The Royal College of Nursing wants tougher safe staffing rules as 40,000 posts are vacant.

Physical activity, including walking and muscle-strengthening activities, were associated with significantly reduced risk of cirrhosis-related death, according to research presented at Digestive Disease Week® (DDW) 2019. Chronic liver disease is increasing, partly due to the obesity epidemic, and currently there are no guidelines for the optimal type of exercise for the prevention of cirrhosis-related mortality. Researchers hope these findings will help provide specific exercise recommendations for patients at risk for cirrhosis and its complications.

Much like cancer, sepsis isn’t simply one condition but rather many conditions that could benefit from different treatments, according to the results of a University of Pittsburgh School of Medicine study involving more than 60,000 patients.

After 20 years of rapid increases in life expectancy at birth, the rate of growth in Australia is now falling behind most other high-income nations, meaning better control of health risk factors such as obesity will be needed if further life expectancy increases are to be achieved, research shows.

Researchers have long believed the obesity epidemic is at least partly related to the proliferation of highly processed foods. Now, new research suggests the connection is real.

In a tightly controlled lab study, scientists found that people ate many more calories – and gained a couple of pounds – when they spent two weeks on a highly processed diet, versus when they ate a diet rich in whole foods.

Extra calorie munching

And it wasn’t just explained by the obvious – processed foods packing more sugar and fat.

Both diets were designed to offer the same number of daily calories, and similar amounts of total sugar, fat, carbs and fibre.

Yet, during their two weeks on mostly processed foods, study volunteers chose to eat more – an extra 500 calories per day, on average. They also gained about two pounds (just under a kilo), whereas they lost that much during their two weeks on the minimally processed diet.

“I was very surprised,” said lead researcher Kevin Hall, of the US National Institute of Diabetes and Digestive and Kidney Diseases.

“I’d thought we wouldn’t see much of an effect of the processed foods, per se, because we’d matched the diets for calories and other components,” Hall explained.

So what explains the extra calorie munching? Hall said he could only speculate.

Faster eating rate

One theory relates to the manner in which people ate: When they were on the heavily processed diet, they ate faster.

Whenever people scarf down their food, Hall explained, that gut has less time to tell the brain it’s full – making it easier to overindulge.

He also said that, to provide enough fibre, the processed diet included supplemented beverages. And since liquid may not be as satisfying as solid foods, Hall said, that might have swayed people’s overall calorie intake.

Whitney Linsenmeyer is a registered dietitian and spokesperson for the Academy of Nutrition and Dietetics. She agreed the faster eating rate could be one explanation for the results.

Slower eating is, in fact, a weight-loss strategy, noted Linsenmeyer, who is also a nutrition instructor at Saint Louis University.

Looking at the diets, she said it’s easy to see how the minimally processed one would require more time and chewing effort.

Amount of food processing

Linsenmeyer pointed to another possible explanation: While the diets had the same amount of total sugar, the processed one had more added sugars.

How did the daily menus differ? Neither diet followed any fad, like low-carb or low-fat or high-protein. The main difference was in the amount of food processing.

A typical processed breakfast included a bowl of sweetened breakfast cereal and a packaged muffin with margarine; or an English muffin with egg, bacon and processed cheese, plus packaged tater tots. Breakfast on the minimally processed diet included Greek yogurt or oatmeal with fresh fruit and nuts; or eggs with hash browns made from fresh potatoes.

Dinner on the processed diet included things like packaged ravioli with processed cheese and white bread; or canned chili with store-bought tortilla chips and salsa. Dinner on the minimally processed menu featured things like beef, whole-grain barley, and plenty of fruits and vegetables.

Twenty study participants lived in a lab for a month, spending two weeks on each diet. They were allowed to eat as much of the offered food as they wanted; they simply ate more when they were on the processed diet.

Hall noted that there are many popular weight-loss diets that demonise particular nutrients or foods. “But one thing they all have in common is that they limit processed foods,” he said.

Eating foods that we cook

This study doesn’t prove that’s why people may lose weight on the diets, Hall stressed. But it’s food for thought, he said.

Linsenmeyer emphasised this point: Eating healthfully is not only about nutrients. “It’s also about eating food that we cook, not that we allowed food manufacturers to prepare for us.”

She and Hall both acknowledged, however, that many people lack the time, money or skills it takes to drop processed foods from their lives.

“Just telling people to eat healthier may not be enough if we don’t improve access to healthy foods,” Hall said.

The study was published online in Cell Metabolism.

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Can you predict the spot of your next pimple as accurately as the date of your next period? If you the answer is yes, there’s probably a reason you keep getting a pimple in the same spot.

Luckily, there are steps you can take to end the vicious cycle of super stubborn, frustrating pimples, says Dr Joshua Zeichner, director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in NYC.

