Demystifying Cholesterol
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All About Cholesterol
When it comes to cholesterol, the most common lay understanding (especially under a certain age) is “it’s bad”.
A more informed view (and more common after a certain age) is “LDL cholesterol is bad; HDL cholesterol is good”.
A more nuanced view is “LDL cholesterol is established as significantly associated with (and almost certainly a causal factor of) atherosclerotic cardiovascular disease and related mortality in men; in women it is less strongly associated and may or may not be a causal factor”
You can read more about that here:
Statins: His & Hers? ← we highly recommend reading this, especially if you are a woman and/or considering/taking statins. To be clear, we’re not saying “don’t take statins!”, because they might be the right medical choice for you and we’re not your doctors. But we are saying: here’s something to at least know about and consider.
Beyond HDL & LDL
There is also VLDL cholesterol, which as you might have guessed, stands for “very low-density lipoprotein”. It has a high, unhealthy triglyceride content, and it increases atherosclerotic plaque. In other words, it hardens your arteries more quickly.
The term “hardening the arteries” is an insufficient descriptor of what’s happening though, because while yes it is hardening the arteries, it’s also narrowing them. Because minerals and detritus passing through in the blood (the latter sounds bad, but there is supposed to be detritus passing through in the blood; it’s got to get out of the body somehow, and it’s off to get filtered and excreted) get stuck in the cholesterol (which itself is a waxy substance, by the way) and before you know it, those minerals and other things have become a solid part of the interior of your artery wall, like a little plastering team came and slapped plaster on the inside of the walls, then when it hardened, slapped more plaster on, and so on. Macrophages (normally the body’s best interior clean-up team) can’t eat things much bigger than themselves, so that means they can’t tackle the build-up of plaque.
Impact on the heart
Narrower less flexible arteries means very poor circulation, which means that organs can start having problems, which obviously includes your heart itself as it is not only having to do a harder job to keep the blood circulating through the narrower blood vessels, but also, it is not immune to also being starved of oxygen and nutrients along with the rest of the body when the circulation isn’t good enough. It’s a catch 22.
What if LDL is low and someone is getting heart disease anyway?
That’s often a case of apolipoprotein B, and unlike lipoprotein A, which is bound to LDL so usually* isn’t a problem if LDL is in “safe” ranges, Apo-B can more often cause problems even when LDL is low. Neither of these are tested for in most standard cholesterol tests by the way, so you might have to ask for them.
*Some people, around 1 in 20 people, have hereditary extra risk factors for this.
What to do about it?
Well, get those lipids tests! Including asking for the LpA and Apo-B tests, especially if you have a history of heart disease in your family, or otherwise know you have a genetic risk factor.
With or without extra genetic risks, it’s good to get lipids tests done annually from 40 onwards (earlier, if you have extra risk factors).
See also: Understanding your cholesterol numbers
Wondering whether you have an increased genetic risk or not?
Genetic Testing: Health Benefits & Methods ← we think this is worth doing; it’s a “one-off test tells many useful things”. Usually done from a saliva sample, but some companies arrange a blood draw instead. Cost is usually quite affordable; do shop around, though.
Additionally, talk to your pharmacist to check whether any of your meds have contraindications or interactions you should be aware of in this regard. Pharmacists usually know contraindications/interactions stuff better than doctors, and/but unlike doctors, they don’t have social pressure on them to know everything, which means that if they’re not sure, instead of just guessing and reassuring you in a confident voice, they’ll actually check.
Lastly, shocking nobody, all the usual lifestyle medicine advice applies here, especially get plenty of moderate exercise and eat a good diet, preferably mostly if not entirely plant-based, and go easy on the saturated fat.
Note: while a vegan diet contains zero dietary cholesterol (because plants don’t make it), vegans can still get unhealthy blood lipid levels, because we are animals and—like most animals—our body is perfectly capable of making its own cholesterol (indeed, we do need some cholesterol to function), and it can make its own in the wrong balance, if for example we go too heavy on certain kinds of (yes, even some plant-based) saturated fat.
