commentator. “Every time I hear about a player who is dating their coach, or I see a male physio working on a female body in the gym, it sets my alarm bells ringing.” Shriver shared that she had “conflicted feelings” about Candy, and that though she wasn’t sexually abused, “there was emotional abuse”. “I felt so many horrendous emotions and I felt so alone. The worst would be my anger and jealousy when his wife came to tournaments,” the 22-time grand slam champion wrote. “It was horrible. I can’t even tell you how many nights I just sobbed in my room - and then had to go out and play a match the next day. “Yes, he and I became involved in a long and inappropriate affair. Yes, he was cheating on his wife. But there was a lot about him that was honest and authentic. And I loved him. Even so, he was the grown-up there. “He should have been the trustworthy adult. In a different world, he would have found a way to keep things professional. Only after therapy did I start to feel a little less responsible. Now, at last, I’ve come to realise that what happened is on him.” Shriver wrote the her ability to form normal relationships had been “stunted” by the affair, which had been a “traumatic experience” for her. “The after-effects lasted far beyond the time we spent together. Our affair shaped my whole experience of romantic life,” she wrote. Though she suggested some possible solutions to the issue, Shriver said she doesn’t have all the answers. “By the time they graduate to the main tennis tour, many patterns have already been set,” she wrote. “And then there’s the coaches. The best way to protect their charges is to put them through an education process before they arrive on tour. “The same goes for other credential-holders: physios, fitness trainers and so on. The point has to be made very clearly: these kinds of relationships are not appropriate, and there will be consequences for those who cross the line.” Image: Getty Images

Relationships

Stroke, cancer and other chronic diseases more likely for those with poor mental health

<a href="https://www.aihw.gov.au/reports-statistics/health-welfare-services/mental-health-services/overview">Four million Australians</a>, including our friends, family members, co-workers and neighbours, are living with mental health conditions, including anxiety and depression. A <a href="https://www.vu.edu.au/australian-health-policy-collaboration/publications#chronic-diseases">new report out today</a> from the <a href="https://www.vu.edu.au/australian-health-policy-collaboration">Australian Health Policy Collaboration</a> has found these four million Australians are at much greater risk of chronic physical disease and much greater risk of early death. Having a mental health condition increases the risk of every major chronic disease. Heart disease, high blood pressure, arthritis, back pain, diabetes, asthma, bronchitis, emphysema and cancer are all much more likely to occur among people with anxiety and depression. More than 2.4 million people have both a mental and at least one physical health condition. For the first time in Australia, this report quantifies the extent of this problem. For example, people with mental health conditions are more likely to have a circulatory system disease (that is, heart disease, high blood pressure and stroke). The likelihood increases by 52% for men, and 41% for women. More than a million people are affected by both a circulatory system disease and a mental health condition. These diseases are Australia’s biggest killers. For painful, debilitating conditions such as arthritis and back pain, the numbers are even higher. Arthritis is 66% more likely for men with mental health conditions, and 46% more likely for women, with 959,000 people affected. Back pain is 74% more likely for men with mental health conditions, and 68% more likely for women, with more than a million affected. The gender differences are significant. Women with mental health conditions are much more likely to have asthma than women across Australia as a whole (70% more likely), while men are 49% more likely to have asthma with a mental health condition. The biggest gender difference is cancer. Men with mental health conditions are 84% more likely to have cancer than the general population, and for women the figure is 20%. As more women live with mental health conditions than men, overall, women are 23% more likely to be living with both a mental and physical health condition than men. The report shows having a co-existing mental health condition and chronic physical disease generally results in worse quality of life, greater functional decline, needing to use more health care and higher healthcare costs. These people require more treatment, use more medications, and have to spend more time, energy and money managing their health. People with a mental health condition are also <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60240-2/abstract">more likely to be poorer</a>, less likely to work, less likely to receive health screening and, sadly, <a href="https://www.rethink.org/media/810988/Rethink%20Mental%20Illness%20-%20Lethal%20Discrimination.pdf">more likely to receive substandard care</a> for their physical diseases. On average, people with mental health conditions die younger than the general population, and mostly from preventable conditions. We know from <a href="https://www.bmj.com/content/346/bmj.f2539">earlier research</a>that people with severe mental illnesses die much earlier than the rest of the population. Our report shows even common mental health conditions such as anxiety and depression contribute to more chronic disease, leading to higher rates of early death. <h2>Why?</h2> We don’t know exactly why people with mental health conditions have poorer physical health. The <a href="https://acmedsci.ac.uk/policy/policy-projects/multimorbidity">Academy of Medical Sciences</a> has identified that poor mental health and psychosocial risk factors such as feeling dissatisfied with life, not feeling calm, having sleep problems that affect work, and financial concerns can predict physical disease. Other factors, such as <a href="https://theconversation.com/low-income-earners-are-more-likely-to-die-early-from-preventable-diseases-87676">low socioeconomic status</a>, poor social networks, living in rural areas and smoking are associated with both poor mental health and poor physical health. We do know people with mental health conditions often don’t receive advice about healthy lifestyles, don’t get common tests for disease, and are less likely to receive treatment for disease. Some of this is due to <a href="https://www.ncbi.nlm.nih.gov/pubmed/21379357">stigma and discrimination</a>, and sometimes it’s neglect. People with mental health conditions can <a href="https://www.ranzcp.org/Files/Publications/RANZCP-Serious-Mental-Illness.aspx">fall through the gaps between disjointed physical and mental health systems</a>. <h2>What can we do about it?</h2> There is <a href="https://www.ranzcp.org/Files/Publications/RANZCP-Keeping-body-and-mind-together.aspx">momentum for change</a> among the mental health sector, with dozens of organisations signing up to the <a href="https://equallywell.org.au/">Equally Well</a> consensus statement. This aims to improve the quality of life of people living with mental illness by providing equal access to quality health care. There’s some great work being done around the country, including in the <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/inm.12459">Hunter region</a>, where people with mental health conditions can access tailored help with physical health risk factors such as smoking and diet. People using mental health services should have their physical health regularly assessed, and any problems addressed as early as possible. Better coordination of care would preserve healthcare resources and improve quality of life. Image credits: Getty Images This article originally appeared on <a href="https://theconversation.com/stroke-cancer-and-other-chronic-diseases-more-likely-for-those-with-poor-mental-health-100955" target="_blank" rel="noopener">The Conversation</a>.