Here’s what you need to know about these tough-to-fight pimples – and how to banish them for good.

1. That pimple might actually be a cyst.

Underground pimples that swell up and never come to a head (these suckers are known as cysts) are notorious for showing up in the same exact spot, says Dr Zeichner. They develop when your pore, which is shaped like a long tube, branches out and causes oil to take a detour from its path to the surface of your skin.

When this happens, the oil forms a “balloon-like” shape under the skin and inflates and deflates depending on how much oil you’re producing, Dr. Zeichner adds. If you have big groupings of cysts, which can leave behind scars, then your doctor might prescribe a birth control pill, spironolactone, antibiotics, or even Accutane, says Dr Estee Williams, a dermatologist in NYC.

For the occasional cyst, Dr. Williams recommends a topical treatment. “Cleansers can only do so much,” says. “Acne usually requires leave-on products.” Look for spot treatments that contain glycolic or salicylic acid or benzoyl peroxide.

READ MORE: Yes, You Can Totally Use Witch Hazel For Acne – Here’s How

2. You’re not popping that whitehead the right way.

If you once squeezed a whitehead until it burst, it’s possible that the entire blockage wasn’t removed—meaning that pimple could become inflamed again, says Dr Zeichner. The irritation or exposed bacteria could also cause another pimple to form right next to your previous one. “It might appear like it’s the same zit, but it’s not,” says Dr Zeichner.

It’s easier said than done, but the best thing to do to treat a whitehead is nothing at all. Popping can lead to scarring unless you leave it to a pro. But if you can’t resist the pop, Dr Zeichner recommends using a salicylic acid treatment to remove excess oil and prevent your pore from becoming blocked again.

3. Your dirty habits might be to blame.

Have the habit of touching your face when you’re stressed or reading emails at your desk? What about never disinfecting your cell phone? These breakouts are called acne mechanica, acne caused by heat, friction, and pressure against the skin.

Besides keeping your hands off your face, try cleansing your phone weekly or in between long chat sessions, says Dr Deanne Mraz Robinson, assistant clinical professor of dermatology at Yale New Haven Hospital.

READ MORE: Everything You Need To Know About How To Get Rid Of Acne Scars

4. Period zits are a real thing.

If you swear that your breakout is BFFLs with your period, you’re on to something. “It is due to androgen activation of sebaceous glands,” says Dr Robinson. “It occurs in the same area as this is the area on our face in which the androgens activate our sebaceous glands.” Meaning your lower cheeks, chin, jawline, and neck are right in the line of fire.

You can deal with the drastic hormonal changes from the inside out. “Many times we use spironolactone, an androgen blocker, with or without birth control to help ease hormonal acne,” says Dr Robinson.

If you want to go the OTC route, Dr Robinson recommends a topical retinol.

^{This article was originally published on womenshealthsa.co.za}

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Ashley Oerman and Maddie Aberman

Symptoms of depression seem pretty easy to spot: disinterest in things you used to love, an attitude that can change at the drop of a hat, a desire to eat all of the things (or none of the things).

But here’s the thing: Sometimes you can’t see that stuff – not because it’s not there, but because it’s hidden (yes, even to yourself). You can feel all of those depressed feelings, but still show up for work (and your family and your friends) with a smile on our face.

That’s what’s known as “smiling depression”, which, tbh, sounds counterintuitive, but according to Dr Heidi McKenzie, a clinical psychologist, depression and smiling are not mutually exclusive. Here’s what you need to know about “smiling depression,” including what to do if you think you have it, and how to get help.

READ MORE: Can’t Tell If It’s Anxiety Or Depression? Ask Yourself These 7 Questions

What exactly is ‘smiling depression’?

People with smiling depression often mask the symptoms they are experiencing,” says McKenzie. “They can get up each day, get dressed, show up for work and continue to interact with others in a way that belies how bad they are feeling inside.”

McKenzie says that smiling depression is essentially another name for high-functioning depression or persistent depressive disorder (PDD), a chronic level of sadness that can include sleep or appetite changes, feelings of hopelessness or fatigue, panic attacks and loss of interest in favorite activities. So it’s a totally real thing, and it can leave you in serious pain.

READ MORE: 5 Borderline Personality Signs That Shouldn’t Be Ignored

Why haven’t I heard of ‘smiling depression’?

If you’re looking for “smiling depression” in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), you won’t find it, but experts are fairly comfortable using the term as a stand-in for mild to moderate categories of depression, especially if it prompts someone to seek help for their symptoms when they might not otherwise realise they have a problem.

“I think it’s important to use terms that people can relate to, that can destigmatise depression, and that can encourage people to say they need help,” says psychiatrist Dr Karen Stewart. “People may not know otherwise that what they’ve been experiencing can be attributed to depression.”