Read more: Can Saturated Fats Be Healthy? ← see for example how palm oil and coconut oil are both plant-based, and both high in saturated fat, but palm oil’s is heart-unhealthy on balance, while coconut oil’s is heart-healthy on balance (in moderation).
Want to know more about your personal risk?
Try the American College of Cardiology’s ASCVD risk estimator (it’s free)
Take care!
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How to Be Your Own Therapist – by Owen O’Kane
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Finding the right therapist can be hard. Sometimes, even just accessing a therapist, any therapist, can be hard, if circumstances are adverse. Sometimes we’d like therapy, but want to feel “better prepared for it” before we do.
Owen O’Kane, a highly qualified and well-respected psychotherapist, wants to put some tools in our hands. The premise of this book is that “in 10 minutes a day” one can give oneself an amount of therapy that will be beneficial.
Naturally, in 10 minutes a day, this isn’t going to be the kind of therapy that will work through major traumas, so what can it do?
Those 10 minutes are spread into three sessions:
- 4 minutes in the morning
- 3 minutes in the afternoon
- 3 minutes in the evening
The idea is:
- To do a quick mental health “check-in” before the day gets started, ascertain what one needs in that context, and make a simple plan to get/have it.
- To keep one’s mental health on track by taking a little pause to reassess and adjust if necessary
- To reflect on the day, amplify the positive, and let go of the negative to what extent is practical, in order to rest well ready for the next day
Where O’Kane excels is in explaining how to do those things in a way that is neither overly simplistic and wishy-washy, nor so arcane and convoluted as to create more work and render the day more difficult.
In short, this book is a great prelude to (or adjunct to) formal therapy, and for those for whom therapy isn’t accessible and/or desired, a great way to keep oneself on a mentally healthy track.
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Edamame vs Soybeans – Which is Healthier?
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Our Verdict
When comparing edamame to soybeans, we picked the soybeans.
Why?
You may be thinking: aren’t edamame soybeans? And yes, yes they are. But just like our many instances of pitting Brassica oleracea vs Brassica oleracea (one species, many cultivars e.g. broccoli, cauliflower, kale, cabbage, Brussels sprouts, etc), there are still differences. In this case, edamame and soybeans aren’t even different cultivars, what are conventionally called edamame are just the young beans of the plant, while what are conventionally called soybeans are the mature beans of the plant.
The main nutritional difference is: as they get older, they lose vitamins and gain minerals. More on that later. But first, “main difference” isn’t “only difference”, so…
In terms of macros, edamame have more carbs, while soybeans have a little more fiber and a lot more protein. An easy win for the mature soybeans.
In the category of vitamins, edamame have more of vitamins A, B1, B3, B5, B9, C, E, K, and choline, while soybeans have more of vitamins B2 and B6. A clear win for edamame, this time.
When it comes to minerals, the nutritional tables are turned, and edamame have more manganese and zinc, while soybeans have more calcium, copper, iron, magnesium, phosphorus, potassium, and selenium. An easy win for soybeans.
Adding up the sections makes for a two-to-one victory for soybeans, but by all means enjoy either or both; diversity is good!
Want to learn more?
You might like to read:
What’s Your Plant Diversity Score?
Enjoy!
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Mouthwatering Protein Falafel
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Baking falafel, rather than frying it, has a strength and a weakness. The strength: it is less effort and you can do more at once. The weakness: it can easily get dry. This recipe calls for baking them in a way that won’t get dry, and the secret is one of its protein ingredients: peas! Add to this the spices and a tahini sauce, and you’ve a mouthwatering feast that’s full of protein, fiber, polyphenols, and even healthy fats.
You will need
- 1 cup peas, cooked
- 1 can chickpeas, drained and rinsed (keep the chickpea water—also called aquafaba—aside, as we’ll be using some of it later)
- ½ small red onion, chopped
- 1 handful fresh mint, chopped
- 1 tbsp fresh parsley, chopped
- ½ bulb garlic, crushed
- 1 tbsp lemon juice
- 1 tbsp chickpea flour (also called gram flour, besan flour, or garbanzo bean flour) plus more for dusting
- 2 tsp red chili flakes (adjust per heat preferences)
- 2 tsp black pepper, coarse ground
- 1 tsp ground turmeric
- ½ tsp MSG or 1 tsp low-sodium salt
- Extra virgin olive oil
For the tahini sauce:
- 2 tbsp tahini
- 2 tbsp lemon juice
- ¼ bulb garlic, crushed
- 5 tbsp aquafaba (if for some reason you don’t have it, such as for example you substituted 1 cup chickpeas that you cooked yourself, substitute with water here)
To serve:
- Flatbreads (you can use our Healthy Homemade Flatbreads recipe if you like)
- Leafy salad
Method
(we suggest you read everything at least once before doing anything)
1) Preheat the oven to 350℉ / 180℃.
