Harnessing the power of machine learning to improve urology care

Harnessing the power of machine learning to improve urology care

Urodynamics—a group of tests that evaluate how well the body collects, and then releases, urine—can be crucial for diagnosing urologic problems, particularly in children with spinal cord defects and other neurologic conditions. While urodynamics can provide clinicians with a rich set of data, the interpretation of these tests remains unstandardized. That can make it challenging for urologists to reliably read and analyze the results, says Hsin-Hsiao Scott Wang, MD, MPH, MBAn, a urologist in the Urodynamics Program at Boston Children’s Hospital.

To address this issue, Wang and his colleagues have developed a predictive model based on machine learning algorithms. This approach promises to improve physicians’ ability to accurately identify detrusor overactivity (DO), a urodynamics finding in which the bladder’s detrusor muscle contracts uncontrollably. Drawing from an archive of 799 urodynamics studies performed at Boston Children’s between 2013 and 2019, they identified five representative patterns of DO. They then created an algorithm and evaluated its performance in predicting DO.

Their results, published November 18, 2020, in Neurourology and Urodynamics, show that this predictive model had great performance with area under the curve over 0.8 and an overall accuracy of 81.35 percent, a sensitivity of 76.92 percent, and a specificity of detecting DO events of 81.41 percent. “We hope this can serve as the cornerstone and basis for future research marrying artificial intelligence (AI) and urodynamics,” says Wang.

Personalizing UTI workups in children

Machine learning also shows promise for helping to personalize the evaluation and treatment of children with urinary tract infections (UTIs). Children with febrile UTIs are at increased risk for anatomical abnormalities, including vesicoureteral reflux (VUR), which in turn is associated with recurrent pyelonephritis and renal scarring. However, it can be challenging to determine which children with UTIs should undergo further evaluation with a voiding cystourethrogram.

For a July 2019 study, Wang and his colleagues in Boston Children’s Department of Urology developed and applied a predictive model to data from 500 pediatric UTI patients. They found that this model predicted recurrent UTIs associated with VUR with very robust performance. The novel machine learning algorithm has the potential to further personalize the treatment of children with an initial UTI and identify those most likely to benefit from further evaluation. The model is now available as a free app called PredictVUR. Preliminary analysis shows that this model has helped tremendously for patient counsel and shared decision making in UTI children management.

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100-year-old World War II veteran becomes 1 millionth Florida senior citizen to receive coronavirus vaccine

A 100-year-old World War II veteran becomes the 1 millionth senior to receive the coronavirus vaccine in Florida, live on

A 100-year-old World War II veteran from Florida became the state’s one-millionth senior citizen to receive the coroonavirus vaccine Friday on “Fox & Friends.”

With Gov. Ron DeSantis looking on, Henry Sayler got the life-saving shot on live television. Nearly two-thirds of the state’s shots thus far have gone to senior citizens.

“I didn’t feel a thing,” he said after receiving the vaccination. “I just want to say how happy we are to live in the No. 1 state in the union and have the No. 1 governor in the union.”

Sayler is also a former GOP state senator who counts astronaut Buzz Aldrin and pilot Charles Lindbergh among his acquaintances.

“He’s an American hero,” DeSantis said, adding Sayler still had a good physique for someone his age.

“This is a handsome individual, and people know it.”

The Republican governor touted Florida’s prioritization of the state’s large senior population but called for the federal government to send more vaccines than it has on a weekly basis.

The Fox & Friends hosts, which included veteran Pete Hegseth, thanked Sayler for his lifetime of service.

Fox News meteorologist Janice Dean, who has quarreled with Democratic New York Gov. Andrew Cuomo over his handling of the coronavirus vaccine with regard to seniors, was visibly moved after Sayler received the shot.

“Amazing,” Dean said. “Seniors first.”

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The Biden administration has set a goal of injecting 100 million Americans in the first 100 days, which would be roughly the current rate the country is on of 1 million per day.

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Global demand for cancer surgery set to grow by almost 5 million procedures within 20 years

cancer

Demand for cancer surgery is expected to increase from 9.1 million to 13.8 million procedures over the next twenty years, requiring a huge increase in the workforce including nearly 200,000 additional surgeons and 87,000 anaesthetists globally. With access to post-operative care strongly linked to lower mortality, improving care systems worldwide must be a priority in order to reduce disproportionate number of deaths following complications.

The findings of the two studies, published in The Lancet and The Lancet Oncology, highlight an urgent need to improve cancer surgery provision in low- and middle income countries, while also scaling-up their workforces in order to cope with increasing demand. Until now, a lack of data examining outcomes of cancer surgery in different income settings, and an absence of evidence-based estimates of future demand, had limited efforts to improve cancer care globally.

Cancer is a leading cause of death and disability globally, and exerts substantial economic impacts, with recent evidence suggesting a disproportionate burden of disease in LMICs. With more than half of cancer patients predicted to require surgery at some stage, it is a pivotal component of multidisciplinary care globally and plays a key role in preventing deaths. A 2015 study estimated that US$6.2 trillion in global GDP could be lost by 2030 if surgical cancer systems are not improved.

While the new studies did not assess impacts of COVID-19, the authors acknowledge that the delivery of high-quality post-operative care is more challenging during the pandemic.

Increasing future demand

The Article in The Lancet Oncology journal is a modelling study of global demand for cancer surgery and estimated surgical and anaesthesia workforce requirements between 2018 and 2040.

Using best-practice guidelines, patient characteristics and cancer stage data, the authors calculated the proportion of newly diagnosed cancer cases requiring surgery in 183 countries. To predict future surgery demand, they applied these rates to GLOBACAN cancer incidence predictions from 2018 to 2040.

