Navigating the health-care system is not easy, but you’re not alone.

10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

Hello, dear reader!

This is my first column for Healthy Debate as a Patient Navigator. This column will be devoted to providing patients with information to help them through their journey with the health-care system and answering your questions.

Here’s a bit about me: I have been a patient partner at The Ottawa Hospital and Ottawa Hospital Research Institute since 2017, and have joined a variety of governance boards that work on patient and caregiver engagement such as the Patient Advisors Network, the Ontario Health East Region Patient and Family Advisory Council and the Equity in Health Systems Lab.

My journey as a patient partner started much before 2017 though. When I was a teenager, I was diagnosed with a cholesteatoma, a rare and chronic disease that causes the development of fatty tumors in the middle ear. I have had multiple surgeries to try to fix it but will need regular follow-ups to monitor whether the tumor returns. Because of this, I also live with an invisible disability since I have essentially become functionally deaf in one ear and often rely on a hearing aid when I navigate the world.

Having undergone three surgeries in my adolescent years, it was my experience undergoing surgery for an acute hand and wrist injury following a jet ski accident as an adult that was the catalyst for my decision to become a patient partner. There was an intriguing contrast between how I was cared for at two different health-care institutions, my age being the deciding factor at which hospital I went to (a children’s hospital or an adult one).

The most memorable example was how, as a teenager or child, you were never left alone before surgery, and nurses and staff took all the time necessary to comfort me and answer my (and my family’s) questions. I also remember how right before putting me to sleep, the whole staff initiated a surgical pause and introduced themselves and explained to me what their role was during my surgery.

None of that happened as an adult. I was left in a hallway while the operating theater was prepared, anxious and alone with staff walking by not even batting an eye. My questions felt like an annoyance to the care team; as soon as I was wheeled onto the operating room table, the anesthetist quickly put me to sleep. I didn’t even have the time to see who else was there.

Now don’t get me wrong: I am incredibly appreciative with the quality of care I received, but it was the everyday interactions with the care teams that I felt could be improved. And so, while I was recovering from that surgery, I looked for a way to help other patients and the hospital improve its care. I discovered the hospital’s patient engagement program, applied, and the rest is history!

Since then, I have worked on a host of patient-centered policy and research projects and fervently advocate that surgical teams adopt a more compassionate approach with patients before and after surgery.

I’d be happy to talk a bit more about my journey if you ask, but with that out of the way … Welcome to our first patient navigator column about patient engagement.

Conceptualizing the continuum of Patient Engagement

In the context of Canadian health care, patient engagement is a multifaceted concept that involves active collaboration between patients, caregivers, health-care providers and researchers. It involves patients and caregivers as active contributors in decision-making processes, health-care services and medical research. Though the concept is not new, the paradigm shift toward patient engagement in Canada started around 2010.

I like to conceptualize the different levels of patient engagement as a measure of the strength of the relationship between patients and their interlocutors – whether it’s a healthcare provider, administrator or researcher – charted against the duration of the engagement or the scope of input required from the patient.

Defining different levels of Patient Engagement

Following the continuum, let’s begin by defining different levels of patient engagement. Bear in mind that these definitions can vary from one organization to another but are useful in generally labelling the level of patient engagement a project has achieved (or wishes to achieve).

Patient involvement: If the strength of the relationship between patients and their interlocutors is minimal and not time consuming or too onerous, then perhaps it can be categorized as patient involvement. This applies to many instances of transactional engagement.

Patient advisory/consulting: Right in the middle of our continuum, patients can find themselves engaging in patient advisory or consulting work, where projects are limited in scope and duration or complexity, and the relationship is not as profound as a partnership.

Patient partnership: The stronger the relationship is between the patient and their interlocutor, and the longer the engagement activity lasts or how much input the patient is providing, the more this situation can be categorized as patient partnership. It is the inverse of patient involvement.

Examples of the different levels of Patient Engagement

Let’s pretend you are accompanying a loved one to an appointment to manage a kidney disease, requiring them to undergo dialysis treatment. We’ll use this scenario to exemplify what label could be used to describe the level of engagement.

Patient involvement: In our case, if your loved one – or you – fills out a satisfaction or feedback survey about your experience in the waiting room and all that needed to be done was to hand it back to the clerk or care team, then, at a basic level, you could likely label this interaction as a form of patient involvement. It can also involve open consultations around a design of a new look and feel for a hospital, or the understandability of a survey or communications product. Interactions with the care team, administrators or researchers are minimal and often transactional.

