How to boost your immune system in good time for flu season

Already starting to panic about flu season? You’re not alone.

Do you need a flu jab? How can you tell the difference between flu symptoms and coronavirus? How can you boost your immune system ahead of winter?

There has been an intense focus on health and immunity this year thanks to Covid-19 and now everyone’s starting to think about how best to protect themselves for the winter.

‘The immune system is one of the most complex and comprehensive systems in the human body,’ says Mike Wakeman, a clinical pharmacist and ambassador for health food supplement CurraNZ.

‘It’s also one of the most important. It’s the invisible barrier against all sorts of foreign assaults from micro-organisms (fungal infections, bacteria and Covid-19) and allergens (pollens, dust mites and chemicals) that we encounter on a daily basis.’

Our first level of immunity is called the innate immune system and is activated as soon as a disease-causing micro-organism is detected. It can detect invaders such as viruses, bacteria, parasites and toxins and attempt to kill them off, before they can enter the body.

‘Innate immunity is made up of things like skin, the gastrointestinal tract and the respiratory tract. Inside these parts of the body are barriers like mucus, secretion and gastric acid, which try to stop the invaders getting in. The innate system also has immune cells (called macrophages), which are some of the most abundant cells in the human body and specialise in detecting and destroying bacteria and other harmful organisms by engulfing and killing them,’ says Mike.

The second level of protection is called the adaptive immune system, which is activated to enhance the innate system.

‘This is mainly cells called lymphocytes,’ explains Mike. ‘They are a type of white blood cell that have the ability to recognise a unique part of a micro-organism, memorise it and produce specific pathogen-neutralising compounds known as immunoglobulins. So when the body encounters this particular antigen [foreign substance] again it can produce more of the immunoglobulins it knows can kill it. This is the basis of how immunisations and flu jabs work.’

Generally, our immune system does an amazing job of defending us but a recent review in the Journal of Sport and Health Science found that ageing, obesity, and inactivity have a negative effect on the immune system.

‘The idea of boosting your immunity sounds like a simple enough process, but it’s not like giving yourself an injection or taking a shot,’ says Mike.

‘You need to think more about optimising your immunity on a daily basis as some vitamins and minerals take longer to generate their effect than others. Vitamin C is water soluble so absorbed straight away, while vitamin D is fat-soluble so is stored in fat cells rather than circulating in the body.

‘Autumn is the best time to think about how to build up immunity for winter and a good quality multi-vitamin is a cheap way to start optimising your protection.’

Spot the signs of a weakened immune system

Don’t wait until you become poorly to start looking after yourself – if you are suffering from any of these problems it’s worth taking stock and taking some extra care, says Mike.

Spot the signs

Cracks in the corner of the mouth

‘This can indicate some aspects of the immune system might be under stress. Vitamins and minerals are vital as they can help to resolve minor issues like this.’

Constant cold symptoms or infection

‘Constant and repeated colds are not only a sign of a weakened immune system, but also place extra demands on immune micronutrient status.’

Wounds take longer to heal

‘Poor healing is a typical symptom of a challenged immune system, and a number of vitamins, such as vitamin C can help improve the skin function.’

Bleeding gums

‘Often poor oral hygiene can be a major challenge to the immune system, so brush your teeth regularly, twice daily and don’t forget to floss.’

Constantly tired and over-stressed

‘Stress can really impact on our immune function, so take time out to look after yourself, get some exercise and relieve stress and exhaustion as much as possible.’

A weakened immune system can be helped with simple diet changes. ‘Most of us are deficient in vitamin D which is produced by the body when we’re exposed to sunshine,’ says Mike.

‘We don’t get enough of it during the summer and definitely not in winter. Oily fish, like pilchards, sardines, mackerel and some salmon are a good source of vitamin D and also high in omega-3 fatty acids, which may also help enhance the function of the immune cells.’

Mike is keen to emphasise that lots of what you need to bolster the immune system can be found in food. ‘You should be eating at least five portions of fruit and veg a day,’ he says.