The team’s analysis estimates that the number of cancer cases requiring surgery globally each year will rise from 9.1 million to 13.8 million (52%, an increase of 4.7 million) from 2018 to 2040. The greatest relative increase will occur in 34 low-income countries, where the number of cases requiring surgery is expected to more than double by 2040 (314,355 cases to 650,164, 107%).

Current and future surgical and anaesthesia workforces needed for the optimal delivery of cancer surgery services were also predicted using staffing estimates based on optimal surgical use in high-income countries as a benchmark for global requirements. To evaluate staffing gaps, the optimal estimated workforce (median workforce of 44 high-income countries) was compared with numbers of surgeons and anaesthetists in each country.

The authors estimate there is currently a global shortage of 199,000 (56%) surgeons and 87,000 (51%) anaesthetists (current workforce of 766,000 surgeons and 372,000 anaesthetists, compared with 965,000 and 459,000 optimal workforce, respectively, estimated by the team’s model). The gap is estimated to be greatest in low-income countries, where the current surgeon availability is 22,000 fewer than the model estimated optimal number of 28,000 surgeons. The current number of anaesthetists in low-income countries falls 11,000 below the model estimated demand of 13,000 anaesthetists.

In recognition of the rising global demand for cancer surgery, estimates were calculated for the optimal surgical and anaesthesia workforces needed in 2040. Extrapolating 2018 data, taking account of predicted future cancer incidence burden in each country, revealed that the surgical workforce will need to increase from 965,000 in 2018 to 1,416,000 (47% increase) in 2040. The anaesthetist workforce would need to rise from 459,000 in 2018 to 674,000 (47% increase) in 2040.

The greatest relative increase in optimal workforce requirements from 2018 to 2040 will occur in low-income countries, where surgeon numbers are required to rise from 28,210 to 58,219 by 2040 (106%). Anaesthetist numbers will also need to increase from 13,000 to 28,000 by 2040 (115%).

However, to match the current benchmark of high-income countries, the actual number of surgeons in low-income countries would need to increase almost 400% (increase from 6,000 to 28,000), and anaesthetists by nearly 550% (increase from 2,000 to 13,000), of their baseline values. This is because the current workforce in these countries is already substantially smaller than in high-income countries.

Dr. Sathira Perera, from the University of New South Wales, Australia, said: “Our analysis has revealed that, in relative terms, low-income countries will bear the brunt of increased future demand for cancer surgery, bringing with it a need to substantially increase numbers of surgeons and anaesthetists. These findings highlight a need to act quickly to ensure that increasing workforce requirements in low-income countries are adequately planned for. There needs to be an increased focus on the application of cost-effective models of care, along with government endorsement of scientific evidence to mobilise resources for expanding services.”

Estimates in the study relied on several assumptions. Predictions of future cancer rates were based on 2018 estimates, however, country-level changes—such as economic developments or altered capacity to screen for early diagnosis—could alter cancer incidence and therefore surgical demand and workforce requirements. Observed gaps in the workforce could also be narrower than the actual gaps in practice, as predictions were conservative because they only considered initial surgical encounters and did not account for any follow-up interactions.

Cancer surgery outcomes

The Article in The Lancet is an observational study exploring global variation in post-operative complications and deaths following surgery for three common cancers.

Deaths among gastric cancer patients were nearly four times higher in low/lower middle-income countries (33 deaths among 326 patients, 3.72 odds of death) than high-income countries (27 deaths among 702 patients).

Patients with colorectal cancer in low/lower middle-income countries were also more than four times more likely to die (63 deaths among 905 patients, 4.59 odds of death), compared with those in high-income countries (94 deaths among 4,142 patients). Those in upper middle-income countries were two times as likely to die (47 deaths among 1,102 patients, 2.06 odds of death) as patients in high-income countries.

No difference in 30-day mortality was seen following breast cancer surgery.

Similar rates of complications were observed in patients across all income groups, however those in low/lower middle-income countries were six times more likely to die within 30 days of a major complication (96 deaths among 133 patients, 6.15 odds of death), compared with patients in high-income countries (121 deaths among 693 patients). Patients in upper middle-countries were almost four times as likely to die (58 deaths among 151 patients, 3.89 odds of death) as those in high-income countries.

Patients in upper middle-income and low/lower middle-income countries tended to present with more advanced disease compared with those in high-income countries, however researchers found that cancer stage alone explained little of the variation in mortality or post-operative complications.

Between April 2018 and January 2019, researchers enrolled 15,958 patients from 428 hospitals in 82 countries undergoing surgery for breast, colorectal or gastric cancer. 57% of patients were from high-income countries (9,106 patients), with 17% from upper middle-income countries (2,721 patients), and 26% from low/lower middle-income countries (4,131 patients). 53% (8,406) of patients underwent surgery for breast cancer, 39% (6,215) for colorectal cancer, and 8% (1,337) for gastric cancer.

Assessing hospital facilities and practices across the different income groups revealed that hospitals in upper middle-income and low/lower middle-income countries were less likely to have post-operative care infrastructure (such as designated post-operative recovery areas and consistently available critical care facilities) and cancer care pathways (such as oncology services). Further analysis revealed that the absence of post-operative care infrastructure was associated with more deaths in low/lower middle-income countries (7 to 10 more deaths per 100 major complications) and upper middle-income countries (5 to 8 more deaths per 100 major complications).

Professor Ewen Harrison, of the University of Edinburgh, UK, said: “Our study is the first to provide in-depth data globally on complications and deaths in patients within 30 days of cancer surgery. The association between having post-operative care and lower mortality rates following major complications indicates a need to improve care systems to detect and intervene when complications occur. Increasing this capacity to rescue patients from complications could help reduce deaths following cancer surgery in low- and middle-income countries.

