Does caffeine enhance performance?

About 80% of the world’s caffeine is consumed in the form of coffee.
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Chris Forbes-Ewan, Defence Science and Technology Organisation

Unlike many drugs, caffeine may be taken legally by people of all ages, which helps make it the world’s most widely used stimulant.

Approximately 80% of the world’s caffeine is consumed in the form of coffee; it’s been estimated that 500 billion cups of coffee are consumed throughout the world every year.

Tea, chocolate, cola drinks, and energy drinks and shots are the other main sources of caffeine.

Impact on physical performance

Caffeine has been used to good effect by athletes as an aid to physical performance for many years. Initially, it was believed to be of greatest benefit in endurance events (marathon running, for instance, or long-distance swimming).

More recently, we’ve realised that caffeine also boosts performance for short-term, high-intensity activities, such as middle-distance running, and stop-start sports, such as tennis.

Until a decade or so ago, it was thought that very high doses of caffeine (higher than could be obtained by simply drinking coffee, for example) were needed to enhance athletic performance.

Initially, caffeine was believed to be of greatest benefit in endurance events, such as long-distance swimming.
Airman Magazine/Flickr

Such high doses could usually only be obtained from caffeine-containing capsules, and often led to adverse side effects.

Consequently, the International Olympic Committee (IOC) banned caffeine use by athletes above a certain level of intake.

But by early this century, it became clear that moderate doses of caffeine — achievable by drinking coffee, tea or energy drinks — were just as effective as very high doses for enhancing physical performance. And they had minimal risk of side effects.

It was also discovered that caffeine intake is “self-limiting” to some extent, that is, extremely high doses are likely to have a detrimental effect on athletic performance.

So, in 2004, the IOC ban on caffeine was completely lifted; Olympic athletes may now take as much caffeine as they like.

How much is enough?

What, then, is the most appropriate source of caffeine if you’re an athlete who wants to safely obtain a performance benefit?

The amount of caffeine in tea and coffee varies greatly.
Ryan Hyde

Well, you could try coffee or tea, but the amount of caffeine in these beverages varies greatly. Energy drinks, on the other hand, are formulated to contain a known quantity of caffeine, so they allow for a more controlled intake.

A dose of about three milligrams of caffeine per kilogram of body weight will give you the desired boost to performance, with little likelihood of inducing the “caffeine shakes” that can result from overdosing.

So, for example, if an energy drink contains 80 milligrams of caffeine, and you weigh 55 kilograms, a couple of cans of energy drink will provide the recommended dose.

Some people believe that caffeine is a diuretic, that it promotes excessive urine production and therefore leads to dehydration. This is not correct, at least when caffeine is consumed in moderate amounts by habitual users.

People who regularly drink tea, coffee, cola drinks, energy drinks or energy shots can expect to receive the desired performance enhancement from caffeine without experiencing greater dehydration.

Making you sharper

There’s also evidence that caffeine improves some aspects of mental performance. Doses up to about 200 milligrams (similar to the dose that enhances physical performance) lead to increasingly quicker reactions, increased alertness, elevated mood and improvements in activities such as typing (greater typing speed with fewer mistakes).

The quantity of caffeine needed to enhance mental performance can be obtained by drinking one or two cups of coffee, one or two cans of energy drink, or several cups of tea. (But note the earlier advice that caffeine concentration is very variable in coffee and tea.)

Energy drinks are formulated to contain a known quantity of caffeine, so they allow for a more controlled intake.
Nattu/Flickr

People who need to maintain vigilance during a period when they would normally be asleep, such as long-distance truck drivers, nightwatchmen, shift workers, students “cramming” for exams and soldiers on sentry duty, often use caffeine from coffee, tea, energy drinks and shots or capsules to keep them awake and alert.

The US Army now uses a commercially available caffeinated chewing gum called “Stay Alert” in one of its combat rations (the First Strike Ration). This ration is issued to soldiers who are expected to take part in operations of up to 72 hours with minimal sleep. Stay Alert gum contains 100 milligrams of caffeine per stick and there are five sticks in the First Strike Ration.

A little doubt

In the interests of objectivity, I should point out that a small minority of researchers believe that caffeine does not truly enhance mental performance. Rather, they claim that taking caffeine will simply overcome the drop in performance that results from caffeine withdrawal in people who are used to having caffeine in their body.

But looking at data from military studies I’m familiar with, I believe there’s little room for doubt that caffeine can greatly enhance at least some aspects of cognitive performance, particularly when people are sleep-deprived.

It’s important to keep in mind though that overdosing on caffeine is potentially dangerous, particularly for those (mostly young) people who consume too many energy drinks or shots – especially if they combine these with alcohol.

The ConversationCaffeine undoubtedly enhances many aspects of physical performance, and very likely several aspects of mental performance too. And unlike most performance-enhancing drugs, it’s legal, readily available, and comes in forms that are highly acceptable to most people.

Chris Forbes-Ewan, Senior Nutritionist, Defence Science and Technology Organisation

This article was originally published on The Conversation. Read the original article.