‘Not only do vitamins and minerals optimise the immune system, they have an anti-inflammatory effect too, so if the immune system over-responds, these micronutrients can help resolve the inflammation this causes. These vitamins and minerals also help the body produce anti-bacterial compounds that fight infection within the body while compounds known as polyphenols support immunity.’

So, a healthy diet has never been more important. When teamed with a good quality multi-vitamin you should stand a better chance of fighting off the winter nasties.

Supplements to help boost your immune system

Five of the best supplements to give a helping hand

1. Extra special

Vitabiotics Immunace Extra Protection contain lycopene, resveratrol, astaxanthin, alpha lipoic acid and vit D. £10.15 (30 tablets)

2. Gum deal

Sambucol ImmunoForte Gummies contain black elderberry flavonoids, plus vitamin C, zinc and high levels of antioxidants. Suitable for vegans. £11 (30 gummies)

3. Vit blitz

Urgent-C Everyday Immune Support contains 1,000mg of vitamin C, plus vitamin D, zinc, selenium, beta glucans and elderberry extract which all help the normal function of the immune system. £14.95 (30 sachets)

4. Berry nice

Blackcurrants offer anti-viral and anti-microbial properties to help the body ward off infection. A single capsule of CurraNZ is equivalent to a handful of berries. £21.75 (30 capsules)

5. Sweet Treat

Made with all-natural ingredients and boosted with 100 per cent NRV vitamin D, C and B12, these new Perkier +Immune bars are tasty plant-based snacks to boost immune health. £15.99 (15 bars)

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How even a short walk can boost your memory

How even a short walk can boost your memory: Exercise improves concentration and problem-solving skills, scientists discover

  • Scientific review found people improved on memory tests after exercising 
  • Findings come from 13 studies which were analysed by Swedish researchers 
  • Exercise is believed to increase levels of a protein called ‘brain-derived neurotrophic factor’ which is thought to be important for memory function

A short walk, run or bike ride could provide a memory boost in less than an hour.

A scientific review looked at people aged 18 to 35 who walked, ran or cycled at moderate to high intensity and then took tests such as remembering a list of 15 words.

The participants, who exercised in bursts of two minutes, or 15 minutes, half an hour or an hour, improved on tests and showed better concentration and problem-solving skills.

The findings come from 13 studies which were analysed by Swedish researchers.

A short walk, run or bike ride could provide a memory boost in less than an hour

The authors, from Jonkoping and Linkoping universities, conclude: ‘This systematic review strongly suggests that aerobic, physical exercise followed by a brief recovery… improves attention, concentration, and learning and memory functions in young adults.’

Exercise is believed to increase levels of a protein called ‘brain-derived neurotrophic factor’ which is thought to be important for memory.

But not everyone is a natural athlete or has hours to work out. 

The review wanted to see if a single bout of exercise could have an effect, so looked at studies exploring this with young adults over ten years.

The review, published in the journal Translational Sports Medicine, found exercise from two minutes to an hour improved memory and thinking skills for up to two hours.

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Ever heard of a surgical assistant? Meet a new boost to your medical bills

Izzy Benasso was playing a casual game of tennis with her father on a summer Saturday when she felt her knee pop. She had torn a meniscus, one of the friction-reducing pads in the knee, locking it in place at a 45-degree angle.

Although she suspected she had torn something, the 21-year-old senior at the University of Colorado in Boulder had to endure an anxious weekend in July 2019 until she could get an MRI that Monday.

“It was kind of emotional for her,” said her father, Steve Benasso. “Just sitting there thinking about all the things she wasn’t going to be able to do.”

At the UCHealth Steadman Hawkins Clinic Denver, the MRI confirmed the tear, and she was scheduled for surgery on Thursday. Her father, who works in human resources, told her exactly what to ask the clinic regarding her insurance coverage.

Steve had double-checked that the hospital; the surgeon, Dr. James Genuario; and Genuario’s clinic were in her Cigna health plan’s network.

“We were pretty conscious going into it,” he said.