Patient advisory/consulting: If your loved one was asked for more detailed information about survey results over the course of a few meetings, this could represent patient advisory/consulting. This could mean that patients meet with program administrators and care providers and share their insights on how things can be improved. It essentially involves patients providing advice to health-care institutions from the perspective of patients, their family members and caregivers.

Patient advisors or consultants are often appointed by hospitals or academic institutions to offer insights at multiple stages of health-care delivery and research. They can help pilot an initiative based on that feedback or evaluate whether the new solutions are working. Often patient advisors are engaged in smaller-term individual projects and meet with the project team as regularly as required.

Patient partnership: Going above and beyond patient advisory, if patients have built a trusting relationship with their care team or administrators, they could feel comfortable enough to partner with them and initiate a project of their own. This could be for a project in which they study a different form of treatment to improve patient-centered outcomes (like the time it takes to feel “normal” following a session); it could be working together to identify and remove barriers for other patients that need to access that type of care. These projects are not fulfilled overnight, but require a collaborative, longstanding and trusting relationship between patients and health-care providers, administrators or researchers. It ensures that patients, regardless of severity or chronicity of their illness, can meaningfully contribute their experiences to aid in improving patient care, or develop or implement policies, pilots or research projects from start to finish.

It is leveraging that lived and living experience to its full extent and having the patient partner involved as an equal voice in the decision-making process for a project – over many months, usually – that the engagement could be labeled a partnership.

Last words

The point of this column will be to answer or explore issues or questions related to patient engagement, health communications or even provide some thoughts on how to handle a particular situation.

I would be happy to collect your questions and feedback at any time, which will help inform future columns. Just email me at max@le-co.ca or connect with me on social media (Linked In, X / Twitter).

It’s not easy to navigate our health-care systems, but you are not alone.

This article is republished from healthydebate under a Creative Commons license. Read the original article.

Don’t Forget…

Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

Recommended

  • Measles cases are rising—here’s how to protect your family
  • Beetroot vs Pumpkin – Which is Healthier?
    Beetroot triumphs for its protein, fiber, and mineral content, offering a powerful nutritional punch compared to pumpkin.

Learn to Age Gracefully

Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:

  • What Are Nootropics, Really?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    What are nootropics, really?

    A nootropic is anything that functions as a cognitive enhancerin other words, improves our brainpower.

    These can be sensationalized as “smart drugs”, misrepresented excitingly in science fiction, meme-ified in the mundane (“but first, coffee”), and reframed entirely, (“exercise is the best nootropic”).

    So, clearly, “nootropics” can mean a lot of different things. Let’s look at some of the main categories…

    The neurochemical modulators

    These are what often get called “smart drugs”. They are literally drugs (have a chemical effect on the body that isn’t found in our diet), and they affect the levels of certain neurotransmitters in the brain, such as by:

    • Adding more of that neurotransmitter (simple enough)
    • Decreasing the rate at which we lose that neurotransmitter (re-uptake inhibitors)
    • Antagonizing an unhelpful neurotransmitter (doing the opposite thing to it)
    • Blocking an unhelpful neurotransmitter (stopping the receptors from receiving it)

    “Unhelpful” here is relative and subjective, of course. We need all the neurotransmitters that are in our brain, after all, we just don’t need all of them all the time.

    Examples: modafinil, a dopamine re-uptake inhibitor (mostly prescribed for sleep disorders), reduces the rate at which our brains scrub dopamine, resulting in a gradual build-up of dopamine that we naturally produced, so we get to enjoy that dopamine for longer. This will tend to promote wakefulness, and may also help with problem-solving and language faculties—as well as giving a mood boost. In other words, all things that dopamine is used for. Mirtazaрine, an adrenoreceptor agonist (mostly prescribed as an antidepressant), increases noradrenergic neurotransmission, thus giving many other brain functions a boost.

    Why it works: our brains need healthy levels of neurotransmitters, in order to function well. Those levels are normally self-regulating, but can become depleted in times of stress or fatigue, for example.

    The metabolic brain boosters

    These are the kind of things that get included in nootropic stacks (stack = a collection of supplements and/or drugs that complement each other and are taken together—for example, a multivitamin tablet could be described as a vitamin stack) even though they have nothing specifically relating them to brain function. Why are they included?