What’s the point of sex? It’s good for your physical, social and mental health

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Committing to a safe and active sex life could boost your health in 2017.
pedrosimoes7/flickr , CC BY-NC

Fiona Kate Barlow, The University of Queensland and Brendan Zietsch, The University of Queensland

The act of penetrative sex has evolved over millions of years as a mechanism to deliver sperm to eggs and initiate pregnancy. But there’s more to sex than just the meeting of two sets of genes. The ‘What’s the point of sex?’ series examines biological, physical and social aspects of sex and gender.

Today’s piece describes physical, social and mental health benefits that are a consequence of consenting sexual relationships, or the pursuit of them.

Whether you talk about it in polite society or not, sex is central to who you are as a person. In fact, we are all here as a result of meaningful looks, snatched moments, sweaty palms, clumsy first touches, tangled limbs and orgasms.

Were sex only important for procreation, it would more than do its job from an evolutionary perspective. However, evidence suggests that at a physical and social level, sex is about much more than making babies.

Most nonhuman animals have no interest in sex outside of a reproductive context. But women have sex throughout their menstrual cycle despite being fertile for only a few days each month, and go on having sex long after menopause renders them infertile. And of course, couples who are of the same sex, using contraception or infertile are no less keen for congress than any pregnancy-focused counterparts.

Ultimately, no one knows for sure what the point of all this sex is, but its other biological effects may provide clues.

Sex brings people together

Have you ever met someone who is right for you “on paper”, but when push comes to shove their scent seems wrong, or the spark isn’t there? Our bodies can tell our minds who we don’t want to be with. Similarly, our bodies can give us strong signals about whether we want to stay close to somebody.

When we touch, kiss and have sex, our body responds with a release of hormones linked to bonding. Most important among these appear to be oxytocin and vasopressin.

Such releases are particularly marked during sexual excitement and orgasm. The release of these chemicals is thought to promote love and commitment between couples and increase the chance that they stay together.

Some research supporting this comes from studies of rodents. For example, female voles (sturdy little mouse-type creatures) have been found to bond to male voles when their copulation with them is paired with an infusion of oxytocin.

In humans, those couples who have sex less frequently are at greater risk of relationship dissolution than are friskier couples.

But oxytocin is not just good for pair bonding. It is released from the brain into the blood stream in many social situations, including breastfeeding, singing and most activities that involve being “together” pleasurably. It appears oxytocin plays a role in a lot of group oriented and socially harmonious activities, and is implicated in altruism.

Bonobos resolve conflicts through sexual activities.
LaggedOnUser/flickr, CC BY-SA

Bonobos (a species of great ape) appear to take full advantage of the link between harmony and sex, often resolving conflicts or comforting one another by rubbing genitals, copulating, masturbating or performing oral sex on one another. This isn’t something to try during a tense board meeting, but such findings hint at the potential role lovemaking may play in reconciliation between couples.

Sex is a healthy activity

Sex is a form of exercise: a fun online calculator can help you calculate how much energy you burned during your last sex session.

People with poor physical or emotional health are also more likely to have sexual problems. Here causality is hard to establish – healthier people will tend to be “up” for more sex, but it is also likely that the physical workout and bonding benefits conferred by satisfying sex lead to healthier, happier lives.

It’s also possible our long, energetic and physically demanding style of sex evolved to help us appraise the health of potential long-term partners.

Sex can make us creative

Some theorists propose art forms such as literature, music and painting result from our drive to get people in bed with us.

In a society in which there’s at least some choice available in whom we mate with, competition will be fierce. Consequently, we need to display characteristics that will make us attractive to those we are attracted to.

In humans, this is thought to result in competitive and creative displays, as well as displays of humour. We certainly see evidence of the success of this tactic: musicians, for example, are stereotyped as never lacking a potential mate. Picasso’s most productive and creative periods usually coincided with the appearance of a new mistress on the scene.

Science says: go for it

The ConversationWhat then does science tell us? Simply put, non-reproductive sex is an activity that can bring biological rewards. It can bring people together, help drive creative endeavours, and contribute to good health.

Fiona Kate Barlow, Senior Research Fellow, The University of Queensland and Brendan Zietsch, Research Fellow, The University of Queensland

This article was originally published on The Conversation. Read the original article.

What is normal vaginal discharge and what’s not?

From a woman’s first periods until menopause, menstrual hormones drive her vaginal discharge.
Annette Shaff/Shutterstock

Melissa Kang, University of Technology Sydney

V-juice, vovey-goo, vu-dew… there are many ways to describe the natural fluid that comes out of the vagina. It varies in consistency, texture, smell, taste and volume in the same woman from day to day, week to week, month to month and beyond.

During puberty, several hormones act together to grow the vagina, uterus, fallopian tubes, ovaries and external genitals. The hormones oestrogen and progesterone contribute most to the evolution of the glorious ecosystem that is the adult vagina.

The adult vagina is a muscular, elastic tube extending from the cervix (lower part of the uterus) to its opening between the urethra (where urine leaves the bladder) and anus.

