Why Dr. Fauci Thinks You Should Wear Two Masks

If you’ve been paying close attention to pandemic expert Dr. Anthony Fauci and you’ve been masking up, you might have noticed officials belonging to the freshly minted Biden administration going above and beyond by wearing not just one masks, but two — one on top of the other — since the Inauguration. And if you’re wondering whether official directives might have changed with regard to mask wearing, they haven’t; well, not exactly.

In an interview with NBC’s Savannah Guthrie, Dr. Fauci says that double masking “likely works” because masks are physical barriers that keep potentially infectious droplets, and the virus those could carry, from getting into our systems and getting us sick. “If you have a physical covering with one layer, you put another layer on, it just makes common sense that it likely will be more effective, and that’s the reason why you see people double masking, or doing a version of the N-95,” Dr. Fauci explained.

Dr. Fauci’s input on wearing two masks is worth considering, particularly with the news that more contagious variants of the COVID-19 virus have been spotted in the United Kingdom, South Africa, Brazil, and closer to home in California (via USA Today). He also told Guthrie on The Today Show that vaccine manufacturers are already working on creating booster shots that will help keep the inoculations effective against COVID-19.

Wearing two masks could be a good idea under certain circumstances

There is a practical reason why double masking could be a good idea. As The New York Times points out, there is a need to think about the kind and quality of the masks we are using to keep ourselves and our loved ones safe against this potentially deadly virus that continues to spread across the country.

Because not all masks are created equal, you might want to double up on yours, especially if you’re not entirely certain about the quality of the masks that you might be using. The latest research on masks and mask wearing urges us to remember that the quality of your mask matters, and that better filters mean better protection against the coronavirus.

So, what exactly do you need to know when choosing a mask during the pandemic? Keep reading to find out some key tips.

Certain masks work best against the coronavirus

A study done earlier by scientists at Virginia Tech and reported by the New York Times pointed out that the best mask “has two tightly woven layers of outer material with a filter material sandwiched in the middle.” The study suggests you make use of masks that are made with material that features tight weaves and also fits your face better, and that face shields should be used with a mask, since the plastic barriers don’t offer much protection — if at all.

If masks don’t appear to work, it’s because they are either too thin, or wearers don’t use them properly. Still, “Something is better than nothing,” Dr. Linsey Marr, who was part of the research team, told the New York Times. “Even the simplest cloth mask of one layer of material blocks half or more of aerosols we think are important to transmission. If you go to a tighter weave and more layers, you’ll get even better performance.”

Double masks and N-95s only work if you wear them properly

One doctor thinks venturing out into the public wearing two masks may be a bit much, because doubling up on masks doesn’t exactly mean you’re doubly safe from the new coronavirus variants. Dr. Graham Snyder of WakeMed tells ABC News, “[Wearing two masks] will decrease the transmission of the virus by a small amount. [But] it’s, it’s not going to make it to zero and it’s not going to be a big jump, but it would help a little bit more.” There’s also the added grief of finding that it might be too difficult to breathe if you have two masks on so you’re tempted to not wear any masks at all. His advice: go ahead and pull two masks on — but only if you’re able to keep them on.

And before you think about heading out and buying a stock of high-performance, medical-grade N-95s in place of wearing two masks, consider this advice from Baltimore’s former health commissioner, emergency physician Dr. Leana Wen. “You could have a very good N95 mask, but let’s say that somebody isn’t wearing it properly or is only wearing it 50 percent of the time. I would rather that someone wear a surgical mask or cloth mask 100 percent of the time, correctly and consistently,” she tells NBC.

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Coronavirus: why combining the Oxford vaccine with Russia’s Sputnik V vaccine could make it more effective

Coronavirus: why combining the Oxford vaccine with Russia's Sputnik V vaccine could make it more effective

When the efficacy of the Oxford/AstraZeneca vaccine was announced in late 2020, there was some confusion. The overall efficacy of the vaccine at stopping people developing symptomatic COVID-19, two weeks after the second dose, was 70%. But this wasn’t the whole picture.

This figure was based on averaging the results from two groups. In one group, which was given two full doses, the vaccine was 62% effective at stopping people developing symptoms. But in the second group, a dosing error meant that volunteers received a half dose followed by a full one. This ended up being 90% protective against developing COVID-19.

This was intriguing. Why would giving people less of the vaccine lead to a more effective immune response? The answer to this may lie in the design of the vaccine, and could mean that there are ways to make this vaccine—and others that use the same design—more effective.

How the Oxford vaccine works

Vaccines work by exposing the immune system to recognisable parts—or “antigens”—of pathogens that cause disease, such as bacteria or viruses. The immune system then mounts a response. Immune cells called B cells make antibodies to destroy the pathogen. Sometimes T cells can also be called into action, which eliminate our own cells that have been infected with the pathogen.

Some B and T cells then remember the antigens for the future. At some future point, if the person is exposed to the pathogen, these long-lasting memory cells can quickly order more antibodies to be made to destroy the pathogen and attack infected cells.

In effect, the principle of vaccination is to “mimic” an infection, but in a controlled way so that immunity is generated without causing illness. After a few weeks, once T cells and B cells have been generated, the person vaccinated will be protected. For certain vaccines, this requires two doses, as in some people the first dose alone won’t generate complete immunity. The booster dose ensures as many people as possible acquire protection.

In the case of the coronavirus vaccines, a number of methods are used to present the virus’s antigens to the immune system. Some, such as the Sinopharm and Sinovac vaccines in China, simply present the body with a whole, inactivated version of the coronavirus. But others instead instruct the vaccinated person’s own cells to produce a specific part of the coronavirus: the spike protein on its outer surface, which is a particularly recognisable antigen.