“High quality all-round surgical care requires appropriate recovery and ward space, a sufficient number of well-trained staff, the use of early warning systems, and ready access to imaging, operating theatre space, and critical care facilities. While in this study it wasn’t possible to assess cancer patients’ full healthcare journey, we did identify several parts of the surgical health system, as well as patient-level risk factors, which could warrant further study and intervention.”

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Study finds genetic clues to pneumonia risk and COVID-19 disparities

pneumonia

Researchers at Vanderbilt University Medical Center and colleagues have identified genetic factors that increase the risk for developing pneumonia and its severe, life-threatening consequences.

Their findings, published recently in the American Journal of Human Genetics, may aid efforts to identify patients with COVID-19 at greatest risk for pneumonia, and enable earlier interventions to prevent severe illness and death.

Despite the increasing availability of COVID-19 vaccines, it will take months to inoculate enough people to bring the pandemic under control, experts predict. In the meantime, thousands of Americans are hospitalized and die from COVID-19 each day.

“This study is so important because we performed analyses separately in participants of Caucasian ancestry as well as African ancestry to identify genetic risk factors contributing to pneumonia susceptibility and severity,” said Jennifer “Piper” Below, Ph.D., associate professor of Medicine and the paper’s corresponding author.

“Combined with systemic racism and socioeconomic factors that have been reported by others, these genetic risk differences may contribute to some of the disparities we observe in COVID-19 outcomes,” Below said.

The researchers conducted genome-wide association studies (GWAS) of more than 85,000 patients whose genetic information is stored in VUMC’s BioVU biobank and which has been linked to “de-identified” electronic health records stripped of personal identifying information. GWAS can identify associations between genetic variations and disease.

With colleagues from the University of North Carolina at Chapel Hill, the University of Texas MD Anderson Cancer Center in Houston, and the Icahn School of Medicine at Mount Sinai in New York, the VUMC researchers identified nearly 9,000 cases of pneumonia in patients of European ancestry, and 1,710 cases in patients of African ancestry.

The strongest pneumonia association in patients of European ancestry was the gene that causes cystic fibrosis (CF). This disease produces abnormally thick mucus leading to chronic infections and progressive respiratory failure.

In patients of African ancestry, the strongest pneumonia association was the mutation that causes sickle cell disease (SCD), a red blood cell disorder that increases the risk for pneumonia, influenza and acute respiratory infections.

Children with CF and SCD are at particular risk for severe disease if they contract COVID-19.

The researchers found that “carriers” who are unaffected by CF yet carry a copy of the CF gene had a heightened susceptibility to pneumonia, and those who are unaffected by SCD yet carry a copy of the SCD mutation were at increased risk for severe pneumonia.

Further studies will be needed to determine whether these carriers also bear “a silent, heightened risk for poor outcomes from COVID-19,” the researchers said.

To identify other genetic variations that increase pneumonia risk, they removed patients with CF and SCD from their analysis, repeated the GWAS, and used another technique called PrediXcan, which correlates gene expression data with traits and diseases in the electronic health record.

This time they found a pneumonia-associated variation in a gene called R3HCC1L in patients of European ancestry, and one near a gene called UQCRFS1 in patients of African ancestry. The molecular function of R3HCC1L is unclear, but deletion of the UQCRFS1 in mice disrupts part of their infection-fighting immune response.

“Although our understanding about the genetic mechanism of pneumonia is still limited, this study identified the novel candidate genes, R3HCC1L and UQCRFS1, and offered an insight for further host genetic studies of COVID-19,” said the paper’s first author, Hung-Hsin Chen, Ph.D., MS, a postdoctoral fellow in Below’s lab.

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5 Reasons to Wear a Mask Even After You’re Vaccinated

As an emergency physician, Dr. Eugenia South was in the first group of people to receive a covid vaccine. She received her second dose last week  — even before President-elect Joe Biden.

Yet South said she’s in no rush to throw away her face mask.

“I honestly don’t think I’ll ever go without a mask at work again,” said South, faculty director of the Urban Health Lab at the University of Pennsylvania in Philadelphia. “I don’t think I’ll ever feel safe doing that.”

And although covid vaccines are highly effective, South plans to continue wearing her mask outside the hospital as well.

Health experts say there are good reasons to follow her example.

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“Masks and social distancing will need to continue into the foreseeable future — until we have some level of herd immunity,” said Dr. Preeti Malani, chief health officer at the University of Michigan. “Masks and distancing are here to stay.”

Malani and other health experts explained five reasons Americans should hold on to their masks:

1. No vaccine is 100% effective.

Large clinical trials found that two doses of the Moderna and Pfizer-BioNTech vaccines prevented 95% of illnesses caused by the coronavirus. While those results are impressive, 1 in 20 people are left unprotected, said Dr. Tom Frieden, a former director of the Centers for Disease Control and Prevention.

Malani notes that vaccines were tested in controlled clinical trials at top medical centers, under optimal conditions.

In the real world, vaccines are usually slightly less effective. Scientists use specific terms to describe the phenomenon. They refer to the protection offered by vaccines in clinical trials as “efficacy,” while the actual immunity seen in a vaccinated population is “effectiveness.”

The effectiveness of covid vaccines could be affected by the way they’re handled, Malani said. The genetic material used in mRNA vaccines — made with messenger RNA from the coronavirus — is so fragile that it has to be carefully stored and transported.

Any variation from the CDC’s strict guidance could influence how well vaccines work, Malani said.

2. Vaccines don’t provide immediate protection.

No vaccine is effective right away, Malani said. It takes about two weeks for the immune system to make the antibodies that block viral infections.