Natural vaginal discharge is a rich cocktail of components.
Alila Medical Media/Shutterstock

What lies within the vaginal walls has inspired folklore over centuries: penis-devouring teeth, serpents and dragons. This has essentially served to demonise women’s sexuality.

Rather than a menagerie of deadly creatures, the inner lining of the vagina is made up of a type of skin cell which does not contain keratin. Keratin is the tough protein found in external, exposed skin cells (as well as hair and nails) which helps skin form a protective barrier. The vaginal lining is therefore much softer, and is supported by a network of blood vessels which “leak” clear watery fluid into the vaginal space (called a transudate).

The cervix protrudes into the top of the vagina, and is made up of unique cell “zones” which are highly responsive to hormones and produce mucus.

During ovulation, cervical mucus has a thin, runny, egg-white-like consistency that is clear. At other times of the menstrual cycle it tends to be thick and opaque.

Adult vaginas contain a range of active glands – mini-organs that make sweat or oils. They also contain lactobacilli – microorganisms that live in the healthy adult vagina and maintain an acidic pH (4 – 4.5) which protects the vagina from infection.

Natural vaginal discharge is a rich cocktail of these components: transudate, mucus, sweat, oils, lactobacilli, menstrual flow and cells from the vaginal lining.

From a woman’s first periods until menopause, menstrual hormones drive her vaginal discharge. On average, she makes one to four millilitres of vaginal fluid a day. This increases with higher oestrogen levels, such as during pregnancy and ovulation.

Sexual arousal leads to sudden bursts (or trickles) of fluid, due to increased blood flow in the pelvis and thus more vaginal transudate.

The dramatic decrease in oestrogen levels after menopause leads to changes in the vagina’s cell lining, reduction in lactobacilli numbers, and a much drier vagina.

When is vaginal discharge problematic?

For some women, excessive amounts of discharge can cause discomfort. Some women have “cervical ectopy”, which can increase discharge. This is where the zone of mucus-producing cells of the cervix faces outward into the top of the vagina, instead of being within the cervical canal.

Altering the pH of the vagina can lead to the overgrowth of organisms such as candida, a yeast, commonly called thrush. The typical discharge caused by thrush is white, cottage cheese-like and accompanied by an itch and sometimes redness, swelling and pain during urination.

Bacterial vaginosis is another overgrowth condition, of a type of bacteria. BV might not cause noticeable extra discharge but if it does, it is often fishy-smelling and frothy.

Sexually transmitted infections (STIs) are sometimes the cause of vaginal discharge, the most notable being chlamydia, gonorrhoea or trichomonas. All three STIs can be asymptomatic in women (especially chlamydia), but if a discharge is present, it tends to be purulent – meaning pus-producing – in chlamydia and gonorrhoea infections, and yellow, frothy and smelly in trichomonas infections.

Skin conditions of the vulva and vagina can also affect vaginal discharge. Irritation from perfumes, deodorants, soaps and over-cleaning can lead to chronic dermatitis, while douching and spermicides can irritate the vaginal lining or change the delicate ecological balance.

Some women also have allergies to latex (the ingredient in most condoms) or other products that might enter the vagina. In all of these skin-related problems, discharge is not necessarily the main symptom, and itch, pain, redness or swelling might be more prominent.

Tampons accidentally left inside the vagina for days (and sometimes weeks!) often cause a smelly discharge.

If you’re concerned about your vaginal discharge, visit your GP or your local sexual health, women’s health or family planning clinic. The doctor or nurse might enquire about your menstrual and pregnancy history, use of contraception and hormones, sexual history, medical history including skin conditions and use of topical products on the genital skin, the presence of other symptoms, and use of tampons or other objects inserted into the vagina.

The ConversationExamining vaginal discharge under the microscope helps identify or rule out overgrowths and infections, and specific DNA or other tests can accurately pinpoint the common STIs.

Melissa Kang, Associate professor, University of Technology Sydney

This article was originally published on The Conversation. Read the original article.

How we found the gene for a rare heart disease and why it matters

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Bongani Mayosi, University of Cape Town

Heart disease is the world’s number one killer. In sub-Saharan Africa infections like HIV and TB take the lead but heart diseases such as heart muscle disease (or cardiomyopathy) are a close second as a cause of death. After 20 years of research scientists at the University of Cape Town have identified the mutations in a gene called CDH2, or cadherin 2, that’s responsible for an inherited form of heart muscle disease that affects the right side of the heart in a condition known as cardiomyopathy. The Conversation Africa’s Health and Medicine Editor Candice Bailey spoke to Professor Bongani Mayosi about the significance of the discovery.

What is cardiomyopathy and what do we know about it?

Arrhythmogenic right ventricular cardiomyopathy [ARVC]).

Cardiomyopathy is the technical term for a heart muscle disease. It is particularly feared because it can cause sudden death in people younger than 35, especially during athletic activity.

This is a condition in which the heart’s structure and function is abnormal without the usual causes of heart disease such as high blood pressure, coronary artery disease (which causes a heart attack), valvular heart disease, pericardial disease or congenital heart disease.