These vaccines do this by delivering the part of the coronavirus’s genetic code that encodes the spike protein into the cells of the body, which then read the code and start making the protein. Some, such as the Pfizer/BioNTech and Moderna vaccines, deliver the code in the form of messenger RNA (mRNA). Others use a harmless virus to get the genetic code inside cells; the Oxford vaccine uses chimpanzee adenovirus, genetically altered so that it’s unable to reproduce, called ChAdOx1. These are known as viral-vector vaccines.

How design could affect efficacy

It’s not yet known why the reduced-dose regimen of the Oxford vaccine showed better efficacy in trials, but it could be down to the viral vector.

When a person is given a viral-vector vaccine, as well as generating an immune response against the coronavirus’s spike protein, the immune system will also mount a response against the viral vector itself. This immune response may then destroy some of the booster dose when it is subsequently delivered, before it can have an effect. This has long been recognised as a problem.

However, a lower first dose might not allow for a strong anti-vector immune response to develop, which could leave the booster dose unscathed and lead to greater overall efficacy. If it turns out that this is the case, then future work will need to establish the optimum dosing regimen for generating the strongest immune response.

The Russian Sputnik V vaccine acknowledges that immunity to the viral vector could be a problem, but comes up with a different solution. It uses two different human adenoviruses—Ad26 and Ad5 (out of the 50 that affect humans) – for its two vaccine doses. This heterologous (or hybrid) vaccine, with different vectors for prime and booster vaccinations, is less likely to have one jab generate an immune response against the viral vector that then interferes with the other. The vaccine is therefore less likely to have a reduced efficacy.

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Why we need to get creative when it comes to talking about pain

What [do] I mean by sitting in a pit of fire? You’ve got every nerve ending that’s just going hellfire, and you just don’t know what to do with yourself.

Forty-two year old Emma has experienced chronic pain from a spinal cord injury for the last year. For Emma and many others, living with severe pain is now part and parcel of everyday life. It is estimated that 35-51% of people in the UK live with chronic pain. But communicating that experience can be a challenging endeavor.

We interviewed people with spinal cord injuries and women with endometriosis – a condition where tissue resembling the lining of the womb grows elsewhere in the body causing severe pain—in an effort to find out about their experiences and to learn more about how they talk about pain.

This research suggests that the inability to communicate pain effectively may partly account for delays in diagnosing some conditions. We also found that people with various types of chronic pain—such as that caused by endometriosis and spinal cord injury – often use metaphors to describe it.

Many speak of their pain in terms of being attacked. What might sound overly dramatic actually uses a variety of mechanisms, ranging from conveying high levels of pain severity and trying to make sense of the experience, to expressing the emotional consequences.

In using these expressions, sufferers may be trying to elicit support and empathy from others. At the moment though, widespread practice in pain consultation involves the use of numerical rating scales asking people to identify a number that best represents their pain.

The use of such potentially simplistic and reductionist tools means that a holistic assessment of the physical, psychological and social complexity of the pain experience is neglected.


https://youtube.com/watch?v=eakyDiXX6Uc%3Fcolor%3Dwhite

Using metaphors to talk about pain

In conducting our research, we found that the ways people spontaneously talk about their experience of pain go beyond the measuring capacities of the standard assessment tools. For example, the McGill pain questionnaire asks people to rank each of the descriptive words such as “searing,” “pinching” and “flashing” in terms of their pain intensity.

But many people describe their pain in ways that aren’t measured in this questionnaire. For example, one participant described their pain as feeling like “you’re dragging your organs.” Such creative and detailed descriptions often capture both the severity and the distress pain causes. However, not all expressions convey the intended message effectively.

Common pain descriptors such as “shooting” and “stabbing” pain may fail to articulate intended meaning as they have lost their metaphorical force due to overuse. These are known as dead metaphors. So more detailed creative descriptions, often involving similes, may be more effective in helping the listener to understand, assess and provide better support.

We found interesting examples of creative and extended metaphors such as: “It feels like somebody putting barbed wire through your belly button in a figure of eight … And then they set fire to the barbed wire and it starts getting hot and everything’s just being squished inside you.”

Using highly personal and creative metaphors like this provides a mechanism to communicate pain in one’s own terms rather than being restricted by standardised assessments. “It’s like some little devil in the corner. Yeah, you know like that little exorcist thing in the corner … torturing me.”

This language could help others understand more clearly how a sufferer is feeling and perhaps elicit some support. However, these benefits may come at a cost to the person in pain. We also found that some metaphorical expressions alluding to torture and attack could reflect individuals’ perceptions of pain as a physical threat, leading to higher levels of distress, fear and despair.

As a result, the use of such language could increase the attention that an individual pays to their pain. This has been shown to also lead to an increase in pain intensity, as people become more aware of, and sensitive to, the sensation.

Promoting effective pain talk

Pain is a private experience; encouraging people to find different and more appropriate ways to talk about it can help them make sense of their unique experience and describe it more effectively.

People with different conditions tend to use similar types of metaphorical expressions. For example, we found that words like “pins and needles” and “electricity” are often used to describe nerve pain associated with conditions like spinal cord injury. Similarly, expressions involving physical action such as “tearing” and “pulling” are more commonly found in descriptions of endometriosis pain.

This, in turn, can potentially guide doctors to identify potential causes of pain in certain conditions, like endometriosis. For example, a description such as “feeling like a balloon is about to explode” may point to inflammation, while “felt like I had tiny people with ropes tied tightly around my insides and pulling down” may be indicative of a deeper, more visceral pain.

