Explainer: what are wisdom teeth and should I get mine out?

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If you’re experiencing pain while your wisdom teeth are erupting, you should see your dentist.
Dr Partha Sarathi Sahana Flickr

Seth Delpachitra, University of Melbourne; Anton Sklavos, University of Melbourne, and Dragan Grubor, University of Melbourne

Unfortunately, oral and dental pain is something everyone can relate to. One of the most common reasons people visit the dentist is for pain related to their “wisdom teeth”, or the third set of molar (grinding) teeth to erupt from the gums.

It’s difficult to prevent wisdom tooth problems from occurring – even in those with excellent oral hygiene habits. Even with no gum disease or tooth decay, wisdom teeth can be a source of pain, swelling, and infection.

Read more:
Health Check: is chewing gum actually good for your teeth?

What is a wisdom tooth?

All people develop two sets of teeth in their lifetime. The first set (“baby teeth”) start to develop during infancy, and provide the necessary function of cutting and grinding food in childhood. From the age of six until early adulthood, these teeth are gradually replaced with the second set, or “permanent” teeth. Generally, the average adult will have a total of 32 permanent teeth.

The “wisdom teeth”, or third molars, are the last of the permanent teeth to erupt into the mouth. This tends to occur at the age of 18-25 years (historically but inaccurately associated with the development of wisdom).

Wisdom teeth are always the teeth furthest back in each quadrant of the mouth. Most people develop four wisdom teeth, but many people may only have three, two, one, or if you are particularly lucky, none.

A set of four impacted wisdom teeth.
Author provided

The wisdom of extracting third molars

Anthropologists believe changes in our dietary habits to softer, less abrasive foods have reduced the amount of tooth wear, meaning larger teeth and less room in the jaw. As such, by the time wisdom teeth erupt, there may not be enough space in the jaw for this process to occur normally. The result is impaction, where the tooth emerges at an abnormal angle. This can cause pain for two reasons:

  1. the erupting wisdom tooth can press on the second molar

  2. the tooth can stay partially erupted, leading to a pocket in the gum where food can collect, potentially causing infection and tooth decay.

A serious and unfortunately common complication of impacted wisdom teeth is infection, which if left untreated can spread deep into the face and neck and become life-threatening.

In very rare circumstances, tissue around the impacted teeth can become abnormal and lead to the development of cysts or tumours.

Impacted wisdom teeth never become fully functional, and the best way to manage the problems they cause is to remove the tooth. Because of the tight space and impaction, this is generally a complex surgical procedure that requires a specialist oral and maxillofacial surgeon, who are both doctors and dentists.

Read more:
Four myths about water fluoridation and why they’re wrong

When should I get them out?

In many people, wisdom teeth can erupt and grow normally, and there is no reason to remove them. While everyone should have a routine dental x-ray around the time of wisdom tooth emergence, only people with pain or signs of impaction or abnormalities need removal.

Occasionally, your surgeon may recommend a period of observation as it may be too early to tell whether your teeth will become impacted or not.

If your dentist does recommend removal, timing wisdom tooth extraction is based on a combination of symptoms, risks, and convenience. Removing wisdom teeth too early can mean a more challenging operation as the teeth may still be deeply embedded in the jaw bone; too late can mean an increased risk of complications due to the negative effects of ageing on the bone, teeth and gums.

Having wisdom teeth removed from age 18-25 is generally recommended, as there is a decreased chance of damage to adjacent teeth, lower risks associated with the procedure, and a faster recovery time.

What are the risks?

As with any surgery, there are some risks associated with the procedure. Some minor swelling, bruising, bleeding, and pain is to be expected, and this usually lasts no more than one week.

The following small but unexpected complications may occur following your surgery:

  • dry socket, or alveolar osteitis, is a painful condition of excessive inflammation in the wisdom tooth socket and this can occur days after the procedure. Dry socket is not an infection, but a failure to appropriately maintain a blood clot in the extraction socket, which is necessary for healing to occur. Dry socket is much more common in cigarette smokers, and so it’s generally advised not to smoke in the days preceding wisdom tooth extraction, up until the gum tissue has healed.

  • nerve injury. Close to the roots of lower wisdom teeth is a nerve that supplies feeling to the lip and chin. Sometimes this can be damaged during the procedure, leading to temporary numbness in these areas. Another nerve that supplies taste and feeling to the tongue may also be injured during the procedure, but this is less likely. Very rarely, nerve injuries can be permanent. Your surgeon should discuss this with you during consultation, as the wisdom tooth may not be suitable for extraction if intimately involved with the nerves in the region.

  • post-operative infections are a complication of any surgical procedure, and wisdom tooth extraction is no different. While there is no need to routinely use antibiotics after tooth extraction, your surgeon may offer antibiotic therapy if there are early signs of infection at the surgical site.

All surgeries carry risks.
from http://www.shutterstock.com

Read more:
Bad teeth? Here’s when you can and can’t blame your parents

‘Knocked out’ or ‘in the chair’?