    The brain needs so much fuel. Metabolically speaking, it’s a gas-guzzler. It’s the single most resource-intensive organ of our body, by far. So, metabolic brain boosters tend to:

    • Increase blood flow
    • Increase blood oxygenation
    • Increase blood general health
    • Improve blood pressure (this is relative and subjective, since very obviously there’s a sweet spot)

    Examples: B-vitamins. Yep, it can be that simple. A less obvious example might be Co-enzyme Q10, which supports energy production on a cellular level, and good cardiovascular health.

    Why it works: you can’t have a healthy brain without a healthy heart!

    We are such stuff as brains are made of

    Our brains are made of mostly fat, water, and protein. But, not just any old fat and protein—we’re at least a little bit special! So, brain-food foods tend to:

    • Give the brain the fats and proteins it’s made of
    • Give the brain the stuff to make the fats and proteins it’s made of (simpler fats, and amino acids)
    • Give the brain hydration! Just having water, and electrolytes as appropriate, does this

    Examples: healthy fats from nuts, seeds, and seafood; also, a lot of phytonutrients from greens and certain fruits. Long-time subscribers may remember our article “Brain Food: The Eyes Have It!” on the importance of dietary lutein in reducing Alzheimer’s risk, for example

    Why it works: this is matter of structural upkeep and maintenance—our brains don’t work fabulously if deprived of the very stuff they’re made of! Especially hydration is seriously underrated as a nootropic factor, by the way. Most people are dehydrated most of the time, and the brain dehydrates quickly. Fortunately, it rehydrates quickly as well when we take hydrating liquids.

    Weird things that sound like ingredients in a witch’s potion

    These are too numerous and too varied in how they work to cover here, but they do appear a lot in nootropic stacks and in popular literature on the subject.

    Often they work by one of the mechanisms described above; sometimes we’re not entirely sure how they work, and have only measured their effects sufficiently to know that, somehow, they do work.

    Examples: panax ginseng is one of the best-studied examples that still remains quite mysterious in many aspects of its mechanism. Lion’s Mane (the mushroom, not the jellyfish or the big cat hairstyle), meanwhile, is known to contain specific compounds that stimulate healthy brain cell growth.

    Why it works: as we say, it varies so much from on ingredient to another in this category, so… Watch out for our Research Review Monday features, as we’ll be covering some of these in the coming weeks!

    (PS, if there’s any you’d like us to focus on, let us know! We always love to hear from you. You can hit reply to any of our emails, or use the handy feedback widget at the bottom)

    Share This Post

  • Cashew Nuts vs Coconut – Which is Healthier?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Our Verdict

    When comparing cashew nuts to coconut, we picked the cashews.

    Why?

    It can be argued this isn’t a fair comparison, as coconuts aren’t true nuts, but it’s at the very least a useful comparison, because they have very similar (often the same) culinary uses, so deciding between one or the other is something people will often do.

    In terms of macros, cashews have 6x the protein and more than 2x the fiber, as well as slightly more fat (but the fats are healthy, as are those of coconut, by the way) and 2x the carbs. Depending on what you’re looking for, this head-to-head could come out differently, but we say it’s a win for cashews.

    You may be wondering: if cashews have more of all those things, what are coconuts made of? And the answer is that coconuts have 8x the water (and yes, this is counting the coconut meat only, not including the milk inside). Of course, if you get dessicated coconut, then it won’t have that, but we’re comparing fresh to fresh.

    In the category of vitamins, cashews have a lot more of vitamins B1, B2, B3, B5, B6, E, and K. Meanwhile, coconut has more vitamin C, but it’s not a lot. An easy win for cashews here.

    When it comes to minerals, cashews have rather more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc. On the other hand, coconut has more sodium. Another easy win for cashews.

    Cashews also have the lower glycemic index.

    All in all, cashews win the day.

    Want to learn more?

    You might like to read:

    Take care!

    Share This Post

  • Exercise, therapy and diet can all improve life during cancer treatment and boost survival. Here’s how

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    With so many high-profile people diagnosed with cancer we are confronted with the stark reality the disease can strike any of us at any time. There are also reports certain cancers are increasing among younger people in their 30s and 40s.