Pain is also an all-round experience, and its impact goes beyond the physical. The way that someone talks about their experience can also highlight its effect on other parts of their lives, such as mental health and socialising. For example, pain described as “all-consuming” could reveal an emotional dimension while talking about how people in pain “hide from the world” could indicate a drive to conceal pain from others and avoid seeking help.

Encouraging people to talk about pain in their own terms is key to understanding and supporting their individual needs. In fact, this is what our participants ask for: “Listen closely” or “Be more open-minded about the difficulty of describing pain I can’t explain well.”

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Astrologer Explains Why You Don’t Relate To Your Sun Sign

Are you a skeptic who thinks horoscopes are nonsense because the description of your sign isn’t even close to your personality? Well, before you dismiss the entire concept of astrology, Phoenix Knor’malle, a psychic advisor at MysticSense.com, explained that there’s actually a very logical reason why your sun sign might not ring true.

“Occasionally, I hear people stating that they do not relate at all to their sun sign,” Knor’malle said in an interview with The List. “Typically, these people relate more to their moon or rising placements more than the sun placement,” which make up the “big three” of your astrological chart. If you don’t relate to your sun sign, moon sign, or your rising sign, Knor’malle conceded, “It is easy to question if astrology is even real!” She went on to add, “However, there is a good reason why some people do not relate to their sun sign … The cause for this disconnection lies in the houses.”

Explaining that “the first house in astrology represents the identity and sense of self,” Knor’malle noted, “The signs that fall into this house will typically be the ones that you ‘resonate with’ on a personal level. In situations where you do not identify with your sun sign, there is probably a good chance that your sun sign is not in the first house.” This isn’t the only reason why your sun sign might not seem to fit your personality, though.

If you're born on the cusp of two signs, your sun sign might not run true

If your birthday is on the last day of one sun sign, it’s possible that the sun sign the day after will be a better fit for your personality. Or, if your birthday is on the first day of when a sun sign begins, you might have more in common with the star sign that ended the day before you were born, according to Phoenix Knor’malle. 

“Cusps are born on or near the transition date of two zodiac signs,” the MysticSense.com psychic advisor explained. “Cusps can lean more heavily towards one sign than the other, or they can be a balance of both.” In fact, this is a pretty common phenomenon for cusp babies. “Many times, I hear people saying that they are a cusp between X and Y signs and their birthday is in Y, but they feel more like X sign,” Knor’malle continued. “It is possible that being on a cusp of two signs minimizes the traits of one, making it harder to relate to. “

What if your personality is the opposite of your star sign profile?

It’s one thing if your sun sign doesn’t really match your personality, but what if the description of your star sign literally sounds like the opposite of you? For example, Virgos are known for being organized — but you’re a mess. There’s actually an astrological explanation for that, as well. 

“It is possible that a retrograde may influence how the energy of your sun sign is manifesting in your life,” Phoenix Knor’malle explained. “Retrograde means that a planet appears to be moving in the opposite direction, thus affecting how the astrological qualities of that planet manifest themselves during the retrograde period.”

So, how can you tell whether you’re a retrograde baby? A reading with a professional astrologer can help you understand the position of the planets when you were born. “If you happened to be born when your sun’s ruling planet was in retrograde, there is a chance that this altered the way the qualities of that sign manifest in your personality,” Knor’malle said. “I like to think of a retrograde in astrology a bit like reading a reversed tarot card; it is the same basic meaning, but with a very different emphasis.”

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Pets, touch and COVID-19: Why our furry friends are lifesavers

Lockdowns, job losses and social isolation have been the hallmarks of 2020 as COVID-19 tightens its grip on the world, not only infecting millions and leaving a mounting death toll, but also denying humans the most basic sense—touch.

In the absence of human-to-human contact, in millions of households worldwide, animals have stepped into the breach for many people, providing much-needed comfort via cuddles, pats and a constant physical presence.

A new study published by University of South Australia researchers points to the lifesaving role that pets have played in 2020 and why governments need to sit up and take notice.

The Journal of Behavioural Economics for Policy paper outlines how pets have a crucial role to play in an era where human-human contact can be life endangering.

Lead author Dr. Janette Young says physical touch is a sense that has been taken for granted—even overlooked—until COVID-19 visited our door earlier this year.

“In a year when human contact has been so limited and people have been deprived of touch, the health impacts on our quality of life have been enormous,” Dr. Young says.

“To fill the void of loneliness and provide a buffer against stress, there has been a global upsurge in people adopting dogs and cats from animal shelters during lockdowns. Breeders have also been inundated, with demands for puppies quadrupling some waiting lists.”

Spending on pets was already hitting record levels, topping $13 billion in Australia and in the region of US$260 billion globally in 2020, but this is bound to be surpassed.

It is estimated that more than half the global population share their lives with one or more pets. The health benefits have been widely reported, but little data exists regarding the specific benefits that pets bring to humans in terms of touch.

“Pets seem to be particularly important when people are socially isolated or excluded, providing comfort, companionship and a sense of self-worth,” Dr. Young says.

“Touch is an understudied sense, but existing evidence indicates it is crucial for growth, development and health, as well as reducing the levels of the stress hormone cortisol in the body. It is also thought that touch may be particularly important for older people as other senses decline.”

In interviews with 32 people, more than 90 percent said touching their pets both comforted and relaxed them—and the pets seemed to need it as well.

Examples of dogs and cats touching their owners when the latter were distressed, sad, or traumatized were cited. Many people referenced pets’ innate ability to just “know” when their human counterparts weren’t feeling well and to want to get physically close to them.

“The feedback we received was that pets themselves seem to get just as much pleasure from the tactile interaction as humans,” Dr. Young says.