Wisdom teeth can be removed under local anaesthesia, or general anaesthesia. In either case, the surgical procedure involved is the same. Your specialist will generally offer both options, unless there’s a particular reason to not proceed with one or the other.

General anaesthetic is performed in a day surgery or hospital and involves a specialist anaesthetist to put you to sleep using medications through a drip. As a result, you will not be awake for the procedure nor remember any associated discomfort.

A general anaesthetic is very safe and commonly used for minor operations, but they do require you to be fasted for at least six hours before the operation, and you may experience some drowsiness, nausea, or lethargy for 24 hours afterwards. Depending on your medical status and conditions, you may not be suitable for general anaesthetic.

Local anaesthetic involves the administration of dental injections to numb the tooth and surrounding tissues. While the dental injections may cause some minor discomfort initially, the procedure is painless, but you may still feel vibration and hear noises associated with the dental instruments.

But no general anaesthetic means no associated side effects, so most people can return to their usual duties shortly after the procedure. Local anaesthetic may not be suitable in complex or difficult cases, or if you suffer from severe anxiety visiting the dentist.

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So if you’re experiencing any pain in your jaw, talk to your dentist. She will be able to assess your wisdom teeth and order an x-ray, reassure you if everything is normal, or refer you to a specialist if needed.

Seth Delpachitra, Clinical Tutor in Oral and Maxillofacial Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne; Anton Sklavos, Clinical Demonstrator Oral Surgery, University of Melbourne, and Dragan Grubor, Associate Professor of Oral and Maxillofacial Surgery, University of Melbourne

This article was originally published on The Conversation. Read the original article.


We asked five experts: is it possible to catch up on sleep?

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If you try to go too long without sleep, your body will just force it upon you.
Stephen Oliver/Unsplash

Alexandra Hansen, The Conversation

It’s Friday and you’re clocking off, and after a few sleepless nights you want to tuck yourself up early and catch up on all the sleep you’ve lost. But does it really work that way?

During sleep our memories from the day are solidified and our brain does a bit of a clean-up sorting through the things we need to hold onto and discard from the day. We also get the rest we need to ensure we can function properly the following day.

But not all of us manage to get eight hours sleep per night, and might miss out on some of these benefits. So we asked five experts if it’s possible to catch up on missed sleep later.

Three out of five experts said yes

Here are their detailed responses:


The ConversationIf you have a “yes or no” health question you’d like posed to Five Experts, email your suggestion to: alexandra.hansen@theconversation.edu.au

Alexandra Hansen, Health + Medicine Section Editor/Global Editor, The Conversation

This article was originally published on The Conversation. Read the original article.

Research Check: can sleeping too much lead to an early death?

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Don’t worry, it’s still OK to have that sleep in or afternoon nap.
Kinga Cichewicz

Stephanie Centofanti, University of South Australia and Siobhan Banks, University of South Australia

A recent study in the Journal of the American Heart Association has led to headlines that will make you rethink your Saturday morning sleep in.

Don’t set the alarm just yet. Yes, the researchers found a link between people who usually slept for longer than eight hours a night and their chances of having heart disease or dying prematurely.

But they didn’t show that sleeping longer caused these health problems. It might be that people with health, psychological or social problems are more likely to sleep for longer.

How was the research conducted?

The research article investigated links between sleep duration and cardiovascular disease and death. Cardiovascular diseases affect the heart and blood vessels, and include heart attacks and strokes. They’re a leading cause of death but many of the risk factors are modifiable health behaviours, such as not getting enough exercise.

Read more:
How Australians Die: cause #1 – heart diseases and stroke

The authors investigated the cardiovascular risk associated with each hour below seven hours – and each hour above eight hours – of sleep per night. They also looked at the link between sleep quality, cardiovascular disease and death.

The authors pooled together 74 existing studies from 1970 to 2017, covering 3.3 million participants.

In this case, the existing studies used population registries, death certificates, questionnaires, interviews and medical records to gain information about cardiovascular disease and health. To gain information on sleep duration, they used questionnaires or interviews.

What did they find?

The researchers found getting more than eight hours of sleep was associated with an increased risk of cardiovascular disease – a 17% increase for nine hours and a 23% increase for ten hours of sleep.

They also found a link between longer sleep times and an increased risk of premature death – a 23% increase for nine hours, a 52% increase for ten hours and a 66% increase for 11 hours of sleep.

Sleep durations of less than seven hours were also associated with strokes, although to a lesser extent than longer sleep durations. Five hours of sleep was associated with a 29% increased risk of strokes, compared to a 41% increase with ten hours of sleep.

Poor sleep quality wasn’t associated with increases in premature death, but it was associated with a 44% increased risk of coronary heart disease.

Most people need around seven to nine hours of sleep a night, but sleep needs vary greatly.
Lesly Juarez

The authors conclude that sleeping longer than seven to eight hours a night may be associated with a moderate degree of harm compared to sleeping for shorter than recommended. Sleep duration and quality, they say, may therefore be helpful markers for increased cardiovascular risk.