McKenzie agrees, explaining that the idea of “smiling depression” can go a long way towards busting the myth of the depressed person as someone who only stays in bed all day with the blinds drawn.

While some people with depression become bedridden (it can happen with major depressive disorder), many others are able to do their jobs, take care of their families and even smile, laugh or maintain their sense of humour, says McKenzie. Assuming you must be fine because you don’t fit the stereotypical picture of mental illness could do long-term harm to your health and wellbeing.

READ MORE: 8 Signs You Have Anxiety That’s Messing With Your Life

How do I know if I have ‘smiling depression’?

There’s no single answer here, but there are plenty of signs and symptoms to watch for. If you’re feeling totally drained at the end of every day and have no idea why, McKenzie says you may be doing a lot of emotional legwork to fight through your depression. Here’s a few physical examples of how that might look, according to McKenzie:

It takes serious effort for you to get up in the morning, do your hair and make-up and get yourself to work. Once there, you can play the role of happy employee (asking your co-workers about their weekend plans or accepting lunch invites) but you might feel empty and disconnected while participating.

You can power through your work day, successfully balancing a budget or managing a classroom of pre-schoolers, but you struggle to maintain your focus; when you finally get home, you’re so exhausted you neglect all your personal responsibilities and fall into bed (or asleep on the couch) before dinner.

Your self-care has totally dropped off the charts. You spend so much energy keeping up with the bare minimum that you’re skipping workouts, making unhealthy food choices and dodging invites to hang with your friends.

You’re constantly experiencing a cycle of negative emotions, by either feeling guilt or shame for feeling down, or by berating yourself for being lazy when you can’t find the energy to do something.

You dabble in something called “passive suicidal ideation”, which means you aren’t actively planning to take your own life, but you don’t feel upset or distressed by the thought of dying suddenly (like in a car accident, for example).

READ MORE: 10 Signs That Someone You Know Is Emotionally Unstable

I think I might have ‘smiling depression’. What do I do now?

First off, try to dismiss any thoughts of shame, blame or guilt associated with the idea of depression. There is zero reason to feel embarrassed about saying you have it – or that you need help.

Secondly, Stewart recommends making an appointment with your doc or a mental health professional ASAP for a thorough evaluation if you’ve noticed symptoms lasting most of the day for a minimum of two weeks. Being officially diagnosed with depression – and knowing which category of it you have – is important to finding the right treatment.

Speaking of treatment, that’s your third step. Thankfully, you have several options: lifestyle changes, therapy and medication, says Stewart. “You can pick and choose from those three or do a combination of all of them.”

According to Stewart, lifestyle changes involve paying attention to your diet, sleep and exercise habits, while medication usually involves taking a selective-serotonin reuptake inhibitor (SSRI), which can give you a much-needed boost of mood-improving serotonin. And as far as therapy goes, cognitive behavioural therapy is a solid choice that Stewart says will teach you how to manage your thoughts and behaviours to improve your overall mood.

Whatever treatments you choose, the key is to get help – both professionally and from trusted friends or family members. Like any other health condition, it will take time to feel better, but relief can be found.

“Working on a day-to-day basis on developing a sense of self-compassion for not being at your best is an important step toward feeling better,” says McKenzie. “Know that the condition is highly treatable and take the steps to reach out for help.”

^{This article was originally published on womenshealthsa.co.za}

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Sarah Bradley

A woman struggled with a vitamin B12 deficiency for five years before doctors correctly diagnosed her condition, a new case report from the BMJ says.

The woman, who was 61 when doctors evaluated her, has a condition called Addison’s anemia. The condition is also called pernicious anemia, and it's caused by a decrease in red blood cells due to a lack of vitamin B12.

What’s especially frightening about the new case report is that the woman’s symptoms mimicked dementia, and she wasn’t properly diagnosed with Addison’s anemia and treated for it for years. Her sister cared for her after her mental health deteriorated as a result of her deficiency.

RELATED: 21 Important Facts About Vitamin B12 Deficiency

“According to her sister, she continued talking and shouting about the spirits of dead relatives whom she could see clearly and who told her not to take her medication. She feared that her family would poison her and refused to share meals with them,” the new case report says.

Additionally, she struggled with memory loss and couldn’t be trusted to go outside on her own “as she would get lost and be unable to return home without help.”

“The patient was conscious but disoriented in time and space. Her speech was slurred, and, according to her sister, sometimes incomprehensible,” the report says, noting that the woman experienced visual and auditory hallucinations.

Once doctors finally did figure out that her symptoms were not caused by a mental disorder such as paranoia or schizophrenia but actually a vitamin deficiency, the patient was treated with a medicine called olanzapine, which is used to treat schizophrenia. She was given 10 milligrams of the antipsychotic each day, and this caused the mental symptoms that had previously been mistaken for dementia to subside.