Not just dogs and cats either. Interviewees mentioned birds, sheep, horses and even reptiles who reciprocate touch.

“Animals, like people, are living, breathing others, with individual interests, styles and preferences. While culturally, animals are not seen as ‘human,” they are still seen as individuals with likes and dislikes.

“In the era of COVID-19, social distancing, sudden lockdowns and societal upheaval, our pets may be the only living beings that many people are able to touch and draw comfort from.

“Humans have an innate need to connect with others but in the absence of human touch, pets are helping to fill this void. They need to be considered from a policy angle, therefore, to help mitigate some of the mental and physical stressors that people are experiencing during this time.”

Dr. Young says hospitals, hospices and aged care facilities should be encouraging pet connections with residents.

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Why DID England rugby star.Steve Ojomoh have a stroke at 48?

Steve Ojomoh was an England rugby star… so why DID he have a stroke at 48?

As a former England rugby player and aged just 48, Steve Ojomoh might have seemed an unlikely candidate for a stroke. Indeed, he thought he was perfectly fit and healthy

As a former England rugby player and aged just 48, Steve Ojomoh might have seemed an unlikely candidate for a stroke. Indeed, he thought he was perfectly fit and healthy.

So two years ago, when he developed an excruciating headache, he put it down to stress and a poor night’s sleep.

‘I became aware of an awful fizzing sensation across my whole head,’ recalls Steve, who had 12 caps for England during the 1990s and played for Bath and Gloucester. 

But he took a couple of paracetamol and carried on with a business lunch.

Less than 24 hours later, though, Steve was in hospital fighting for his life.

When the headache didn’t abate, he says, he had thought it might be a tumour — ‘but a stroke never crossed my mind. I thought only old people had strokes.

‘I couldn’t believe someone as young and as apparently healthy as me could have one.’

Yet Steve’s experience is not that unusual. A study by Public Health England in 2018 found that 38 per cent of first-time strokes occur in people aged between 40 and 69. 

And according to the Stroke Association, a quarter of strokes in the UK are now happening to people of working age.

A stroke occurs when blood flow to the brain is interrupted, either by a clot (known as an ischaemic stroke) or when a blood vessel bursts (a haemorrhagic stroke).

Explaining the rise in younger patients, David Werring, a professor of clinical neurology at the National Hospital for Neurology and Neurosurgery in London, says they are less likely to be aware that they have raised blood pressure, blood sugar or cholesterol than older people, as they are less likely to bother with annual health checks available from their GP which can identify such stroke risks.

Lifestyle has a very strong role to play in stroke risk. ‘Lack of exercise, poor diet, being overweight, having diabetes and/or high cholesterol are all contributing risk factors for stroke at all ages,’ says Professor Werring.

‘But the strongest risk factor, particularly for haemorrhagic stroke, is high blood pressure.

‘People now in their 30s and 40s might not think they have problems and many lead unhealthy lives not realising their blood pressure is dangerously high.’

A study by Public Health England in 2018 found that 38 per cent of first-time strokes occur in people aged between 40 and 69 [File photo]

According to the Stroke Association, 55 per cent of people who have a stroke have hypertension. And for every ten people diagnosed with high blood pressure, seven remain undiagnosed and untreated — which could add up to more than five million people at risk in England alone.

‘High blood pressure damages the blood vessels by making them less elastic and increases the likelihood of stroke due to artery-blocking blood clots and brain haemorrhages from a ruptured small artery,’ says Professor Werring.

Before his stroke, Steve, now 50, had no idea that his blood pressure was dangerously high. Nor did he realise that his ethnicity — he was born in Nigeria — also put him at greater risk of a stroke (studies show that people of West African and Asian descent are more likely to suffer from hypertension).

It is not known what causes high blood pressure, but genetics and an unhealthy diet play a part.

In many ways, Steve, who runs a childcare business and lives in Trowbridge, Wiltshire, with his wife Lisa, 48, a business consultant, and their children Max, 20, and Ava, 12, can now see that he ticked the boxes for many of the risk factors for stroke.

‘I was so busy with work that I wasn’t making time to exercise,’ he says. ‘I loved carbs and a meal wasn’t a meal unless my plate was piled with rice and potatoes. I tended to binge drink when I went out, and I was incredibly stressed.’

Professor Werring says that stress alone won’t cause a stroke — ‘but stress does cause inflammation in the body, which raises blood pressure and levels of fat and sugar in the blood, so it could be a contributing factor’.

The day of his stroke, back at home after his lunch, Steve’s headache built and built.

‘Over the next 18 hours, the agony became so intense that just breathing hurt,’ says Steve. ‘I kept telling myself it was stress — there was so much going on and I’d been feeling like a pressure cooker.’

With his wife away on business, Steve did not get checked until the following morning as he didn’t want to disrupt his children’s sleep. By 6am, he felt like his head might explode and he was dizzy and confused. He vaguely remembers crawling into his son Max’s bedroom and begging for a lift to the local A&E in Bath.

Tests showed he had had a haemorrhagic stroke and he was transferred to a specialist stroke unit at Southmead Hospital in Bristol, 13 miles away. In theatre, blood was drained from his brain and he came round in intensive care to find Lisa by his side.

‘When I was told I’d had a stroke and was lucky to be alive, I was confused and traumatised,’ says Steve, who spent the next four weeks in hospital. He needed the drain in his head for another fortnight and his blood pressure was monitored to ensure he wasn’t at risk of having another stroke.

Back at home, he had to take it easy. Although he had no severe physical impairments from the stroke, his memory and processing skills were badly hit. He had to take a year off from his business and says that even now he struggles to be around too many people as he is easily overwhelmed.