Based on this, they suggest clinicians:

  • be aware people who report sleeping too much or waking up feeling unrefreshed warrant further clinical assessment

  • promote good sleep practices and discuss sleep with patients.

What does it all mean?

Don’t make any rash changes to your sleeping patterns just yet. We can’t conclude from this study that longer sleep causes cardiovascular disease or a greater risk of early death. There appears to be a correlation, but given the design of the study, we can’t establish causation.

Read more:
Clearing up confusion between correlation and causation

Before we even go as far as saying there’s a correlation between longer sleep duration and cardiovascular disease, there are a few things to take into account.

The included studies used subjective measures of sleep, and the length of time in which the participants were asked about their sleep duration (in the past week, month or year) may have varied.

Lab-based sleep studies show it’s really hard to remember how long it took you to fall asleep, how many times you woke up during the night, and how much sleep you got in total. Quite often the amount of time a person spends in bed as opposed to the amount of time a person is asleep in bed can affect these subjective ratings of sleep duration and quality.

So, at best, we can say people who feel like they sleep more and have poorer sleep quality may be at higher risk of developing cardiovascular disease.

Because this is a meta-analysis (which pooled 74 studies), the authors also acknowledge we can’t look at individual patient-level data. Therefore, assumptions can’t be made about the links between cardiovascular disease, sleep and other risk factors that might have been at play.

In other words, a whole range of other underlying issues probably contributed to these findings. Health issues that can lead to increased subjective sleep duration or reduced sleep quality include depression, obstructive sleep apnoea, anaemia, inflammatory disorders and other sleep disorders.

There are also many psychological and social factors that might influence how much a person sleeps. Unemployment, low socioeconomic status, low levels of physical activity and poor nutrition can all lead to increases in sleep duration and feelings of being unrefreshed during the day.

A lot of these health issues and psychological factors happen to be well-known risk factors for cardiovascular disease. So, it’s probable these factors are the underlying mechanisms leading to an increased risk of cardiovascular disease and increased sleep duration, rather than too much sleep directly affecting cardiovascular risk.

Those with a poor diet and low levels of physical activity may sleep longer and feel unrefreshed the next day.
Thomas Habr

The question of how sleeping too much affects health is interesting and important to investigate further using different research designs. Cohort studies, where large groups of people are studied over a long period, would allow us to investigate and draw more solid conclusions about the causal links between sleep duration and health.

Is it better to sleep less?

If you’re tempted to stay up late to squeeze in a few more episodes of your favourite TV show, think again. Many studies conducted in controlled, experimental conditions show not getting enough sleep affects physical and psychological functioning and can contribute to the development of chronic health issues such as type 2 diabetes.

Read more:
Health Check: three reasons why sleep is important for your health

Most adults need around seven to nine hours of sleep a night, but individual sleep needs can vary greatly. Make sure you get enough sleep so you feel refreshed and be sure to share any concerns about your sleep with your doctor. – Stephanie Centofanti and Siobhan Banks

Blind peer review

This is a fair and accurate assessment of the study and its findings. Self-reports of sleep are not always reflective of true sleep duration or quality. And it’s likely other health conditions are the underlying reason for the increased risk.

People should listen to their own body when determining how much sleep is the right amount for them, as sleep duration can vary greatly between individuals. – Gemma Paech

Read more:
Explainer: how much sleep do we need?

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

Stephanie Centofanti, Research Fellow, Sleep & Chronobiology Laboratory, Behaviour-Brain-Body Research Centre, University of South Australia and Siobhan Banks, Associate Professor, University of South Australia

This article was originally published on The Conversation. Read the original article.

Health Check: why do we get nose bleeds?

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The cause of nose bleeds is not always clear.
From shutterstock.com

David King, The University of Queensland

Nose bleeds, or epistaxes, are often a mystery to the 60% of us who have had at least one in our lifetime. Suddenly, and without obvious cause, bright red blood starts streaming from one nostril.

Usually they’re not something to worry about, but why we get them is not always clear.

What causes nose bleeds?

The nose is very prone to bleeding. This is because of the important role it plays in warming and humidifying the air we breathe. Large numbers of small blood vessels lie just under a thin layer of skin, as a heat exchange mechanism for air going to the lungs.

A number of things can cause those vessels to rupture and the nose to bleed.

A blow to the face may lead to a nose bleed, with or without a fractured nose.

Nasal infections and dryness are known to increase the frequency of bleeds. In one study, people who got nose bleeds were seven times more likely to have staphylococcal bacteria in their nose than than their peers who didn’t get nose bleeds.

Very hot or cold weather may increase the likelihood of nose bleeds, with low levels of humidity making this worse. One study from the United States showed 40% more attendances to the emergency department for nose bleeds in winter, while nose bleeds in parts of Africa are higher in the hot, dry season.

