TOPLINE:

Moderate to vigorous aerobic physical activity performed in the evening is associated with the lowest risk for mortality, cardiovascular disease (CVD), and microvascular disease (MVD) in adults with obesity, including those with type 2 diabetes (T2D).

METHODOLOGY:

• Bouts of moderate to vigorous aerobic physical activity are widely recognized to improve cardiometabolic risk factors, but whether morning, afternoon, or evening timing may lead to greater improvements is unclear.
• Researchers analyzed UK Biobank data of 29,836 participants with obesity (body mass index, › 30; mean age, 62.2 years; 53.2% women), including 2995 also diagnosed with T2D, all enrolled in 2006-2010.
• Aerobic activity was defined as bouts lasting ≥ 3 minutes, and the intensity of activity was classified as light, moderate, or vigorous using accelerometer data collected from participants.
• Participants were stratified into the morning (6 AM to < 12 PM), afternoon (12 PM to < 6 PM), and evening (6 PM to < 12 AM) groups based on when > 50% of their total moderate to vigorous activity occurred, and those with no aerobic bouts were considered the reference group.
• The association between the timing of aerobic physical activity and risk for all-cause mortality, CVD (defined as circulatory, such as hypertension), and MVD (neuropathy, nephropathy, or retinopathy) was evaluated over a median follow-up of 7.9 years.

TAKEAWAY:

• Mortality risk was lowest in the evening moderate to vigorous physical activity group (hazard ratio [HR], 0.39; 95% CI, 0.27-0.55) and even lower in the T2D subgroup (HR, 0.24; 95% CI, 0.08-0.76) than in the reference group.
• Mortality risk was lower in the afternoon (HR, 0.60; 95% CI, 0.51-0.71) and morning (HR, 0.67; 95% CI, 0.56-0.79) activity groups than in the reference group, but this association was weaker than that observed in the evening activity group.
• The evening moderate to vigorous activity group had a lower risk for CVD (HR, 0.64; 95% CI, 0.54-0.75) and MVD (HR, 0.76; 95% CI, 0.63-0.92) than the reference group.
• Among participants with obesity and T2D, moderate to vigorous physical activity in the evening was associated with a lower risk for mortality, CVD, and MVD.

IN PRACTICE:

The authors wrote, “The results of this study emphasize that beyond the total volume of MVPA [moderate to vigorous physical activity], its timing, particularly in the evening, was consistently associated with the lowest risk of mortality relative to other timing windows.”

SOURCE:

The study, led by Angelo Sabag, PhD, Charles Perkins Centre, The University of Sydney, Sydney, was published online in Diabetes Care.

LIMITATIONS:

Because this was an observational study, the possibility of reverse causation from prodromal disease and unaccounted confounding factors could not have been ruled out. There was a lag of a median of 5.5 years between the UK Biobank baseline, when covariate measurements were taken, and the accelerometry study. Moreover, the response rate of the UK Biobank was low.

DISCLOSURES:

The study was funded by an Australian National Health and Medical Research Council Investigator Grant and the National Heart Foundation of Australia Postdoctoral Fellowship. The authors reported no conflicts of interest.

Source: medscape.com

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You can’t treat something until you know it’s there. Currently, there’s no cure for Alzheimer’s disease (AD) but earlier diagnosis may lead to better understanding of how the disease inexorably progresses, which in turn may lead to prevention of AD and ultimately eradication of this horrific scourge. The latest breakthroughs in earlier diagnosis and even perhaps pre-diagnosis have involved lumbar punctures, brain MRIs, eye exams, and blood tests.

A 2024 study, performed across multiple medical centers in China and involving more than 1,300 volunteers, suggests tests which foretell AD may soon be a reality. The doctors involved in the inquiry performed serial spinal taps (a procedure during which a needle is introduced into the lower back and cerebrospinal fluid (CSF), the watery substance that bathes the spine and brain, is sampled). They repeated the spinal tap every few years for an entire score of years (between 2000 and 2020).

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In September 2023, President Biden announced health care provider training, allocating over $8 million through 18 awards to train primary care medical students, physician assistant students, and medical residents in providing culturally and linguistically appropriate care for individuals with limited English proficiency, as well as those with physical or intellectual and developmental disabilities.

Individuals with severe and profound autism deserve special consideration when it comes to accommodating their health care needs, as they face unique challenges.

Adults with autism have an increased risk of premature mortality compared to the general population, with a mean age of mortality at 54 years compared to 70 years. This risk is even more pronounced for those with lower functioning abilities, where the mean age of mortality drops to 40 years. Limited research on health care barriers suggests that health services, funding, and physician training are not yet adequately meeting the needs of this population.

These individuals may struggle to communicate their pain or discomfort and may resist cooperating with medical procedures. Moreover, they may lack an understanding of nonverbal cues and find unfamiliar environments and procedures extremely frightening. It often requires years of desensitization programming and behavior modification for individuals with severe autism to become comfortable with medical tests and procedures. Some may even display aggressive or self-injurious behaviors when faced with medical procedures, necessitating collaboration and brainstorming among health care professionals and other caregivers. This is a complex issue.

The Biden administration believes that a mere $8 million can help individuals with intellectual and developmental disabilities access health care. However, addressing the challenges faced by this population is not as straightforward as such a small funding amount might suggest. Furthermore, by grouping this effort together with assisting individuals with limited English proficiency, the administration may overlook the distinctive nature of the challenges posed by severe/profound autism.

According to the National Council on Severe Autism, autism policy has shifted away from addressing the needs of children and adults severely disabled by autism, instead focusing on solutions more suitable for those with milder disabilities who can self-advocate. If this provider training initiative is intended to address the needs of individuals with severe/profound autism, the Biden administration risks trivializing the challenges faced by these families.

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My Health Records. The name suggests that they are the record of the person about whom the records are being made. You. Me. But, is this really the case?

If the records were truly ‘yours’ or ‘mine’, then why are they compulsory with a huge rigmarole to go through to get out of them known as ‘opt out’?

We operate under the premise of freedom of choice in this country. However, it has been reported that once a record has been created, even if you opt out, the data will still be kept. To have a system where it is opt-out and a record is automatically created for all people and from which data cannot be deleted even if a person opts out of the system is a matter that fundamentally violates freedom of choice and autonomy.

Why keep data if the records are voluntary and the ownership of the patient?

What are the hidden agendas here?

There certainly are benefits to the notion of a shared health record. Patient convenience, results easily available for all carers who access the record. But we need to question, what data is being stored, and why, and what data is being and will be accessed, and by whom?

In an ideal world we would understand that nobody would use the data in these records and in an ideal world we would simply consider that these records are a convenient way of having all of the information in the one place. But the reality is, that is simply not the case.

We need to question why so many big companies are getting involved in the electronic data industry.

Apple, Google and Telstra have all invested heavily in developing e-health records and/or apps so that people can access their records. Lets be honest and speak frankly here. These companies do nothing for humanitarian reasons. It’s all about profit.

• What are they, or their affiliates going to do with YOUR health data?
• Who are they selling it to, and for what?
• And, are you going to get any of the profit from the on-selling of YOUR data?

Traditionally medical records are there so that doctors can understand what is happening in a patient’s condition to help them to see the full picture. The My Health Record has a condition that patients can log in and adjust the data that is stored in their health record. This has the potential for inaccurate and incomplete data to be stored in the health record. How will that help health care professionals better take care of their patients? Inaccurate information is not only not useful, it can be dangerous.

Additionally, anyone in an institution can log in to access the e-health record, and you will not know who it was or, what they did with that information.

At present, health records are the property of the hospitals and the relevant medical practice/clinician.

Granted such a position is not trouble free, but we need to be open and honest about the My Health Record and the problems it proposes, and the real agenda(s) behind it.

I was told directly by a CEO of a major private health insurer that the reason they want the My Health Record is not for patient convenience, but because they want access to all of the aggregate data, so that they can design algorithms for the population.

I was earlier openly told by a person developing the e-health records that the reason that companies like Telstra are getting involved is so they can get access to clinical and genomic data. An area that is fraught with concern as outlined by Elizabeth Sigston.

This is about money, and big companies, not about the ease of individual health care and we need to be clear about that.

The terms and conditions of the My Health Record state that the data can be used for research and public health purposes. That means that every consultation with a doctor is part of research. Usually, when people involve themselves in research, it is a matter of very specific consent. How many people know that when they have a My Health Record that their life will be one big investigation, the results of which they will not know the answers to and for whom the profits will be going to large companies?

Furthermore, the matter of consent on so many levels aside, the reality is, that no data is actually anonymous. Data breaches occur often, and the records are not safe from being breached, and thus patient identities and health histories being discovered. This is potentially diabolical.

Additionally, what is concerning, is WHO exactly can access YOUR files?

The government states that it is passing legislation that only a court order can allow government agencies and police to access health care records, but that is a law that is a law now.

Laws can change with a change in government or public opinion and once your data is stored, it is there for anyone to use and access as defined and made available by political positions in the future.