“Psychotic symptoms responded favorably to olanzapine. At the subsequent revaluation, there were no reports of aggressive behavior and the persecutory delusions and hallucinations had stopped,” the case report said.

RELATED: How to Prevent Dementia, According to New WHO Guidelines

The woman’s case of “reversible dementia” highlights just how much vitamin B12 does for the body. It's neccessary for proper neurological function and the formation of red blood cells.

In addition to Addison’s anemia, vitamin B12 deficiencies are linked to megaloblastic anemia and glossitis (inflammation of the tongue).

Vitamin B12 can be found in fish, poultry, eggs, and milk, but plant foods don’t generally have vitamin B12.

While a vitamin B12 deficiency can obviously be very dangerous, most people in the US need not worry about how much of it they’re consuming. “Most children and adults in the United States consume recommended amounts of vitamin B12, according to analyses of data from the 1988-1994 National Health and Nutrition Examination Survey and the 1994-1996 Continuing Survey of Food Intakes by Individuals,” the NIH says.

RELATED: How to Find the Best Multivitamin for You

Nicki Chapman will not host the Chelsea Flower Show following surgery to remove a brain tumour.

Health experts have long touted the benefits of a low-fat diet for preventing heart disease, but now a large study suggests it might do the same against breast cancer.

Researchers found that eating low-fat foods reduced a woman’s risk of dying from breast cancer by 21%. What’s more, the women on low-fat diets also cut their risk of dying from any cause by 15%.

Effect of a low-fat diet

“This is the only study providing randomised controlled trial evidence that a dietary intervention can reduce women’s risk of death from breast cancer,” said study author Dr Rowan Chlebowski. He is from the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center in Torrance, California.

Diet has long been suspected to be a factor in cancer. Obesity has been linked to 12 different types of cancers, including postmenopausal breast cancer, according to the American Institute for Cancer Research. And, a diet full of healthy foods, such as vegetables, fruits, whole grains and legumes is thought to help protect against cancer.

Chlebowski noted that previous studies have shown a higher cancer incidence in countries where people tend to eat more fat.

The latest study looked at the effect a low-fat diet might have on the incidence of breast cancer and death.

Nearly 49 000 postmenopausal women from 40 centres across the United States were included in the study. The women were between the ages of 50 and 79, and had no history of previous breast cancer. Eighty percent of the women were white, which Chlebowski said matched the population when the study began.

Emphasis on vegetables, fruits, legumes and whole grains

Between 1993 and 1998, the women were randomly assigned to one of two dietary groups. One group was assigned to a normal diet. This diet had about 32% of their calories from fat. The low-fat group had a target of 20% or less of calories from fat.

Chlebowski said the low-fat diet was close in content to the Dietary Approaches to Stopping Hypertension (DASH) diet. This emphasises eating vegetables, fruits, legumes and whole grains, while avoiding high-fat meats and dairy products, according to the US National Heart, Lung, and Blood Institute.

The low-fat group lost a modest amount of weight. Chlebowski said there was about a 3% difference in weight between the groups. He said the researchers factored the weight difference into their calculations and that weight alone didn’t affect the risk of death.

Women in the low-fat group adhered to the diet for about 8.5 years, and both groups were followed for an average of nearly 20 years.

The women in the low-fat group weren’t able to achieve the 20%-or-less target for fat, but they did manage around 25%, according to the researchers. And they did increase their intake of fruits, vegetables and grains.

Dietary moderation

“The diet was more moderate than originally planned. But we saw a diet of 25% to 27% fat is largely achievable,” Chlebowski said.

He said the researchers don’t know if any individual components of the diet were more important than others, but they hope further study will tease that out.

In the meantime, Chlebowski said he thinks the message should be one of dietary moderation rather than looking for any one particular food or food group. He said the women in the low-fat study group reduced their overall calories, changed their cooking methods, and reduced their portions of meat and dairy products.

The findings are to be presented at the American Society of Clinical Oncology (ASCO) annual meeting, in Chicago. Findings presented at meetings are typically viewed as preliminary until they’ve been published in a peer-reviewed journal.

ASCO breast cancer expert Dr Lidia Schapira, from Stanford University, noted that this study shows “what we put on the plate matters. It’s worth coaching and pushing patients to put more fruits and vegetables on their plates.”

Not an incredibly restrictive diet

She added that even when women didn’t reach the more stringent dietary fat goal of 20%, they still showed a health advantage from trying to reduce the fat in their diets.

Dr Monica Bertagnolli, president of ASCO, said these findings were “really, really striking”.

She noted, “This was not an incredibly restrictive diet. People were able to adhere to it pretty well.”

And yet, the incidence of breast cancer went down by 8% in the women on low-fat diets.

“They were getting fewer breast cancers, and even when they did get breast cancer, their death rate was reduced,” Bertagnolli said.

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