Read more:
I’ve always wondered: why your nose runs when it’s cold

Depending on the location of the ruptured blood vessels, the bleed is classified as anterior (the front part of the nose) or posterior (the back part of the nose). The blood from an anterior bleed will predominantly flow out of the nostrils, while with a posterior bleed, much of the blood will end up in the throat to be spat up or swallowed.

Occasionally, the cause of vomiting up blood can be traced to a nose bleed the person wasn’t aware of.

Higher risk groups

Nose bleeds are common in young children, where it is usually mild and from the front of the nose.

A study of children presenting to a US emergency department showed the majority had stopped bleeding before they were assessed by the doctor. Of the small number who required treatment, 93% settled easily with simple treatments, such as pressure to the front of the nose.

Young children also have a tendency to pick at “scabs” in the nose – consisting of dried mucus and dead cells – exposing shallow blood vessels just under the inflamed skin.

Nose bleeds are more common among children.
From shutterstock.com

The second peak is in the over-65 age group, where the nose bleed may be more severe.

In this group, nose bleeds may be indicative of a more serious health problem such as bleeding disorders and chronic sinus infections. Rarer causes include local cancers and leukaemia.

Bleeding due to blood thinning medication, or sometimes as a side effect of nasal steroid sprays, are becoming more common.

Bleeding from the back of the nose, while less common overall, is more likely to occur in older people. It’s also likely to be more difficult to control and may continue for many hours.

Extensive blood loss may occasionally lead to anaemia or require a transfusion. The risk of death from nose bleeds is extremely low. Out of 2.4 million deaths in the US in 1999, four were due to nose bleeds. Often the nose bleed has simply complicated other existing medical conditions.

Read more:
What can go wrong in the blood? A brief overview of bleeding, clotting and cancer

What to do

Not knowing how long your nose will continue to bleed and the amount of blood lost can be disconcerting. But people generally overestimate blood loss.

Most first aid recommendations are fairly consistent. They suggest the patient should be quietly seated, leaning forward (to avoid swallowing blood) and applying pressure to the front, soft part of the nose.

If the bleeding is severe, persists for more than 30 minutes, or is caused by a blow to the head or side effects of medication, see a doctor.

Doctors will use various methods to apply pressure directly to the site of the bleeding. These include packing the nose with a long thread of ribbon gauze material soaked in medication to constrict blood vessels, or the use of balloon catheters (small balloons inserted into the nostrils).

If the bleeding doesn’t stop after 30 minutes, you should seek medical attention.
From shutterstock.com

If you have recurrent minor bleeds, try nasal decongestant sprays or nasal lubricants such as petroleum jelly (Vaseline).

The other approach is to seal the bleeding vessels with chemical (such as silver nitrate applicators) or heat cauterisation. But cauterisation is painful and a systematic review of treatments showed it’s no more effective than antibiotic cream or petroleum jelly.

Sesame oil based nasal sprays have shown benefit in small trials in the lubrication of dry noses. This may assist in controlling crusting that’s associated with nose bleeds. But sesame oils are yet to be comprehensively assessed for this purpose.

The ConversationSimple nose bleeds can usually be managed with simple treatments. If recurrent or serious then a search for the underlying cause is needed to guide effective treatment.

David King, Senior Lecturer, The University of Queensland

This article was originally published on The Conversation. Read the original article.

Working four-day weeks for five days’ pay? Research shows it pays off

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A four-day week trial showed that if workers have more control over their job, they feel and perform better.
from http://www.shutterstock.com, CC BY-SA

Jarrod Haar, Auckland University of Technology

Employees at a New Zealand company behind an innovative trial of a four-day working week have declared it a resounding success, with 78% saying they were better able to manage their work-life balance.

Perpetual Guardian, which manages trusts and wills, released their findings from the trial, which was prompted by research that suggests modern workers are only productive for about three hours in a working day.

The analysis shows that employees working four-day weeks felt better about their job, were more engaged, and generally reported greater work-life balance and less stress – all while maintaining the same level of productivity. Interestingly, they also experienced a small but significant decrease in work demands.

The setting

The company asked its 240 office workers to work a four-day week (at eight hours per day) instead of five days, while still being paid their usual five-day salary. The trial was inspired by growing evidence that modern open-plan workplaces can be distracting for workers and reduce productivity.

Read more:
A new study should be the final nail for open-plan offices

Managing director Andrew Barnes thought a shorter working week might be an innovative way to get employees to focus on their work and maintain overall productivity, while providing benefits such as an enhanced work-life balance, better mental health and fewer cars on the road.

The results show a 24% increase in employees saying their work-life balance had improved, a significant improvement in engagement and a 7% drop in stress levels – all without a reduction in productivity.

The challenge

The first challenge for the company was that not everybody does the same work across a varied workplace. It is not a production line making widgets, where productivity can be measured easily.

Their solution was to ask teams (and their managers) to detail what they actually did in their job and how they might do it over four days instead of five. This involved organising coverage within teams so that they could still meet deadlines and maintain performance and productivity. In practice, the four-day week meant employees within a team all had a day off each week, but that this day moved from Monday to Friday across the trial period.