This is deeply concerning.

I support great health records. However, as yet, I have seen no provisions and not a solid foundation about actual patient care that supports the use and widespread use of My Health Record.

It is very clear to me from the discussions and the debates, that the My Health Record, is not actually truly about our, mine or your records: it is about the vested interests of agencies and bodies that are bigger than us as individuals. Our information and our lives are to be pawns in a bigger play. And the consequences of that will affect all of us. And that just ain’t cricket. I plan to opt out.

https://drmaxine.com.au/

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When in our lives, and particularly in medicine, do we get taught to appreciate ourselves, or learn that it is an important thing to do?

Let me answer that for you: Never!!

In medical school we learn that we need to get the marks and learn things; we learn that there are consequences if we get things ‘wrong’. We learn to tip toe around certain individuals, please people, say the right things, bury the natural feelings and needs of our own bodies to do ward rounds standing for hours on end, stand in theatre for hours on end, with no toilet breaks or opportunities for hydration, to take phone calls at times that don’t suit us, to not get breaks to feed ourselves, to be at the mercy of the opinions of the senior doctors that we work with, we take criticism and at times harassment from other health care staff and administration, but, never at any stage do we learn to appreciate ourselves.

We are always criticising ourselves, seeing where we could have done better, looking for room for improvement. We wait for other to criticise us and we accept this as ‘normal’. We have the constant critical gaze on ourselves, measuring ourselves to an impossible imaginary standard of ‘doctordom’.

Never at any stage do we learn to stop and appreciate ourselves, who we are and what we bring with such attention to microscopic detail as the critical lens offers us!

What if we were to pay attention to our day in all of the microscopic detail and look for things to appreciate rather than criticise? Could this affect our well-being?

We know that a hallmark of burnout is self criticism, feeling that you are not doing a good job, that nothing is good enough and nothing makes a difference. This is the end result of a lifelong pattern of thinking where we are trained to criticise ourselves.

Burnout is associated with higher rates of cardiovascular disease and it is known that stressful emotions result in more erratic heart rhythm patterns, which affects the heart and other parts of the body. Our emotions affect our health and well-being: stressful emotions such as anger, frustration and insecurity affect both our mental and emotional health. Constant criticism and fault finding based on comparison leads to secondary feelings of emotional tension, which creates other health issues.

What if we were to turn that around and appreciate ourselves?

Feelings of appreciation result in better health and well-being. I have found that for myself, and also, science has observed it too.

Why are we spending time in self criticism instead of self appreciation?

Why do we not appreciate:

The difference that we make.

The difference that our smile and laugh makes.

The difference that our care makes.

The difference that the way we are affects the ward staff and their health and well-being.

The difference the drug we just prescribed made to that patient’s life that they wouldn’t have had had we not chosen to go to medical school and learn about health care.

The fact that the procedure that we just performed made a real difference in the life of that person and their family.

The difference that our personality brings to the hospital or the practice that we work at.

The fact that we took the time to check the blood results and call a patient about their result.

The fact that we care.

The way that we tidied the desk made the whole room feel great.

The fact that we got up and got dressed today, perhaps even choosing the colour that we wanted to wear – and gee, it makes the light in our eyes shine!

The fact that we can breathe. Literally.

How loving and caring we are at home.

The fact that we chose to exercise and how good it made us feel.

The healthy food choice we made that kept us sustained for the whole day and how that made everyone feel because we felt great.

The way we did our hair and or make up in the morning and how it still looks great halfway through the day.

The twinkle in our eyes.

And the list could go on and be endless!!

Who we are makes a big difference in what we do: what we do is incredible and needs to be appreciated, but who we are also needs appreciating.

Self appreciation opens the heart and allows us to appreciate others too, which instead of complaining about others and finding them ‘hard to deal with’ leads to us seeing the things in them that we really appreciate.

And this leads to a more loving and fulfilling practice of medicine and life in general.

So go ahead, this week, make your healthy lifestyle tip self-appreciation, and see how many moments you can find appreciation in.

Let me know  – did it make a difference for you?

https://drmaxine.com.au/

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Working abroad has many advantages that are not so obvious at first sight. Of the many benefits appreciated by doctors with foreign experience, we decided to highlight the 5 most interesting which, in our opinion, greatly contribute to doctors who decide to return home from another European country.

If you are interested in what the process of employment and going to another country looks like, our colleague Zrinka described the same process in detail in an interview for National Medical Newspapers.

1. 1. Acquiring new skills and experience

Work experience in the profession plays the biggest role whether you are applying for a new job or looking for a salary increase at your current place. But the experience in a hospital that has a higher flow of patients, more modern equipment or is internationally known for its approach to certain branches of medicine also brings remarkable weight to your work. With the acquisition of new skills and work on procedures available in more developed hospitals, your CV will stand out much better in the eyes of employers, and it is also worth pointing out that you can further improve your foreign language or master a new one by going abroad.

2. 2. Expanding horizons

Staying in a foreign culture will bring you closer to some things you haven’t even thought about until now. Whether it’s a more practical approach to patients, whether you’ve found enjoying yourself in atypical outdoor activities, or simply enjoying a foreign kitchen, exposure to new experiences will always broaden your horizons and bring a lot of positives.

3. 3. Possibility of temporary work in the future

Employers in some of the countries we work with also offer temporary work opportunities. Once you have acquired a license and have work experience in a foreign country, the door opens for you to return to it for a few months to earn extra money or simply change the environment for a while.

4. 4. Possibility of working in telemedicine (for certain specializations)

Just as the acquired license opens the door to temporary positions, for certain specializations there is also the possibility of working in telemedicine. So through a few extra hours that you will work from the comfort of your own home, you can earn nice pocket money for the work you put in.

5. 5. Higher earnings and achieving a proportional share of your future pension

One of the reasons why doctors decide to leave their home country is much better compensation in the rest of the EU. However, in addition to higher monthly earnings, working abroad also allows for a proportional pension once you execute your rights for it, which will certainly make your life easier in the future.

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Every night when you wake up this week, it will be dark, and a brief wash of panic will tumble over you as your mind tries to rapidly sort out just how late you are to wherever it is you should be speeding towards on a Sunday at 9 PM.

This is how most of my night shifts start. A black morning that my muddled resident brain spins its wheels through like a car stuck in mud with no traction.

Most people don’t like working at night; it’s not a circadian rhythm bodies embrace with ease. Being in emergency medicine means that inevitably, some of the shifts you work will be overnight, at least while you’re a resident. You learn the contortionist act of switching nights to days. Like walking on the ceiling, everything is neatly flipped, and you are the perfect opposite of the waking world.

As emergency medicine residents, our night escapades are not restricted to the emergency department. I’ll spend several months up in the ICU, a three-pronged compilation of units on the third floor of the hospital. Each month, I will work a week of nights — both thrilling and terrifying. Around 8 or 9 PM most nights, whenever someone remembers, all lights but the bare necessities get flipped off. Delirium runs rampant here: between the infections, the alarms, and around-the-clock wakeups for lab draws, vital checks, and medications to sedate for the pain, for the unnatural presence of a breathing tube down the throat, delirium is the default.

The darkened hallways are a reminder of the cyclical nature of a day. The evening becomes a witching hour, like it’s the light that has been driving us all this time. The nurses and respiratory therapists pull out books snatched from their bedside tables, reading in the moments between being needed.

At 3 AM, the nurses bathe a young woman with eyes yellow as a black cat’s. Since communication is scarce, the whiteboards in every room list patient preference: favorite music, favorite TV shows, preferred name or nickname. The woman has “country music” written on hers, next to cards pinned up on a corkboard from her boyfriend.

A knife’s width of light escapes from the closed door. You can hear Miranda Lambert coming from a phone turned up loud while they tag-team her bath time, wiping along the curve of her spine and turning her, ad-libbing lyrics they don’t know. It feels like a sad parody of a late-night sleepover, where gossip opens its wide mouth and hopes and dreams are tried on like the latest fruit-scented, glitter-bodied Smackstick.

I worked in the pediatric ED the weekend of Halloween. The day before I flipped to nights, I couldn’t sleep, so I read up on 12-foot skeletons from The Home Depot being in short supply and the environmental pitfalls of artificial cobwebs, and took a walk through my neighborhood counting RIP tombstones and pumpkins at varying stages of decay, a halo of flies surrounding the oldest.

I’ve always thought an abandoned hospital, or even the emptied basement of a very unabandoned one, would be the best place for a haunted house. What is it about discarded hospital detritus that makes our skin crawl? In the end, it’s the folding walker, old commode, wheelchair with a worn seat cushion like a tangled stomach in the middle that makes us cry out. Maybe it was never the past that haunted us.

