A Ringside Doctor Explains Why TJ Dillashaw Was Allowed to Keep Fighting With a Severe Eye Cut

MMA bantamweight fighter TJ Dillashaw defeated Sandhagen at UFC Fight Night over the weekend, but a cut in his inner left eyebrow very nearly derailed the entire fight and took him out of action. In a new video on his YouTube channel, David Abbasi, MD, a surgeon and pro ringside physician, examines the decision made by the ringside doctor on Fight Night to allow Dillashaw to continue with the match after his injury.

“Cuts in that area will naturally flow down and the blood will flow down into the eye and potentially affect vision,” he says. “The other thing with his specific cut is that it was very severe in the way it was extended down, and the worry was that it would potentially go all the way down into the eye socket area, because a cut can continue to propagate if it continues to get punched.”

There are a couple of factors that go into making that call as a ringside doctor, Abbasi explains. Firstly, it comes down to the personal comfort level of the medic present, and that can vary. “There’s a lot of pressure for ringside doctors,” he says. “You’re damned if you do and you’re damned if you don’t… If you stop it, you’re going to have an angry fighter and angry fans. If you don’t, you’re going to get criticized for maybe that’s not the safest thing to do.”

Abbasi continues that Dillashaw himself did something very significant that may have affected the outcome of the doctor’s decision. “As we come in and assess that fighter, we ask them questions, we’re looking for body language, we’re looking responses, does that fighter really want to continue the fight… TJ Dillashaw says ‘absolutely I can.’ It was a very positive response… A lot of times you can tell by the body language or the response of the fighter whether they want to continue or not.”


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A new mathematical model assesses ICU patients mortality risk

hospital patient

A research team has developed a new machine learning-based model that predicts the risk of mortality of intensive care unit patients according to their characteristics. The research was published in the latest edition of the journal Artificial Intelligence in Medicine.

Under the framework of artificial intelligence, machine learning allows a model to gain knowledge based on the information provided by available historical data, and automatically modifies its information when new information appears. One of the current challenges is the creation of models with which to make personalized medical predictions, and one of the areas in which artificial intelligence can be of great help is in deciding how to proceed with intensive care unit (ICU) patients. This process is complex and comes at a high cost, and depends on the inherent variability of the opinion of specialists, based on their experience and instinct. Therefore, to improve the quality of care in the ICUs, it is important to set down protocols based on objective data and on an accurate prediction of a patient’s risk of mortality according to their characteristics. In this sense, machine learning tools may be of great help to medical experts.

The researchers, led by Dr. Rosario Delgado from the Department of Mathematics of the UAB, in collaboration with Head of the ICU at Hospital de Mataró Dr. Juan Carlos Yébenes, UAB associate lecturer Àngel Lavado from the Information Management Unit of the Maresme Health Consortium, and José David Núñez-González, Ph.D. student of the UAB Department of Mathematics, used machine learning tools to create a model capable of predicting the risk of mortality of ICU patients, based on a real database which also served to validate the model. The model will aid in the decision-making process of healthcare workers by improving the prediction of premature deaths, making medical decisions about high-risk patients more efficient, evaluating the effectiveness of new treatments and detecting changes in clinical practices.

The use of this model represents a clear improvement in traditional approaches, consistent with predicting the risk of mortality based on the Acute Physiology And Chronic Health Evaluation (APACHE) score—a questionnaire widely used to assess a person’s state of health with the help of different indicators. The new model makes use of an estimated logistical regression that was validated in previous groups of patients. Researchers were able to demonstrate experimentally that the new model they created overcomes the weak points of traditional approaches, offering good results and presenting itself as a better alternative.

The predictive self-learning prognosis model created by researchers consists in a set of Bayesian classifiers used by assigning a life prognosis label (live or die) to each individual, according to traits such as demography, gender and age; the Charlson comorbidity index; their place of origin; the cause of admission; the presence or lack of sepsis; severity reached in the first 24 hours after aadmission; and the APACHE II score.

Researchers improved the model’s prediction through a combination of individual predictions of each classifier designed in a way that the faults of some predictions could be compensated with other correct predictions, and taking into account the imbalance represented by a low proportion of patients dying in the ICUs. The model predicts the cause of death of patients at a high risk, as well as the outcome of patients at a low risk of dying. This type of model is known as a hierarchical predictive model, given that there are two stages of prediction.

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Teen Volunteers Get a Foot in the Door for Nursing Home Careers

Jasmine De Moya, 17, has dreamed for years of working in the medical field, and she yearned to spend time with older people, missing her grandparents, who live in the Dominican Republic. A program sponsored by the New Jewish Home health system in New York City that combines volunteering and free training for entry-level health jobs, career coaching and assistance on her college prep is helping make her hopes come alive.