The expectation was that if workers could maintain the same level of productivity and do so in four days, they should achieve greater personal benefits and the company would make other gains through enhanced reputation, recruitment and retention, as well as energy savings (20% reduction in staff at work).

There is a large body of research showing that if organisations care about their employees’ well-being, staff will respond with better job attitudes and performance. In addition, research shows that work-life balance is important for job satisfaction and general well-being, and that by being able to spend more time away from their job, employees engage better with their work.

However, there is the potential that employees might report greater stress and issues around work demands because they are now, in effect, doing their current workload in four days rather than five.

The findings

To enable analysis of the trial, employees and managers completed pre- and post-trial surveys. Additional employee data were collected at the end of last year. Thus, analysis is based on five different data sets, from employees and managers.

The results show that employees’ perceptions of support changed across the trial. Employees felt that the four-day week (with five days’ pay) showed how much their employer cared about their well-being. This type of perception helps organisations because their employees work harder, are more satisfied and want to stay in their jobs longer. They also perform better.

The employees reported better job satisfaction and engagement, and felt their teams had become more cohesive and skilled at doing their work together. This likely reflects the team focus at the start of the trial when they spent time developing the new four-day approach.

Another finding was that employees reported a small but significant decrease in work demands. This is interesting because there was a potential issue of staff feeling more stressed, but research shows that having more control over one’s job enhances psychological well-being. The fact that Perpetual Guardian allowed employees to plan their work week actually aided their ability to do it in a timely and stable manner.

Finally, the supervisors rated their team performance as no different across the trial. However, supervisors also found their teams had greater creativity and engaged in more helpful behaviours, as well as giving better service performance.

The four-day week trial showed that workers can complete their work satisfactorily, or even better in some aspects, while enjoying greater work-life balance and reduced stress. This reflects the power of organisational support and highlights the performance benefits that can be achieved when an organisation takes the risk to trust their employees and support them in a new approach to work.

The ConversationThe eight-week trial was a success and the organisation is now refining the approach before rolling it out full time.

Jarrod Haar, Professor of Human Resource Management, Auckland University of Technology

This article was originally published on The Conversation. Read the original article.

We asked five experts: is BMI a good way to tell if my weight is healthy?

File 20180522 51105 dj1quu.jpg?ixlib=rb 1.1
BMI takes into account your height and your weight, and that’s it.
from http://www.shutterstock.com

Alexandra Hansen, The Conversation

Staying a healthy weight can be a challenge, and knowing what weight is healthy for you can be too. Most people rely on the body mass index, or BMI, which is a measure of our weight in relation to our height.

Many experts have criticised this fairly limited measure of the health of our weight, yet it still remains the most popular way for most people to judge a healthy weight.

We asked five experts if the BMI is a good indicator of a healthy weight.

Five out of five experts said no

Here are their detailed responses:


If you have a “yes or no” health question you’d like posed to Five Experts, email your suggestion to: alexandra.hansen@theconversation.edu.au

The ConversationDisclosures: Emma Gearon has received an Australian Government Research Training Program Scholarship.

Alexandra Hansen, Health + Medicine Section Editor/Global Editor, The Conversation

This article was originally published on The Conversation. Read the original article.

Health Check: what causes chilblains and how can I prevent them?

File 20180703 116123 1sjqrdz.jpg?ixlib=rb 1.1
Red, itchy and dry spots on your fingers and toes are caused by cold, but should resolve on their own.
from http://www.shutterstock.com

Michelle Rodrigues, St Vincent’s Hospital Melbourne

While some of us love the winter chill, this winter others will notice itchy or tender red lumps on their fingers and toes.

These small bumps are called chilblains (also known as pernio) and they occur with exposure to cold. While children and the elderly are most commonly affected, other age groups are not immune to this problem.

Several hours after exposure to cold, damp weather, the blood vessels in the fingers and toes tighten up and get smaller (called vasoconstriction) to keep the warm blood as far away from the skin as possible, as this is where heat is lost.

When returning to a warm environment from the cold, these blood vessels expand again, but can get inflamed (called vasculitis) if this happens too quickly.

Read more:
Health Check: do cold showers cool you down?

This causes itch and burning in the affected area. Small reddish lumps can appear on the skin, which may become painful or blistered. In those with skin of colour, chilblains may look purple-ish or even present as a brown patch of skin. The most commonly affected areas include the fingers, toes, ears and nose.

If they’re untreated, chilblains can swell and form blisters, with a risk of ulcers, scarring and infection. But usually, if extremities are warmed, they will get better on their own in a few weeks.

This reaction is more common in people who have a family history of chilblains and those who have problems with their blood circulation. Smoking, diabetes and high cholesterol can lead to poorer blood circulation. People who are underweight or have diseases that affect connective tissue (such as lupus) are also at increased risk of chilblains.