    On the positive side, medical treatments for cancer are advancing very rapidly. Survival rates are improving greatly and some cancers are now being managed more as long-term chronic diseases rather than illnesses that will rapidly claim a patient’s life.

    The mainstays of cancer treatment remain surgery, chemotherapy, radiation therapy, immunotherapy, targeted therapy and hormone therapy. But there are other treatments and strategies – “adjunct” or supportive cancer care – that can have a powerful impact on a patient’s quality of life, survival and experience during cancer treatment.

    PeopleImages.com – Yuri A/Shutterstock

    Keep moving if you can

    Physical exercise is now recognised as a medicine. It can be tailored to the patient and their health issues to stimulate the body and build an internal environment where cancer is less likely to flourish. It does this in a number of ways.

    Exercise provides a strong stimulus to our immune system, increasing the number of cancer-fighting immune cells in our blood circulation and infusing these into the tumour tissue to identify and kill cancer cells.

    Our skeletal muscles (those attached to bone for movement) release signalling molecules called myokines. The larger the muscle mass, the more myokines are released – even when a person is at rest. However, during and immediately after bouts of exercise, a further surge of myokines is secreted into the bloodstream. Myokines attach to immune cells, stimulating them to be better “hunter-killers”. Myokines also signal directly to cancer cells slowing their growth and causing cell death.

    Exercise can also greatly reduce the side effects of cancer treatment such as fatigue, muscle and bone loss, and fat gain. And it reduces the risk of developing other chronic diseases such as heart disease and type 2 diabetes. Exercise can maintain or improve quality of life and mental health for patients with cancer.

    Emerging research evidence indicates exercise might increase the effectiveness of mainstream treatments such as chemotherapy and radiation therapy. Exercise is certainly essential for preparing the patient for any surgery to increase cardio-respiratory fitness, reduce systemic inflammation, and increase muscle mass, strength and physical function, and then rehabilitating them after surgery.

    These mechanisms explain why cancer patients who are physically active have much better survival outcomes with the relative risk of death from cancer reduced by as much as 40–50%.

    Mental health helps

    The second “tool” which has a major role in cancer management is psycho-oncology. It involves the psychological, social, behavioural and emotional aspects of cancer for not only the patient but also their carers and family. The aim is to maintain or improve quality of life and mental health aspects such as emotional distress, anxiety, depression, sexual health, coping strategies, personal identity and relationships.

    Supporting quality of life and happiness is important on their own, but these barometers can also impact a patient’s physical health, response to exercise medicine, resilience to disease and to treatments.

    If a patient is highly distressed or anxious, their body can enter a flight or fight response. This creates an internal environment that is actually supportive of cancer progression through hormonal and inflammatory mechanisms. So it’s essential their mental health is supported.

    several people are lying on recliners with IV drips in arms to receive medicine.
    Chemotherapy can be stressful on the body and emotional reserves. Shutterstock

    Putting the good things in: diet

    A third therapy in the supportive cancer care toolbox is diet. A healthy diet can support the body to fight cancer and help it tolerate and recover from medical or surgical treatments.

    Inflammation provides a more fertile environment for cancer cells. If a patient is overweight with excessive fat tissue then a diet to reduce fat which is also anti-inflammatory can be very helpful. This generally means avoiding processed foods and eating predominantly fresh food, locally sourced and mostly plant based.

    two people sit in gym and eat high protein lunch
    Some cancer treatments cause muscle loss. Avoiding processed foods may help. Shutterstock

    Muscle loss is a side effect of all cancer treatments. Resistance training exercise can help but people may need protein supplements or diet changes to make sure they get enough protein to build muscle. Older age and cancer treatments may reduce both the intake of protein and compromise absorption so supplementation may be indicated.

    Depending on the cancer and treatment, some patients may require highly specialised diet therapy. Some cancers such as pancreatic, stomach, esophageal, and lung cancer can cause rapid and uncontrolled drops in body weight. This is called cachexia and needs careful management.

    Other cancers and treatments such as hormone therapy can cause rapid weight gain. This also needs careful monitoring and guidance so that, when a patient is clear of cancer, they are not left with higher risks of other health problems such as cardiovascular disease and metabolic syndrome (a cluster of conditions that boost your risk of heart disease, stroke and type 2 diabetes).

    Working as a team

    These are three of the most powerful tools in the supportive care toolbox for people with cancer. None of them are “cures” for cancer, alone or together. But they can work in tandem with medical treatments to greatly improve outcomes for patients.