Over the past three years, Jasmine has learned a lot about caring for older people, from the importance of speaking slowly and being gentle with frail residents who may have hearing or comprehension problems to how to brush their teeth or bathe them.

“We practiced first with mannequins, so when we actually [worked on residents] I was in shock,” she said. “Cleaning a body and their private areas, I never expected I would do that. But then I got used to it.”

Last summer, Jasmine completed a certified nursing assistant training course. She has also researched and applied for colleges and student loans with help from an organization that the geriatrics career development program provides to volunteers like her. After graduating from high school last month, Jasmine will start nursing school at Lehman College in the Bronx in the fall. She’ll be the first in her family to attend college.

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Since it launched in 2006, the geriatrics career development program has helped more than 700 high school students from 10 underserved schools in New York City get hands-on experience with geriatric care at the New Jewish Home in Manhattan and the Harry and Jeanette Weinberg Gardens senior living facility in the Bronx. Ninety-nine percent of program participants graduate from high school, and more than 150 have gone on to college.

The advantages of the program are also evident for the New Jewish Home, which operates two nursing homes, senior housing and assisted living facilities and a home care business in the New York City area. By familiarizing young people with geriatric care careers, the system aims to address its growing need for workers as the tide of baby boomers enter their later years.

Six of the top 10 fastest-growing jobs in the decade leading up to 2029 are projected to be in health care, according to the federal Bureau of Labor Statistics, including home health and personal care aides.

“One of our biggest challenges is that there aren’t enough people who want to work in this industry,” said Dr. Jeffrey Farber, president and CEO of the New Jewish Home system. “People don’t want to work with older adults.”

The New Jewish Home began its career development program for teens 15 years ago with the idea of training and hiring them as nursing assistants, Farber said.

But it has become more than that. Working a few afternoons a week for three years with older adults, students gain insights into aging and develop relationships with residents, some of whom are assigned as mentors. It also gives students assistance with figuring out career goals and putting the pieces in place to get there.

“I think the students would be successful without us, but we provide the structure and resources to help them succeed,” said John Cruz, senior director of workforce initiatives at the New Jewish Home, who oversees the program.

Students generally must devote two afternoons after school every week and several weeks during the summer, said Cruz. The program curriculum, developed with Columbia University Teachers College, initially teaches students basics about patient privacy, Medicare/Medicaid and overcoming stereotypes about older people. By the time they’re seniors in high school, students can train as certified nursing assistants and work as paid interns supporting the residents on the days they spend at the facility.

As part of the program, students may also become certified in other jobs, including patient care technician, phlebotomist, EKG technician, and medical coding and billing staff.

The pandemic, however, changed things. The New Jewish Home in Manhattan was hit hard, with dozens of covid deaths at the 514-bed facility.

Since volunteers weren’t permitted inside the facility, the home instead hired many of them as part-time employees so they could continue to help seniors. This also gave students a chance to complete the clinical training portion of their certified nursing assistant coursework.

In addition to the program for high school students, the health system created a program in 2014 for people ages 18 to 24 who are unemployed and out of school, training them to become certified home health aides and nursing assistants. Nearly 200 have completed the program and the New Jewish Home has hired three-quarters of them, at a starting wage of $15 to $19 an hour.

Both programs are supported primarily by grants from foundations.

In February, the state announced that nursing homes could accept visitors again, following federal guidelines. But many nursing home residents still rely on virtual visits, and during the spring Jasmine spent her time helping them connect with their families and other loved ones by iPad or phone.

The isolation was hard on the residents, and students provided sorely missed company. Asked how the students helped her, resident Dominga Marquez, 78, said, “Just talk.”

“We are lonely,” said Marquez. “I have a lot of friends that used to come every week to visit but, with the pandemic, nobody came.”

Kennedy Johnson, 17, said helping seniors experience virtual visits with their families during the pandemic made him realize how much he takes for granted.

“With the pandemic and doing the virtual calls, seeing how these families don’t get to interact with their loved ones every day, that really opened my eyes,” he said.

Working at the New Jewish Home was the first time Kennedy had ever been in a nursing home or seen the kinds of work that staff members do.

In the fall, he will start at Morehouse College in Atlanta and plans to major in political science. His goal: “I want to be a health care attorney so I can represent people … like this.”