Keep your extremities covered, and warm them up slowly if they get cold.
from http://www.shutterstock.com

The diagnosis is usually straightforward and no extra tests are needed. But occasionally other conditions need to be excluded, such as lupus and Raynaud’s disease (where small arteries narrow, limiting blood circulation). For this, your doctor might need to do some blood tests or even take a small piece of skin (skin biopsy) to confirm the diagnosis.

Read more:
Forget heatwaves, our cold houses are much more likely to kill us

If the weather gets the better of you and chilblains do appear, your doctor is likely to suggest topical steroid creams to help with itch and inflammation. For more severe cases, medications that open (dilate) blood vessels, such as nifedipine and diltiazem, can be used.

But we all know prevention is better than cure, so here are some tips to avoid chilblains:

  • clothing: keep your extremities warm with covered shoes, gloves and ear muffs

  • temperature control: keep your skin dry and warm, and when you’re rewarming your skin, do it slowly and gently

  • get active: staying active and keeping fit with physical activity improves circulation so will decrease the risk of developing chilblains

  • The Conversationavoid smoking and eat well to optimise the health of your blood vessels.

Michelle Rodrigues, Consultant Dermatologist, St Vincent’s Hospital Melbourne

This article was originally published on The Conversation. Read the original article.

Health Check: should you weigh yourself regularly?

File 20180624 26549 1cd7rwy.jpg?ixlib=rb 1.1
Men respond better to structured “weigh-ins” than women.

Clare Collins, University of Newcastle and Rebecca Williams, University of Newcastle

For some, jumping on the scales is a daily or weekly ritual; while others haven’t seen a set of scales for years. Some may still be scarred by memories of being weighed in public with results broadcast to all.

So, is it helpful to weigh yourself? And if so, how often should you do it?

For adults carrying excess weight and who are trying to manage their weight, the answer is yes: weighing yourself regularly can help you lose more weight initially, and keep it off.

Read more:
BMI is underestimating obesity in Australia, waist circumference needs to be measured too

But for adolescents or those who have experienced disordered eating, it’s best to keep the scales out of sight.

What does the research say?

Most studies have investigated the impact of self-weighing along with other weight-loss strategies such as a low-kilojoule diet.

These studies show self-weighing is an inexpensive technique that may help with weight loss and maintenance, particularly for men, who often respond well to structured “weigh-ins”.

Only one study has investigated the use of self-weighing as the sole weight-loss strategy. This US research study invited 162 adults who were wanting to lose weight to a single educational weight-loss seminar.

Half of the people were instructed to weigh themselves daily and got visual feedback on their weight change over two years. The other half were not asked to weigh themselves daily, until the second year.

Keeping track of your weight can help you avoid gradual weight creep.

During year one, men in the daily self-weighing group lost more weight than the control group, but women did not. The average number of times people weighed themselves a week was four.

In the second year, men in the daily self-weighing group maintained their weight loss. Those in the control group, who had now started daily weighing, lost weight, while the women stayed the same.

Having regular weigh-ins with a health professional can also help. A review of more than 11,000 overweight people attending a weight management program in GP clinics in Israel found those who had regular weigh-ins with the nurse or dietitian were more likely to lose more than 5% of their body weight. This amount of weight loss is associated with a major reduction in the risk of developing type 2 diabetes.

How often should you weigh yourself?

A review of 24 randomised controlled trials found there was no difference in weight loss between those who weighed themselves daily versus weekly.

No matter what other features the weight-loss program includes, the key to better results appears to be regular self-weighing, which means at least weekly.

Making yourself “accountable” for weigh-ins either by having a set day to weigh-in or joining a weight loss program can help you lose more weight.

Another important point is that not weighing yourself regularly when you are on a weight-loss diet is a risk factor for weight gain.

Read more:
You don’t have to be the biggest loser to achieve weight loss success

When is self-weighing harmful?

Regular weighing is not recommended for adolescents. Research suggests it doesn’t help with weight management and can negatively impact on young people’s mental health, especially for girls.

A ten-year study of the relationship between self-weighing, weight status and psychological outcomes of almost 2,000 teens in the US found that self-weighing had no helpful impact on weight or BMI.

However, it was associated with weight concerns, poor self-esteem and trying to lose weight though unhealthy methods such as excessive fasting.

Over the ten years, more frequent weighing was associated with a decrease in body satisfaction and self-esteem, and an increase in weight concerns and depression in the young women.

Self-weighing has few benefits and many potential harms for teens.
Dragana Gordic/Shutterstock

For young men, with the exception of weight concerns, there were no significant relationships between self-weighing and other variables.

An increased frequency of self-weighing throughout the high school years may flag the need to investigate an adolescent’s overall well-being and psychological health.

Self-weighing can also affect the self-esteem and psychological well-being of adults, especially women. This is of particular concern for those with eating disorders, as weighing frequency can be associated with greater severity of eating disorders.

For some people, self-weighing could be the key to losing or keeping weight off, while for others, it may do harm. Consider your life stage, pre-existing health conditions and your mental well-being when deciding whether regular weighing is worth it for you.

The Conversation

Read more:
Why now is the best time to go on a diet, or the science of post-holiday weight loss

Clare Collins, Professor in Nutrition and Dietetics, University of Newcastle and Rebecca Williams, Postdoctoral Researcher, University of Newcastle

This article was originally published on The Conversation. Read the original article.

We’re laughing in an echo chamber: it’s time to rethink satire

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John Oliver presents Last Week Tonight. Is he merely preaching to converted?
Screenshot from Youtube

Katrina Spadaro, University of Sydney

In 2017 the BBC asked a timely question: are we living in a golden age of satire? The evidence suggests we might be. From the revitalisation of America’s late night comedy scene to Australian shows such as Shaun Micallef’s Mad as Hell and Tom Ballard’s Tonightly, our appetite for satire appears stronger than ever.

Australian satirists, such as The Chaser and those producing the comedic newspaper The Beetoota Advocate, are buoyed by material ranging from humdrum policy issues like tax cuts to the rich comic potential of Barnaby Joyce’s private life. American satire, so often gravitating towards issues of violence and race, provides a sobering comparison.

While enthusiasts of satire may celebrate, this groundswell is not necessarily a good thing. Satire and laughter can be therapeutic ways to orient ourselves in troubled, and increasingly polarised, times. But they are not guaranteed to prompt social or political change. That’s because humour is more likely to speak to ideological groups than across them.

Since the transmission of humour relies on shared sets of knowledge, values and assumptions, bread-and-butter satiric devices like irony can fall flat when used beyond particular social groups. In many ways, this seems obvious. A John Oliver monologue critiquing US hostilities to refugees, for example, will only be considered funny by an audience sympathetic to their plight.

But when satiric miscommunication takes place, it can have chilling consequences. Research by humour scholar Peter Jelavich provides a troubling example of a time when humour failed to cut through. In Weimar Germany, Jewish entertainers such as Max Reinhardt took to cabaret stages with comic routines that exaggerated anti-Semitic stereotypes, highlighting how ridiculous they were. But it seems that these performances had the opposite effect on some non-Jewish audiences.

As hostilities towards Jews grew, the Central Association of German Citizens of Jewish Faith warned of the dangers of these satires. They noted that during one cabaret,

many Christian members of the audience seemed to enjoy the fact that caricatures of Jewish nature, Jewish morals, and Jewish behaviour depicted in the racist yellow press were now spotlighted ‘True to life’ in front of their very eyes.

The irony of the performance was failing to translate between the two groups. Where Jewish performers aimed to mock stereotypes, non-Jewish audiences saw an affirmation of their own anti-Semitic prejudices.

Weimar Germany is an extreme and disturbing case study in the transmission of humour. But it illuminates a point still relevant today: sometimes satirical humour can segregrate further those with different backgrounds and beliefs, rather than opening a dialogue between them.

Today, when our values and attitudes are more polarised than ever, satire can simply strengthen existing social groupings, even aggravating misunderstandings between them.

“They hate your guts,” Donald Trump told supporters at a rally in Michigan, the day after Michelle Wolf’s searing monologue at the 2018 White House Correspondents’ Dinner. The ease with which satire can be twisted into propaganda entrenching political divides should give us pause. Combined with social media – which allow us to cherry-pick the exact ideologies we’re exposed to – much of today’s satire may be too busy preaching to the choir to proselytise to those outside the echo chamber.

The free speech defence

In the ancient world, the satirist was envisioned as a whistle-blower, bent on exposing and reforming defective institutional mores. Humour was not considered the primary aim of satire, but the means to a reformative end: discourse and change.

The Roman satirist Horace defended his use of humour by arguing that “ridicule often decides matters of importance more effectually and in a better manner than severity”. This was a rationale upheld by Renaissance satirists. Defending himself against charges of frivolity, Renaissance scholar Erasmus insisted that his satire was intended “to advise, not to rebuke, to do good, not injury, to work for, not against, the interests of men”. For all the good intentions of Erasmus and his ilk, whether satire is an effective means of generating change remains to be proven.

Today, satire is most often defended under the banner of free speech. In 2016, when scandal erupted over the late Bill Leak’s dubious take on Indigenous incarceration rates, the conversation was immediately subsumed by the broader debate over the parameters of free speech. In particular, it fuelled the debate around Section 18C of the Racial Discrimination Act, which regulates speech that is offensive, humiliating, and insulting.

American comedian Kathy Griffin similarly found herself in hot water last year when she posed for a promotional shoot with an image of Donald Trump’s decapitated head. Both incidents attracted outrage and impassioned defences – albeit from opposite sides of the political spectrum.

Given the noble intentions claimed by the early satirists, we should hold satire to higher standards than those of legality and social acceptability. When satire becomes a footnote in broader debates about free speech and censorship, it’s easy to lose sight of its initial civic role: promoting social reform.