Covid vaccines will take a little longer than other inoculations, such as the flu shot, because both the Moderna and Pfizer products require two doses. The Pfizer shots are given three weeks apart; the  Moderna shots, four weeks apart.

In other words, full protection won’t arrive until five or six weeks after the first shot. So, a person vaccinated on New Year’s Day won’t be fully protected until Valentine’s Day.

3. Covid vaccines may not prevent you from spreading the virus.

Vaccines can provide two levels of protection. The measles vaccine prevents viruses from causing infection, so vaccinated people don’t spread the infection or develop symptoms.

Most other vaccines — including flu shots — prevent people from becoming sick but not from becoming infected or passing the virus to others, said Dr. Paul Offit, who advises the National Institutes of Health and Food and Drug Administration on covid vaccines.

While covid vaccines clearly prevent illness, researchers need more time to figure out whether they prevent transmission, too, said Phoenix-based epidemiologist Saskia Popescu, an assistant professor in the biodefense program at George Mason University’s Schar School of Policy and Government.

“We don’t yet know if the vaccine protects against infection, or only against illness,” said Frieden, now CEO of Resolve to Save Lives, a global public health initiative. “In other words, a vaccinated person might still be able to spread the virus, even if they don’t feel sick.”

Until researchers can answer that question, Frieden said, wearing masks is the safest way for vaccinated people to protect those around them.

4. Masks protect people with compromised immune systems.

People with cancer are at particular risk from covid. Studies show they’re more likely  than others to become infected and die from the virus, but may not be protected by vaccines, said Dr. Gary Lyman, a professor at Fred Hutchinson Cancer Research Center.

Cancer patients are vulnerable in multiple ways. People with lung cancer are less able to fight off pneumonia, while those undergoing chemotherapy or radiation treatment have weakened immune systems. Leukemia and lymphoma attack immune cells directly, which makes it harder for patients to fight off the virus.

Doctors don’t know much about how people with cancer will respond to vaccines, because they were excluded from randomized trials, Lyman said. Only a handful of study participants were diagnosed with cancer after enrolling. Among those people, covid vaccines protected only 76%.

Although the vaccines appear safe, “prior studies with other vaccines raise concerns that immunosuppressed patients, including cancer patients, may not mount as great an immune response as healthy patients,” Lyman said. “For now, we should assume that patients with cancer may not experience the 95% efficacy.”

Some people aren’t able to be vaccinated.

While most people with allergies can receive covid vaccines safely, the CDC advises those who have had severe allergic reactions to vaccine ingredients, including polyethylene glycol, to avoid vaccination. The agency also warns people who have had dangerous allergic reactions to a first vaccine dose to skip the second.

Lyman encourages people to continue wearing masks to protect those with cancer and others who won’t be fully protected.

5. Masks protect against any strain of the coronavirus, in spite of genetic mutations.

Global health leaders are extremely concerned about new genetic variants of the coronavirus, which appear to be at least 50% more contagious than the original.

So far, studies suggest vaccines will still work against these new strains.

One thing is clear: Public health measures — such as avoiding crowds, physical distancing and masks — reduce the risk of contracting all strains of the coronavirus, as well as other respiratory diseases, Frieden said. For example, the number of flu cases worldwide has been dramatically lower since countries began asking citizens to stay home and wear masks.

“Masks will remain effective,” Malani said. “But careful and consistent use will be essential.”

The best hope for ending the pandemic isn’t to choose between masks, physical distancing and vaccines, Offit said, but to combine them. “The three approaches work best as a team,” he said.

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China to donate 500,000 Covid-19 vaccines to Pakistan

vaccine

China will donate 500,000 doses of its COVID-19 vaccine to Pakistan, the country’s foreign minister Shah Mahmood Qureshi said Thursday.

It comes as the number of coronavirus cases surged to 527,146 in Pakistan, with over 11,000 deaths since the virus was first detected in February last year.

“Pakistan greatly appreciates the 500,000 doses of the vaccine gifted by China,” foreign minister Qureshi tweeted.

The news follows similar announcements from other nations in the region—the Philippines, Cambodia and Myanmar have all announced they were set to receive vaccine donations from Beijing.

Qureshi had earlier told reporters: “China has assured us that the first shipment of half a million doses will be free of cost and will arrive by end of January”.

Beijing also promised to send another one million doses by end of February, he said, adding that emergency use and authorisation of the SinoPharm vaccine had been approved in Pakistan.

For years, China has focused much of its attention in Pakistan on mammoth development projects, bankrolling the construction of roads, power plants and a strategic port.

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Now that psychiatric care has gone online, many patients want it to stay there

Now that psychiatric care has gone online, many patients want it to stay there

Only a year ago, Michigan Medicine psychiatrists were trying to recruit patients to give telepsychiatry a try, with very little success.

The psychiatrists worked with people by video only 26 times in six months, while 30,000 visits happened in person. But that changed quickly when the coronavirus pandemic forced closures in the area in late March.

Now, not only have patients seeking help with mental health issues been working through their emotions and experiences by video and phone for months—many would like to keep those options, a new study shows.

“Telepsychiatry is an interesting tool for various reasons in terms of providing early access to care, connecting patients in rural areas or who live far away from clinics to be able to get good evidence-based care,” said study author Dr. Jennifer Severe, a psychiatrist who helped launch a test of telehealth initiatives at the University of Michigan’s outpatient psychiatry clinic.

“Even patients who are closer, based on life burden and expectation, they might not be able to keep up with their appointments, so telehealth actually offers a way to remain connected with care, regardless of how busy people’s lives might be,” Severe said.