We have been studying the form of heart muscle disease called arrhythmogenic right ventricular cardiomyopathy or ARVC. In this disease, the muscle of the right side of the heart is lost and replaced by scar or fat. As a result, the heart is prone to beating irregularly and fast, causing sudden death because blood is not being effectively pumped to the rest of the body.

This is a rare condition that affects one in every 5000 people in the general population. People who participate in elite sport are prone to the condition if they are carriers of a genetic mutation. That’s why there’s a need to screen elite athletes for heart disease to prevent the onset of sudden death while exercising.

It’s an inherited disease. Often several generations of a family will suffer from the same condition.

How is it treated?

Treatment depends on the symptoms of the person affected with the condition. If a person has had syncope (fainting) or has been resuscitated from cardiac arrest, then a cardioverter defibrillator (ICD) needs to be implanted. This is a small device the size of a watch that s implanted under the breast muscle and has a wire that is inserted through the vein into the heart. It provides a shock to the heart in the event of an abnormal heart rhythm to prevent sudden death.

Sometimes an individual’s condition is discovered before symptoms develop, for example during family screening after a relative’s sudden death. In these cases the advice is to avoid activities – such as participation in competitive contact sports – that may predispose the affected individual to sudden death. Some individuals develop heart failure, in which case medication for the treatment of heart failure will be prescribed.

So what is the breakthrough and why is it important?

The importance of the discovery is twofold, and has both scientific and clinical impact.

On the one hand it helps to clarify the genetic mechanisms underlying ARVC which will assist with future research to develop drugs which could prevent sudden death. On the other hand it makes possible the early detection of many unsuspecting people who are affected by ARVC. In fact, often the diagnostic clinical signs of the disease become clear only after many years. If a subject with ARVC is a carrier of a mutation on the gene CDH2, we will know if other members of his family are genetically affected in a few days and we could immediately start preventive strategies.

This may lead to a reduction of cases of sudden death in patients with this mutation.

What does it mean for cardiovascular studies?

We have found a completely new mechanism to explain the underlying cause of sudden death. This is a seminal observation in biology and offers a new opportunity for a potential target for drugs. This will lead to new treatments being developed.

The finding is also important because it is proof to aspiring young scientists that discovery science is taking place in South Africa. And it’s important that the research was conducted in the public service – this will dispel the perception that the sector isn’t capable of producing such research and results.

The ConversationWe will now conduct large-scale screening activities to establish how common this gene is as well as work on understanding the gene better.

Bongani Mayosi, Dean and Professor of Medicine at the Faculty of Health Science, University of Cape Town

This article was originally published on The Conversation. Read the original article.

Why men wake up with erections

Many men are not actually aroused when they wake up erect.
from www.shutterstock.com.au

Sergio Diez Alvarez, University of Newcastle

The morning penile erection, or as it is medically known, “nocturnal penile tumescence”, is not only an interesting physiological phenomenon, it can also tell us a lot about a patient’s sexual function.

Morning penile erections affect all males, even males in the womb and male children. It also has a female counterpart in the less frequently discussed nocturnal clitoral erection.

What causes erections?

Penile erections occur in response to complex effects of the nervous system and endocrine system (the glands that secrete hormones into our system) on the blood vessels of the penis.

When sexually aroused, a message starts in the brain, sending chemical messages to the nerves that supply the blood vessels of the penis, allowing blood to flow into the penis. The blood is trapped in the muscles of the penis, which makes the penis expand, resulting in an erection.

Several hormones are involved in influencing the brain’s response, such as testosterone (the main male hormone).

This same mechanism can occur without the involvement of the brain, in an uncontrolled reflex action that is in the spinal cord. This explains why people with spinal cord damage can still get erections and why you can get erections when not sexually aroused.

What about erections while we sleep?

Nocturnal penile erections occur during Rapid Eye Movement (REM) sleep (the phase during which we dream). They occur when certain areas of the brain are activated. This includes areas in the brain responsible for stimulating the parasympathetic nerves (“rest and digest” nerves), suppressing the sympathetic nerves (“flight and fight” nerves) and dampening areas producing serotonin (the mood hormone).

Sleep is made up of several cycles of REM and non-REM (deep) sleep. During REM sleep, there is a shift in the dominant system that’s activated. We move from sympathetic (fight and flight) stimulation to parasympathetic (rest and digest) stimulation. This is not found during other parts of the sleep cycle.

This shift in balance drives the parasympathetic nerve response that results in the erection. This is spontaneous and does not require being awake. Some men may experience nocturnal penile tumescence during non-REM sleep as well, particularly older men. The reason for this is unclear.

The reason men wake up with an erection may be related to the fact we often wake up coming out of REM sleep.

Testosterone, which is at its highest level in the morning, has also been shown to enhance the frequency of nocturnal erections. Interestingly, testosterone has not been found to greatly impact visual erotic stimuli or fantasy-induced erections. These are predominantly driven by the “reward system” of the brain which secretes dopamine.

Men don’t wake up with erections because they’ve been having sexy dreams.
from www.shutterstock.com

Since there are several sleep cycles per night, men can have as many as five erections per night and these can last up to 20 or 30 minutes. But this is very dependent on sleep quality and so they may not occur daily. The number and quality of erections declines gradually with age but they are often present well beyond “retirement age” – attesting to the sexual well-being of older men.