    If you or someone you care about has cancer, national and state cancer councils and cancer-specific organisations can provide support.

    For exercise medicine support it is best to consult with an accredited exercise physiologist, for diet therapy an accredited practising dietitian and mental health support with a registered psychologist. Some of these services are supported through Medicare on referral from a general practitioner.

    For free and confidential cancer support call the Cancer Council on 13 11 20.

    Rob Newton, Professor of Exercise Medicine, Edith Cowan University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

    Share This Post

Related Posts

  • Measles cases are rising—here’s how to protect your family
  • How often should you wash your sheets and towels?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Everyone seems to have a different opinion when it comes to how often towels and bed sheets should be washed. While many people might wonder whether days or weeks is best, in one survey from the United Kingdom, almost half of single men reported not washing their sheets for up to four months at a time.

    It’s fairly clear that four months is too long to leave it, but what is the ideal frequency?

    Bed linen and towels are quite different and so should be washed at different intervals. While every week or two will generally suffice for sheets, towels are best washed every few days.

    Anyway, who doesn’t love the feeling of a fresh set of sheets or the smell of a newly laundered towel?

    Why you should wash towels more often

    When you dry yourself, you deposit thousands of skin cells and millions of microbes onto the towel. And because you use your towel to dry yourself after a shower or bath, your towel is regularly damp.

    You also deposit a hefty amount of dead skin, microbes, sweat and oils onto your sheets every night. But unless you’re a prolific night sweater, your bedding doesn’t get wet after a night’s sleep.

    Towels are also made of a thicker material than sheets and therefore tend to stay damp for longer.

    So what is it about the dampness that causes a problem? Wet towels are a breeding ground for bacteria and moulds. Moulds especially love damp environments. Although mould won’t necessarily be visible (you would need significant growth to be able to see it) this can lead to an unpleasant smell.

    As well as odours, exposure to these microbes in your towels and sheets can cause asthma, allergic skin irritations, or other skin infections.

    A couple changing the sheets on their bed.
    People don’t always agree on how often to change the sheets.
    http://rawpixel.com/Shutterstock

    So what’s the ideal frequency?

    For bedding, it really depends on factors such as whether you have a bath or shower just before going to bed, or if you fall into bed after a long, sweaty day and have your shower in the morning. You will need to wash your sheets more regularly in the latter case. As a rule of thumb, once a week or every two weeks should be fine.

    Towels should ideally be washed more regularly – perhaps every few days – while your facecloth should be cleaned after every use. Because it gets completely wet, it will be wet for a longer time, and retain more skin cells and microbes.

    Wash your towels at a high temperature (for example, 65°C) as that will kill many microbes. If you are conscious of saving energy, you can use a lower temperature and add a cup of vinegar to the wash. The vinegar will kill microbes and prevent bad smells from developing.

    Clean your washing machine regularly and dry the fold in the rubber after every wash, as this is another place microbes like to grow.

    Smelly towels

    What if you regularly wash your towels, but they still smell bad? One of the reasons for this pong could be that you’ve left them in the washing machine too long after the wash. Especially if it was a warm wash cycle, the time they’re warm and damp will allow microbes to happily grow. Under lab conditions the number of these bacteria can double every 30 minutes.

    It’s important to hang your towel out to dry after use and not to leave towels in the washing machine after the cycle has finished. If possible, hang your towels and bedding out in the sun. That will dry them quickly and thoroughly and will foster that lovely fresh, clean cotton smell. Using a dryer is a good alternative if the weather is bad, but outdoors in the sun is always better if possible.

    Also, even if your towel is going to be washed, don’t throw a wet towel into the laundry basket, as the damp, dirty towel will be an ideal place for microbes to breed. By the time you get to doing your washing, the towel and the other laundry around it may have acquired a bad smell. And it can be difficult to get your towels smelling fresh again.

    A young woman loading a washing machine.
    Towels should be washed more often than sheets.
    New Africa/Shutterstock

    What about ‘self-cleaning’ sheets and towels?

    Some companies sell “quick-dry” towels or “self-cleaning” towels and bedding. Quick-dry towels are made from synthetic materials that are weaved in a way to allow them to dry quickly. This would help prevent the growth of microbes and the bad smells that develop when towels are damp for long periods of time.