For the study, published recently in the journal JMIR Formative Research, researchers surveyed 244 patients or parents of minor patients in summer 2020. The patients had mental health appointments in the first weeks of the pandemic shutdown.

Most of the survey participants had their own or their child’s first pandemic-time appointment through a video call. A minority of patients, 13.5%, started telepsychiatry with phone visits. That group was more likely to be older than 45.

Nearly all of the study participants who had a telepsychiatry visit said it went as well as expected or better.

About half (46.7%) said they were likely to continue with telepsychiatry even after in-person visits were available again. Those who had appointments by phone instead of video were much less likely to want to continue remote mental health care in the future.

“The excitement is there, but we need to make sure that we have a way to keep up with the demand,” Severe said.

This data could help inform the decisions of health insurers and government agencies who will make decisions about whether and how to pay mental health care providers for future virtual care, Severe said.

To improve access, while the survey was ongoing, senior study author Dr. Mary Carol Blazek led development of a program called Geriatric Education for Telehealth Access, or GET Access, to help older patients.

The study didn’t cover the issue of no-shows and appointment cancelations, but those have been reduced substantially, according to Michigan Medicine.

Phone and video visits within established patient-mental health provider relationships are equally effective, Severe said.

However, for first visits, the therapists typically try to avoid using the phone because it can reduce communication cues and limits observing facial expressions, interaction and movement, which can help evaluate mental health status. Sometimes physical exams can be required to assess a patient’s balance and mobility, as well as check for medication side effects.

“Sometimes communication might be difficult. Sometimes you might need to do a physical exam. There might be a lack of important physical exam approaches and communication techniques that might be missing,” Severe said. “So, that’s one reason I will say telehealth might not be for everyone.”

Severe hopes to see more of a blended approach after the pandemic, where a patient may do a face-to-face visit, followed by a couple of telehealth visits, and then return for another face-to-face visit.

During the pandemic, telehealth has been responsible for saving small mental health practices while also continuing to help patients, said Vaile Wright, senior director of health care innovation for the American Psychological Association.

“The evidence is pretty strong. People are having mental health difficulties, much more so than in the past and, thankfully, they are seeking out treatment,” Wright added. “I think telehealth makes it possible for them to do so safely.”

For some people, it may be harder to connect in a virtual environment. For others, it may make it easier because they don’t have to get time off work, figure out child care or travel to the office.

Issues to consider are ensuring that patients understand the online platform, have adequate internet accessibility and have adequate privacy in their homes to have a mental health appointment. Backup safety plans also need to be considered, Wright said.

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Woman begs doctors to remove womb after suffering period pains so bad she faints

A woman who suffers with period pains so agonising they leave her suicidal, says doctors won’t remove womb in case she decides she wants children.

Kacey Read has suffered with horrific period pains since she was 12. The pain gets so bad that screams involuntarily, vomits and sometimes even passes out.

Doctors have tried the 21-year-old on various birth control methods to manage the pain, but have had no success. Kacey says the pain and her symptoms mean she is unable to hold down a job.

Kacey has begged doctors to remove her womb to stop the pain and help her mental state, but said they refused due to the fact she might want kids one day.

So now, the graduate is crowdfunding to pay for the operation privately.

‘Every doctor said I’d grow out of it, but nearly ten years on I’m still getting cramps so severe that I pass out from the pain,’ says Kacey, from Brighton.

‘It isn’t just the physical pain I experience, but also the cyclical emotional dips I go through because of my periods. So I really don’t get a day’s rest.

‘I’m tired of it making me so depressed that I can’t get out of bed for a week. I’m tired of having to plan my life around it.’

Kacey says that every time she has asked about the possibility of a hysterectomy, medical professionals have dismissed her.

‘I’ve been told that it’s not possible, I’m too extreme and that it would “destroy me as a woman”,’ she explains.

‘I’m tired of doctors taking away my autonomy and telling me they can’t operate because I might want kids one day.

‘I’ve had suicidal thoughts because of this – it’s not about whether I have kids, it’s about whether I have any quality of life. I’m an adult and I’ve made my mind up, I want this to end.’

Kacey’s extreme period pain is likely to have been caused by an underlying medical condition, such as endometriosis or adenomyosis.

She has never been formerly diagnosed with either of these conditions, which are known to be incredibly hard to diagnose, women often suffer for years before they are officially given a diagnosis.

Kacey was due to undergo an investigative laparoscopy to see if she has endometriosis, but sadly the procedure has been cancelled twice over the past year due to Covid-19.

After doctors refused to perform a hysterectomy, Kacey is now fundraising for the surgery and hopes to raise £8,500 for both the procedure and consultation appointments.

She says: ‘It will mean I won’t have to face four or five days of unbearable pain – and I won’t have to keep calling in sick.

‘In terms of my mood, it’s not an instant fix, but I’m hoping it will help. I think this is the perfect treatment. I can finally have autonomy over my body.

‘It’s not fair that I have to try and raise £8,500 just to be in control of my own life. I don’t want to be doing this, but it’s my only hope.’

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When You’re Anxious All Day, This Is What Really Happens To Your Body

Since the dawn of civilization, humans have been wired with a fight-or-flight response to danger. Though threats have become tamer over time, many of us still feel like we’re being chased by saber-toothed cats. Today, anxiety is commonly triggered by situations like giving presentations at work, offering ourselves up to be judged on social media, or talking to strangers. In other cases, it may not be caused by any single situation in particular. 

While many of us feel anxious from time to time, experiencing anxious thoughts and feelings on a recurring basis can indicate the presence of an anxiety disorder. Anxiety disorders are “the most common mental illness” in the United States, affecting one in five adults, and “women are more than twice as likely as men” to experience one. According to the National Institute of Mental Health, anxiety disorders can be caused or worsened by physical factors, including thyroid problems, medications, or substances like caffeine. Anxiety can also have long- or short-term physical effects ranging from mild discomfort to life-threatening conditions. Learning about these effects may seem anxiety-inducing, but you can use your awareness to make lifestyle changes that may help soothe your body and mind. Here’s what happens to your body when you’re anxious all day.

You may have difficulty concentrating if you're always anxious

When you’re anxious all day, it can be difficult to focus on anything other than your anxiety. “Difficulty concentrating is one of the most common diagnostic criteria across DSM-5 categories,” reads a 2017 article in the Journal of Anxiety Disorders, “especially within the emotional (mood- and anxiety-related) disorders.” Because difficulty concentrating tends to be subjective and difficult to measure, not much is known about the extent of its relationship to anxiety. One possible explanation is that anxiety causes your body to release stress hormones, such as adrenaline and cortisol (via Harvard Medical School), which can potentially make you feel jittery and on edge. The stress response requires a lot of physical energy and shifts the brain away from rational thinking and into survival mode, according to WellDoing.org.

Certain lifestyle changes can help boost concentration, and many of them overlap with suggested changes for anxiety management. Healthline recommends eating a balanced diet, getting plenty of sleep, and lowering caffeine consumption. It could also help to engage in a stress-reducing activity such as journaling, meditating, or reading. (Here are some creative activities that could ease your anxiety.)

You might suffer from tension headaches and migraines

People with anxiety may be prone to tension headaches. The exact causes of tension headaches are unknown, but according to Healthline, common triggers include abnormal serotonin levels, trouble sleeping, muscle tension, and stress — all of which could be anxiety-related. Additionally, according to the American Migraine Association, nearly half of all migraine sufferers in the United States also suffer from anxiety. Medical research published in The Journal of Headache and Pain suggests that individuals who suffer from migraines are five times more likely to experience anxiety than those who don’t. So, if you have anxiety, you may be familiar with migraines, too. And vice versa.

To prevent potentially anxiety-induced headaches, Healthline suggests being aware of your triggers. Common migraine triggers include alcohol, caffeine, changes in hormone levels, lack of sleep, and general stress. You may also try to manage your anxiety directly in order to prevent headaches, such as by practicing yoga or meditation. Standard self-care measures, such as exercising daily and drinking plenty of water, can also be helpful in keeping both headaches and anxiety at bay.

Still, anxiety headaches cannot be prevented completely. When they do arise, you may consider treatment options like medication, therapy, or acupuncture. (Here are therapist-approved ways to cope with anxiety.)

Your breath may become short, shallow, or rapid

The relationship between anxiety and breathing can be a catch-22: Anxiety can cause breathing difficulties, and breathing difficulties can cause anxiety. According to Healthline, when the fight-or-flight response sets in with heightened anxiety, you may experience breathing-related symptoms, such as a “tightness” in the chest, shortness of breath (known as dyspnea), or rapid breathing as the body attempts to pump oxygen into your muscles to get you ready for the possibility of “flight,” or running away from what triggered the response.

Deep breathing exercises can help you manage anxiety and related breathing symptoms. Diaphragmatic breathing, for example, involves placing your hand on your stomach as you take deep breaths, paying attention to the stomach as it rises and falls with each breath. Surprisingly, exercises like running can also help when you feel anxious all day, as the body is already prepared for “flight.” Notably, breathing from the nose, in particular, can help you avoid hyperventilation.

If you're anxious every day, you may experience heart palpitations

Episodes of anxiety can trigger heart palpitations, which can make you feel like your heart is racing or fluttering. Stress hormones affect the parts of the brain that regulate the cardiovascular system, so when these hormones set in, cardiovascular functions, such as blood pressure and heart rate, respond accordingly. Healthline reports that palpitations can also be triggered by too much caffeine, which notably commonly triggers anxiety too.

According to Harvard Health Publishing, research suggests that individuals who have generalized anxiety disorder experience cardiac events, such as heart attacks, more frequently than those who do not. Research suggests individuals with anxiety issues may also be more prone to heart disease due to low levels of omega-3 fatty acids, which are found in foods such as seafood, nuts, and seeds. If you experience anxiety, you may quell cardiovascular symptoms in the short-term by cutting down on your morning cups of coffee and in the long-term by eating your omega-3s and avoiding smoking and drinking alcohol.

Your digestive system is thrown off balance by anxiety

Anxiety can feel like butterflies in your stomach — and there’s a scientific explanation as to why. Harvard Health Publishing deems it the “gut-brain connection,” which refers to the gut’s sensitivity to emotions, including anxiety. Your brain and intestines send signals back and forth, which means stomach trouble can cause anxiety and anxiety can cause stomach trouble. Symptoms may include stomach cramps, heartburn, loose stools, and nausea. The “gut-brain connection” can also cause or worsen chronic digestive issues like irritable bowel syndrome.

According to the Anxiety and Depression Association of America, the gut is highly responsive to emotions due to its high volume of nerves and its connections to the brain. To manage both anxiety and digestive upset, you can opt for gut-healthy foods, including probiotics and certain fermented foods, such as yogurt, kombucha, and miso. You may also try avoiding foods that might throw your gut off balance, such as animal proteins and foods that are fried or highly processed, as noted by Medical News Today.

Your sex drive may take a nosedive when you're anxious all day

“All anxiety is a distraction that limits sexual success,” Laurel Steinberg, PhD, a sex and relationship therapist and Columbia University psychology professor, told Health. A bout of anxiety can kill the mood in the bedroom, and chronic anxiety disorders can put a long-term damper on your sex life and a strain on your relationship.

If you are having sex, but feeling anxious while doing so, your body’s stress response can make it almost impossible to relax into orgasm. Anxious feelings can also make it more nerve-wracking to be vocal about what you want or to feel confident in your body in front of your partner.

And then there’s the ultimate catch-22 of the sex-anxiety tug-of-war: As Healthline puts it, “What’s a bigger orgasm killer? Anxiety or anti-anxiety medication?” If you take anti-anxiety meds, you may experience a lower sex drive and find it difficult or even impossible to reach orgasm when you do have sex — the same sex-related symptoms that can accompany untreated anxiety. While there is no straightforward solution for navigating anxiety and sexual satisfaction, your mental health should remain paramount. “An ideal sex life, and relationship in general, is securing your happiness and then helping your partner to be happy — put your own oxygen mask on first,” says psychiatrist Laura F. Dabney, M.D. (via Healthline).

You may have trouble sleeping when you're always anxious

As with many physical symptoms of anxiety, sleep-related symptoms can create a vicious cycle. Ruminating on anxious thoughts can keep you up at night, and the sleep deprivation that results can worsen anxiety. According to Sleep Foundation, “serious sleep disturbances, including insomnia, have long been recognized as a common symptom of anxiety disorders.”

A key factor in insomnia is hyperarousal, which is when the body is in a heightened state of alertness due to stress, per a review in Nature and Science of Sleep. Individuals with anxiety disorders may also have higher sleep reactivity, “which means they are much more likely to have sleeping problems when facing stress” (via Sleep Foundation). Anxious rumination before bed can also disturb the deepest point in the sleep cycle, rapid-eye movement sleep, and even bring on nightmares. In turn, lack of sleep or even low-quality sleep can wreak havoc on individuals’ emotional and mental health.

Aside from medication and cognitive behavioral therapy for insomnia, sleep hygiene practices can set the stage for a good night’s sleep. The Anxiety and Depression Association of America suggests setting a consistent sleep schedule; avoiding stimulants and screens before bed; and keeping the temperature, noise, and light in your bedroom at comfortable levels.

If you're usually anxious, you may be more prone to aches and pains

Researchers studying the brain and the nervous system have discovered that physical pain shares certain biological connections with anxiety. As anxiety causes tension in the mind, it often prompts the muscles to tense up, which can cause everyday aches and pains. Harvard Health Publishing reported a link between psychiatric disorders and chronic pain syndromes, such as headaches, irritable bowel syndrome, and low back pain.

A combination of medication and psychotherapy has proven to be effective in chronic cases of both anxiety and pain. But according to the Anxiety and Depression Association of America, individuals who experience both anxiety and chronic pain may have a lower pain tolerance and be prone to the side effects of certain medications, which can complicate treatment.

Harvard Health Publishing cited a study that found that “hypnosis training reduced both gastrointestinal distress and levels of depression and anxiety” in 71 percent of individuals studied. Individuals may also lessen their anxiety and physical pain through relaxation techniques, such as mindfulness and yoga, and by avoiding foods, such as gluten, dairy, nightshades, and alcohol.

Your risk of depression may increase when you're anxious

According to the Mayo Clinic, anxiety can be both a symptom and a cause of major clinical depression. The Anxiety and Depression Association of America reports that “there is no evidence one disorder causes the other, but there is clear evidence that many people suffer from both disorders.”

Depression is more common among women than among men, per the Anxiety and Depression Association of America. In women, depression “tends to manifest as sadness, worthlessness, and guilt.” Anxiety and depression share similar symptoms, including “nervousness, irritability, and problems sleeping and concentrating.” 

Though the two conditions vary, they require similar clinical treatments in the forms of psychotherapy and medication. Lifestyle factors, such as “improving sleep habits, increasing social support, using stress-reduction techniques, or getting regular exercise” can also help, per Mayo Clinic. Individuals who have anxiety, depression, or both are advised to avoid alcohol and non-prescription drugs.

You may feel irritable

Irritability is a common symptom of both anxiety and depression. According to Medical News Today, irritability can be inflamed by factors such as “life stress, a lack of sleep, low blood sugar levels, and hormonal changes.” Irritable feelings are sometimes accompanied by similar symptoms to anxiety, including “confusion or difficulty concentrating, excessive sweating, a rapid heartbeat, [and] fast or shallow breathing.” Your efforts to avoid anxiety-inducing situations may make you hypersensitive to even minor irritations, which can cause more extreme or long-term irritability.

Your irritable feelings do not mean you’re a disagreeable or grumpy person. An anxious, hyper-aroused state can make minor annoyances or inconveniences seem like colossal threats due to fight-or-flight instincts. If you’re feeling irritable, CalmClinic recommends communicating with the people around you about how you’re feeling and what you need, and apologizing if necessary. 

Anxiety, irritability, and mood swings are often caused or worsened by hormonal imbalances. The Women in Balance Institute suggests limiting processed foods, maximizing organic fruits and vegetables, and replacing coffee and soda with green tea and water.

When you're always anxious, you may experience panic attacks

Anxiety attacks and panic attacks are two different things, but they have similar emotional and physical symptoms. According to Healthline, unexpected panic attacks involve flurries of fear or feelings of impending doom that may come on for unknown reasons. Expected panic attacks often occur in response to specific fears or situations that the sufferer finds stressful. Panic attacks are often intense, while anxiety attacks may vary in severity, and panic attacks typically last no more than ten minutes, per WebMD. Multiple panic attacks may indicate a panic disorder.