Mind

Midlife chronic conditions associated with higher dementia risk as we age

Middle-aged people with multiple chronic conditions may have a higher risk of developing dementia later in life according to a new study. French researchers <a href="https://www.scimex.org/newsfeed/midlife-chronic-conditions-linked-to-increased-dementia-risk-later-in-life" target="_blank" rel="noopener">found</a> that middle aged people with at least two chronic conditions - including diabetes, high blood pressure, coronary heart disease and chronic lung disease (COPD) - have a higher risk of dementia than those who develop these conditions when they are older. While studies have shown that having two or more chronic conditions - known as multimorbidity - is common, especially among older people and those with dementia, little is known about how multimorbidity affects one’s risk of dementia. The new study, published in the <a href="https://doi.org/10.1136/bmj-2021-068005" target="_blank" rel="noopener">BMJ</a>, saw the team use data collected from over 10,000 British men and women involved in the Whitehall II Study, which looks at the association between social, behavioural and biological factors and long-term health. Of the 10,095 participants in the study, about 600 people (6.6 percent) had multimorbidity at 55, while 3200 people (32 percent) did by 70. When participants first joined the study between the ages of 35 and 55, they were free of dementia. Over a median follow-up period of 32 years, the team identified 639 people with dementia. The researchers then found that, considering factors such as age, sex, diet and lifestyle, people with multimorbidity at 55 had a 2.4-times higher risk of dementia compared to those without any of the 13 chronic conditions they looked at. They also found that this association weakened as the age that people were diagnosed with multiple chronic conditions increased. Though the team did find an association between age, multimorbidity and dementia risk, they stressed it was an observational study that can’t establish cause and effect. They also noted some limitations to their study, such as the misclassification of some dementia cases, and that the study participants were likely to be healthier than the general population. Despite these limitations, the researchers said their findings could be promising for finding ways of preventing dementia. “Given the lack of effective treatment and its personal and societal implications, finding targets for prevention of dementia is imperative,” they write. “These findings highlight the role of prevention and management of chronic diseases over the course of adulthood to mitigate adverse outcomes in old age.” Image: Getty Images

Body

Coffee may prevent chronic liver disease

<div class="copy"> Drinking coffee – whichever way you take it – may reduce the risk of liver disease, according to a new <a rel="noreferrer noopener" href="https://doi.org/10.1186/s12889-021-10991-7" target="_blank">study</a> published in the journal BMC Public Health. A team of researchers, from the universities of Southampton and Edinburgh in the UK, analysed <a rel="noreferrer noopener" href="https://www.ukbiobank.ac.uk/" target="_blank">UK Biobank</a> data on 495,585 participants, followed over roughly 11 years, to monitor the development of chronic liver disease and its relationship to coffee consumption. Coffee drinkers had a 21% reduced risk of chronic liver disease and a 49% reduced risk of death from liver disease, according to the study. The maximum benefit was found among those who drank ground coffee, which contains high levels of the ingredients kahweol and cafestol – which have been <a rel="noreferrer noopener" href="https://pubmed.ncbi.nlm.nih.gov/17590492/" target="_blank">shown</a> to be beneficial against liver disease in animal trials. But even instant coffee, which has low levels of these two key ingredients, had a marked benefit in reducing risk of liver disease, suggesting other ingredients or combinations are also beneficial. The find is important because chronic liver disease is a <a rel="noreferrer noopener" href="https://www.ncbi.nlm.nih.gov/books/NBK554597/" target="_blank">growing cause</a> of morbidity and mortality worldwide. “Coffee is widely accessible and the benefits we see from our study may mean it could offer a potential preventative treatment for chronic liver disease,” says lead author Oliver Kennedy, of the University of Southampton. “This would be especially valuable in countries with lower income and worse access to healthcare and where the burden of chronic liver disease is highest.” Coffee has <a rel="noreferrer noopener" href="https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/coffee-and-health/faq-20058339" target="_blank">often had a bad rap</a>, with early studies suggesting negative health impacts and a <a rel="noreferrer noopener" href="https://hellogiggles.com/lifestyle/health-fitness/health-benefits-caffeine-free/" target="_blank">bevy</a> of health gurus and online blogs espousing the benefits of abandoning the drink. But in recent years, a number of studies have demonstrated the potential benefits of coffee against a range of illnesses, including <a rel="noreferrer noopener" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1125458/" target="_blank">Parkinson’s disease</a>, <a rel="noreferrer noopener" href="https://care.diabetesjournals.org/content/29/2/398" target="_blank">type 2 diabetes</a>, and <a rel="noreferrer noopener" href="https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.119.006799" target="_blank">heart failure</a>. The authors conducted their research based on the “biological plausibility” of coffee as a preventive factor in liver disease. Caffeine is a non-selective antagonist of the A2aA receptor. When activated, the A2aA receptor stimulates collagen production by hepatic stellate cells, which mitigate against liver fibrosis. Other active ingredients including kahweol, cafestol and chlorogenic acid have also been shown to protect against fibrosis in animal studies. The authors note that coffee consumption was only reported at initial enrolment into the study, so long-term changes in consumption are not accounted for. The participants in the study were also predominantly white and from higher socio-economic backgrounds, skewing the results towards particular physiologies and lifestyle factors, highlighting the need for further research. Image credits: Getty Images </div> <div id="contributors"> This article was originally published on <a href="https://cosmosmagazine.com/health/coffee-may-prevent-chronic-liver-disease/">cosmosmagazine.com</a> and was written by Amalyah Hart. </div>

Body

Physical symptoms linked to genetic risk of depression

People who experience physical symptoms such as chronic pain, fatigue and migraines are also more likely to have a higher genetic risk of clinical depression, according to a new study. Researchers from the University of Queensland collaborated with the QIMR Berghofer Medical Research Institute at the Royal Brisbane and Women’s Hospital to conduct a new study published in <a rel="noopener" href="https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2783096" target="_blank">JAMA Psychiatry</a>. They analysed data from over 15,000 volunteers, who provided information about their mental health history, depression symptoms, and a DNA sample. The team found that participants who had a higher genetic risk of developing clinical depression were more likely to experience additional physical symptoms. Dr Enda Byrne, a senior research fellow in psychiatric genetics and one of the researchers involved, said the study aimed to improve understanding of the genetic risks of depression and how other symptoms can be used to aid diagnosis. <img style="width: 500px; height: 281.25px;" src="https://oversixtydev.blob.core.windows.net/media/7845012/depression1.jpg" alt="" data-udi="umb://media/e08ca3fc9f134a3c8fb3556dde363b83" /> Dr Enda Byrnes, the senior author of the latest study on depression and genetic risk. Image: The University of Queensland “A large proportion of people with clinically-diagnosed depression present initially to doctors with physical symptoms that cause distress and can severely impact on people’s quality of life,” <a rel="noopener" href="https://www.scimex.org/newsfeed/genetic-risk-for-clinical-depression-linked-to-physical-symptoms" target="_blank">he said</a>. “Our research aimed to better understand the biological basis of depression and found that assessing a broad range of symptoms was important. “We wanted to see how genetic risk factors based on clinical definitions of depression differed - from those based on a single question to those based on a doctor’s consultation about mental health problems.” Genetic risks of depression, explained Many different factors can contribute to the onset of depression, and there is strong evidence to suggest that genetics can affect the likelihood of developing the mental illness. Individuals can be predisposed to developing depression if someone in their family has been diagnosed. If a person’s biological parent has been diagnosed with clinical depression, their genetic risk of developing the illness sits at <a rel="noopener" href="https://www.blackdoginstitute.org.au/wp-content/uploads/2020/04/1-causesofdepression.pdf" target="_blank">about 40 percent</a>, with the other 60 percent coming from factors in their environment such as stress and age. Previous studies have also examined the role genetics plays in depression, but Dr Byrne said it can be difficult to find genetic risk factors that are specific to clinical depression. “Previous genetic studies have included participants who report having seen a doctor for worries or tension - but who may not meet the ‘official’ criteria for a diagnosis of depression,” he said. The researchers also stressed the importance of using a large number of samples in order to identify the risk factors for clinical depression but not for other definitions of depression. “It is also linked to higher rates of somatic symptoms - that is, physical symptoms that cause distress and can severely impact on people’s quality of life,” Dr Byrne said. “Our results highlight the need for larger studies investigating the broad range of symptoms experienced by people with depression.” Image: Getty Images

Mind

Pain and the brain: Closing the gap between modern pain science and clinical practice

<div> <div class="copy"> Statistics show that chronic pain affects 3.4 million Australians – that’s almost 14% of the population. But while pain science discoveries have enormous consequences on chronic pain treatment, the medical community knows little about them. Pain scientists have been urging clinicians for decades to ditch the traditional biomedical approach and adopt a multidisciplinary and multimodal methodology to chronic pain treatment. This latter approach considers the biological, psychological and social factors that affect the patient’s perception of danger. Evidence-based treatment includes a <a rel="noreferrer noopener" href="https://www.sciencedirect.com/science/article/pii/S0004951414601690?via%3Dihub" target="_blank">combination</a> of pharmacological and non-pharmacological techniques, including pain education, physiotherapy management and mental health support. “We have developed a four-steps process that brings together all these ideas (drawn from modern pain science),” says Professor Benedict Wand, a pain scientist at the University of Notre Dame. The first, fundamental step of this process, he says, is modern pain neurobiology education, which helps people gain a less threatening understanding of pain. The second step is helping the person feel safe to move, while the third step includes an active progressive rehabilitation that gradually loads the body so that movement continues to feel safe. Lastly, the focus shifts towards making the body stronger. Read more: <a rel="noreferrer noopener" href="https://cosmosmagazine.com/health/medicine/chronic-pain-in-women-could-be-genetic/" target="_blank">Chronic pain in women could be genetic</a> The biomedical model in which most health professionals in Australia have been trained describes pain as a direct consequence of tissue damage – the more severe an injury, the stronger the pain. In this model, pain provides an accurate measure of the state of the tissues, and it can be ‘fixed’ by providing pain relief. “We originally thought that pain was a simple readout of noxious information from the body,” says Wand. “But that is certainly not the process that underpins complex and long-standing pain experiences.” Decades of <a rel="noreferrer noopener" href="http://www.cor-kinetic.com/wp-content/uploads/2014/04/reconceptualizing-pain.pdf" target="_blank">research</a> in pain science have led scientists to believe that the level of pain is not an indication of the level of tissue damage. Instead, scientists have discovered that pain is a vital mechanism that happens in the brain (and not in the tissues) to protect us from more severe injuries. When we get hurt, pain receptors send a ‘possible threat’ signal to the brain, which then evaluates the danger of the threat by drawing information from current and past experiences and the state of the mind. If the brain does not perceive the circumstance as dangerous, it will not cause pain. If we are anxious or frightened, our brain might perceive the situation as dangerous and produce pain to protect us. “An interaction between incoming information from the world around you and held information – things that you already think and feel and believe – gives rise to an experience of pain when you judge your body to be under threat or needing protection,” says Wand. In one <a rel="noreferrer noopener" href="https://journals.lww.com/pain/Fulltext/2007/12150/The_context_of_a_noxious_stimulus_affects_the_pain.9.aspx" target="_blank">study</a>, scientists placed an ice-cold rod on the back of volunteers’ hands while showing them either a red or blue light. The rod was at the same temperature each time, but those who were shown the red light, which in our imagery represents danger, reported more intense pain than those who saw the blue light. In another <a rel="noreferrer noopener" href="https://journals.lww.com/pain/Fulltext/1998/01000/The_role_of_prior_pain_experience_and_expectancy.24.aspx" target="_blank">experiment</a>, volunteers put their heads inside what they thought was a ‘head stimulator’. In front of them, researchers manoeuvred an ‘intensity knob’. The volunteers reported levels of pain that correlated with the intensity on the knob, although the stimulator was doing nothing at all. These studies suggest that pain is not a response to real danger or physical damage but to perceived danger, says Professor Lorimer Moseley, a pain scientist at the University of South Australia. Consequently, psychosocial factors that alter our perception of threat play a crucial role in the level of pain we experience. When pain becomes chronic, it is less about physical damage and more about a pain system that has become excessively protective. A physical cause of the pain might never be found in scans, yet the pain people feel is real, says Moseley. <h2>Go the distance for pain science</h2> While lack of access to multidisciplinary pain services is a countrywide issue, rural and regional areas are severely underserved. Pain Revolution is <a rel="noreferrer noopener" href="https://www.painrevolution.org/" target="_blank">an organisation</a> set up to close the gap between modern pain science and clinical practice in rural and regional communities. The organisation has established a Local Pain Educator Program that trains rural and regional GPs and health professionals in modern pain science and management. In turn, they support their communities by providing pain education to the public. With another project called the Local Pain Collectives, Pain Revolution helps rural and regional health professionals establish community-based, interdisciplinary networks to build their skills in contemporary pain education and management. “Two essential ingredients for recovery from persistent pain are learning and movement,” says Moseley, who is also CEO of Pain Revolution. “There is very strong evidence that movement is medicine. Our muscles, bones, ligaments, skin, tendons – you name it – love movement.” To support its work, Pain Revolution has launched a virtual challenge to raise funds called Go the Distance. “Go the Distance is challenging everyone to learn a bit more about pain and get moving, and walking, running and cycling are three easy ways to do it,” says Moseley. The initiative has replaced the annual Rural Outreach Tour, which had previously been the major Pain Revolution fundraiser. “Like many events in 2021, COVID has meant that we had to find an alternative to the tour,” says Moseley. The initiative will be held in October, and it challenges participants to walk, run or ride as far as possible to support people who suffer from chronic pain and often don’t receive medical care that is based on the latest scientific evidence. If you want to help, support our science writer Manuela Callari, who has taken the challenge, by donating <a rel="noreferrer noopener" href="https://painrevolution.raisely.com/manuela-callari" target="_blank">here</a>. If you want to sign up as an individual, or join a team, go to <a rel="noreferrer noopener" href="http://painrevolution.raisely.com/" target="_blank">painrevolution.raisely.com</a>. Image credit: Shutterstock This article was originally published by <a rel="noopener" href="https://cosmosmagazine.com/health/pain-and-the-brain-closing-the-gap-between-modern-pain-science-and-clinical-practice/" target="_blank">cosmosmagazine.com</a> and was written by Dr Manuela Callari. </div> </div>

Body

Chronic pain could be changing your brain

The way we feel - whether it’s happiness, irritation or any other emotion - has been found to be a balancing act between two chemical messengers in our brains. But, for the more than 3 million Australians who experience chronic pain, new research has found the likelihood of experiencing negative emotions more often than positive ones is higher. The new study, which used advanced imaging techniques to scan the brains of volunteers with and without a history of chronic pain, saw that those affected by chronic pain tend to be more anxious and depressed due to disruptions in the communication between cells. “Chronic pain is more than an awful sensation,” <a rel="noopener" href="https://newsroom.unsw.edu.au/news/science-tech/chronic-pain-might-impact-how-brain-processes-emotions" target="_blank">says</a> Associate Professor Sylvia Gustin, the senior author of the new study and a neuroscientist and psychologist at the University of New South Wales and NeuRA. “It can affect our feelings, beliefs and the way we are.” What happens in the brain Emotions are processed by many different areas in the brain, which work together as a network. These regions include the amygdala (responsible for handling positive and negative information), and the prefrontal cortex (which helps us regulate our emotions). For example, when something frightening is happening, the amygdala sends that information to the prefrontal cortex, which decides whether to communicate with other areas of the brain so you can run away or react in other ways. This communication requires the help of chemical ‘messengers’ called neurotransmitters, which both help in sending messages between cells and regulating everything from mood to appetite.. One neurotransmitter called gamma-aminobutyric acid (GABA) can stop neurons from becoming over excited to limit communication between the amygdala and the prefrontal cortex. A second, called glutamate, can excite them. These neurotransmitters work together to regulate mood, so that our feelings help motivate us to take action when we need to, without feeling overwhelmed or overly anxious. <img style="width: 500px; height: 499.99999999999994px;" src="https://oversixtydev.blob.core.windows.net/media/7842887/gettyimages-1030518600.jpg" alt="" data-udi="umb://media/47371b7ecc6f445b94f92f194fa15a0c" /> Image: Getty Images In previous studies on animal models, scientists found that subjects in pain experience varying levels of glutamate. Similarly, a <a rel="noopener" href="https://pubmed.ncbi.nlm.nih.gov/31849800/" target="_blank">decrease in glutamate</a> has also been seen in humans experiencing chronic pain, matching a decline in their emotional regulation. However, changes in the amount of GABA in subjects experiencing pain has only been seen in mice, which is where this new study comes in. The study By scanning the brains of 48 participants with and without chronic pain, the scientists were able to determine whether the levels of GABA differed when someone was in pain and not in pain. Though the sample size isn’t large, the study does show enough evidence to support the view that being in pain for a long period of time changes how the brain processes emotions. “We have discovered, for the first time, that ongoing pain is associated with a decrease in GABA, an inhibitive neurotransmitter in the medial prefrontal cortex. In other words, there’s an actual pathological change going on,” Gustin says. <blockquote 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);" class="instagram-media" data-instgrm-captioned="" data-instgrm-permalink="https://www.instagram.com/p/CR3BpqlK9kg/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="13"> <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> <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;" rel="noopener" href="https://www.instagram.com/p/CR3BpqlK9kg/?utm_source=ig_embed&utm_campaign=loading" target="_blank">A post shared by NeuRA (@neuraustralia)</a> </div> </blockquote> With lower levels of GABA, it can become harder to dampen the thought processes which deal with our emotional responses and reasoned-out thoughts and actions. Why it matters Understanding how pain affects our emotions in the long term can help researchers develop ways to manage its effects, including poorer sleep, additional stress, and feelings of guilt. “It’s important to remember it’s not you - there’s actually something physically happening to your brain,” says Gustin. “The brain can’t dampen down these feelings on its own, but it is plastic - and we can learn to change it.” This research was published in the <a rel="noopener" href="https://onlinelibrary.wiley.com/doi/10.1002/ejp.1838" target="_blank">European Journal of Pain</a>.

Mind

Glenn Close opens up about traumatic cult childhood

Glenn Close is opening up about her past. As a respected actress in Hollywood, many know that the 74-year-old has been nominated for an Oscar eight times, but what is relatively unknown in comparison is her upbringing in a movement called Moral Re-Armament (MRA), which has been described as cult-like. “It’s astounding that something you go through at such a young stage in your life still has such a potential to be destructive,” the star said during an interview on Prince Harry and Opray Winfrey's new Apple TV+ series The Me You Can't See. “I think that’s childhood trauma, because of the devastation, emotional and psychological, of the cult,” she added. “I am psychologically traumatised.” Close said that her father William became involved in the movement when she was just a child and took their family to the MRA's Switzerland headquarters. The family lived their for two years while William worked as a doctor in Africa. Ultimately, the family would be involved with the organisation for about 15 years. “It was basically a cult. Everyone spouted the same things, and there’s a lot of rules, a lot of control,” recalled Close. ”Because of how we were raised, anything you thought you’d do for yourself was considered selfish. We never went on any vacations or had any collective memories of stuff other than what we went through, which was really awful.” She said the way she was raised had lasting effects on her, and even played a role in her relationships. Close has been married and divorced three times, and also shares a daughter, Annie, with a previous long-time partner. “I have not been successful in my relationships and finding a permanent partner, and I’m sorry about that,” she explained. “I think it’s our natural state to be connected like that. I don’t think you ever change your trigger points, but at least you can be aware of them, and at least you can maybe avoid situations that might make you vulnerable, especially in relationships.” She joked: “It’s probably why we all have our dogs.” At the age of 22, Close left the organisation and went to William & Mary College in Virginia to study drama. Close mentioned that she ended up in therapy to help treat the issues brought on by her upbringing and also went on to reveal the mental health issues her family faced. Her sister Jessie has been diagnosed with bipolar disorder and her nephew suffers from schizophrenia. “Jessie was always considered the wild one, the rebel, but when she came up to me one summer at my parents’ house in Wyoming, her kids were already in the car, and she came up to me and said, ‘I need help, I can’t stop thinking about killing myself,’ and for me it was a shock,” the star said. “She ended up in hospital. I took her there. She was finally at age 50 properly diagnosed with bipolar one with psychotic tendencies.”