    But the notion of self-cleaning products is more complicated. Most of these products contain nanosilver or copper, antibacterial metals that kill micro-organisms. The antibacterial compounds will stop the growth of bacteria and can be useful to limit smells and reduce the frequency with which you need to clean your sheets and towels.

    However, they’re not going to remove dirt like oils, skin flakes and sweat. So as much as I would love the idea of sheets and towels that clean themselves, that’s not exactly what happens.

    Also, excessive use of antimicrobials such as nanosilver can lead to microbes becoming resistant to them.The Conversation

    Rietie Venter, Associate professor, Clinical and Health Sciences, University of South Australia

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

    Don’t Forget…

    Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

    Learn to Age Gracefully

    Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:

  • Increase in online ADHD diagnoses for kids poses ethical questions

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    In 2020, in the midst of a pandemic, clinical protocols were altered for Ontario health clinics, allowing them to perform more types of care virtually. This included ADHD assessments and ADHD prescriptions for children – services that previously had been restricted to in-person appointments. But while other restrictions on virtual care are back, clinics are still allowed to virtually assess children for ADHD.

    This shift has allowed for more and quicker diagnoses – though not covered by provincial insurance (OHIP) – via a host of newly emerging private, for-profit clinics. However, it also has raised significant ethical questions.

    It solves an equity issue in terms of rural access to timely assessments, but does it also create new equity issues as a privatized service?

    Is it even feasible to diagnose a child for a condition like ADHD without meeting that child in person?

    And as rates of ADHD diagnosis continue to rise, should health regulators re-examine the virtual care approach?

    Ontario: More prescriptions, less regulation

    There are numerous for-profit clinics offering virtual diagnoses and prescriptions for childhood ADHD in Ontario. These include KixCare, which does not offer the option of an in-person assessment. Another clinic, Springboard, makes virtual appointments available within days, charging around $2,600 for assessments, which take three to four hours. The clinic offers coaching and therapy at an additional cost, also not covered by OHIP. Families can choose to continue to visit the clinic virtually during a trial stage with medications, prescribed by a doctor in the clinic who then sends prescribing information back to the child’s primary care provider.

    For-profit clinics like these are departing from Canada’s traditional single-payer health care model. By charging patients out-of-pocket fees for services, the clinics are able to generate more revenue because they are working outside of the billing standards for OHIP, standards that set limits on the maximum amount doctors can earn for providing specific services. Instead many services are provided by non-physician providers, who are not limited by OHIP in the same way.

    Need for safeguards

    ADHD prescriptions rose during the pandemic in Ontario, with women, people of higher income and those aged 20 to 24 receiving the most new diagnoses, according to research published in January 2024 by a team including researchers from the Centre for Addictions and Mental Health and Holland Bloorview Children’s Hospital. There may be numerous reasons for this increase but could the move to virtual care have been a factor?

    Ontario psychiatrist Javeed Sukhera, who treats both children and adults in Canada and the U.S., says virtual assessments can work for youth with ADHD, who may receive treatment quicker if they live in remote areas. However, he is concerned that as health care becomes more privatized, it will lead to exploitation and over-diagnosis of certain conditions.

    “There have been a lot of profiteers who have tried to capitalize on people’s needs and I think this is very dangerous,” he said. “In some settings, profiteering companies have set up systems to offer ADHD assessments that are almost always substandard. This is different from not-for-profit setups that adhere to quality standards and regulatory mechanisms.”

    Sukhera’s concerns recall the case of Cerebral Inc., a New York state-based virtual care company founded in 2020 that marketed on social media platforms including Instagram and TikTok. Cerebral offered online prescriptions for ADHD drugs among other services and boasted more than 200,000 patients. But as Dani Blum reported in the New York Times, Cerebral was accused in 2023 of pressuring doctors on staff to prescribe stimulants and faced an investigation by state prosecutors into whether it violated the U.S. Controlled Substances Act.

    “At the start of the pandemic, regulators relaxed rules around medical prescription of controlled substances,” wrote Blum. “Those changes opened the door for companies to prescribe and market drugs without the protocols that can accompany an in-person visit.”

    Access increased – but is it equitable?

    Virtual care has been a necessity in rural areas in Ontario since well before the pandemic, although ADHD assessments for children were restricted to in-person appointments prior to 2020.