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Factbox: Latest on the worldwide spread of the coronavirus

(Reuters) – The Asia-Pacific region continues to battle major outbreaks due to the highly contagious Delta variant, while worries about Johnson & Johnson’s vaccine emerged after rare cases of a neurological disorder were reported weeks after inoculation.

FILE PHOTO: A healthcare worker administers the first dose of the Comirnaty Pfizer–BioNTech COVID-19 vaccine against the coronavirus disease (COVID-19) to a man at a vaccination centre in Ronda, Spain June 30, 2021. REUTERS/Jon Nazca

DEATHS AND INFECTIONS

* Eikon users, see COVID-19: MacroVitals here for a case tracker and summary of news

EUROPE

* All health workers in France must get COVID-19 jabs and anyone wanting to get into a cinema or board a train will need to show proof of vaccination or a negative test under new rules announced by President Emmanuel Macron.

* Dutch Prime Minister Mark Rutte conceded that restrictions had been lifted too soon in the Netherlands and he apologised as infections surged to their highest levels of the year.

* Spain’s two-week COVID-19 contagion rate kept rising on Monday, more than tripling in two weeks as infections have soared especially among young people.

ASIA-PACIFIC

* South Korea reported more than 1,000 new cases for a seventh straight day, as the country battles its worst-ever outbreak spurred by the highly contagious Delta variant

* Australia reported a slight easing in new COVID-19 cases in Sydney but left open the possibility of extending a lockdown in the country’s largest city.

* New Zealand said 13 more crew members of a fishing boat quarantined in Wellington have tested positive for COVID-19.*

India’s full rollout of the Sputnik V vaccine will have to be put on hold until the Russian producer provides equal quantities of its two differing doses, Dr. Reddy’s Laboratories Ltd said.

* Thailand will use AstraZeneca’s vaccine as a second dose for those who received Sinovac’s shot as their first dose.

AMERICAS

* At the request of the Supreme Court, Brazil’s federal police has formally opened a probe into President Jair Bolsonaro related to alleged irregularities in the purchase of an Indian vaccine and could now question him, a source with knowledge of the matter said.

MIDDLE EAST AND AFRICA

* At least 44 people were killed and over 67 injured in a fire likely caused by an oxygen tank explosion at a coronavirus hospital in Iraq’s southern city of Nassiriya.

* The Kuwaiti Cabinet decided to close all activities for children, including summer clubs, from July 25 until further notice.

MEDICAL DEVELOPMENTS

* Johnson & Johnson said it is in discussions with the U.S. FDA, which added a warning to the company’s vaccine factsheet after rare cases of a neurological disorder, Guillain-Barré syndrome, were reported six weeks after inoculation.

* Italian biotech firm ReiThera said its vaccine candidate showed a strong immune response and no major side effects in intermediate Phase II clinical trials.

ECONOMIC IMPACT

* Asian shares climbed in early trade on Tuesday after Wall Street hit record highs overnight, as investors awaited the second-quarter earnings season and a batch of economic data, including key U.S. inflation figures. [MKTS/GLOB]

* China’s customs administration spokesperson Li Kuiwen said the country’s trade may slow in the second half of 2021, mainly reflecting the statistical impact of the high growth rate last year.

* The European Central Bank will start tapering its pandemic-related asset purchases after its September meeting and stop buying them by the end of March, according to a Reuters poll.

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A third of teens, young adults reported worsening mental health during pandemic

anxiety

As typical social and academic interaction screeched to a halt last year, many young people began experiencing declines in mental health, a problem that appeared to be worse for those whose connections to family and friends weren’t as tight, a new study has found.

In June 2020, researchers invited participants in an ongoing study of teenage boys and young men in urban and Appalachian Ohio to complete a survey examining changes to mood, anxiety, closeness to family and friends, and other ways the pandemic affected their lives. The study, co-led by researchers at The Ohio State University and Kenyon College, appears in the Journal of Adolescent Health.

Nearly a third of the 571 participants reported that their mood had worsened or their anxiety had increased between March 2020 and June 2020. The study found that worsening mood and increased anxiety during the pandemic were more likely in those with higher socioeconomic status, those who felt decreasing closeness to friends and family and those who were older. Self-reported increases in anxiety were more common among those with a history of depression and/or anxiety.

One example of feedback from a participant: “A return to a much more introverted, anxious and sedentary lifestyle, after recently making attempts to become more social, outgoing and level-headed.”

The research team said the study shines light on those who could be most vulnerable to mental health struggles during a pandemic, and potentially during other situations in which they find themselves isolated from their typical social interaction.

“Though serious cases of COVID-19 have been rare among young people, the pandemic appears to have taken another toll on them,” said study senior author Amy Ferketich, a professor of epidemiology at Ohio State.