‘I feel fortunate that I didn’t have my stroke during the pandemic as that has made things much more difficult, but I often still feel vulnerable,’ says Steve.

But the stroke gave him the fright he needed to change his lifestyle. He has addressed his stress levels and overhauled his diet. He is also on medication to help get his blood pressure down. 

‘I started playing golf a couple of times a week as it was a wonderful distraction and great exercise,’ says Steve. He also makes sure he walks at least 10,000 steps a day.

‘I have lost a stone-and-a-half and stopped drinking completely. I’ve also cut out carbs and now eat lots of fruit and veg.’

Regardless of age, recovery from a stroke doesn’t follow a specific timetable, says Professor Werring. Around a third of stroke patients end up with long-term disability.

‘We know that younger people recover more fully than older patients, possibly because their brains have more capacity to reorganise and adapt to injury from stroke,’ says Professor Werring.

‘The pandemic has made the recovery process more challenging for people, but virtual rehabilitation and therapy is proving possible and effective.’

Steve recognises that his own recovery is going to take time. ‘I can’t multi-task any more and it definitely takes my brain longer to work,’ he says. ‘But I am still here, and I am learning to live my life in a different way. I have been lucky to get a second chance.’

Steve Ojomoh is supporting the Stroke Association Hope After Stroke campaign. Visit stroke.org.uk/donate/hope

Citizen science

The medical breakthroughs helped by ordinary people. This week: Cell analysis

Understanding the make-up of cells can provide vital clues to a wide range of diseases. 

The Etch a Cell science project, launched in 2017 and run by the Francis Crick Institute in London, asked members of the public to analyse images of cells produced using electron microscopes (which show particularly high resolution images).

After online training, volunteers used their computer to draw around a cell feature known as the nuclear envelope — the barrier that separates genetic information or DNA, inside the cell brain (the nucleus), from the chemicals and reactions going on in the rest of the cell. Scientists believe the ‘nuclear envelope’ plays a key role in the cell, which means changes to the area can cause a range of diseases.

More than 104,000 classifications were submitted by thousands of volunteers and will now be used to better understand the biology of cells and train computers to analyse data even faster.

Do I really need…

This week: DualGel posted heel wedge with arch support and soft spur spot, £16, simplyfeet.co.uk

Claim: A wedge made from silicone that’s placed under the heel inside the shoe, it’s said to help with flat feet, high arches or knee pain by providing support. 

It also has a soft ‘cushioning’ on the heel to relieve pain from heel spurs — growths that can cause pain.

Expert verdict: Mike O’Neill, a podiatrist at the private Princess Margaret Hospital, Windsor, says: ‘A heel spur is often associated with plantar fasciitis — painful inflammation of the fibrous band of connective tissue [plantar fascia] that runs along the bottom of the foot. Shock absorption under the heel is important in helping resolve this heel pain.

‘These wedges are small enough to fit in most footwear, which is helpful as many support insoles are too large to use and have to be cut down. Though exactly how they help with knee pain or high arches is unclear.’

DualGel posted heel wedge with arch support and soft spur spot, £16

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DR MICHAEL MOSLEY: Why won't the NHS tell you how to treat diabetes?

DR MICHAEL MOSLEY: Why won’t the NHS tell you the secret to treating diabetes? (Clue: It costs nothing)

Eight years ago I managed to beat type 2 diabetes by going on my 5:2 diet (cutting my calories two days a week) and losing weight — 9kg to be precise. 

Since then I’ve become something of a broken record on the importance of shedding body fat to improve your blood sugar levels.

So I was delighted last week by the news from the Norfolk Diabetes Prevention Study — the largest of its kind in the world — which showed that even modest weight loss can have a big impact.

A recent review by Danish researchers found more than 70 per cent of people with type 2 diabetes who had lost significant amounts of weight were still medication-free more than five years later [File photo]

The Norfolk study recruited more than 1,000 people with pre-diabetes (meaning they had raised blood sugar levels). They were asked to lose weight, then were monitored for more than eight years. Those who managed to lose 2kg to 3kg, and keep it off, almost halved their risk of developing full-blown type 2.

This adds to extensive research carried out by British scientists showing that, as well as pre-diabetes, type 2 diabetes can be put into remission by going on a rapid weight-loss diet. And, as we’ve known for 20 years, weight-loss surgery can also reverse type 2.

In fact, a recent review by Danish researchers found more than 70 per cent of people with type 2 diabetes who had lost significant amounts of weight were still medication-free more than five years later.

Despite all this, the NHS Choices website still tells you type 2 diabetes is a ‘progressive’ disease that ‘usually gets worse over time’, with most people needing ever increasing levels of medication. What a depressing — and I would argue inaccurate — message.

So why aren’t they being a bit more encouraging? The situation with type 2 diabetes reminds me of a tussle I had with the medical establishment more than 25 years ago. 

In 1993 I was looking around for a subject to make a science documentary, when I came across the work of two Australians, Dr Barry Marshall and Dr Robin Warren, who had a striking new theory about stomach ulcers.

I was delighted last week by the news from the Norfolk Diabetes Prevention Study — the largest of its kind in the world — which showed that even modest weight loss can have a big impact [File photo]

At the time, stomach or duodenal ulcers (affecting the first part of the small intestine) were incredibly common but, like type 2, were seen as something of a mystery.

Gut ulcers can be excruciatingly painful and lead to internal bleeding. Doctors knew they were caused by excess acid and they could be managed by drugs such as ranitidine, which stopped the stomach from producing acid. These drugs, known as proton pump inhibitors, were expensive but there was a lot of incentive to use them because if you didn’t, or if the drugs stopped working, there was a high chance you’d need some of your stomach and intestines removed.