It’s also important to highlight the counterpart phenomenon in women, which is much less researched. Pulses of blood flow in the vagina during REM sleep. The clitoris engorges and vaginal sensitivity increases along with vaginal fluidity.

What’s its purpose?

It has been suggested “pitching a tent” may be a mechanism for alerting men of their full overnight bladder, as it often disappears after emptying the bladder in the morning.

It’s more likely the reason for the morning erection is that the unconscious sensation of the full bladder stimulates nerves that go to the spine and these respond directly by generating an erection (a spinal reflex). This may explain why the erection goes away after emptying one’s bladder.

Scientific studies are undecided as to whether morning erections contribute to penile health. Increased oxygen in the penis at night may be beneficial for the health of the muscle tissues that make up the penis.

What does it mean if you don’t get one?

Loss of nocturnal erection can be a useful marker of common diseases affecting erectile function. One example is in diabetics where the lack of morning erections may be associated with erectile dysfunction due to poor nerve or blood supply to the penis. In this case, there’s a poor response to the messages sent from the brain during sleep which generate nocturnal erections.

It is thought nocturnal erections can be used as a marker of an anatomical ability to get an erection (a sign that the essential body bits are working), as it was thought to be independent of psychological factors that affect erections while awake. Studies have suggested, however, that mental health disorders such as severe depression can affect nocturnal erections. Thus its absence is not necessarily a marker of disease or low testosterone levels.

The frequency of morning erections and erection quality has also been shown to increase slightly in men taking medications for erectile dysfunction such as Viagra.

So is all this morning action good news?

While some men will put their nocturnal erections to good use, many men are not aroused when they have them and tummy sleepers might find them a nuisance.

The ConversationSince good heart health is associated with an ability to have erections, the presence of nocturnal erections is generally accepted to be good news. Maintaining a healthy lifestyle is important in avoiding and even reversing erectile dysfunction, so it’s important to remember to eat healthily, maintain a healthy weight, exercise and avoid smoking and alcohol.

Sergio Diez Alvarez, Director Of Medicine, The Maitland and Kurri Kurri Hospital, University of Newcastle

This article was originally published on The Conversation. Read the original article.

Five ways virtual reality is improving healthcare

chombosan/Shutterstock

Wendy Powell, University of Portsmouth

Virtual reality is much more than just a new form of entertainment, it is increasingly being used in a wide range of medical applications, from treatments to training. Here are a few of them.

1. Pain management

There is good scientific evidence that virtual reality (VR) can help relieve pain. The parts of the brain that are linked to pain – the somatosensory cortex and the insula – are less active when a patient is immersed in virtual reality. In some instances, it can even help people tolerate medical procedures that are usually very painful.

Other studies have shown that amputees can benefit from VR therapy. Amputees often feel severe pain in their missing limb, which can be hard to treat with conventional methods, and often doesn’t respond well to strong painkillers like codeine and morphine. However, a technique called “virtual mirror therapy”, which involves putting on a VR headset and controlling a virtual version of the absent limb seems to help some patients cope better with this “phantom pain”.

2. Physical therapy

VR can be used to track body movements, allowing patients to use the movements of their therapy exercises as interactions in a VR game. For example, they may need to lift an arm above their head in order to catch a virtual ball.

It’s more fun doing exercises in virtual reality than it is in a gym, so people are more motivated to exercise. It can help in other ways too. For example, we found that for patients who are anxious about walking, we can control their virtual environment so that it looks as though they are moving much slower than they actually are. When we do this, they naturally speed up their walking, but they don’t realise they are doing it and so it isn’t associated with pain or anxiety.

Studying how people perceive and interact with VR systems helps us design better rehabilitation applications.

Virtual reality can be used in physical therapy.
Wendy Powell, Author provided

3. Fears and phobias

If you have an irrational fear of something, you might think the last thing you need is to see it in virtual reality, however, this is one of most established forms of medical VR treatment. Phobias are often treated with something called graded-exposure therapy, where patients are slowly introduced to their fear by a therapist. Virtual reality is perfect for this as it can be adjusted precisely for the needs of each patient, and can be done in the doctor’s office or even at home. This is being used to treat phobias such as fear of heights and fear of spiders, but also to help people recover from post-traumatic stress disorder (PTSD).

4. Cognitive rehabilitation

Patients with brain injury from trauma or illness, such as stroke, often struggle with the everyday tasks that we take for granted, such as shopping or making plans for the weekend. Recreating these tasks within virtual environments and allowing patients to practise them at increasing levels of complexity can speed up recovery and help patients regain a higher level of cognitive function.

Doctors can also use these same virtual environments as an assessment tool, observing patients carrying out a variety of real-world complex tasks and identifying areas of memory loss, reduced attention or difficulty with decision-making.

In the future your doctor may prescribe one of these.
Anton Gvozdikov/Shutterstock

5. Training doctors and nurses

Virtual reality is, of course, not just for patients. It also offers benefits to healthcare professionals. Training doctors and nurses to carry out routine procedures is time consuming, and training generally needs to be delivered by a busy – and expensive – professional. But virtual reality is increasingly being used to learn anatomy, practise operations and teach infection control.

The ConversationBeing immersed in a realistic simulation of a procedure and practising the steps and techniques is far better training than watching a video, or even standing in a crowded room watching an expert. With low-cost VR equipment, controllable, repeatable scenarios and instant feedback, we have a powerful new teaching tool that reaches well beyond the classroom.

Wendy Powell, Reader in Virtual Reality, University of Portsmouth

This article was originally published on The Conversation. Read the original article.

Study confirms ‘flushing’ blocked fallopian tubes can improve fertility and reduce need for IVF

Our results are an important gain for couples facing the diagnosis of infertility.
from shutterstock.com

Ben Mol, University of Adelaide

A technique that effectively “unblocks” a woman’s fallopian tubes by flushing them with liquid to help her conceive has been used for decades, with varying levels of success. Now a study has confirmed that the method significantly improves fertility, and that a certain type of fluid – one that is oil-based rather than water-based – shows strong results.

Published in The New England Journal of Medicine, our H2Oil study involved 1,119 women in 27 medical centres in The Netherlands. All women were younger than 38 and had been trying to conceive for 18 months on average.

The women were randomly allocated to receive either an oil- or water-based substance. Of those whose tubes were flushed with the oil-based substance, 40% achieved successful pregnancies within six months, compared to 29% among women receiving the water-based substance. This is a significant statistical difference.

Our results are an important gain for couples facing the diagnosis of infertility. For those without a clear cause for their infertility, it represents a potential alternative when they would otherwise have had no other course of action than to pursue invasive IVF treatment.

IVF not first port of call

When a couple embark on the journey to parenthood, eight or nine out of ten conceive without difficulty. But about 15% of couples find themselves fulfilling the medical definition of “infertility” – being unable to conceive within 12 months of unprotected intercourse.

For such couples, a breakthrough occurred in 1978, when biologist Bob Edwards and gynaecologist Patrick Steptoe assisted in the birth of Louise Brown – the first “test tube baby”, born through the assistance of in vitro fertilisation (IVF).

IVF involves fertilising the egg with the sperm in the laboratory, then reintroducing the early embryo to the uterus. The technique has since helped more than 5 million babies to be born. In 2010, Edwards received the Nobel prize for its development.

But management of infertility does not mean instant recourse to IVF. It first requires a careful medical investigation of the infertile couple. Investigations aim to ensure ovulation (release of the egg, or oocyte) has occurred, and that spermatozoa (sperm) are normally formed, capable of motion and sufficient in number.

Tubal patency

Fertilisation occurs inside a woman’s fallopian tube. So, the doctor will check whether her fallopian tubes are open. This means there are no obstructions to the meeting of the egg and the sperm. This is called “tubal patency” and is often confirmed with imaging techniques that allow the fallopian tubes to be visualised.

The technique commonly used to visualise fallopian tubes is called a hysterosalpingogram, also referred to as an HSG. It involves the gynaecologist passing a tube through the cervix (the narrow passage between the uterus and vagina) into the uterus.

A hysterosalpingogram is a technique used to visualise fallopian tubes to see if there are any obstructions to fertilisation.
from shutterstock.com

A substance that enhances the contrast of fluids and other body structures is then passed through the tube into the uterus, until it reaches the fallopian tubes. Where there is tubal patency, this substance flows freely though the tubes into the abdominal cavity, which can be visualised with X-ray.

The HSG procedure allows about 5% of infertile couples to be diagnosed with blocked tubes, which indicates that the egg and sperm can never meet. In the past, this has meant surgery to unblock the tubes. These days, couples can be referred to IVF.

Although HSG is used to check whether tubes are blocked, many women have actually conceived in the first three to six months after undergoing the procedures. This indicates that the so-called “flushing of the tubes” during the HSG process itself has a beneficial effect on fertility.

An oil-based solution

A review of studies exploring fertility success after HSG in 2015 suggested that flushing the tubes with a contrast substance that can be dissolved in oil is better in improving fertility than using a water-soluble one.

Tubal flushing has several advantages over IVF, including that the benefit persists over time, while IVF only helps for the current cycle. Tubal flushing also helps achieve an otherwise natural conception, and its costs are around A$600, a fraction of the cost of a A$10,000 IVF cycle. IVF also has a heavy impact on emotional wellbeing and sometimes causes medical complications.

In our study, 40% of women undergoing HSG with an oil-based contrast achieved a successful pregnancy within six months. That’s 40% of couples with unexplained infertility who could avoid the huge financial and emotional costs associated with undergoing IVF treatment. The only known risk of the procedure is leakage of contrast into blood circulation, but we did not see that in our study.

How does it work?

The reality is, we still don’t fully understand why HSG works. But there is clear benefit from this technique, particularly for women who don’t present with any other treatable fertility symptoms.

Further research would need to be conducted – not only into the underlying mechanism, but whether the same benefits are seen in women undergoing assessment of their tubes with flushing by saline at ultrasound, or at a surgical inspection of the abdomen (laparoscopy).

The technique of tubal flushing has been used for 100 years. We believe it is a viable investigation and treatment for infertility before couples seek IVF.

The ConversationThe results of the study were presented at the 13th World Congress on Endometriosis in Vancouver, Canada, on Thursday, May 18, 2017.

Ben Mol, Professor, University of Adelaide

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Increasing caesarean sections in Africa could save more mothers’ lives

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Salome Maswime, University of the Witwatersrand and Gwinyai Masukume, University of the Witwatersrand

Caesarean sections have been lifesaving procedures for hundreds of thousands of women across the world who experience complications during labour.

Globally, it’s estimated that just under 20% of births take place via caesarean section – a percentage that’s gone up over the last three decades. This has raised concerns, particularly in high-income countries where generally too many caesarean sections are performed.

But in many African countries women who are medically required to have caesarean sections are not able to access them. This is due to several reasons, the most prominent being weak health systems and a lack of resources.

This needs to be fixed as women in sub-Saharan African suffer from the highest maternal mortality ratio in the world. Close to 550 women die for every 100 000 children that are born. This amounts to 200 000 maternal deaths a year – or two thirds of all maternal deaths per year worldwide.

Some of these deaths could be prevented if skilled health personnel were able to perform caesarean sections safely. But this would require proper equipment and supplies including drugs and blood transfusions.

Research shows that low-income countries with the lowest caesarean section rates also have the highest maternal mortality rates.

Improving the access and availability of caesarean sections on the continent is therefore pivotal to reducing the number of maternal deaths and to achieve the sustainable development goal on maternal health of reducing maternal deaths to less than 70 per 100 000 live births by 2030.

Africa’s challenge

Between 1990 and 2015 maternal mortality dropped by about 44% across the world. And several countries in Africa have halved their levels of maternal mortality between 1990 and 2015. In Mali, for example, 1010 women died for every 100 000 children born in 1990. By 2015, this figure dropped to 587.

Despite this massive reduction, more than 800 women continue to die from preventable causes around childbirth every day, most in sub-Saharan Africa and South Asia. And millions more will suffer serious injuries, infections, complications or disabilities due to insufficient treatment.

The World Health Organisation has found that in countries where at least 10% of women have caesarean sections the number of maternal and newborn deaths decrease.

The organisation has not identified an ideal caesarean section rate, however there’s evidence that rates above 20% at country level might be to too high. But it encourages governments to make every effort to provide the procedure to women in need of it.

Africa has the lowest caesarean section rate in the world. In Europe about a quarter of births are conducted via caesarean section while Latin America and the Caribbean have caesarean section rates of about 40.5%.

In Africa only 7.3% of babies are born via this method. But it’s a very mixed picture across the continent. Some countries have very high rates such as Egypt (51.8%) and Mauritius (47%), the highest in Africa. And despite a 4.5% overall increase across the continent from 1990, there’s been a decline in some countries like Nigeria and Guinea which now stands at about 2%. Zimbabwe has maintained its caesarean section rates at 6%.

Caesarean section rate in selected African countries.
Provided

When caesars matter

Caesarean sections often happen at the end of a series of complex events. There can be both pre-existing and pregnancy related complications. The need for caesarean sections can be aggravated by a range of issues such as delays in accessing the appropriate level of care, transportation delays as well as a shortage of necessary technologies.

Complications require prompt access to quality obstetric services equipped with life-saving drugs, including antibiotics, and the ability to provide blood transfusions or other surgical interventions.

But there are several barriers to improving the caesarean section rates in a country. These include:

  • a shortage of midwives, obstetricians, anaesthetists, laboratory and other allied personnel,
  • limited access to health care, information and
  • a lack of equipment.

Cost is another significant barrier. It was estimated, almost a decade ago, that it would cost US$430 million to perform the almost 3 million additional caesarean sections needed.

Different playing fields

While reducing unnecessary caesarean sections may be a priority in high-income countries, access to it will save more lives, particularly in countries where deliveries in a health care facility are considered a luxury.

Many African countries are trying to increase the number of women delivering in a health care facility by a skilled birth attendant. In Africa, more than 40% of births are not attended by a skilled health provider.

The ConversationInequities in access to caesarean sections across different parts of sub-Saharan Africa and other low-income countries need to be addressed. And soon if the continent wants to reduce its unacceptably high maternal mortality rates.

Salome Maswime, Lecturer in Obstetrics and Gynaecology, University of the Witwatersrand and Gwinyai Masukume, Medical Doctor, Epidemiologist and Biostatistician: University College Cork, University of the Witwatersrand

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Perspectives on antibiotic resistance: how we got here, where we’re headed

Jessie Schanzle, The Conversation

On May 26, researchers at Walter Reed National Military Medical Centers reported that they had detected bacteria with a gene that makes it resistant to colistin, the antibiotic of last resort. The news has health officials and scientists deeply concerned because this is the first time that the gene, called MCR-1, has been identified in the United States.

The gene was found in a strain of E. coli, from the urine of a Pennsylvania woman who was treated for a urinary tract infection in late April. Fortunately, in this case, the woman’s infection was treatable with antibiotics. What worries officials, however, is that MCR-1 is mobile. It can be passed on to other bacteria.

The fear, in other words, is that the gene could wind up in a bacterium that is resistant to the other antibiotics in our arsenal, raising the spectre of a “superbug” that no antibiotic can treat.

Antibiotic resistance isn’t a new problem, nor is it one that will be going away any time soon. According to the Centers for Disease Control and Prevention, two million people are infected with antibiotic-resistant bacteria in the United States each year, and 23,000 people die as a result of these infections.

We know that overuse and misuse of antibiotics can drive resistance. So what drives that overuse? Finding and developing new antibiotics is critical, but are there other ways that we can control or halt the spread of infections or kill pathogenic bacteria?

Scientists are searching for answers. Here are highlights from The Conversation US’ coverage of this issue.

Why are antibiotics overused?

While antibiotics are great at fighting bacterial infections, they aren’t effective against infections caused by viruses, like the common cold. But many patients still ask for antibiotics, even if they have illnesses that antibiotics can’t treat.

Research from George Washington University showed that three-quarters of the patients surveyed in an inner city Baltimore emergency room said “they would take antibiotics ‘just in case’ or because ‘it can’t hurt.’”

More competition between doctors for patients can also drive antibiotic prescribing and certain medical professions play a bigger role than others.

Dermatologists, for example, prescribe five percent of antibiotics, but make up only one percent of all physicians. And their patients may wind up taking antibiotics for longer than national guidelines recommend, and at higher doses than necessary. As Adam Friedman, a professor of dermatology, explains:

Antibiotics may be prescribed at higher doses than what is really needed to treat acne. While antibiotics can kill the bacteria associated with acne, it’s their anti-inflammatory effects, not their antimicrobial effects, that yield the biggest skin-clearing benefits. The result is that the bacteria associated with acne are becoming resistant to common antibiotics – and this overuse also contributes to more harmful bacteria, like Staphlycoccus aureus and Streptococcus becoming resistant.

What we are learning about resistant bacteria

The conventional wisdom used to be that resistant bacteria were also less fit. But an international team of researchers recently discovered that resistance can actually make some bacteria fitter and more virulent. While this may not be true with every kind of bacteria, it’s a sobering thought.

Bacteria are found pretty much anywhere. Not only do they live all over your skin and throughout your body, they also cover just about every surface you encounter. Erica Hartmann at the University of Oregon, who studies microbes in indoor environments, asks if antimicrobial chemicals – from hand soaps to cleaning supplies – are increasing the spread of antibiotic resistance. Her research, which is still ongoing, involves vacuuming up dust samples in public spaces from under sinks, behind toilets and along walls and cubicles.

In fact, the majority of bacteria love to join together in so-called biofilm communities. It’s these biofilms that cause the majority of infections in hospital settings. For reasons scientists don’t completely understand, the biofilm lifestyle renders bacteria much less susceptible to disinfectants and antibiotics of all kinds.

Karin Sauer of Binghamton University describes how she and other researchers are working on unraveling the ways bacteria living in biofilms communicate and coordinate – in order to use their own systems against them.

There has to be some good news, right?

As resistance to our antibiotic arsenal grows, scientists are looking for new ways to fight back.

What if, for instance, we had a way to target only pathogenic – “bad” – bacteria, while leaving the beneficial or harmless ones alone? And what if we could make sure that the bad bacteria couldn’t easily develop resistance to this targeting?

CRISPR gene editing techniques could allow us to use bacteria’s own immune systems against them by chopping up targeted genes, which would lead to death.

Another promising option harnesses the naturally antimicrobial properties of silver.

Meanwhile researchers at the University of Colorado at Boulder are finding ways to use nanoparticles, a million times smaller than a millimeter, to target drug-resistant bacteria without harming healthy tissue in the body.

CDC Director Tom Friden speak at the National Press Club on May 26.

Looking at the world before antibiotics

We need new antibiotics, but combating resistance will take more than that.

As Tom Frieden, the director of the Centers for Disease Control and Prevention, said in a press conference on May 26 after the MCR-1 discovery:

We can make new ones, but without better stewardship and identification of outbreaks, we’ll lose these miracle drugs. The medicine cabinet is empty for some patients. It is the end of the road for antibiotics unless we act urgently.

So what would a post-antibiotic world look like? Let’s look at it another way. Before antibiotics existed, how did we treat infections?

As Christie Columbus from Texas A&M Health Science Center explains, bloodletting, mercury and plant based-treatments were used – with varying degrees of success. She cautions that:

The ConversationAlternative therapies have been used to treat infections since antiquity, but none are as reliably safe and effective as modern antimicrobial therapy. Unfortunately, due to increasing resistance and lack of development of new agents, the possibility of a return to the pre-antimicrobial era may become a reality.

Jessie Schanzle, Desk Editor, Health and Medicine, The Conversation

This article was originally published on The Conversation. Read the original article.