Eleanor Tetreault, the study’s lead author and a recent graduate of Kenyon College, said the existing relationships formed within the ongoing Buckeye Teen Health Study provided an opportunity to quickly assess any perceived changes in mood or anxiety at the onset of the pandemic.

Though the findings about worsening mental health are concerning, Tetreault said there were some surprising positive themes that emerged as she and fellow researchers dived into the respondents’ answers to open-ended survey questions.

“The group that had really positive experiences talked about the opportunity for self-exploration, having more time to sit and think or get more connected to their family—at this age, most people are just going, going, going all the time and all the sudden they had this period of time where they could slow down,” said Tetrault, who completed a Pelotonia Summer Research Internship at Ohio State’s Comprehensive Cancer Center in 2020.

Though the researchers can’t be sure what contributed to the worsening mood and anxiety among some respondents, they do have theories.

Being cooped up with parents who were struggling to work from home and manage the stress of the pandemic could be distressing to young people, Ferketich said, adding that those whose home lives weren’t stable to begin with would be hardest hit. Participants from higher socioeconomic groups may have been more likely to have parents who were able to work from home and were more likely to report worsening mental health in the first months of the pandemic.

And though the break from the usual routine “might have been kind of nice at first, it did seem that for some people that changed over time, leading them more toward social isolation, anxiety and depression,” Tetreault said.

Though pandemics are rare, the findings from the study don’t apply just to a global crisis, she said.

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Sublingual Immunotherapy: Where Does It Stand?

This is part 3 of a three-part series. Part 1 is here. Part 2 is here.

Sublingual immunotherapy (SLIT) emerged over a century ago as a gentler alternative to allergy shots. It uses the same antigens found in allergy shots, delivering them through tablets or drops under the tongue rather than by injecting them into the skin.

Dr Sakina Bajowala

Yet injection immunotherapy has been the mainstay of allergy treatment in the United States. Allergy shots are “the bread and butter, keeping the lights on at allergy practices,” said allergist Sakina Bajowala, MD, of Kaneland Allergy and Asthma Center, in the Chicago area. So even “when environmental SLIT showed quite clearly that it had efficacy, people were so slow to adapt.”

SLIT — a daily treatment that builds protection from allergens gradually over years with few side effects — is popular around the globe, particularly for environmental allergies. But only a handful of clinics offer food SLIT. Even though recent trials in peanut-allergic children show that SLIT is far safer than oral immunotherapy and about as effective as the US Food and Drug Administration (FDA)–approved peanut allergy product and has lasting benefits for toddlers, many allergists lack experience with customized immunotherapies and hesitate to offer an unregulated treatment for which the evidence base is still emerging.

Why Hasn’t Food Allergy SLIT Caught On?

One issue is that there is scant evidence from randomized controlled trials. The treatments that clinics offer often hinge on insurance coverage, and increasingly, insurers only cover FDA-approved products. FDA approval requires thousands of patients being enrolled in long, expensive studies to prove the treatment’s merit. In a similar vein, doctors are trained to question methods that lack a strong publication base, for good reason.

Yet SLIT caught the attention of pioneering physicians who were intrigued by this “low and slow” immune-modifying approach, despite limited published evidence, and they sought real-world experience.

Dr David Morris

The late physician David Morris, MD, came across SLIT in the 1960s while searching for alternative ways to help mold-allergic farmers who were suffering terrible side effects from allergy shots. Morris attended conferences, learned more about sublingual techniques, got board certified in allergy, and opened Allergy Associates of La Crosse, in Wisconsin, in 1970 to offer SLIT as a treatment for food and environmental allergies.

Dr Nikhila Schroeder

Morris and colleagues developed a protocol to create custom SLIT drops tailored to individual patients’ clinical histories and allergy test results. The method has been used to treat more than 200,000 patients. It has been used by allergist Nikhila Schroeder, MD, MEng, who learned SLIT methods while treating nearly 1000 patients at Allergy Associates. In 2018, she opened her own direct-care SLIT practice, Allergenuity Health, in the Charlotte metropolitan area of North Carolina (see part 2 of this series).

Bajowala’s clinic offers SLIT in addition to oral immunotherapy (OIT). She was encouraged by the recent toddler SLIT data but wondered whether it would translate to a real-world setting. According to her calculations, the published protocol — according to which participants receive up to 4 mg/d over 6 months and continue receiving a daily maintenance dose of 4 mg for 3 years — would cost $10,000 per patient.

With this dosing regimen, the intervention is unaffordable, Bajowala said. And “there’s no way to make it cheaper because that’s the raw materials cost. It does not include labor or bottles or profit at all. That’s just $10,000 in peanut extract.”

Owing to cost, Bajowala’s clinic generally uses SLIT as a bridge to OIT. Her food allergy patients receive up to 1 mg/d and remain at that dose for a month or so before transitioning to OIT, “for which the supplies are orders of magnitude cheaper,” she said.

Schroeder said there is evidence for efficacy at microgram and even nanogram dosing — much lower than used in the recent food SLIT trials. Maintenance doses range from 50 ng/d to 25 μg/d for environmental SLIT and 4–37 μg/d for food SLIT, she said. The La Crosse method uses even lower dose ranges.

However, dosing information is not readily available, Schroeder noted. She has spent years scrutinizing articles and compiling information from allergen extract suppliers — all the while treating hundreds of SLIT patients. “I have had to expend a lot of time and effort,” said Schroeder. “It’s really hard to explain quickly.”

In the published literature, SLIT dosing recommendations vary widely. According to a 2007 analysis, environmental allergy symptoms improved with doses over a 1000-fold range. What’s more, success did not scale with increased dosing and seemed to depend more on frequency and duration of treatment.

Dr Edwin Kim

There are fewer studies regarding food SLIT. The most promising data come from recent trials of peanut-allergic children led by Edwin Kim, MD, director of the UNC Food Allergy Initiative, University of North Carolina School of Medicine, Chapel Hill, North Carolina. Still, “I am nervous to tell people to go do this based on 150 kids at one site,” Kim said. “We need to have a gigantic study across multiple sites that actually confirms what we have found in our single center.”

Because there are few published trials of food SLIT, confusion about which doses are optimal, how early to start, and how long the benefits last will be a barrier for many clinicians, said Douglas Mack, MD, FRCPC, assistant clinical professor in pediatrics at McMaster University, in Hamilton, Ontario, Canada.

Dr Douglas Mack

Much could be learned from Allergy Associates of La Crosse, Allergenuity Health, and other clinics with SLIT experience involving thousands of patients. But that real-world data are messy and difficult to publish. Plus, it is hard for private allergists to find time to review charts, analyze data, and draft papers alongside seeing patients and running a clinic — especially without students and interns, who typically assist with academic research, Schroeder said.

Ruchi Gupta, MD, MPH, professor of pediatrics and medicine at Northwestern University Feinberg School of Medicine, in Chicago, Illinois, and colleagues worked with a La Crosse team 6 or 7 years ago to try to analyze and publish SLIT outcomes for 121 peanut-allergic children who were treated for food and environmental allergies at the Wisconsin clinic. The researchers had hoped to publish an article describing caregiver-reported and clinical outcomes.

Among 73 caregivers who responded to a survey, more than half reported improved eczema, asthma, and environmental allergy symptoms, and virtually all families said SLIT calmed anxieties and minimized fear of allergic reactions. However, the clinical outcomes — skinprick test results, immune changes, and oral food challenges — were not as robust. And the data were incomplete. Some patients had traveled to La Crosse for SLIT drops but underwent skin and blood testing with their local allergist. Compiling records is “so much harder when you’re not doing a prospective clinical trial,” Gupta said.

Jeff Kessle, MBA

The caregiver-reported outcomes were presented as a poster at the 2015 annual meeting of the American College of Allergy, Asthma and Immunology and the 2016 annual meeting of the Pediatric Academic Society, said Jeff Kessler, MBA, FACHE, who is practice executive at La Crosse. However, with only self-reported data and no convincing lab metrics, the findings were never submitted for publication.

Others are eager to see clearer proof that SLIT works at doses lower than those published in the most recent trials. “If we can get efficacy with lower doses, that means we can increase accessibility, because we can lower the cost,” Bajowala said.

Dr Robert Wood

Robert Wood, MD, professor of pediatrics and director of pediatric allergy and immunology at Johns Hopkins, has a pending grant proposal for a multifood trial of SLIT. “It’s a big missing piece,” he said.

Mack said that in Canada, there was “almost an instant change in group think” when the Canadian Society of Allergy and Clinical Immunology published guidelines in support of OIT. With the new guidelines, “people are less concerned about liability,” Mack said. “Once they start getting into OIT, I think you’re going to see SLIT coming right along for the ride.”

The shift will be slower in the United States, which has 20 times as many practicing allergists as Canada. Nevertheless, “I totally think SLIT has a place at the table,” Mack said. “I hope we start to see more high-quality data and people start to use it and experiment with it a bit and see how it works.”

This is part 3 of a three-part series. Part 1 is here. Part 2 is here.

Esther Landhuis is a freelance science journalist in the San Francisco Bay Area. Her work has appeared in Scientific American, Nature, Kaiser Health News, Undark, and elsewhere. She can found on Twitter @elandhuis.

For more news, follow Medscape on Facebook, Twitter, Instagram, and YouTube.

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Mexico adds nearly 8,000 COVID-19 cases, highest daily jump since February

FILE PHOTO: People line up to buy as the coronavirus disease (COVID-19) outbreak continues in Mexico City, Mexico July 2, 2021. Picture taken July 2, 2021. REUTERS/Edgard Garrido

MEXICO CITY (Reuters) -Mexican health authorities reported on Tuesday the biggest jump in new daily coronavirus infections since late February, signs of a surging pandemic amid a slow vaccination rollout.

The health ministry reported 7,989 new confirmed cases of COVID-19 along with 269 more fatalities, bringing the overall total to 2,549,862 infections and 233,958 deaths.

The number of new infections on Tuesday marks the highest level of the daily count since February 26, the data showed.

The government has said the real number of cases is likely significantly higher, and separate data published recently suggested the actual death toll could be 60% higher than the official count.

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Is Honey a Good Natural Sweetener Substitute for Vegans?

Those people who wanted to lose weight and regulate their blood sugar already know the drill: as much as possible, you are to avoid eating refined sugar as well as its variants that are hidden in processed foods.

We tend to seek healthier alternatives to sweeten our foods without spiking up our blood sugar. And when we talk about natural sweeteners, the first thing that comes to mind is honey. Honey is a natural sweetener produced by bees. But the vegans are concerned on whether or not honey is good to incorporate in their strict diet regimen. Here’s what the experts have to say.

The Vegan Definition

According to the Vegan Society, the idea of veganism originated back in the 1940s where they define it as the way of living that seeks to avoid all forms of exploitation of animals for clothing, food, or any other purpose. The philosophy also extends to seeking animal-free alternatives for the benefit of the animals, environment, and humanity.

When it comes to dietary terms, it means practicing a lifestyle of dispelling all products derived from animals. So according to Jessica Cording R.D, honey should be prohibited to all vegans. However, there’s a catch to this principle.

If we’re to follow the principles of veganism, honey technically falls under the exploitation of “bees.”

According to the author of Main Street Vegan, Victoria Moran, some vegans tend to eat dairy products during the late 80s’ without eating its main animals like pork, chicken, or beef. They call themselves ovo-Lacto vegetarians who consume vegetables and dairy.

The reason behind this varied diet is because vegans need to have sources of protein. That’s why the definition of veganism has evolved for the past years, and the society leaves it to the people to decide whether or not they want to incorporate honey in their diet.

The Ethical Reasons

Bees pollinate plants to increase and spread the production of foods.

According to the author of The Small Change Diet, honey should be banned from vegan consumption since it basically comes from an insect. However, it’s hard to draw the line on whether or not to consume this food due to ethical reasons.

For example, bees are natural pollinators. And most farm factories would produce bees to pollinate foods like the almonds in California or blueberries in Maine. If you follow the vegan definition, vegans shouldn’t eat blueberries and almonds too since it exploits bees. However, most vegans eat these foods so the same principle also applies when it comes to consuming honey.

Honey Alternatives

If you choose to follow a strict vegan diet and ditch honey, the health experts recommend you use these alternatives.

Natural Honey

If you want to taste natural honey, you can buy a product called Bee made of pure, organic apples. This type of honey is made from fruit without the usage of bees or any insects. What’s great about this product is that it offers several varieties according to your preferences.

Stevia

Aside from being a plant-based natural sweetener, stevia doesn’t spike your blood sugar levels.

Stevia is a natural sweetener that came from the stevia plant, so vegans can enjoy incorporating this sweetener to their diet without feeling guilty. You can use this in your dessert recipes. It’s also perfect for those who want to lose weight or are suffering from diabetes since it regulates your blood sugar levels. You can enjoy consuming this without worrying about your sugar levels. If not, you can use agave nectar or maple syrup as another healthy and vegan alternative.

The Verdict

Technically, honey isn’t a vegan food based on the experts’ explanation, but it all falls down to what you want and not want to incorporate in your diet. If you want to be lax in your vegan diet, then there’s no harm in using honey. The vegan society also won’t rally in front of your house for it. But if you want to adhere to the diet’s principles religiously, then you may opt to drop honey and use the alternatives instead.

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Does a plant-based diet really help beat COVID-19?

Does a plant-based diet really help beat COVID-19?

Since the beginning of the pandemic, it’s been suggested that certain foods or diets may offer protection against COVID-19. But are these sorts of claims reliable?

A recent study published in BMJ Nutrition, Prevention and Health sought to test this hypothesis. It found that health professionals who reported following diets that are vegetarian, vegan or pescatarian (those that exclude meat but include fish) had a lower risk of developing moderate-to-severe COVID-19.

Additionally, the study found that those who said they eat a low-carbohydrate or high-protein diet seemed to have an increased risk of contracting moderate-to-severe COVID-19.

This may make it sound like certain food preferences—such as being vegetarian or a fish eater—may benefit you by reducing the risk of COVID-19. But in reality, things aren’t so clear.

Self-reporting and small samples

First, it’s important to underline that reported diet type didn’t influence the initial risk of contracting COVID-19. The study isn’t suggesting that diet changes the risk of getting infected. Nor did it find links between diet type and length of illness. Rather, the study only suggests that there’s a link between diet and the specific risk of developing moderate-to-severe COVID-19 symptoms.

It’s also important to consider the actual number of people involved. Just under 3,000 health professionals took part, spread across six western countries, and only 138 developed moderate-to-severe disease. As each person placed their diet into one of 11 categories, this left a very small number eating certain types of diet and then even smaller numbers getting seriously ill.

This meant, for instance, that fish eaters had to be grouped together with vegetarians and vegans to produce meaningful results. In the end only 41 vegetarians/vegans contracted COVID-19 and only five fish eaters got the disease. Of these, just a handful went on to develop moderate-to-severe COVID-19. Working with such small numbers increases the risk of a falsely identifying a relationship between factors when there isn’t one—what statisticians call a type 1 error.

Then there is another problem with studies of this type. It’s observational only, so can only suggest theories about what is happening, rather than any causality of diet over the effects of COVID-19. To attempt to show something is actually causal, you ideally need to test it as an intervention—that is, get someone to switch to doing it for the study, give it time to show an effect, and then compare the results with people who haven’t had that intervention.

This is how randomised controlled trials work and why they are considered the best source of evidence. They are a much more robust method of testing whether one single thing is having an effect on something else.

Plus, there is also the problem that the diet people say they consume may not be what they actually eat. A questionnaire was used to find out what foods people ate specifically, but responses to this were also self-reported. It also had only 47 questions, so subtle but influential differences in people’s diets may have gone unnoticed. After all, the foods available in the US do differ from those available in Spain, France, Italy, the UK and Germany.

So what does this tell us?

When it comes to trying to determine the best diet for protecting against COVID-19, the truth is we don’t have enough quality data—even with the results of this study, which are a small data set and only observational.

And a further issue is that the study didn’t look at the quality of people’s diets by assessing which foods they actually ate. This is another reason why it needs treating with caution. Self-declared diet types or food questionnaires may not capture information on the variety and type of foods eaten—for instance missing details about how much fresh or processed food someone eats, how meals are eaten and with whom. And as alluded to above, self-reported data on what people eat is also notoriously inaccurate.

The bottom line is: the name of what you call your diet is far less important than what you actually eat. Just because a diet is vegetarian or pescatarian doesn’t automatically make it healthy.

For now, the robust evidence isn’t there to suggest that being vegetarian or pescatarian protects against COVID-19—so there’s no need to rush to switch your diet as a result of this study. However, what we do know is that keeping active, eating a sensible healthy diet and keeping our weight in check helps to fortify us against a wide range of health issues, and this could include COVID-19.

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“My confidence has taken a hit during lockdown – how can I get it back?”

Written by Lauren Geall

As Stylist’s junior digital writer, Lauren Geall writes on topics including mental health, wellbeing and work. She’s also a big fan of houseplants and likes to dabble in film and TV from time-to-time.

Could the isolation of lockdown be the reason why so many of us are feeling less confident in ourselves? We asked an expert to explain. 

It’s no secret that the pandemic has taken a toll on our collective mental health. Whether you’ve struggled with health anxiety surrounding the virus itself, dealt with feelings of loneliness as a result of lockdown restrictions or experienced increased stress due to blurred work/life boundaries while working from home, the last 14 months have placed a strain on us all.

In my case, this has meant a decrease in my self-esteem and confidence as a result of spending time away from people during lockdown.

It’s a fact I’ve noticed particularly as lockdown restrictions have eased and I’ve been able to see friends again; whereas before I might have gone into a social situation without a second thought, I’m now doubting everything I say, worrying about what other people think of me and generally feeling unsure about myself and the way I present to the world.  It feels weird to admit, but spending time alone – and not being able to see myself through the eyes of other people – has messed with my sense of self.