Robin and Barry, however, were convinced they had a cheap and effective cure. Their research showed that most patients with ulcers were infected with a bacterium, which the two doctors called Helicobacter pylori.

The patients’ stomachs were producing more acid to get rid of the bacterium, but this failed because Helicobacter is resistant to acid attack. But it is vulnerable to the right antibiotics.

To prove the point, Barry deliberately infected himself with Helicobacter (he swallowed a flask of it) and soon developed gastritis — massive inflammation — which he cured with a short course of antibiotics. This was in 1984.

Nine years later, when I began filming with Robin and Barry, there was still widespread resistance to their claims, despite extensive proof they were right.

When I asked Barry how long he thought it would take to persuade his colleagues to take their claims seriously, he laconically replied, ‘Well it’s been ten years and ten per cent of doctors are treating ulcers this way. Perhaps in 100 years they will all be doing it.’

In fact, within ten years almost all doctors were doing it. Not least because Barry and Robin won the Nobel Prize for Medicine in 2004 for their work.

But back in 1994, when my documentary, Ulcer Wars, detailing their work, came out, the medical reaction was either indifference or hostility. A review in The British Medical Journal by a leading gastroenterologist described the film as ‘one sided and tendentious’.

However, patients with duodenal ulcers who’d watched the programme soon began demanding antibiotic treatment.

Many later wrote to me and as one man put it: ‘I saw your programme a week before I was due to have surgery, and it was only because my doctor was prepared to listen that I was cured by antibiotics rather than having a chunk of my guts removed.’

Why did it take so long for doctors to adopt this approach, despite overwhelming evidence that eradicating Helicobacter could change patients’ lives? This was a question that researchers from Harvard asked in 2019 — concluding that it was mainly because doctors get much of their information from pharmaceutical companies, and these companies had no incentive to promote a cheap alternative to their acid-reducing drugs (which, of course, you took for life).

The parallels with type 2 diabetes are clear. As the millions of those affected in the UK will know, type 2 is usually treated with medication. 

While this will reduce the long-term damage caused by high blood sugar levels, it doesn’t deal with the underlying disease — and like all medication, the drugs can have significant side-effects, particularly when you move on to injecting insulin.

So how long before there’s widespread acceptance that most cases of type 2 diabetes can be put into remission by a rapid weight-loss diet? 

It is beginning to happen, but I wouldn’t guarantee that NHS Choices will be telling you the good news any time soon.

Like us, worms need to sleep. And the way their bodies prepare for sleep is also surprisingly similar to humans — one of the key triggers for a bit of shut eye is the release of melatonin, also known as the ‘hormone of darkness’.

Melatonin is produced in your brain and levels rise when it gets dark (synthetic melatonin is a popular sleep aid and is used to treat jet lag — I find it very effective).Now researchers at the University of Connecticut have discovered how melatonin actually works — in worms at least.

It slows the release of neurotransmitters, substances that allow messages to travel between nerve cells. So melatonin effectively tells your brain cells to stop chatting to each other — the chemical equivalent of a giant ‘shhh’!

Covid-19 vaccines are like buses; you wait for one, then two come along, almost together, with other contenders coming close behind.

This week we learnt that the vaccine made by Moderna may be even more effective than Pfizer’s. That both are more than 90 per cent effective is fantastic news and a real poke in the eye for the sceptics who claimed we might never get a vaccine against Covid-19, let alone several.

These findings also suggest that our immune system is doing what evolution designed it to do: mount a strong response to the virus.

There was a fear that Covid-19 might mutate into a more resistant form — or that our immune response might weaken. 

Yet recent research suggests that while antibody levels tend to fall over time, your immune system retains a ‘memory’ of the virus. So if you encounter it again, your body is ready to begin churning out antibodies and T-killer cells.

Which makes me wonder why Boris, who’s had Covid, is self-isolating. He’s unlikely to be ‘bursting with antibodies’ as he claims, but he’s also very unlikely to get it again, or to be infectious, so I can’t see how he’s a threat to others. 

Our immune system has been severely tested by Covid, but as the new vaccines show, it just needs a bit of help to get back on top.

Covid-19 vaccines are like buses; you wait for one, then two come along, almost together, with other contenders coming close behind [File photo]

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Why it's so important for Black and Asian people to access therapists of colour

When you’re choosing a therapist, it’s important that you find someone who can understand your perspective of the world.

But for people from ethnic minority groups, there is a distinct lack of professionals who are able to relate to their specific life experiences – including issues of race, religion and culture – because the overwhelming majority of therapists are white.

People from Black, Asian and other ethnic minority communities have a higher risk of developing mental health conditions than white people – but they are less likely to be able to access mental health services.

Black Brits are four times more likely to be sectioned than white patients, and ethnic minority patients are more likely to be given medication than be offered talking therapies like counselling or psychotherapy.

Put simply, mental health services in the UK are consistently failing people of colour. And the stark lack of diversity within the profession may be a significant contributing factor.

An American study found that in 2015 86% of psychologists in the US workforce were white. It is a similar story here in the UK. Only 9.6% of qualified clinical psychologists in England and Wales are non-white, in contrast to 13% of the population.

The impact of not seeing yourself reflected in the mental healthcare system can be really damaging. It can be isolating and it can prevent people from getting the help they need.

Shalanah, a fashion buyer from south London, has struggled with anxiety and OCD for most of her adult life. She started seeing a white therapist soon after she graduated from university, as her mental health took a sharp downturn.

‘It was the first time I realised I needed some professional help, and I was actually feeling really proud of myself for being proactive with my mental health,’ Shalanah tells Metro.co.uk.

‘At first it was fine, it was good. My therapist illuminated a lot of underlying issues for me, and helped me understand some of my triggers. It felt like things were moving in the right direction.

‘But as time went on, I just felt there was a bit of a disconnect between us. And I didn’t know how to address it.’

Shalanah says that experiencing microaggessions and racism – as a dark-skinned Black woman – at university and when she started work were contributing factors in her anxiety and low self-esteem. But she struggled to find the words to explain this to her therapist.

‘I’m not going to lie, it felt awkward,’ she says.

‘I didn’t know how to tell this white woman about my daily lived experiences as a Black woman. I just got the sense that she wouldn’t get it. And when I did try to explain, I felt like she was minimising.

‘When I told her that I felt I would never progress in my job because there were literally no senior Black women I could look up to, she made it all about my own self-esteem, and she wasn’t able to acknowledge the realities of structural and systemic inequalities.

‘Therapy is supposed to be this completely safe space where you can be open and honest, right? So how am I meant to do that if I feel like I have to leave part of myself outside the door?’

Shalanah stopped going to therapy after about six months. She started using medication for her anxiety, alongside mindfulness exercises like meditation, breathing exercises and yoga. But she does miss the release of talking to somebody face to face. She says she is now looking for a Black, female therapist – but they can be hard to come by.

In response to this lack of diverse therapists, qualified therapist Sharnade George has launched a new directory to help people find therapists who aren’t white.

Cultureminds Therapy Platform is an online booking platform for diverse communities offering safe and secure counselling and psychotherapy. The aim is to match people from marginalised communities with suitable therapists who will offer them a deeper cultural understanding.

‘In the past, when people would think about therapy, what would come to mind is – “that’s for white people”,’ Sharnade tells Metro.co.uk.

‘I remember working in a psychiatric hospital and telling a nurse I wanted to become a clinical psychologist and she replied: “You won’t be able to do that, it’s a white, middle-class job”.

‘This has stayed with me all my life and has been one of the reasons why I won’t give up in being a representative for Black culture and ensuring that we are seen, heard and helped within the healthcare industry.’

Sharnade says that finding suitable mental health services is more important than ever for ethnic minority communities, thanks to the pressures of the pandemic and the disproportionate impact it has had on Black and Asian people.

‘We have to see people from these cultures represented more in the media,’ says Sharnade. ‘There is a lack of representation, which is why people feel uncomfortable to seek help – they feel like they are alone.’

The Mental Health Foundation reported in 2019 that people from Black and minority ethnic groups in the UK are more likely to experience a poor outcome from mental health treatment and more likely to disengage from mainstream mental health services, leading to social exclusion and a deterioration in their mental health.

‘Mainstream mental health services often fail to understand or provide services that are acceptable and accessible to non-white British communities and meet their particular cultural and other needs,’ the report concluded.

This is exactly what Sharnade hopes to tackle with her therapy directory. She says traditional mental health options often fail people of colour because of a fundamental cultural disconnect.

‘Therapists of colour are not automatically in a position to better serve clients of colour, but they are often more equipped by tradition of being able to identify with the realities of people of colour,’ she explains.

‘Cultural competence plays a big role in therapy. For example, seeing a Black therapist who is self-aware and has an understanding your cultural lens, cultural differences, practices, and world views, whilst being able to comprehend, communicate and effectively interact, can be very impactful with the client’s journey.

‘Having a professional who understands our cultural upbringing, history and oppression can be healing for clients, who may finally feel as though they are being understood.

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New research reveals why low oxygen damages the brain

Brain cell dysfunction in low oxygen is, surprisingly, caused by the very same responder system that is intended to be protective, according to a new published study by a team of researchers at the Case Western Reserve University School of Medicine.

“These powerful protein responders initially protect brain cells from low oxygen as expected, but we find that their prolonged activity leads to unintended collateral damage that ultimately impairs brain cell function,” said the study’s principal investigator Paul Tesar, a professor in the Department of Genetics and Genome Sciences at the Case Western Reserve School of Medicine and the Dr. Donald and Ruth Weber Goodman Professor of Innovative Therapeutics.

Defining the mechanism of brain-cell damage in low oxygen conditions provides an opportunity to develop effective therapies, including a class of drugs studied in their research that could inform future clinical approaches for many neurological diseases caused by low oxygen. The work also clarifies how the response to low oxygen causes disease in other tissues outside the brain.

Their research was published online Oct. 21 in the journal Cell Stem Cell.

The body’s response to low oxygen

With the dawn of an oxygenated atmosphere, a burst of multicellular life was possible, as oxygen could be used to produce the energy needed to support complex life functions. Given the requirement of oxygen for life, nearly all organisms evolved a mechanism to rapidly respond to low oxygen—a condition called hypoxia. The Noble Prize in Physiology or Medicine was awarded in 2019 for discoveries of how cells in our body sense low oxygen levels and respond to stay alive.

At the core of this ancient response are proteins called hypoxia-inducible factors (HIFs), which instruct the cell to minimize oxygen consumption and maximize their access to oxygen. In this way, HIFs can be thought of as valiant heroes attempting to protect and resuscitate cells in the immediate response to low oxygen.

Prolonged hypoxia causes dysfunction in many tissues. In particular, stem cells in the brain are impaired by hypoxia in many diseases, including stroke, cerebral palsy related to premature birth, respiratory distress syndromes, multiple sclerosis and vascular dementia. Even the significant neurological damage caused by COVID-19 is attributed to hypoxia.

Until now, the precise causes of cell malfunction due to low oxygen were unknown.

The dark side of the hypoxia response

In this study, researchers developed a new approach to closely study how the hypoxia responder proteins function. By comparing how they work in brain-stem cells with other tissues, such as heart and skin, the scientists confirmed that the hypoxia responder proteins perform a beneficial function to promote cell survival in low oxygen in all tissues. However, these same hypoxia responder proteins had a previously unappreciated dark side, as they also switched on other cellular processes outside of the core beneficial response.

The team then demonstrated that this additional—and previously unknown—response is what impaired brain-stem cell function. This suggests that, while hypoxia responder proteins evolved to promote cell survival in all tissues of the body in low-oxygen conditions, their powerful effects can also have unintended consequences to disrupt cell function.

New opportunities for treating hypoxia damage

The authors tested thousands of drugs to try to restore brain-stem cell function to overcome the damaging effects of the hypoxia responder proteins. They discovered a group of drugs that specifically overcome the damage-inducing response, while leaving the beneficial response intact.

“One of the exciting avenues that stems from this work is identifying drugs that specifically target the damaging side of the hypoxia response while sparing the beneficial side,” said first author Kevin Allan, a graduate student in Case Western’s Medical Scientist Training Program. “This offers a new perspective on combating tissue damage due to hypoxia.”

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Joe Biden Says He's Had a Stutter All His Life—Here's Why It Can Be So Hard to Overcome This Speech Disorder

A stutter can be an extremely debilitating and frustrating speech disorder, but it hasn’t held Joe Biden back. In December 2019, Biden revealed on Twitter that he had worked his whole life to overcome a stutter, and has mentored kids with the same speech disorder. 

During a presidential-primary debate in Atlanta in November 2019, Biden stuttered several times. Shortly afterward, he spoke to The Atlantic about living with a stutter since he was a young boy, telling writer John Hendrickson, who also has a stutter, that it “can’t define who you are.”

What is stuttering, exactly? 

Stuttering (sometimes called stammering or disfluent speech) is characterized by repetition, prolongation (extending the duration) of sounds, and interruptions in speech known as blocks, per the National Institute on Deafness and Other Communication Disorders (NIDCD). A person who stutters knows exactly what they want to stay, but has difficulty with the flow of the words. In some cases, they may experience rapid eye blinks or lip tremors alongside the stuttering. 

“The signs and symptoms of stuttering are easily recognizable,” Avivit Ben-Aharon MS Ed, founder and clinical director of Great Speech Inc., tells Health. “Stutterers tend to repeat syllables, parts of words, and make some words or sounds longer. Some stutterers can produce words but with excessive physical difficulty.” 

The NIDCD says stuttering is most common in children between ages 2 and 6—which is the period when they’re developing language skills. Around 95% of children who stutter show signs of it before the age of 5, Ben-Aharon says. Boys are up to three times as likely to stutter as girls, a difference that becomes even greater as they get older. 

According to The Stuttering Foundation, a nonprofit organization that supports those who stutter, stuttering affects roughly 70 million people (that’s about 1% of the population)—3 million of them live in the United States.

What causes stuttering? 

It's not known for sure, but it’s likely to be a combination of multiple factors. “Recent research indicates that genetics, family history (often male), neuromuscular development, and the child’s environment, including family dynamics, all play a role in the onset of stuttering,” Ben-Aharon says. 

The Stuttering Foundation says approximately 60% of people who stutter have a family member who actively stutters, or used to. (Biden’s uncle on his mother’s side—known as “Uncle Boo-Boo”—stuttered his whole life, Biden told The Atlantic.)

Although emotional problems and parenting don’t appear to cause stuttering, environmental factors and speaking demands may increase or decrease stuttering, Ben-Aharon adds. Stress too can exacerbate it, but isn’t considered a cause. 

How can stuttering be managed?

Although there’s no cure for stuttering, lots of treatment options are available, including stuttering therapy, drug therapy, self-help groups, and electronic devices to help control fluency, such as a device that fits into the ear canal (just like a hearing aid) and digitally replays a slightly altered version of the person’s voice into their ear so that it sounds as if their speech is in sync with someone else’s.

“If stuttering persists in children for more than six months, speech therapy is generally needed to learn strategies and techniques that are helpful in managing their stuttering, Ben-Aharon says. “The therapeutic process focuses on relaxation and breathing strategies to reduce tension as well as slowing down the rate of speech to minimize the dysfluency.” 

Does a stutter ever go away on its own? 

The NIDCD says approximately 75% of children outgrow stuttering. However, the longer someone stutters, the less likely they are to make a full recovery. According to The Stuttering Foundation, no more than a quarter of people who still stutter at 10 will be completely free from the disorder in adulthood. And children who continue to stutter may have the disorder for the rest of their lives—like Biden. 

“Whether a child who stutters continues stuttering through the adult years often depends on the age the child begins to stutter and whether there is a family history of stuttering,” Ben-Aharon explains.  

How does stuttering affect a person’s mental health?

So much of our lives rely on communication with others, so stuttering can have a huge impact on quality of life and interpersonal relationships. Also, the stigma attached to it may negatively influence job performance and opportunities. 

“Stuttering can affect socialization, causing anxiety and depression in those who are struggling to communicate,” Ben-Aharon adds. “When individuals who stutter feel rushed or sense the impatience of others who try to finish their sentences, their anxiety often increases—while their inclination to socialize decreases.”

Ben-Aharon finds that some people don’t seem to be impacted emotionally by their stuttering, while others see it as a challenge to overcome. “They embrace the techniques and strategies offered through speech therapy to maximize communication,” she says. “And in our practice, we are noticing greater acceptability around stuttering and less of our patients are reporting bullying or negative responses in school.”

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