Isabel met with Genuario’s physician assistant on Wednesday, and the following day underwent a successful meniscus repair operation.

“I had already gotten a ski pass at that point,” she said. “So that was depressing.” But she was heartened to hear that with time and rehab she would get back to her active lifestyle.

Then the letter arrived, portending of bills to come.

The Patient: Izzy Benasso, a 21-year-old college student covered by her mother’s Cigna health plan.

The Total Bill: $96,377 for the surgery was billed by the hospital, Sky Ridge Medical Center in Lone Tree, Colorado, part of HealthONE, a division of the for-profit hospital chain HCA. It accepted a $3,216.60 payment from the insurance company, as well as $357.40 from the Benassos, as payment in full. The surgical assistant billed separately for $1,167.

Service Provider: Eric Griffith, a surgical assistant who works as an independent contractor.

Medical Service: Outpatient arthroscopic meniscus repair surgery.

What Gives: The Benassos had stumbled into a growing trend in health care: third-party surgical assistants who aren’t part of a hospital staff or a surgeon’s practice. They tend to stay out-of-network with health plans, either accepting what a health plan will pay them or billing the patient directly. That, in turn, is leading to many surprise bills.

Even before any other medical bills showed up, Izzy received a notice from someone whose name she didn’t recognize.

“I’m writing this letter as a courtesy to remind you of my presence during your surgery,” the letter read.

It came from Eric Griffith, a Denver-based surgical assistant. He went on to write that he had submitted a claim to her health plan requesting payment for his services, but that it was too early to know whether the plan would cover his fee. It didn’t talk dollars and cents.

Steve Benasso said he was perplexed by the letter’s meaning, adding: “We had never read or heard of anything like that before.”

Surgical assistants serve as an extra set of hands for surgeons, allowing them to concentrate on the technical aspects of the surgery. Oftentimes other surgeons or physician assistants—or, in teaching hospitals, medical residents or surgical fellows—fill that role at no extra charge. But some doctors rely on certified surgical assistants, who generally have an undergraduate science degree, complete a 12- to 24-month training program, and then pass a certification exam.

Surgeons generally decide when they need surgical assistants, although the Centers for Medicare & Medicaid Services maintains lists of procedures for which a surgical assistant can and cannot bill. Meniscus repair is on the list of allowed procedures.

A Sky Ridge spokesperson said that it is the responsibility of the surgeon to preauthorize the use and payment of a surgical assistant during outpatient surgery, and that HealthOne hospitals do not hire surgical assistants. Neither the assistant nor the surgeon works directly for the hospital. UC School of Medicine, the surgeon’s employer, declined requests for comment from Genuario.

Karen Ludwig, executive director of the Association of Surgical Assistants, estimates that 75% of certified surgical assistants are employed by hospitals, while the rest are independent contractors or work for surgical assistant groups.

“We’re seeing more of the third parties,” said Dr. Karan Chhabra, a surgeon and health policy researcher at the University of Michigan Medical School. “This is an emerging area of business.”

And it can be lucrative: Some of the larger surgical assistant companies are backed by private equity investment. Private equity firms often target segments of the health care system where patients have little choice in who provides their care. Indeed, under anesthesia for surgery, patients are often unaware the assistants are in the operating room. The private equity business models include keeping such helpers out-of-network so they can bill patients for larger amounts than they could negotiate from insurance companies.

Surgical assistants counter that many insurance plans are unwilling to contract with them.

“They’re not interested,” said Luis Aragon, a Chicago-area surgical assistant and managing director of American Surgical Professionals, a private equity-backed group in Houston.

Chhabra and his colleagues at the University of Michigan recently found that 1 in 5 privately insured patients undergoing surgery by in-network doctors at in-network facilities still receive a surprise out-of-network bill. Of those, 37% are from surgical assistants, tied with anesthesiologists as the most frequent offenders. The researchers found 13% of arthroscopic meniscal repairs resulted in surprise bills, at an average of $1,591 per bill.

Colorado has surprise billing protections for consumers like the Benassos who have state-regulated health plans. But state protections don’t apply to the 61% of American workers who have self-funded employer plans. Colorado Consumer Health Initiative, which helps consumers dispute surprise bills, has seen a lot of cases involving surgical assistants, said Adam Fox, director of strategic engagement.

Resolution: Initially, the Benassos ignored the missive. Izzy didn’t recall meeting Griffith or being told a surgical assistant would be involved in her case.

But a month and a half later, when Steve logged on to check his daughter’s explanation of benefits, he saw that Griffith had billed the plan for $1,167. Cigna had not paid any of it.

Realizing then that the assistant was likely out-of-network, Steve sent him a letter saying “we had no intention of paying.”

Griffith declined to comment on the specifics of the Benasso case but said he sends letters to every patient so no one is surprised when he submits a claim.

“With all the different people talking to you in pre-op, and the stress of surgery, even if we do meet, they may forget who I was or that I was even there,” he said. “So the intention of the letter is just to say, ‘Hey, I was part of your surgery.'”

After KHN inquired, Cigna officials reviewed the case and Genuario’s operative report, determined that the services of an assistant surgeon were appropriate for the procedure and approved Griffith’s claim. Because Griffith was an out-of-network provider, Cigna applied his fee to Benasso’s $2,000 outpatient deductible. The Benassos have not received a bill for that fee.

Griffith says insurers often require more information before determining whether to pay for a surgical assistant’s services. If the plan pays anything, he accepts that as payment in full. If the plan pays nothing, Griffith usually bills the patient.

The Takeaway: As hospitals across the country restart elective surgeries, patients should be aware of this common pitfall.

Chhabra said he’s hearing more anecdotal reports about insurance plans simply not paying for surgical assistants, which leaves the patient stuck with the bill.

Chhabra said patients should ask their surgeons before surgery whether an assistant will be involved and whether that assistant is in-network.

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GPs text messages boost cervical screening uptake

Sending a text message reminder can lead to more women taking up cervical screening, new research has shown.

In a study of almost 15,000 women in Northwest London, SMS reminders increased cervical screening participation by around five percent.

Based on these findings, the NHS rolled out text message reminders across London in late 2018 for a six-month trial, which saw a similar rise of 4.8 percent in cervical screening uptake. That is the equivalent of 13,400 more women being screened as a result of the campaign.

Cervical screening can help save lives by spotting harmful or potentially harmful changes in cervical cells earlier, meaning women can get access to treatment when it’s more likely to be effective. This means that cervical screening can lead to better outcomes for women, as well as helping to prevent cervical cancer.

But cervical screening rates have been falling in Britain. To address this, a team from Warwick Business School, Imperial College, Public Health England, UCL and Imperial College Healthcare NHS Trust explored whether sending a text to remind women that their smear test is due could encourage more people to make and attend an appointment.

Ivo Vlaev, Professor of Behavioural Science at Warwick Business School, said: “We very much hope the rest of the country implements this revolutionary behavioural approach as soon as possible.

“Our study suggests that messages endorsed by a person’s GP can be effective at increasing cervical screening uptake, but also that a simple reminder can be as good as or better than many other type of messages that we studied.

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“We’re delighted that our findings have already been implemented in a successful pilot campaign in London, which we hope will be extended so that more women can benefit from cervical screening, which we know saves lives. In order to make the most of the impact that SMS reminders can have on uptake, it will be important for services to have up-to-date phone numbers for their patients.”

The study, which ran from February to October in 2015, saw 14,500 women aged 24-64 participate and was supported by the London Borough of Hillingdon Clinical Commissiong Group and participating GP practices.

In the first study 3,133 women aged 24-29 were randomised to receive either no SMS, or an SMS endorsed by their GP. A second study saw a further 11,405 women aged 30-64 randomised to receive either no SMS, a standard reminder to book an appointment via text, an SMS endorsed by their GP, or one of four SMS’ using behavioural science nudges. There were social norms messages relaying the local proportion or number of women being screened.

Will nudges boost cervical cancer screening?

Then there were texts using gain-framed and loss-framed messages, with one highlighting the potential benefits of screening with the number of lives saved by screening each year and another detailing the amount of lives lost if women are not screened.

In study one, participation was higher in those who received a GP-endorsed SMS (31.4 percent) compared to those who received no SMS (26.4 percent). In study two, participation was highest in those who received a GP-endorsed SMS (38.4 percent) or a standard reminder SMS (38.1 percent), compared to no SMS (34.4 percent).

More women in the trial attended cervical screening if they received a text message, compared to those who didn’t. Rates were highest among those who received a standard reminder or a GP-endorsed text, both of which saw around a five percent increase in participation.

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Slightly more women also attended screening if they were sent a text framed around potential losses or gains, but attendance was not significantly higher than for those who were not sent a text message.

However, when the researchers excluded cases where the text was not successfully sent (determined from delivery status information), the study found that uptake was higher across all of the different SMS messages, compared to no message.

Sarah Huf, Honorary Clinical Research Fellow at Imperial’s Institute of Global Health Innovation, said: “Not only do text message reminders improve cervical screening rates, our results indicate that what we write in the message matters.

“We hope that this low-cost intervention will be adopted beyond London. Given the likely detrimental impact of the ongoing COVID-19 pandemic on cancer screening rates across the UK, simple interventions such as text message reminders could support efforts to increase cervical screening as services resume normal practice.”

As it costs around just 3p to send a text, SMS reminders would be a relatively inexpensive intervention for health systems. Although if practices don’t already have the required software, there are further costs attached to setting this up.

Based on the results of this study, the researchers are now extending their work to find out whether the specific wording of text message reminders can influence rates of breast screening.

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These Baby High Chairs Will Give Them the Safe Boost They Need

Aside from diapers and baby formula, the other constant in your life as a parent of a baby is going to be a reliable baby high chair. Whether you’re eating at home, at a relative’s, or at a restaurant, you’re going to need something to give them a boost while keeping them safely contained so you can eat too. The best baby high chairs come in a variety of shapes, sizes, and colors that you can match to their favorite outfits or colors. Many high chairs come with different features, so it’s important to consider what’s the best option for you and your little one.

When you’re picking out a baby high chair, you’ll first want to determine where you’re going to use it most. If you’re looking for a travel-friendly version, you’ll want a compact one that’s easy to fit in the car. To avoid buying high chairs as they grow out of them, one that easily adjusts as they grow up is a must. Some high chairs even convert into a step stool, so that’s another smart thing to consider. Ahead, we’ve rounded up the best baby high chairs to meet your needs.

1. Infantino High Chair

They (and you) won’t be able to resist this darling fox baby high chair. This four-in-one baby high chair is also smart too by saving space in your home. It converts from a booster into a toddler chair with ease so it will grow with them as they outgrow their baby high chair. It’s also easy to clean and has an easy release food tray for fuss-free cleaning. You can wipe down the soft cushioning without a problem, too. With front wheels, you can reposition the chair to face however you’d like.

2. Graco Everystep High Chair

If you want a baby high chair that does more than let your little one safely sit, then this convertible option will meet your needs. This smart high chair easily converts from a high chair to a kids step stool for when they need to reach for the counter. With seven total growing stages, you can keep this high chair for years without having to replace it as they get bigger. It’s narrowed down to three stages: the infant high chair with three reclining positions, fully featured baby high chair with seven height positions and dishwasher-safe tray insert, and infant booster seat that brings them right up to the table by attaching to the table.

3. Fisher Price SpaceSaver High Chair

Whether you have tight quarters at home or travel often with baby, this compact baby high chair is going to save a ton of valuable space wherever you go. Not to mention, it has a stylish neutral design that will look great in your home. It may be smaller, but it still packs in all the features of a full size high chair. It even transforms from an infant booster to a toddler one too, so you don’t have to purchase a new one as they get older. There’s two height adjustments and three recline positions for ultimate comfort, and the machine-washable seat pad makes clean ups a breeze. The deep-dish tray prevents food from falling over the edge, too.


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