2) Blend the peas and chickpeas in a food processor for a few seconds. You want a coarse mixture, not a paste.
3) Add the rest of the main section ingredients except the olive oil, and blend again for a few more seconds. It should still have a chunky texture, or else you will have made hummus. If you accidentally make hummus, set your hummus aside and start again on the falafels.
4) Shape the mixture into balls; if it lacks structural integrity, fold in a little more chickpea flour until the balls stay in shape. Either way, once you have done that, dust the balls in chickpea flour.
5) Brush the balls in a little olive oil, as you put them on a baking tray lined with baking paper. Bake for 15–18 minutes until golden, turning partway through.
6) While you are waiting, making the tahini sauce by combining the tahini sauce ingredients in a high-speed blender and processing on high until smooth. If you do not have a small enough blender (a bullet-style blender should work for this), then do it manually, which means you’ll have to crush the garlic all the way into a smooth paste, such as with a pestle and mortar, or alternatively, use ready-made garlic paste—and then simply whisk the ingredients together until smooth.
7) Serve the falafels warm or cold, on flatbreads with leafy salad and the tahini sauce.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Tahini vs Hummus – Which is Healthier?
- Our Top 5 Spices: How Much Is Enough For Benefits? ← we scored 4/5 today!
Take care!
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Women and Minorities Bear the Brunt of Medical Misdiagnosis
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Charity Watkins sensed something was deeply wrong when she experienced exhaustion after her daughter was born.
At times, Watkins, then 30, had to stop on the stairway to catch her breath. Her obstetrician said postpartum depression likely caused the weakness and fatigue. When Watkins, who is Black, complained of a cough, her doctor blamed the flu.
About eight weeks after delivery, Watkins thought she was having a heart attack, and her husband took her to the emergency room. After a 5½-hour wait in a North Carolina hospital, she returned home to nurse her baby without seeing a doctor.
When a physician finally examined Watkins three days later, he immediately noticed her legs and stomach were swollen, a sign that her body was retaining fluid. After a chest X-ray, the doctor diagnosed her with heart failure, a serious condition in which the heart becomes too weak to adequately pump oxygen-rich blood to organs throughout the body. Watkins spent two weeks in intensive care.
She said a cardiologist later told her, “We almost lost you.”
Watkins is among 12 million adults misdiagnosed every year in the U.S.
In a study published Jan. 8 in JAMA Internal Medicine, researchers found that nearly 1 in 4 hospital patients who died or were transferred to intensive care had experienced a diagnostic error. Nearly 18% of misdiagnosed patients were harmed or died.
In all, an estimated 795,000 patients a year die or are permanently disabled because of misdiagnosis, according to a study published in July in the BMJ Quality & Safety periodical.
Some patients are at higher risk than others.
Women and racial and ethnic minorities are 20% to 30% more likely than white men to experience a misdiagnosis, said David Newman-Toker, a professor of neurology at Johns Hopkins School of Medicine and the lead author of the BMJ study. “That’s significant and inexcusable,” he said.
Researchers call misdiagnosis an urgent public health problem. The study found that rates of misdiagnosis range from 1.5% of heart attacks to 17.5% of strokes and 22.5% of lung cancers.
Weakening of the heart muscle — which led to Watkins’ heart failure — is the most common cause of maternal death one week to one year after delivery, and is more common among Black women.
Heart failure “should have been No. 1 on the list of possible causes” for Watkins’ symptoms, said Ronald Wyatt, chief science and chief medical officer at the Society to Improve Diagnosis in Medicine, a nonprofit research and advocacy group.