Caring

Ashley Judd opens up about traumatic incident in Congo jungle

Ashley Judd has gone into detail about her horrific experience after shattering her leg in the Congolese jungle, revealing it was locals who saved her. The beloved actress, who was in the Congo to track endangered Bonobos, explained that she sustained “massive catastrophic injuries” after tripping over a fallen tree. “What was next was an incredibly harrowing 55 hours,” she said. She then told fans how she lay on the forest floor in agony, with the belief that her “internal bleeding would have likely killed her". However, she says she owes all her thanks to a man named Dieumerci, who “stretched out his leg and put it under my grossly misshapen left leg to try to keep it still. It was broken in four places and had nerve damage. Dieumerci (“Thanks be to God”) remained seated, without fidgeting or flinching, for five hours on the rainforest floor.” The actress then described another local man named Papa Jean who spent five hours searching for her, gave her a stick to bite on, then went on to readjust the shattered pieces of her leg. “It took five hours, but eventually he found me, wretched and wild on the ground, and calmly assessed my broken leg. He told me what he had to do,” she wrote. “I bit a stick. I held onto Maud. And Papa Jean, with certainty, began to manipulate and adjust my broken bones back into something like a position I could be transported in, while I screamed and writhed. How he did that so methodically while I was like an animal is beyond me. He saved me.” <blockquote 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);" class="instagram-media" data-instgrm-permalink="https://www.instagram.com/p/CLW2-QohZps/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="13"> <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> <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;" rel="noopener" href="https://www.instagram.com/p/CLW2-QohZps/?utm_source=ig_embed&utm_campaign=loading" target="_blank">A post shared by Ashley Judd (@ashley_judd)</a> </div> </blockquote> She then went on to say a group of men improvised a hammock and spent three hours carrying Judd through the forest to find transportation. The actress’ story does not end there though, as she told fans that her dear friend, a man named Maradona, volunteered to ride with her for six hours on a motorbike and kept her from falling off. She wrote: “Didier drove the motorbike. I sat facing backwards, his back my backrest. When I would begin to slump, to pass out, he would call to me to re-set my position to lean on him. Maradona rode on the very back of the motorbike, I faced him. “He held my broken leg under the heel and I held the shattered top part together with my two hands. Together we did this for six hours on an irregular, rutted and pocked dirt road that has gullies for rain run off during the rainy season. Maradona was the only person to come forward to volunteer for this task.” Judd wrote that she made the decision to come forward about the accident as a way to spread the word about “what it means to be Congolese in extreme poverty with no access to health care, any medication for pain, any type of service, or choices.” “The difference between a Congolese person and me is disaster insurance that allowed me, 55 hours after my accident, to get to an operating table in South Africa,” she says, adding that villages in <a rel="noopener" href="https://deadline.com/tag/congo/" target="_blank">Congo</a> lack not only electricity but “a simple pill to kill the pain when you’ve shattered a leg in four places and have nerve damage.” The actress now lies in her hospital bed in South Africa, saying: “I wake up weeping in gratitude, deeply moved by each person who contributed something life giving and spirit salving during my gruelling 55 hour odyssey.”

Caring

Why a friend's death can be as traumatic as losing a family member

The death of a friend is a loss that most people face at some point in their lives – often many times. But it is a grief that may not be taken seriously by employers, doctors or others. The so-called <a href="https://journals.sagepub.com/doi/abs/10.2190/om.66.2.a">hierarchy of grief</a>, a scale used to determine who is considered a more legitimate mourner than others, puts family members at the top. For this reason, the death of a close friend can feel shunted to the periphery and has been described as a <a href="https://www.tandfonline.com/doi/abs/10.1080/02682629908657467?journalCode=rber20&">disenfranchised grief</a>. There has not been much research on the impact the death of a friend has on a person, so we set out to address this with our <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0214838">latest study</a>. We discovered that, far from being a trivial loss, the health and well-being of people who lose a close friend has a heavy toll in the four years after that loss. For our study, published in PLOS ONE, we analysed responses from an Australian <a href="https://melbourneinstitute.unimelb.edu.au/hilda">household survey</a> of more than 26,000 people. Of the people who completed the survey, over 9,500 had experienced the death of a close friend. Our analysis showed that life satisfaction of the bereaved fell sharply (figure 1) compared with a matched non-bereaved group. There is a large and sharp drop in this life satisfaction from month three to nine and another smaller yet still sizeable drop at months 19 to 21. <img src="https://images.theconversation.com/files/273318/original/file-20190508-183100-1n93aql.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" alt="" /> Figure 1. Life satisfaction. Author provided In the graph below, the impact on general health is shown comparing the bereaved group with a matched non-bereaved group. You can see the bereaved group tracking clearly lower than the non-bereaved for 24 months, an effect that continues for four years. <img src="https://images.theconversation.com/files/273330/original/file-20190508-183089-1wj8ffj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" alt="" /> Figure 2. General health. Author provided Social functioning and mental health are also worse after the death of a friend, which you can see in the final two graphs. <img src="https://images.theconversation.com/files/273331/original/file-20190508-183112-1gyx3ls.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" alt="" /> Figure 3. Social functioning. Author provided <img src="https://images.theconversation.com/files/273334/original/file-20190508-183109-m4cdnb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" alt="" /> Figure 4. Mental health. Author provided These findings suggest we need to take the death of a close friend more seriously and to change the way we support people who are suffering from such a bereavement. Friends are <a href="https://asu.pure.elsevier.com/en/publications/is-friendship-akin-to-kinship">psychological kin</a>, that is, you may even have a stronger bond with friends than people you are related to by birth or marriage. So when a friend dies, the psychological and emotional stress can be as bad as the death of kin. Our analysis shows that if you’re not socially active, the death of a friend can make the impact of the bereavement worse. As your social circle shrinks, you become less resilient to grief because you lose a key source of emotional support from your social network. Challenging the myths The folklore that feelings of sadness and loss reduce considerably after a year also needs to be challenged. Although there are improvements in health and getting on with everyday life, the longer-term effects on mental health and well-being cannot be ignored. This is especially worrying for disenfranchised grief – not only are there marked and enduring long-term effects, but there’s also little recognition that the bereavement was significant. Mental health professionals and employers should now acknowledge the significant effect the death of a friend can have on a person and offer appropriate services and support. The psychological help bereaved people receive is not the same across the board, and this needs to change as we begin to accept the idea that close friends can be considered as psychological kin.<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; text-shadow: none !important;" src="https://counter.theconversation.com/content/116474/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> Written by Liz Forbat, Associate Professor of Ageing, University of Stirling and Wai-Man Liu, Associate Professor, Research School of Finance, Actuarial Studies and Statistics, Australian National University. Republished with permission of <a href="https://theconversation.com/when-a-friend-dies-the-impact-can-be-as-traumatic-as-losing-a-family-member-116474">The Conversation</a>.