Panic attacks can occur as a result of feelings of anxiety that have escalated to extreme levels. Common triggers for both anxiety and panic include driving, social and work situations, and chronic illness or pain, per Healthline. The distinction is that anxiety may come on more slowly than a panic attack would, and it is usually caused by the anticipation of stress or a particular threat. Still, both anxiety and panic can be accompanied by an intense physical response. WebMD warns that particularly intense symptoms — “such as chest pain, shortness of breath, palpitations, dizziness, fainting, and weakness” — should be assessed by a doctor.

You may lose your appetite

In anxious times, you may be too preoccupied by the things that are causing your anxiety to fulfill your own basic needs, like sleeping and even eating. Some people may neglect their need to eat completely. According to the 2015 Stress in America survey by the American Psychological Association, 31 percent of respondents reported that they had “skipped a meal in the last month because of stress” (via Healthline).

Losing your appetite due to anxiety is related to the primal fight-or-flight response, per Healthline. It can also be the result of the body’s excess production of the cortisol stress hormone. “In the acute or immediate setting, stress causes increased levels of cortisol, which in turn increases acid production in the stomach,” said Raul Perez-Vazquez, MD, according to Healthline. “This process is meant to help the body quickly digest food in preparation for ‘fight-or-flight,’ which is mediated by adrenaline. This process also, for the same reasons, decreases appetite.”

It may be helpful to intentionally schedule times for meals and snacks, and to reach for nutritious, easy-to-eat foods.

You may feel dizzy, lightheaded, or nauseous when you're always anxious

According to research published in the Journal of Psychosomatic Research in 2008, “about 28 percent of people with dizziness also have symptoms of at least one anxiety disorder” (via Medical News Today). Anxiety can cause dizziness in a few different ways.

Vasovagal syncope, or a sudden drop in blood pressure, is commonly linked to medical-related phobias and can cause fainting. In other cases, the “subjective feeling of dizziness” can accompany anxiety due to the body reflecting a loss of emotional balance. A 2014 study in the Journal of Psychosomatic Research found a link between “anxious, introverted personality traits” and chronic subjective dizziness. Dizziness can also be caused by anxiety-related breathing problems, such as hyperventilation, which can lead to fainting. 

As with many physical symptoms, dizziness is both a symptom and a cause for anxiety. While medication and therapy may be required in some cases, steps such as lying down, closing your eyes, and breathing gently can help alleviate bouts of anxiety-related dizziness. As with many physical anxiety symptoms, getting plenty of water and sleep can also help to prevent discomfort and keep your body in balance.

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Lack of physical exercise during COVID-19 confinement may lead to a rise in mortality

Lack of physical exercise during COVID-19 confinement may lead to a rise in mortality

Social distancing and working from home help prevent transmission of the novel coronavirus but can be conducive to unhealthy behavior such as binging on fast food or spending more time in a chair or on a couch staring at a screen, and generally moving about less during the day. Scientists believe the reduction in physical activity experienced during the first few months of the pandemic could lead to an annual increase of more than 11.1 million in new cases of type 2 diabetes and result in more than 1.7 million deaths.

The estimates are presented by researchers at São Paulo State University (UNESP), Brazil, in a review article published in Frontiers in Endocrinology. The authors stress that there is an “urgent need” to recommend physical activity during the pandemic.

“Recent studies have shown that people with diabetes face a higher risk of developing the severe form of COVID-19, and of dying if the condition is not properly controlled. Others have shown that social distancing and confinement have considerably reduced levels of physical activity, increased sedentary behavior and lowered the quality of people’s nutrition. Our article serves as a warning about the harmful consequences of these trends,” said Emmanuel Gomes Ciolac, a professor at UNESP’s Department of Physical Education in Bauru, and principal investigator for the study.

The first author of the article is Isabela Roque Marçal, who is studying for a master’s degree at UNESP. She was previously a research intern at the University of Leuven, Belgium, with a scholarship from FAPESP.

Among other data sources, the review covers the findings of an international online survey conducted by a group of 35 research institutions on several continents. According to the results, which are preliminary in that they refer to the first 1,000 volunteers to complete the questionnaire, the level of physical activity decreased 35% in the initial months of confinement, and this was accompanied by a 28.6% increase in sedentary behavior, such as sitting or lying for long periods, and unhealthy eating. Previous studies had already shown that a lack of physical activity helped cause some 33 million cases of type 2 diabetes in 2019 and 5.3 million deaths in 2018.

Based on data for the period before the pandemic, the researchers estimated that the current prevalence of physical inactivity (not getting the minimum amount of exercise recommended by health authorities) was 57.3% among over-forties generally and 57.7% among people at risk for diabetes, so that a lack of exercise can be considered responsible for 9.6% of diabetes cases (11.1 million) and 12.5% of all-cause deaths worldwide (1.7 million) if this prevalence persists for a long time.

Exercising at home

“It’s important to be aware of the difference between insufficient levels of physical activity and sedentary behavior,” Ciolac said. “An insufficiently active person is an individual who doesn’t get the minimum amount of exercise recommended by the World Health Organization.” The WHO recommends at least 150 minutes of moderate aerobic exercise or 75 minutes of vigorous aerobic exercise per week for adults aged 18-64.

Sedentary behavior, he continued, is associated with the time spent sitting, reclining or lying down. Research shows that watching television or working at a computer for long hours can be bad for the health of even physically active people. Those who are required to use a computer all day for their work should get up every 30 minutes or so to stretch their legs and get whatever light exercise is possible.

Confinement should not prevent people from performing more intense physical activity. The WHO’s recommendations, for example, include taking online exercise classes, many of which are free of charge, playing with children, doing household chores such as cleaning and gardening, going up and down stairs, even walking on the spot.

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