Maternal mortality for Black mothers has increased dramatically in recent years. The United States has the highest maternal mortality rate among developed countries. According to the Centers for Disease Control and Prevention, non-Hispanic Black mothers are 2.6 times as likely to die as non-Hispanic white moms. More than half of these deaths take place within a year after delivery.
Research shows that Black women with childbirth-related heart failure are typically diagnosed later than white women, said Jennifer Lewey, co-director of the pregnancy and heart disease program at Penn Medicine. That can allow patients to further deteriorate, making Black women less likely to fully recover and more likely to suffer from weakened hearts for the rest of their lives.
Watkins said the diagnosis changed her life. Doctors advised her “not to have another baby, or I might need a heart transplant,” she said. Being deprived of the chance to have another child, she said, “was devastating.”
Racial and gender disparities are widespread.
Women and minority patients suffering from heart attacks are more likely than others to be discharged without diagnosis or treatment.
Black people with depression are more likely than others to be misdiagnosed with schizophrenia.
Minorities are less likely than whites to be diagnosed early with dementia, depriving them of the opportunities to receive treatments that work best in the early stages of the disease.
Misdiagnosis isn’t new. Doctors have used autopsy studies to estimate the percentage of patients who died with undiagnosed diseases for more than a century. Although those studies show some improvement over time, life-threatening mistakes remain all too common, despite an array of sophisticated diagnostic tools, said Hardeep Singh, a professor at Baylor College of Medicine who studies ways to improve diagnosis.
“The vast majority of diagnoses can be made by getting to know the patient’s story really well, asking follow-up questions, examining the patient, and ordering basic tests,” said Singh, who is also a researcher at Houston’s Michael E. DeBakey VA Medical Center. When talking to people who’ve been misdiagnosed, “one of the things we hear over and over is, ‘The doctor didn’t listen to me.’”
Racial disparities in misdiagnosis are sometimes explained by noting that minority patients are less likely to be insured than white patients and often lack access to high-quality hospitals. But the picture is more complicated, said Monika Goyal, an emergency physician at Children’s National Hospital in Washington, D.C., who has documented racial bias in children’s health care.
In a 2020 study, Goyal and her colleagues found that Black kids with appendicitis were less likely than their white peers to be correctly diagnosed, even when both groups of patients visited the same hospital.
Although few doctors deliberately discriminate against women or minorities, Goyal said, many are biased without realizing it.
“Racial bias is baked into our culture,” Goyal said. “It’s important for all of us to start recognizing that.”
Demanding schedules, which prevent doctors from spending as much time with patients as they’d like, can contribute to diagnostic errors, said Karen Lutfey Spencer, a professor of health and behavioral sciences at the University of Colorado-Denver. “Doctors are more likely to make biased decisions when they are busy and overworked,” Spencer said. “There are some really smart, well-intentioned providers who are getting chewed up in a system that’s very unforgiving.”
Doctors make better treatment decisions when they’re more confident of a diagnosis, Spencer said.
In an experiment, researchers asked doctors to view videos of actors pretending to be patients with heart disease or depression, make a diagnosis, and recommend follow-up actions. Doctors felt far more certain diagnosing white men than Black patients or younger women.
“If they were less certain, they were less likely to take action, such as ordering tests,” Spencer said. “If they were less certain, they might just wait to prescribe treatment.”
It’s easy to see why doctors are more confident when diagnosing white men, Spencer said. For more than a century, medical textbooks have illustrated diseases with stereotypical images of white men. Only 4.5% of images in general medical textbooks feature patients with dark skin.
That may help explain why patients with darker complexions are less likely to receive a timely diagnosis with conditions that affect the skin, from cancer to Lyme disease, which causes a red or pink rash in the earliest stage of infection. Black patients with Lyme disease are more likely to be diagnosed with more advanced disease, which can cause arthritis and damage the heart. Black people with melanoma are about three times as likely as whites to die within five years.
The covid-19 pandemic helped raise awareness that pulse oximeters — the fingertip devices used to measure a patient’s pulse and oxygen levels — are less accurate for people with dark skin. The devices work by shining light through the skin; their failures have delayed critical care for many Black patients.