Relationships

11 things to never say to someone with chronic pain

When someone you care about is living with pain, the most important thing you can do is to support them with understanding. But that’s not always easy. Sydney pain medicine specialist Dr Charlotte Johnstone says, “People tend to talk down to others in chronic pain and try to ‘manage them’ or tell them what they should do – and that closes the conversation.” Instead aim to keep the conversation going, she advises. Allow the person in pain to say what’s wrong and respond in a way that shows you’ve listened. Here’s what not to say - and what they might like to hear instead. 1. “Snap out of it.” In an ideal world we would all have the ability to shake off a black mood or “focus on the positive”. However, pain can feel very isolating. Do you really want to make someone you care about feel even worse because they can’t “brighten up” or “forget about it”, just to make you feel better? Johnstone suggests you avoid asking questions with yes or no answers as they don’t encourage conversation. Instead you could say, “It sounds to me like you’ve had a difficult day and you managed it (this way). How do you think you’re going to handle the rest of the day?” 2. “Well, you don’t look sick.” It’s too easy for someone to misread your incredulity. Are you insinuating they’re putting it on? Or are you being a little patronising because it isn’t true? Instead try asking, “How are you today?” This gives someone who’s already feeling misunderstood, an opportunity to share their feelings. 3. “There’s always someone worse off.” Or just as bad is: “We all have bad days” or, “At least it isn’t cancer.” While you may be trying to give a bit of perspective, you’ll only undercut the emotional and physical pain of the other person. It’s better to concentrate on the positives of your friendship. “Highlight the things you appreciate or you can see they’re doing really well,” suggests Johnstone. Try: “It sounds like you’ve had a tough day today but it’s really nice we can spend some time together now.” 4. “Have you tried …” The reality is they probably are already investigating every possible option. It’s possible nothing will ever erase or even manage their pain and they know it. If you really have to go there, then instead try something like, “You must be driven mad by all these hare-brained cures that people come up with, but every now and then they do seem to work for some people.” 5. “Just don’t think about it and you’ll feel better.” So snapping the elastic band on your wrist distracted you when you were trying to cut back on sugar. That’s great. However, when your loved one’s best day is the equivalent of your worst day, you‘re not exactly on a level playing field. If you really do want to say something, try, “A lot of people say that relaxation or meditation works for them. Have you ever thought of trying it?” Clinical psychologist and pain specialist Toby Newton-John adds, “Be careful not to suggest their pain is psychological, or suggest they see a psychologist without being given ‘permission’ to talk about the emotional affect of their pain. People with chronic pain are often sensitive about either being not seen as genuine - or being ‘weak minded’. A good strategy is to mention your own positive experiences with a psychologist or ask if they’re feeling ‘stressed’, as this is a more neutral word.” 6. “Let me know if I can do anything to help.” The thought is a good one, however try offering something specific such as, “I’d honestly love to help. How about I do your laundry and take your dog for a walk once a week?” Or get into the habit of calling or texting when you’re going to the shops to see if they need anything. 7. “At least you don’t have to go to work/school.” Telling someone with chronic pain that they’re lucky they don’t have to go to work is as insensitive as saying to someone with no legs, “You’re lucky you don’t have to walk up the stairs.” They’re probably dreaming of the time they’re well enough to have something else to fill their day. 8. “Things will get better soon.” Even if things do eventually turn around, your loved one isn’t in the head space to think about some magical time in the future. Your hopes are likely to be taken as annoying. “Do give positive feedback,” advises Newton-John, “but make it about them. Say something like, ‘I really admire the way you do X. Or ‘I think you’re remarkable for coping how you do.” 9. “Wow! You’ve lost so much weight.” Remember the reason behind the weight loss is likely to be associated with their pain so it isn’t necessarily a cause for celebration. Instead try saying, “You look really fit” (but only if it’s true). 10. “Are you in pain because you…” Even if your loved one’s back may hurt them a little more because they’re carrying a few extra kilos, do you really think pointing this out is being supportive? Newton-John adds, “As much as you might be genuinely concerned, enquiring about the cause of someone’s pain is not always helpful or respectful. If they want to tell you about it they will. A lot of people don’t want their pain to define them.” 11. “I feel so sorry for you.” There’s a massive difference between pity and empathy. Instead saying, “I’m here for you,” is always a good option. Newton-John adds, “If you want to convey your empathy then say ‘I admire how well you cope.’” When in doubt? Smile, hug your friend or family member, say “I love you” or “I’m here for you”, hold their hand, sit and truly listen. Written by [AUTHOR]. This article first appeared in <a href="http://www.readersdigest.com.au/healthsmart/tips/11-Things-to-Never-Say-to-Someone-With-Chronic-Pain">Reader’s Digest.</a> For more of what you love from the world’s best-loved magazine, <a href="http://readersdigest.innovations.co.nz/c/readersdigestemailsubscribe?utm_source=over60&utm_medium=articles&utm_campaign=RDSUB&keycode=WRN87V">here’s our subscription offer.</a> <img style="width: 100px !important; height: 100px !important;" src="https://oversixtydev.blob.core.windows.net/media/7820640/1.png" alt="" data-udi="umb://media/f30947086c8e47b89cb076eb5bb9b3e2" />