The ConversationRather than debating its legality, we would do well to consider whether satire, for all its ideological zeal, is useful in creating dialogue and change. Satire is great at provoking introspection in unified social groups, but less effective at speaking across them. In a time when open and inclusive communication is crucial, this kind of discourse may be doing more harm than good.

Katrina Spadaro, PhD candidate, University of Sydney

This article was originally published on The Conversation. Read the original article.

Having a brain injury does not mean you’ll get dementia

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Increasing risk does not mean it’s predetermined.
from http://www.shutterstock.com

Travis Wearne, UNSW and Fiona Kumfor, University of Sydney

Two recent studies recently drew a link between traumatic brain injuries and dementia. Understandably, media outlets were quick to report on these findings.

The Los Angeles Times ran the story:

Even a mild case of traumatic brain injury is linked to an increased risk of dementia

The New York Times reported:

Traumatic Brain Injuries Are Tied to Dementia

But if you have had a traumatic brain injury at some point during your life, what is the actual risk of dementia?

Read more:
How injuries change our brain and how we can help it recover

What is a traumatic brain injury?

Traumatic brain injury refers to damage of the brain caused by an external force, such as from a traffic accident, fall or assault (such as a coward punch). This leads to bruising, bleeding, and tearing of brain tissue.

Traumatic brain injuries fall on a spectrum of severity, with the initial loss of consciousness and duration of confusion (known as post-traumatic amnesia) used to classify brain injuries as mild, moderate, or severe. Most traumatic brain injuries (approximately 80%) are mild.

Read more:
Explainer: what is traumatic brain injury?

What is dementia?

Dementia is caused by a progressive build-up of proteins in the brain, which ultimately causes brain cells to die.

There are several types of dementia, including Alzheimer’s disease, dementia with Lewy bodies, vascular dementia, and frontotemporal dementia.

Each dementia type is caused by a different type of protein, and affects different parts of the brain, leading to diverse symptoms. It’s not known what causes this abnormal build-up of proteins in the brain.

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

Dementia is caused by a progressive build-up of proteins in the brain.
from http://www.shutterstock.com

What did the studies find?

Two recent studies have assessed whether traumatic brain injuries are related to dementia.

  • Study 1. A research group from the University of California examined the medical records of over 350,000 US veterans, half of whom had experienced a traumatic brain injury. They found those who had a mild traumatic brain injury were more than twice as likely to develop dementia. The risk was even greater (about 2.5 times) if they had lost consciousness as a result of the traumatic brain injury. People who had moderate or severe traumatic brain injuries were nearly four times as likely to develop dementia.

  • Study 2. Danish researchers examined the national records of nearly 2.8 million citizens who were over 50 years old between 1999 and 2013. They found 126,734 people had dementia (4.5%) and 132,093 had a history of traumatic brain injury (4.7%). They reported the risk of dementia was 24% higher for people who had a previous traumatic brain injury. These risks were even higher for males, people who had a more severe traumatic brain injury, and for people who had more than one traumatic brain injury in the past.

Both these studies identified cohorts of people and assessed how they changed over time. These studies also used data collected at the time of the traumatic brain injury, rather than relying on people’s memory of injuries in their past. They also used large samples and controlled for medical and psychiatric factors that could influence their results.

The potential for brain injury to lead to dementia is understandably alarming information. The relationship between severe traumatic brain injury and dementia has been known for some time. The risk of dementia following mild injuries is novel and is particularly concerning given the prevalence of sports-related injuries (such as concussions).

In Study 1, only 5.6% of those who had a previous traumatic brain injury developed dementia. In addition, many people with dementia have never had a traumatic brain injury (in Study 2, 94.7% of people with dementia had no history of traumatic brain injury).

This means while a traumatic brain injury may increase the risk of developing dementia, it doesn’t mean you will get dementia if you have experience brain trauma. In the same way that age is a risk factor for a heart disease, not everyone over the age of 65 will have a heart attack.

It’s likely other factors are involved.

Read more:
Kids are more susceptible to brain injury, and concussion has implications beyond what we thought

Take home messages

Multiple risk factors can lead to dementia. And we also know several ways to minimise these risks (known as protective factors). Diet, exercise, good sleep habits, remaining socially connected, and keeping yourself cognitively challenged are important factors in minimising your risk of dementia.

Interestingly, many of the risk factors of dementia are also seen in people following a traumatic brain injury. These include a sedentary lifestyle, mental health issues, social isolation, and reduction in cognitive resilience (known as cognitive reserve).

The ConversationWhile prevention programs to minimise people having a traumatic brain injury in the first place are important, lifestyle, psychological, and social approaches to help people improve their brain health after a traumatic brain injury are also key. Understanding these factors may also help to explain the relationship between traumatic brain injury and dementia.

Travis Wearne, Postdoctoral Research Fellow, UNSW and Fiona Kumfor, Senior research fellow, University of Sydney

This article was originally published on The Conversation. Read the original article.