    But ADHD assessment clinics that charge families out-of-pocket for services are only accessible to people with higher incomes. Rural families, many of whom are low income, are unable to afford thousands for private assessments, let alone the other services upsold by providers. If the private clinic/virtual care trend continues to grow unchecked, it may also attract doctors away from the public model of care since they can bill more for services. This could further aggravate the gap in care that lower income people already experience.

    This could further aggravate the gap in care that lower income people already experience.

    Sukhera says some risks could be addressed by instituting OHIP coverage for services at private clinics (similar to private surgical facilities that offer mixed private/public coverage), but also with safeguards to ensure that profits are reinvested back into the health-care system.

    “This would be especially useful for folks who do not have the income, the means to pay out of pocket,” he said.

    Concerns of misdiagnosis and over-prescription

    Some for-profit companies also benefit financially from diagnosing and issuing prescriptions, as has been suggested in the Cerebral case. If it is cheaper for a clinic to do shorter, virtual appointments and they are also motivated to diagnose and prescribe more, then controls need to be put in place to prevent misdiagnosis.

    The problem of misdiagnosis may also be related to the nature of ADHD assessments themselves. University of Strathclyde professor Matthew Smith, author of Hyperactive: The Controversial History of ADHD, notes that since the publication of Diagnostic and Statistical Manual of Mental Disorders in 1980, assessment has typically involved a few hours of parents and patients providing their subjective perspectives on how they experience time, tasks and the world around them.

    “It’s often a box-ticking exercise, rather than really learning about the context in which these behaviours exist,” Smith said. “The tendency has been to use a list of yes/no questions which – if enough are answered in the affirmative – lead to a diagnosis. When this is done online or via Zoom, there is even less opportunity to understand the context surrounding behaviour.”

    Smith cited a 2023 BBC investigation in which reporter Rory Carson booked an in-person ADHD assessment at a clinic and was found not to have the condition, then had a private online assessment – from a provider on her couch in a tracksuit – and was diagnosed with ADHD after just 45 minutes, for a fee of £685.

    What do patients want?

    If Canadian regulators can effectively tackle the issue of privatization and the risk of misdiagnosis, there is still another hurdle: not every youth is willing to take part in virtual care.

    Jennifer Reesman, a therapist and Training Director for Neuropsychology at the Chesapeake Center for ADHD, Learning & Behavioural Health in Maryland, echoed Sukhera’s concerns about substandard care, cautioning that virtual care is not suitable for some of her young clients who had poor experiences with online education and resist online health care. It can be an emotional issue for pediatric patients who are managing their feelings about the pandemic experience.

    “We need to respect what their needs are, not just the needs of the provider,” says Reesman.

    In 2020, Ontario opted for virtual care based on the capacity of our health system in a pandemic. Today, with a shortage of doctors, we are still in a crisis of capacity. The success of virtual care may rest on how engaged regulators are with equity issues, such as waitlists and access to care for rural dwellers, and how they resolve ethical problems around standards of care.

    Children and youth are a distinct category, which is why we had restrictions on virtual ADHD diagnosis prior to the pandemic. A question remains, then: If we could snap our fingers and have the capacity to provide in-person ADHD care for all children, would we? If the answer to that question is yes, then how can we begin to build our capacity?

    This article is republished from healthydebate under a Creative Commons license. Read the original article.

    Don’t Forget…

    Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

    Learn to Age Gracefully

    Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:

  • Is stress turning my hair grey?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    When we start to go grey depends a lot on genetics.

    Your first grey hairs usually appear anywhere between your twenties and fifties. For men, grey hairs normally start at the temples and sideburns. Women tend to start greying on the hairline, especially at the front.

    The most rapid greying usually happens between ages 50 and 60. But does anything we do speed up the process? And is there anything we can do to slow it down?

    You’ve probably heard that plucking, dyeing and stress can make your hair go grey – and that redheads don’t. Here’s what the science says.

    Oksana Klymenko/Shutterstock

    What gives hair its colour?

    Each strand of hair is produced by a hair follicle, a tunnel-like opening in your skin. Follicles contain two different kinds of stem cells:

    • keratinocytes, which produce keratin, the protein that makes and regenerates hair strands
    • melanocytes, which produce melanin, the pigment that colours your hair and skin.

    There are two main types of melanin that determine hair colour. Eumelanin is a black-brown pigment and pheomelanin is a red-yellow pigment.