Caring

How chronic stress can help cancer spread

Rik Thompson, Professor of Breast Cancer Research, Institute of Health and Biomedical Innovation and School of Biomedical Sciences, Queensland University of Technology and Sandra Hayes, Professor, School of Public Health and Social Work, Queensland University of Technology, explain how chronic stress can help cancer spread. Chronic stress accelerates cancer growth in mice, according to a <a href="http://www.nature.com/ncomms/2016/160301/ncomms10634/full/ncomms10634.html" target="_blank">paper published in Nature Communications</a> this week. The finding points to potential treatment targets to slow the progression of cancer to other organs. The paper revealed findings from several studies, mostly on mice, conducted by a team of researchers from Monash University. Chronic stress refers to prolonged, repeated exposure to stressful situations, such as caring for a sick relative for a long period of time. To mimic the way people feel under significant stress, researchers restrained mice with breast cancer tumours, to make them feel like they couldn’t cope with their circumstances. Over time, the mice developed an increase in the number and size of of their lymphatic vessels – a network of vessels that transports fluid around the body. This enhanced the spread of cancer cells to new sites, a process called cancer progression or metastasis. By blocking the activity of proteins that detect stress, or those that enhance the formation of lymphatic vessels, researchers found they could reduce the spread of cancer cells in the mice. What stress does to the body The research focused on metastasis of breast cancer to other parts of the body, building on previous findings that neurological stress hinders our defence against disease. Previous findings <a href="http://www.nature.com/nrclinonc/journal/v5/n8/full/ncponc1134.html" target="_blank">from human studies</a> have shown poorer cancer survival in people exposed to stressful life experiences and those more prone to stress. Another <a href="http://onlinelibrary.wiley.com/doi/10.1002/cncr.23969/abstract;jsessionid=5F1E795CA48D6B71FC0A85B45799D348.f04t03" target="_blank">clinical trial</a> showed better survival rates for breast cancer patients in remission who participated in a 12-month intervention with strategies to reduce stress, improve mood and alter health behaviours. Everyday stressful experiences pose a threat to the body’s natural balance. This is because stress activates the <a href="https://www.sciencedaily.com/terms/sympathetic_nervous_system.htm" target="_blank">sympathetic nervous system (SNS)</a>, which is responsible for what we know as the fight or flight response. Under stress, the SNS releases higher levels of neurotransmitters. These hormones, such as epinephrine, signal to other cells to activate physiological flight or flight responses, such as a faster heart rate. This is important during times of threat because it makes us more alert and increases physiological functions needed for rapid reactions. But as shown in the Nature Communications study, chronic periods of stress can lead to changes in the lymphatic system. These include an increase in the number of vessels in the tumours as well as the size of these vessels. These changes are associated with the spread of cancer cells to lymph nodes and distant organs, such as the lung. Clinically, we know that when cancer cells have spread through blood vessels into the lymph vessels, that’s an important indicator of poorer prognosis. Preventing this could improve survival rates. It’s not so simple The latest findings have obvious treatment implications, which include using drugs to block stress responses that lead to changes in lymphatic vessels. But blocking any part of a natural pathway can promote a cascade of negative effects. The study reported that a number of patients on drugs often used to treat anxiety and high blood pressure (beta blockers that block the actions of adrenaline) were less likely to have secondary cancer that had spread from its primary site. This is good news, but more work is needed before such interventions can be further tested. This is because the lymphatic system is important in our immune response and manipulating any of its mechanisms could carry potential harms. These include limiting the immune system’s ability to respond to the cancer in the first place. It could also increase the risk of lymphedema – swelling in one or more extremities – that results from impaired flow of the lymphatic system. Although the authors did show supportive data from human clinical subjects, the bulk of the work was done in mouse models. Results from mice experiments don’t always translate to human systems, so further clinical testing is an essential step in translating these findings. Overall, though, the study points the way to potentially helping prevent cancer spreading so far from the original site that it’s too hard to treat. What are your thoughts? Written by Ric Thompson and Sandra Hayes. Republished with permission of <a href="http://www.theconversation.com" target="_blank">The Conversation</a>.<img width="1" height="1" src="https://counter.theconversation.com/content/55619/count.gif?distributor=republish-lightbox-advanced" alt="The Conversation"/>

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Surgery won’t fix my chronic back pain, so what will?

Why do I keep getting urinary tract infections? And why are chronic UTIs so hard to treat?

"I was terrified": Law & Order star reveals traumatic past

90-year-old-with chronic leukaemia skydives for charity

Could mobile phones revolutionise chronic wound treatment?

“It’s not easy”: Michael Klim shares health update

Paul Green’s brain donated to science

Home and Away star opens up on traumatic ordeal

Tennis legend Pam Shriver opens up on "traumatic" affair

Stroke, cancer and other chronic diseases more likely for those with poor mental health

Midlife chronic conditions associated with higher dementia risk as we age

Coffee may prevent chronic liver disease

Physical symptoms linked to genetic risk of depression

Pain and the brain: Closing the gap between modern pain science and clinical practice

Chronic pain could be changing your brain

Glenn Close opens up about traumatic cult childhood

Ashley Judd opens up about traumatic incident in Congo jungle

Why a friend's death can be as traumatic as losing a family member

11 things to never say to someone with chronic pain

How chronic stress can help cancer spread

News

Shop

Catalogues

Travel

Health

Lifestyle

Finance

Entertainment

Property

Information

Keep up to date

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Surgery won’t fix my chronic back pain, so what will?

Why do I keep getting urinary tract infections? And why are chronic UTIs so hard to treat?

"I was terrified": Law & Order star reveals traumatic past

90-year-old-with chronic leukaemia skydives for charity

Could mobile phones revolutionise chronic wound treatment?

“It’s not easy”: Michael Klim shares health update

Paul Green’s brain donated to science

Home and Away star opens up on traumatic ordeal

Tennis legend Pam Shriver opens up on "traumatic" affair

Stroke, cancer and other chronic diseases more likely for those with poor mental health

Midlife chronic conditions associated with higher dementia risk as we age

Coffee may prevent chronic liver disease

Physical symptoms linked to genetic risk of depression

Pain and the brain: Closing the gap between modern pain science and clinical practice

Chronic pain could be changing your brain

Glenn Close opens up about traumatic cult childhood

Ashley Judd opens up about traumatic incident in Congo jungle

Why a friend's death can be as traumatic as losing a family member

11 things to never say to someone with chronic pain

How chronic stress can help cancer spread

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