Before the pandemic, I’d never quite released how important those regular interactions with my friends, work colleagues and peers were to how I see myself.Perhaps I didn’t want to admit it – when modern discourse frowns upon the idea that we might ‘need’ others to feel good about ourselves, it felt weirdly shameful to acknowledge how integral the presence of others is to how I see myself. Did I really need other people to feel happy and content in my own skin?

The answer, as it turns out, is yes – and that’s not necessarily a bad thing. You see while relying purely on external validation isn’t good for you, it’s completely normal to need some sense of feedback from those around you – in fact, it’s part of who we are as humans. 

“We are social creatures – we almost see ourselves through others – so not having that continual feedback can leave us feeling quite insecure,” explains chartered psychologist and author Dr Meg Arroll. “If we think of confidence as on one end of the spectrum and insecurity on the other, without that feedback loop, we’re kind of being nudged into that place of insecurity and feeling quite uncertain in ourselves.”

While, Dr Arroll acknowledges, some people prefer to spend time alone, and may not need as much feedback from others to feel confident, most people will need some kind of reassurance from others. Indeed, it’s actually normal to have different social groups which give you confidence in different areas – all of which add up to give you a certain sense of ‘you’.

“For instance, I feel like a slightly different person with different groups of friends, and it brings different parts of my personality out,” Dr Arroll says. “So, without that, we can almost kind of forget who we are – we need that reflection from others to show us.”

What Dr Arroll is saying makes a lot of sense. For example, I feel completely comfortable chatting to my colleagues at the moment, because I’ve spoken to them day-in-day-out via Zoom throughout the pandemic. However, when I see friends IRL who I haven’t spoken to much (except over text) for the last year, that side of my personality is a little out of practice, so it’s only normal to feel a little uncomfortable and rusty as I slip back into it. 

Getting back to socialising after a year of lockdown restrictions can feel jarring at first.

With this in mind, Dr Arroll suggests that, if you’ve found yourself struggling with your self-esteem and confidence as restrictions ease, one of the best things you can do is to practise a little bit of self-compassion and take ‘baby steps’ to get yourself used to socialising again.

“In different situations there will be different social norms, and because we haven’t been doing them every day, it’s going to take a little bit of time to build up that confidence of really knowing those norms and for them to become automatic again,” Dr Arroll explains.  

“Try to understand and acknowledge that we are our own worst critics,” she adds. “In the instances where we’re doubting ourselves, 99.9% of the time other people won’t have noticed.”

To try and address the amount of self-criticism you’re feeding yourself and practise being more self-compassionate, one of the best things you can do is to deal with your inner critic.

“When I work with patients, I encourage them to replace their inner critic with an inner coach, because we need to really focus on replacing thought patterns, not just trying to extinguish them” Dr Arroll explains.

“A way to do this is to think about someone who makes you feel really positive – it could be a real person, a celebrity, an imagined character – but someone who makes you feel really good about yourself. Try to imagine their tone and the pitch of their voice, and then bring that voice to life in your head.” 

She continues: “Now, whenever that inner critic is starting to say something negative, or questioning something you’ve done, replace it with this coach – you can even imagine a conversation between the critic and the coach, if you want. By doing this, you’re actively engaging in a more positive inner narrative.”

Finally, Dr Arroll suggests, one way to make yourself feel more secure in the moment is to use a have a ‘comfort item’ – something that can help you to feel more grounded when you’re feeling overwhelmed. This could be anything, from a comfy scarf to a good luck charm or even a picture on your phone.

“Whatever it is, have it so that, when you’re starting to feel uncomfortable or insecure, you have that visual reminder that you’re good enough and you’ve got this,” she adds.  

So, there we have it. If like me, you’ve been feeling a little low on confidence since restrictions started easing, you’re certainly not the only one – and there are things you can do in the meantime to make that transition back to ‘normal’ that little bit easier.

The last 14 months have been a rollercoaster ride – and as we start to get back to the things we love, it’s important that we cut ourselves some slack for getting through it all. 

If you, or someone you know, is struggling with their mental health, you can find support and resources on the mental health charity Mind’s website and NHS Every Mind Matters or access the NHS list of mental health helplines and organisations here.

If you are struggling with your mental health, you can also ask your GP for a referral to NHS Talking Therapies, or you can self-refer.

You can also call the Samaritans in the UK on 116 123 or email [email protected] for confidential support.

Images: Getty

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