Seven years after her misdiagnosis, Watkins is an assistant professor of social work at North Carolina Central University in Durham, where she studies the psychosocial effects experienced by Black mothers who survive severe childbirth complications.
“Sharing my story is part of my healing,” said Watkins, who speaks to medical groups to help doctors improve their care. “It has helped me reclaim power in my life, just to be able to help others.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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Dodging Dengue In The US
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Dengue On The Rise
We wrote recently about dengue outbreaks in the Americas, with Puerto Rico declaring an epidemic. Cases are now being reported in Florida too, and are likely to spread, so it’s good to be prepared, if your climate is of the “warm and humid” kind.
If you want to catch up on the news first, here you go:
- UN health agency cites tenfold increase in reported cases of dengue over the last generation
- Puerto Rico has declared an epidemic following a spike in dengue cases
- Dengue fever confirmed in Florida Keys as US on watch for rise in mosquito illness
Note: dengue is far from unheard of in Florida, but the rising average temperatures in each year mean that each year stands a good chance of seeing more cases than the previous. It’s been climbing since at least 2017, took a dip during the time of COVID restrictions keeping people at home more, and then for the more recent years has been climbing again since.
What actually is it?
Dengue is a viral, mosquito-borne disease, characterized by fever, vomiting, muscle pain, and a rash, in about 1 in 4 cases.
Which can sound like “you’ll know if you have it”, but in fact it’s usually asymptomatic for a week or more after infection, so, watch out!
What next, if those symptoms appear?
The good news is: the fever will usually last less than a week
The bad news is: a day or so after that the fever subsided, the more serious symptoms are likely to start—if they’re going to.
If you’re unlucky enough to be one of the 1 in 20 who get the serious symptoms, then you can expect abdominal cramps, repeat vomiting, bleeding from various orifices (you may not get them all, but all are possible), and (hardly surprising, given the previous items) “extreme fatigue and restlessness”.
If you get those symptoms, then definitely get to an ER as soon as possible, as dengue can become life-threatening within hours of such.
Read more: CDC | Symptoms of Dengue and Testing
While there is not a treatment for dengue per se, the Emergency Room will be better able to manage your symptoms and thus keep you alive long enough for them to pass.
If you’d like much more detail (on symptoms, seriousness, at-risk demographics, and prognosis) than what the CDC offers, then…
Read more: BMJ | Dengue Fever
Ok, so how do we dodge the dengue?
It sounds flippant to say “don’t get bitten”, but that’s it. However, there are tips are not getting bitten:
- Use mosquito-repellent, but it has to contain >20% DEET, so check labels
- Use mosquito nets where possible (doors, windows, etc, and the classic bed-tent net is not a bad idea either)
- Wear clothing that covers your skin, especially during the day—it can be light clothing; it doesn’t need to be a HazMat suit! But it does need to reduce the area of attack to reduce the risk of bites.
- Limit standing water around your home—anything that can hold even a small amount of standing water is a potential mosquito-breeding ground. Yes, even if it’s a crack in your driveway or a potted bromeliad.
Further reading
You might also like to check out:
Stickers and wristbands aren’t a reliable way to prevent mosquito bites. Here’s why
…and in case dengue wasn’t bad enough:
Mosquitoes can spread the flesh-eating Buruli ulcer. Here’s how you can protect yourself
Take care!
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Women are less likely to receive CPR than men. Training on manikins with breasts could help
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If someone’s heart suddenly stops beating, they may only have minutes to live. Doing CPR (cardiopulmonary resusciation) can increase their chances of survival. CPR makes sure blood keeps pumping, providing oxygen to the brain and vital organs until specialist treatment arrives.
But research shows bystanders are less likely to intervene to perform CPR when that person is a woman. A recent Australian study analysed 4,491 cardiac arrests between 2017–19 and found bystanders were more likely to give CPR to men (74%) than women (65%).
Could this partly be because CPR training dummies (known as manikins) don’t have breasts? Our new research looked at manikins available worldwide to train people in performing CPR and found 95% are flat-chested.
Anatomically, breasts don’t change CPR technique. But they may influence whether people attempt it – and hesitation in these crucial moments could mean the difference between life and death.
Pixel-Shot/Shutterstock Heart health disparities
Cardiovascular diseases – including heart disease, stroke and cardiac arrest – are the leading cause of death for women across the world.
But if a woman has a cardiac arrest outside hospital (meaning her heart stops pumping properly), she is 10% less likely to receive CPR than a man. Women are also less likely to survive CPR and more likely to have brain damage following cardiac arrests.
Bystanders are less likely to intervene if a woman needs CPR, compared to a man. doublelee/Shutterstock These are just some of many unequal health outcomes women experience, along with transgender and non-binary people. Compared to men, their symptoms are more likely to be dismissed or misdiagnosed, or it may take longer for them to receive a diagnosis.
Bystander reluctance
There is also increasing evidence women are less likely to receive CPR compared to men.
This may be partly due to bystander concerns they’ll be accused of sexual harassment, worry they might cause damage (in some cases based on a perception women are more “frail”) and discomfort about touching a woman’s breast.
Bystanders may also have trouble recognising a woman is experiencing a cardiac arrest.
Even in simulations of scenarios, researchers have found those who intervened were less likely to remove a woman’s clothing to prepare for resuscitation, compared to men. And women were less likely to receive CPR or defibrillation (an electric charge to restart the heart) – even when the training was an online game that didn’t involve touching anyone.
There is evidence that how people act in resuscitation training scenarios mirrors what they do in real emergencies. This means it’s vital to train people to recognise a cardiac arrest and be prepared to intervene, across genders and body types.
Skewed to male bodies
Most CPR training resources feature male bodies, or don’t specify a sex. If the bodies don’t have breasts, it implies a male default.
For example, a 2022 study looking at CPR training across North, Central and South America, found most manikins available were white (88%), male (94%) and lean (99%).
It’s extremely rare for a manikin to have breasts or a larger body. M Isolation photo/Shutterstock These studies reflect what we see in our own work, training other health practitioners to do CPR. We have noticed all the manikins available to for training are flat-chested. One of us (Rebecca) found it difficult to find any training manikins with breasts.
A single manikin with breasts
Our new research investigated what CPR manikins are available and how diverse they are. We identified 20 CPR manikins on the global market in 2023. Manikins are usually a torso with a head and no arms.
Of the 20 available, five (25%) were sold as “female” – but only one of these had breasts. That means 95% of available CPR training manikins were flat-chested.
We also looked at other features of diversity, including skin tone and larger bodies. We found 65% had more than one skin tone available, but just one was a larger size body. More research is needed on how these aspects affect bystanders in giving CPR.
Breasts don’t change CPR technique
CPR technique doesn’t change when someone has breasts. The barriers are cultural. And while you might feel uncomfortable, starting CPR as soon as possible could save a life.
Signs someone might need CPR include not breathing properly or at all, or not responding to you.
To perform effective CPR, you should:
- put the heel of your hand on the middle of their chest
- put your other hand on the top of the first hand, and interlock fingers (keep your arms straight)
- press down hard, to a depth of about 5cm before releasing
- push the chest at a rate of 100-120 beats per minute (you can sing a song) in your head to help keep time!)
https://www.youtube.com/embed/Plse2FOkV4Q?wmode=transparent&start=94 An example of how to do CPR – with a flat-chested manikin.
What about a defibrillator?
You don’t need to remove someone’s bra to perform CPR. But you may need to if a defibrillator is required.
A defibrillator is a device that applies an electric charge to restore the heartbeat. A bra with an underwire could cause a slight burn to the skin when the debrillator’s pads apply the electric charge. But if you can’t remove the bra, don’t let it delay care.
What should change?
Our research highlights the need for a range of CPR training manikins with breasts, as well as different body sizes.
Training resources need to better prepare people to intervene and perform CPR on people with breasts. We also need greater education about women’s risk of getting and dying from heart-related diseases.
Jessica Stokes-Parish, Assistant Professor in Medicine, Bond University and Rebecca A. Szabo, Honorary Senior Lecturer in Critical Care and Obstetrics, Gynaecology and Newborn Health, The University of Melbourne
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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