On Halloween night, I was in the pediatric department. I met the homicide detective walking in for my shift. A 13-year-old has been shot; the police mingle outside the trauma room bay. They haven’t found a family yet. A privacy screen with blue balloons and yellow elephants is drawn around his bed. Like any unexpected death, it will go to the medical examiner, so everything must be left untouched. I imagine the chest tube in place: They tried to drain the blood crowding his heart where it lay tucked and emptied in the cavity of his chest, a motor running on empty. I walked back to the physician’s room and find the other resident at her computer, where she’s curled in her seat with one knee to the chest, her eyes scanning the screen in the mechanical way they do when they aren’t reading but searching.

Nights are fickle beasts; the holes in the healthcare system loom even larger when everything waits until morning. Our infrastructure stretches thinner while the world breaks its own seams, and you can’t look away any more than you can send someone out into the cold or find a homeless shelter that isn’t over capacity. Nights are about figuring it out on your own or praying for the sun to rise.

Savor the feeling of leaving the building in the early morning, the first shift of workers just coming in, lunchboxes drooping from their grasp. It’s another kind of survival, to walk into the crisp morning air, to find the sun hanging low in the sky like a humble savior.

https://www.medscape.com/

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As doctors and as medical students we hear a lot about this thing called ‘work life balance’. We know that we need it, we are told that we need it but we are not really told what it is, why we need it and how to get it.

By the very notion that it is called ‘work life balance’ we learn that ‘work’ is a harmful thing to be minimised and that ‘life’ is something completely different, something that we are missing out on when we are ‘working’. This actually only compounds the stress that we are feeling when ‘work’ is ‘taking up’ our time!

It’s definitely unhealthy for us to be working all the time, to the extent that we neglect other areas of our health, physical well-being, neglecting exercise, neglecting good nutrition, neglecting our relationships, our emotional health and well-being and neglecting the need that we have for sleep or rest, or even perhaps other aspects of expression that we feel are vital for our health and well-being.

But work itself is not an issue. HOW we work can be an issue.

We are told that work life balance is taking days off, taking holidays, making sure that we have hobbies etc and we might think that it is having time to go out to restaurants for dinner. These things are fantastic and fun, but on reflection, are these things truly what create consistent day to day great health and well-being for us?

We know and we are told that we need ‘work life balance’ to stop us from burning out or from getting sick. It is important for our health and well-being.

If work life balance is about us being consistently truly healthy and well then in addition to caring for ourselves in other areas of our lives, we also need to consider ‘work’ also as being part of life. ‘Work’ is such an important and big part of our lives.  It occupies more hours of the day than anything else! If we place our emphasis on making ‘life’ good to make up for ‘work’ being ‘bad’ then we will never be healthy and well.

To be truly well, we need to be well in all areas of our life.

Days off, holidays and time for family and friends is super important but if we do all of that in a way that is pushing us, keeping us tired and stressed, chasing all of the things that we think we need to ‘do’ in order to meet the picture requirements of a good ‘work life balance’ then it is only going to add to our fatigue and stress.

Ever been on an adventure overseas holiday for a few weeks only to return home more tired than when you went away needing weeks to recover resenting being at work because you were so tired?! If that is the case, the holiday might have looked good on paper, and be filled with lots of stories to tell people, but did it really add to your health and well-being?!!

When it comes to work life balance, holidays are great, and lots of fun, but they are only a few days of the year! For consistent well-being we also need to look at supporting ourselves in all aspects of our day to day lives. As part of that we need to consider that work is equally a part of life as it is a part of life that we live for more hours a day than anything else that we do!

To be truly well and healthy we need to address all areas of life, holding them to be all equal.

Work-life balance in that sense is going to be something that is different for all of us as our needs and life circumstances are all different. It is something that we all need to personalise according to our health and well-being needs. This is something that takes time, and is an ongoing development for us all as our circumstances in life change.

Here are my top five tips for personalising your own work-life balance to support your health and well-being:

1. Consider work as part of life. Don’t act any different at work than you do at home.
2. Take charge of your work situation, own it, don’t just go along with ‘work’ in work hours, work according to your ability, and to your own rhythm
3. Take care of all aspects of your life as needed for your health and well-being:
   1. Sleep
   2. Exercise
   3. Finances – personal and business
   4. Relationships – family, friends colleagues staff
   5. Nutritious eating and drinking
4. Create space and time in your life to take care of all of the above. This will optimise your health and well-being, increasing your work performance.
5. Express yourself truly in all that you do. Be the real you in everything.

Work is not the enemy of life, it is part of life! Enjoy yourself in all aspects of life, take good care of yourself, be true to yourself in all areas of life, and work will not be ‘the chore’ that we need to balance with ‘the rest of life’.

https://drmaxine.com.au/

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