    The amount of the different pigments determines hair colour. Black and brown hair has mostly eumelanin, red hair has the most pheomelanin, and blonde hair has just a small amount of both.

    So what makes our hair turn grey?

    As we age, it’s normal for cells to become less active. In the hair follicle, this means stem cells produce less melanin – turning our hair grey – and less keratin, causing hair thinning and loss.

    As less melanin is produced, there is less pigment to give the hair its colour. Grey hair has very little melanin, while white hair has none left.

    Unpigmented hair looks grey, white or silver because light reflects off the keratin, which is pale yellow.

    Grey hair is thicker, coarser and stiffer than hair with pigment. This is because the shape of the hair follicle becomes irregular as the stem cells change with age.

    Interestingly, grey hair also grows faster than pigmented hair, but it uses more energy in the process.

    Can stress turn our hair grey?

    Yes, stress can cause your hair to turn grey. This happens when oxidative stress damages hair follicles and stem cells and stops them producing melanin.

    Oxidative stress is an imbalance of too many damaging free radical chemicals and not enough protective antioxidant chemicals in the body. It can be caused by psychological or emotional stress as well as autoimmune diseases.

    Environmental factors such as exposure to UV and pollution, as well as smoking and some drugs, can also play a role.

    Melanocytes are more susceptible to damage than keratinocytes because of the complex steps in melanin production. This explains why ageing and stress usually cause hair greying before hair loss.

    Scientists have been able to link less pigmented sections of a hair strand to stressful events in a person’s life. In younger people, whose stems cells still produced melanin, colour returned to the hair after the stressful event passed.

    4 popular ideas about grey hair – and what science says

    1. Does plucking a grey hair make more grow back in its place?

    No. When you pluck a hair, you might notice a small bulb at the end that was attached to your scalp. This is the root. It grows from the hair follicle.

    Plucking a hair pulls the root out of the follicle. But the follicle itself is the opening in your skin and can’t be plucked out. Each hair follicle can only grow a single hair.

    It’s possible frequent plucking could make your hair grey earlier, if the cells that produce melanin are damaged or exhausted from too much regrowth.

    2. Can my hair can turn grey overnight?

    Legend says Marie Antoinette’s hair went completely white the night before the French queen faced the guillotine – but this is a myth.

    Painted portrait of Marie Antoinette with elaborate grey hairstyle.
    It is not possible for hair to turn grey overnight, as in the legend about Marie Antoinette. Yann Caradec/Wikimedia, CC BY-NC-SA

    Melanin in hair strands is chemically stable, meaning it can’t transform instantly.

    Acute psychological stress does rapidly deplete melanocyte stem cells in mice. But the effect doesn’t show up immediately. Instead, grey hair becomes visible as the strand grows – at a rate of about 1 cm per month.

    Not all hair is in the growing phase at any one time, meaning it can’t all go grey at the same time.

    3. Will dyeing make my hair go grey faster?

    This depends on the dye.

    Temporary and semi-permanent dyes should not cause early greying because they just coat the hair strand without changing its structure. But permanent products cause a chemical reaction with the hair, using an oxidising agent such as hydrogen peroxide.

    Accumulation of hydrogen peroxide and other hair dye chemicals in the hair follicle can damage melanocytes and keratinocytes, which can cause greying and hair loss.

    4. Is it true redheads don’t go grey?

    People with red hair also lose melanin as they age, but differently to those with black or brown hair.

    This is because the red-yellow and black-brown pigments are chemically different.

    Producing the brown-black pigment eumelanin is more complex and takes more energy, making it more susceptible to damage.

    Producing the red-yellow pigment (pheomelanin) causes less oxidative stress, and is more simple. This means it is easier for stem cells to continue to produce pheomelanin, even as they reduce their activity with ageing.

    With ageing, red hair tends to fade into strawberry blonde and silvery-white. Grey colour is due to less eumelanin activity, so is more common in those with black and brown hair.

    Your genetics determine when you’ll start going grey. But you may be able to avoid premature greying by staying healthy, reducing stress and avoiding smoking, too much alcohol and UV exposure.

    Eating a healthy diet may also help because vitamin B12, copper, iron, calcium and zinc all influence melanin production and hair pigmentation.

    Theresa Larkin, Associate Professor of Medical Sciences, University of Wollongong

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

    Don’t Forget…

    Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

    Learn to Age Gracefully

    Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails: