Women want to see the same health provider during pregnancy, birth and beyond

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Hazel Keedle, Western Sydney University and Hannah Dahlen, Western Sydney University

In theory, pregnant women in Australia can choose the type of health provider they see during pregnancy, labour and after they give birth. But this is often dependent on where you live and how much you can afford in out-of-pocket costs.

While standard public hospital care is the most common in Australia, accounting for 40.9% of births, the other main options are:

  • GP shared care, where the woman sees her GP for some appointments (15% of births)
  • midwifery continuity of care in the public system, often called midwifery group practice or caseload care, where the woman sees the same midwife of team of midwives (14%)
  • private obstetrician care (10.6%)
  • private midwifery care (1.9%).

Given the choice, which model would women prefer?

Our new research, published BMC Pregnancy and Childbirth, found women favoured seeing the same health provider throughout pregnancy, in labour and after they have their baby – whether that’s via midwifery group practice, a private midwife or a private obstetrician.

Assessing strengths and limitations

We surveyed 8,804 Australian women for the Birth Experience Study (BESt) and 2,909 provided additional comments about their model of maternity care. The respondents were representative of state and territory population breakdowns, however fewer respondents were First Nations or from culturally or linguistically diverse backgrounds.

We analysed these comments in six categories – standard maternity care, high-risk maternity care, GP shared care, midwifery group practice, private obstetric care and private midwifery care – based on the perceived strengths and limitations for each model of care.

Overall, we found models of care that were fragmented and didn’t provide continuity through the pregnancy, birth and postnatal period (standard care, high risk care and GP shared care) were more likely to be described negatively, with more comments about limitations than strengths.

What women thought of standard maternity care in hospitals

Women who experienced standard maternity care, where they saw many different health care providers, were disappointed about having to retell their story at every appointment and said they would have preferred continuity of midwifery care.

Positive comments about this model of care were often about a midwife or doctor who went above and beyond and gave extra care within the constraints of a fragmented system.

The model of care with the highest number of comments about limitations was high-risk maternity care. For women with pregnancy complications who have their baby in the public system, this means seeing different doctors on different days.

Some respondents received conflicting advice from different doctors, and said the focus was on their complications instead of their pregnancy journey. One woman in high-risk care noted:

The experience was very impersonal, their focus was my cervix, not preparing me for birth.

Why women favoured continuity of care

Overall, there were more positive comments about models of care that provided continuity of care: private midwifery care, private obstetric care and midwifery group practice in public hospitals.

Women recognised the benefits of continuity and how this included informed decision-making and supported their choices.

The model of care with the highest number of positive comments was care from a privately practising midwife. Women felt they received the “gold standard of maternity care” when they had this model. One woman described her care as:

Extremely personable! Home visits were like having tea with a friend but very professional. Her knowledge and empathy made me feel safe and protected. She respected all of my decisions. She reminded me often that I didn’t need her help when it came to birthing my child, but she was there if I wanted it (or did need it).

However, this is a private model of care and women need to pay for it. So there are barriers in accessing this model of care due to the cost and the small numbers working in Australia, particularly in regional, rural and remote areas, among other barriers.

Women who had private obstetricians were also positive about their care, especially among women with medical or pregnancy complications – this type of care had the second-highest number of positive comments.

This was followed by women who had continuity of care from midwives in the public system, which was described as respectful and supportive.

However, one of the limitations about continuity models of care is when the woman doesn’t feel connected to her midwife or doctor. Some women who experienced this wished they had the opportunity to choose a different midwife or doctor.

What about shared care with a GP?

While shared care between the GP and hospital model of care is widely promoted in the public maternity care system as providing continuity, it had a similar number of negative comments to those who had fragmented standard hospital care.

Considering there is strong evidence about the benefits of midwifery continuity of care, and this model of care appears to be most acceptable to women, it’s time to expand access so all Australian women can access continuity of care, regardless of their location or ability to pay.

Hazel Keedle, Senior Lecturer of Midwifery, Western Sydney University and Hannah Dahlen, Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline Leader, Western Sydney University

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

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  • Wasting Your Vitamins?

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    Are you flushing away your vitamins?

    Most likely…but you don’t have to.

    We all know what a wasteful expense supplements can sometimes be, but you can optimise your intake to get more bang for your buck!

    Top Tips for Getting Your Money’s Worth:

    1. Liquids are better than tablets—the body can’t absorb nutrients from tablets anywhere as easily as it can from liquids, with some saying as low as a 50% absorption rate for tablets, so if your supplement can come in drinkable form, take it that way!
    2. Capsules are better than tablets—capsules, depending on the kind, contain either a powder (true capsules) or a liquid (softgels). Once the capsule/softgel is broken down in the stomach, it releases its contents, which will now be absorbed as though you took it as a drink.
    3. Stay hydrated—on that note, your body can only make use of nutrients that it can easily transport, and if you’re dehydrated, the process is sluggish! Having a big glass of water with your supplements will go a long way to helping your body get them where they’re needed.
    4. Take with black pepper—studies disagree on exactly how much black pepper improves absorption of nutrients. Some say it improves it by 50%, others say as much as 7x better. The truth is probably that it varies from one nutrient to the next, but what is (almost) universally accepted is that black pepper helps you absorb many nutrients you take orally.
    5. Take with a meal—bonus if you seasoned it with black pepper! But also: many nutrients are best absorbed alongside food, and many are specifically fat-soluble (so you want to take a little fat around the same time for maximum absorption)
    6. Consider split doses—a lot of nutrients are best absorbed when spread out a bit. Why? Your body can often only absorb so much at once, and what it couldn’t absorb can, depending on the nutrient, pass right through you. So better to space out the doses—breakfast and dinner make for great times to take them.
    7. Consider cycling—no, not the two-wheeled kind, though feel free to do that too! What cycling means when it comes to supplements is to understand that your body can build a tolerance to some supplements, so you’ll get gradually less effect for the same dose. Combat this by scheduling a break—five days on, two days off is a common schedule—allowing your body to optimise itself in the process!
    8. Check Medications—and, as is always safe, make sure you check whether any medications you take can interrupt your supplement absorption!

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  • Sea Salt vs MSG – Which is Healthier?

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    Our Verdict

    When comparing sea salt to MSG, we picked the MSG.

    Why?

    Surprise! Or maybe not? The results of the poll for this one should be interesting, and will help us know whether we need to keep mentioning in every second recipe that MSG is a healthier alternative to salt.

    First of all, two things:

    • Don’t be fooled by their respective names, and/or with such, an appeal to naturalism. For example, hydroxybenzoic acids are a major group of beneficial phenolic compounds, whereas hemlock is a wildflower that grows in this writer’s garden and will kill you if you eat it. Actually hydroxybenzoic acids also grow here (on the apple tree), but that’s not the point. The point is: worry less about names, and more about evidence!
    • Don’t be fooled by the packaging. A lot of products go for “greenwashing” of one kind or another. You’re not eating the packaging (hopefully), so don’t be swayed by a graphic designer’s implementation of a marketing team’s aesthetic choices.

    If naturalism is for some reason very important to you though, do bear in mind that glutamates occur generously in many common foodstuffs (tomatoes are a fine, healthy example) and eating tomato in the presence of salt will have the same biochemical effect as eating MSG, because it’s the same chemicals.

    Since there are bad rumors about MSG’s safety, especially in the US where there is often a strong distrust of anything associated with China (actually MSG was first isolated in Japan, more than 100 years ago, by Japanese biochemist Dr. Kikunae Ikeda, but that gets drowned out by the “Chinese Restaurant Syndrome” fear in the US), know that this has resulted in MSG being one of the most-studied food additives in the last 40 years or so, with many teams of scientists trying to determine its risks and not finding any (aside from the same that could be said of any substance; anything in sufficient excess will kill you, including water or oxygen).

    Well, that’s all been about safety, but what makes it healthier than sea salt?

    Simply, it has about ⅓ of the sodium content, that’s all. So, if you are laboring all day in a field under the hot summer sun, then probably the sea salt will be healthier, to replenish more of the sodium you lost through sweat. But for most people most of the time, having less sodium rather than more is the healthier option.

    Want to learn more?

    You might like to read:

    Take care!

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  • Military Secrets (Ssh!)

    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.

    Can you keep a secret?

    When actor Christopher Lee was asked about his time as a British special forces operative, he would look furtively around, and ask “can you keep a secret?” Upon getting a yes, he would reply:

    “So can I”

    We can’t, though! We just can’t help sharing cool, useful information that changes people’s lives. Never is that more critical than now, as the end of January has been called the most depressing time of year, according to Dr. Cliff Arnall at the University of Cardiff. It doesn’t have to be all doom and gloom, though:

    Today we’re going to share a trick… It’s called the “secret of eternal happiness” (yes, we know… we didn’t come up with the name!) and is taught to soldiers to fend off the worst kinds of despair.

    The soldiers would be ordered to take a moment to reflect on the sheer helplessness of their situation, the ridiculous impossibility of the odds against them, all and any physical pain they might suffer, the weakness of their faltering body… and just when everything feels as bad is it can possibly feel, they’re told to say out loud—as sadly as possible—this single word:

    “Boop”

    It all but guarantees to result in cracking a smile, no matter the situation.

    Now this knowledge is yours too! Keep it secret! Or don’t. Sharing is caring.

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  • Top 5 Foods Seniors Should Eat To Sleep Better Tonight (And 5 To Avoid)

    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.

    Dr. Michael Breus, a sleep specialist, advises:

    A prescription for rest

    Dr. Breus’s top 5 foods to eat for a good night’s sleep are:

    1) Chia seeds: high in fiber, protein, omega-3s, calcium, magnesium, phosphorus, and tryptophan, they help raise melatonin levels for better sleep. The high fiber content also reduces late-night snacking, and in any case, it’s recommended to eat them 2–3 hours before bed. As for how, they can be added to smoothies, baked goods, salads, or made into chia seed pudding.

    2) Nuts (especially pistachios & almonds): both of these nuts are rich in B vitamins and melatonin, so take your pick! He does recommend, however, no more than ¼ cup about 1.5 hours before bed. Either can be eaten as-is or with an unsweetened Greek yogurt.

    3) Bananas (especially banana tea): contain magnesium, especially in the peel. Boil an organic banana (with peel) in water and drink the water, which provides magnesium and helps improve sleep. It’s recommended to drink it about an hour before bed.

    10almonds tip: he doesn’t mention this, but if you prefer, you can also simply eat it—banana peel is perfectly edible, and is not tough when cooked. If you’ve ever had plantains, you’ll know how they are, and bananas (and their peel) are much softer than plantains. Boiling is fine, or alternatively you can wrap them in foil and bake them. The traditional way is to cook them in the leaves, but chances are you live somewhere that doesn’t grow bananas locally and so they didn’t come with leaves, so foil is fine.

    4) Tart cherries: are rich in melatonin, antioxidants, and other anti-inflammatory compounds, which all help with falling asleep faster and reducing night awakenings. Can be consumed as juice, dried fruit, or tart cherry extract capsules. Suggested intake: once in the morning and once an hour before bed.

    5) Kiwis: are high in serotonin, which aids melatonin production and sleep. This also helps regulate cortisol levels (lower cortisol promotes sleep). He recommends eating kiwi fruit about 2 hours before bed.

    Also, in the category of foods (or rather: food types) to avoid before bed…

    1. High quantities of red meat: can disrupt sleep-related amino acid balance.
    2. Acidic foods: can cause acid reflux.
    3. High sugar foods: can slow melatonin production when consumed in the evening.
    4. Caffeine-rich foods & drinks: includes chocolate and coffee; avoid in the evening.
    5. Large meals before bed: digestion is less efficient when lying down, causing sleep disruption.

    For more on all of these, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like to read:

    Calculate (And Enjoy) The Perfect Night’s Sleep ← Our “Expert Insights” main feature on Dr. Breus

    Take care!

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  • How do science journalists decide whether a psychology study is worth covering?

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    Complex research papers and data flood academic journals daily, and science journalists play a pivotal role in disseminating that information to the public. This can be a daunting task, requiring a keen understanding of the subject matter and the ability to translate dense academic language into narratives that resonate with the general public.

    Several resources and tip sheets, including the Know Your Research section here at The Journalist’s Resource, aim to help journalists hone their skills in reporting on academic research.

    But what factors do science journalists look for to decide whether a social science research study is trustworthy and newsworthy? That’s the question researchers at the University of California, Davis, and the University of Melbourne in Australia examine in a recent study, “How Do Science Journalists Evaluate Psychology Research?” published in September in Advances in Methods and Practices in Psychological Science.

    Their online survey of 181 mostly U.S.-based science journalists looked at how and whether they were influenced by four factors in fictitious research summaries: the sample size (number of participants in the study), sample representativeness (whether the participants in the study were from a convenience sample or a more representative sample), the statistical significance level of the result (just barely statistically significant or well below the significance threshold), and the prestige of a researcher’s university.

    The researchers found that sample size was the only factor that had a robust influence on journalists’ ratings of how trustworthy and newsworthy a study finding was.

    University prestige had no effect, while the effects of sample representativeness and statistical significance were inconclusive.

    But there’s nuance to the findings, the authors note.

    “I don’t want people to think that science journalists aren’t paying attention to other things, and are only paying attention to sample size,” says Julia Bottesini, an independent researcher, a recent Ph.D. graduate from the Psychology Department at UC Davis, and the first author of the study.

    Overall, the results show that “these journalists are doing a very decent job” vetting research findings, Bottesini says.

    Also, the findings from the study are not generalizable to all science journalists or other fields of research, the authors note.

    “Instead, our conclusions should be circumscribed to U.S.-based science journalists who are at least somewhat familiar with the statistical and replication challenges facing science,” they write. (Over the past decade a series of projects have found that the results of many studies in psychology and other fields can’t be reproduced, leading to what has been called a ‘replication crisis.’)

    “This [study] is just one tiny brick in the wall and I hope other people get excited about this topic and do more research on it,” Bottesini says.

    More on the study’s findings

    The study’s findings can be useful for researchers who want to better understand how science journalists read their research and what kind of intervention — such as teaching journalists about statistics — can help journalists better understand research papers.

    “As an academic, I take away the idea that journalists are a great population to try to study because they’re doing something really important and it’s important to know more about what they’re doing,” says Ellen Peters, director of Center for Science Communication Research at the School of Journalism and Communication at the University of Oregon. Peters, who was not involved in the study, is also a psychologist who studies human judgment and decision-making.

    Peters says the study was “overall terrific.” She adds that understanding how journalists do their work “is an incredibly important thing to do because journalists are who reach the majority of the U.S. with science news, so understanding how they’re reading some of our scientific studies and then choosing whether to write about them or not is important.”

    The study, conducted between December 2020 and March 2021, is based on an online survey of journalists who said they at least sometimes covered science or other topics related to health, medicine, psychology, social sciences, or well-being. They were offered a $25 Amazon gift card as compensation.

    Among the participants, 77% were women, 19% were men, 3% were nonbinary and 1% preferred not to say. About 62% said they had studied physical or natural sciences at the undergraduate level, and 24% at the graduate level. Also, 48% reported having a journalism degree. The study did not include the journalists’ news reporting experience level.

    Participants were recruited through the professional network of Christie Aschwanden, an independent journalist and consultant on the study, which could be a source of bias, the authors note.

    “Although the size of the sample we obtained (N = 181) suggests we were able to collect a range of perspectives, we suspect this sample is biased by an ‘Aschwanden effect’: that science journalists in the same professional network as C. Aschwanden will be more familiar with issues related to the replication crisis in psychology and subsequent methodological reform, a topic C. Aschwanden has covered extensively in her work,” they write.

    Participants were randomly presented with eight of 22 one-paragraph fictitious social and personality psychology research summaries with fictitious authors. The summaries are posted on Open Science Framework, a free and open-source project management tool for researchers by the Center for Open Science, with a mission to increase openness, integrity and reproducibility of research.

    For instance, one of the vignettes reads:

    “Scientists at Harvard University announced today the results of a study exploring whether introspection can improve cooperation. 550 undergraduates at the university were randomly assigned to either do a breathing exercise or reflect on a series of questions designed to promote introspective thoughts for 5 minutes. Participants then engaged in a cooperative decision-making game, where cooperation resulted in better outcomes. People who spent time on introspection performed significantly better at these cooperative games (t (548) = 3.21, p = 0.001). ‘Introspection seems to promote better cooperation between people,’ says Dr. Quinn, the lead author on the paper.”

    In addition to answering multiple-choice survey questions, participants were given the opportunity to answer open-ended questions, such as “What characteristics do you [typically] consider when evaluating the trustworthiness of a scientific finding?”

    Bottesini says those responses illuminated how science journalists analyze a research study. Participants often mentioned the prestige of the journal in which it was published or whether the study had been peer-reviewed. Many also seemed to value experimental research designs over observational studies.

    Considering statistical significance

    When it came to considering p-values, “some answers suggested that journalists do take statistical significance into account, but only very few included explanations that suggested they made any distinction between higher or lower p values; instead, most mentions of p values suggest journalists focused on whether the key result was statistically significant,” the authors write.

    Also, many participants mentioned that it was very important to talk to outside experts or researchers in the same field to get a better understanding of the finding and whether it could be trusted, the authors write.

    “Journalists also expressed that it was important to understand who funded the study and whether the researchers or funders had any conflicts of interest,” they write.

    Participants also “indicated that making claims that were calibrated to the evidence was also important and expressed misgivings about studies for which the conclusions do not follow from the evidence,” the authors write.

    In response to the open-ended question, “What characteristics do you [typically] consider when evaluating the trustworthiness of a scientific finding?” some journalists wrote they checked whether the study was overstating conclusions or claims. Below are some of their written responses:

    • “Is the researcher adamant that this study of 40 college kids is representative? If so, that’s a red flag.”
    • “Whether authors make sweeping generalizations based on the study or take a more measured approach to sharing and promoting it.”
    • “Another major point for me is how ‘certain’ the scientists appear to be when commenting on their findings. If a researcher makes claims which I consider to be over-the-top about the validity or impact of their findings, I often won’t cover.”
    • “I also look at the difference between what an experiment actually shows versus the conclusion researchers draw from it — if there’s a big gap, that’s a huge red flag.”

    Peters says the study’s findings show that “not only are journalists smart, but they have also gone out of their way to get educated about things that should matter.”

    What other research shows about science journalists

    A 2023 study, published in the International Journal of Communication, based on an online survey of 82 U.S. science journalists, aims to understand what they know and think about open-access research, including peer-reviewed journals and articles that don’t have a paywall, and preprints. Data was collected between October 2021 and February 2022. Preprints are scientific studies that have yet to be peer-reviewed and are shared on open repositories such as medRxiv and bioRxiv. The study finds that its respondents “are aware of OA and related issues and make conscious decisions around which OA scholarly articles they use as sources.”

    A 2021 study, published in the Journal of Science Communication, looks at the impact of the COVID-19 pandemic on the work of science journalists. Based on an online survey of 633 science journalists from 77 countries, it finds that the pandemic somewhat brought scientists and science journalists closer together. “For most respondents, scientists were more available and more talkative,” the authors write. The pandemic has also provided an opportunity to explain the scientific process to the public, and remind them that “science is not a finished enterprise,” the authors write.

    More than a decade ago, a 2008 study, published in PLOS Medicine, and based on an analysis of 500 health news stories, found that “journalists usually fail to discuss costs, the quality of the evidence, the existence of alternative options, and the absolute magnitude of potential benefits and harms,” when reporting on research studies. Giving time to journalists to research and understand the studies, giving them space for publication and broadcasting of the stories, and training them in understanding academic research are some of the solutions to fill the gaps, writes Gary Schwitzer, the study author.

    Advice for journalists

    We asked Bottesini, Peters, Aschwanden and Tamar Wilner, a postdoctoral fellow at the University of Texas, who was not involved in the study, to share advice for journalists who cover research studies. Wilner is conducting a study on how journalism research informs the practice of journalism. Here are their tips:

    1. Examine the study before reporting it.

    Does the study claim match the evidence? “One thing that makes me trust the paper more is if their interpretation of the findings is very calibrated to the kind of evidence that they have,” says Bottesini. In other words, if the study makes a claim in its results that’s far-fetched, the authors should present a lot of evidence to back that claim.

    Not all surprising results are newsworthy. If you come across a surprising finding from a single study, Peters advises you to step back and remember Carl Sagan’s quote: “Extraordinary claims require extraordinary evidence.”

    How transparent are the authors about their data? For instance, are the authors posting information such as their data and the computer codes they use to analyze the data on platforms such as Open Science Framework, AsPredicted, or The Dataverse Project? Some researchers ‘preregister’ their studies, which means they share how they’re planning to analyze the data before they see them. “Transparency doesn’t automatically mean that a study is trustworthy,” but it gives others the chance to double-check the findings, Bottesini says.

    Look at the study design. Is it an experimental study or an observational study? Observational studies can show correlations but not causation.

    “Observational studies can be very important for suggesting hypotheses and pointing us towards relationships and associations,” Aschwanden says.

    Experimental studies can provide stronger evidence toward a cause, but journalists must still be cautious when reporting the results, she advises. “If we end up implying causality, then once it’s published and people see it, it can really take hold,” she says.

    Know the difference between preprints and peer-reviewed, published studies. Peer-reviewed papers tend to be of higher quality than those that are not peer-reviewed. Read our tip sheet on the difference between preprints and journal articles.

    Beware of predatory journals. Predatory journals are journals that “claim to be legitimate scholarly journals, but misrepresent their publishing practices,” according to a 2020 journal article, published in the journal Toxicologic Pathology,Predatory Journals: What They Are and How to Avoid Them.”

    2. Zoom in on data.

    Read the methods section of the study. The methods section of the study usually appears after the introduction and background section. “To me, the methods section is almost the most important part of any scientific paper,” says Aschwanden. “It’s amazing to me how often you read the design and the methods section, and anyone can see that it’s a flawed design. So just giving things a gut-level check can be really important.”

    What’s the sample size? Not all good studies have large numbers of participants but pay attention to the claims a study makes with a small sample size. “If you have a small sample, you calibrate your claims to the things you can tell about those people and don’t make big claims based on a little bit of evidence,” says Bottesini.

    But also remember that factors such as sample size and p-value are not “as clear cut as some journalists might assume,” says Wilner.

    How representative of a population is the study sample? “If the study has a non-representative sample of, say, undergraduate students, and they’re making claims about the general population, that’s kind of a red flag,” says Bottesini. Aschwanden points to the acronym WEIRD, which stands for “Western, Educated, Industrialized, Rich, and Democratic,” and is used to highlight a lack of diversity in a sample. Studies based on such samples may not be generalizable to the entire population, she says.

    Look at the p-value. Statistical significance is both confusing and controversial, but it’s important to consider. Read our tip sheet, “5 Things Journalists Need to Know About Statistical Significance,” to better understand it.

    3. Talk to scientists not involved in the study.

    If you’re not sure about the quality of a study, ask for help. “Talk to someone who is an expert in study design or statistics to make sure that [the study authors] use the appropriate statistics and that methods they use are appropriate because it’s amazing to me how often they’re not,” says Aschwanden.

    Get an opinion from an outside expert. It’s always a good idea to present the study to other researchers in the field, who have no conflicts of interest and are not involved in the research you’re covering and get their opinion. “Don’t take scientists at their word. Look into it. Ask other scientists, preferably the ones who don’t have a conflict of interest with the research,” says Bottesini.

    4. Remember that a single study is simply one piece of a growing body of evidence.

    “I have a general rule that a single study doesn’t tell us very much; it just gives us proof of concept,” says Peters. “It gives us interesting ideas. It should be retested. We need an accumulation of evidence.”

    Aschwanden says as a practice, she tries to avoid reporting stories about individual studies, with some exceptions such as very large, randomized controlled studies that have been underway for a long time and have a large number of participants. “I don’t want to say you never want to write a single-study story, but it always needs to be placed in the context of the rest of the evidence that we have available,” she says.

    Wilner advises journalists to spend some time looking at the scope of research on the study’s specific topic and learn how it has been written about and studied up to that point.

    “We would want science journalists to be reporting balance of evidence, and not focusing unduly on the findings that are just in front of them in a most recent study,” Wilner says. “And that’s a very difficult thing to as journalists to do because they’re being asked to make their article very newsy, so it’s a difficult balancing act, but we can try and push journalists to do more of that.”

    5. Remind readers that science is always changing.

    “Science is always two steps forward, one step back,” says Peters. Give the public a notion of uncertainty, she advises. “This is what we know today. It may change tomorrow, but this is the best science that we know of today.”

    Aschwanden echoes the sentiment. “All scientific results are provisional, and we need to keep that in mind,” she says. “It doesn’t mean that we can’t know anything, but it’s very important that we don’t overstate things.”

    Authors of a study published in PNAS in January analyzed more than 14,000 psychology papers and found that replication success rates differ widely by psychology subfields. That study also found that papers that could not be replicated received more initial press coverage than those that could. 

    The authors note that the media “plays a significant role in creating the public’s image of science and democratizing knowledge, but it is often incentivized to report on counterintuitive and eye-catching results.”

    Ideally, the news media would have a positive relationship with replication success rates in psychology, the authors of the PNAS study write. “Contrary to this ideal, however, we found a negative association between media coverage of a paper and the paper’s likelihood of replication success,” they write. “Therefore, deciding a paper’s merit based on its media coverage is unwise. It would be valuable for the media to remind the audience that new and novel scientific results are only food for thought before future replication confirms their robustness.”

    Additional reading

    Uncovering the Research Behaviors of Reporters: A Conceptual Framework for Information Literacy in Journalism
    Katerine E. Boss, et al. Journalism & Mass Communication Educator, October 2022.

    The Problem with Psychological Research in the Media
    Steven Stosny. Psychology Today, September 2022.

    Critically Evaluating Claims
    Megha Satyanarayana, The Open Notebook, January 2022.

    How Should Journalists Report a Scientific Study?
    Charles Binkley and Subramaniam Vincent. Markkula Center for Applied Ethics at Santa Clara University, September 2020.

    What Journalists Get Wrong About Social Science: Full Responses
    Brian Resnick. Vox, January 2016.

    From The Journalist’s Resource

    8 Ways Journalists Can Access Academic Research for Free

    5 Things Journalists Need to Know About Statistical Significance

    5 Common Research Designs: A Quick Primer for Journalists

    5 Tips for Using PubPeer to Investigate Scientific Research Errors and Misconduct

    Percent Change versus Percentage-Point Change: What’s the Difference? 4 Tips for Avoiding Math Errors

    What’s Standard Deviation? 4 Things Journalists Need to Know

    This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.

    Don’t Forget…

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  • HRT Side Effects & Troubleshooting

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    This is Dr. Heather Hirsch. She’s a board-certified internist, and her clinical expertise focuses on women’s health, particularly in midlife and menopause, and its intersection with chronic diseases (ranging from things associated with sexual health, to things like osteoporosis and heart disease).

    So, what does she want us to know?

    HRT can be life-changingly positive, but it can be a shaky start

    Hormone Replacement Therapy (HRT), and in this context she’s talking specifically about the most common kind, Menopausal Hormone Therapy (MHT), involves taking hormones that our body isn’t producing enough of.

    If these are “bioidentical hormones” as used in most of the industrialized world and increasingly also in N. America, then this is by definition a supplement rather than a drug, for what it’s worth, whereas some non-bioidentical hormones (or hormone analogs, which by definition function similarly to hormones but aren’t the same thing) can function more like drugs.

    We wrote a little about his previously:

    Hormone Replacement Therapy: A Tale Of Two Approaches

    For most people most of the time, bioidentical hormones are very much the best way to go, as they are not only more effective, but also have fewer side effects.

    That said, even bioidentical hormones can have some undesired effects, so, how to deal with those?

    Don’t worry; bleed happy

    A reprise of (usually quite light) menstrual bleeding is the most common side effect of menopausal HRT.

    This happens because estrogen affects* the uterus, leading to a build-up and shedding of the uterine lining.

    *if you do not have a uterus, estrogen can effect uterine tissue. That’s not a typo—here we mean the verb “effect”, as in “cause to be”. It will not grow a new uterus, but it can cause some clumps of uterine tissue to appear; this means that it becomes possible to get endometriosis without having a uterus. This information should not be too shocking, as endometriosis is a matter of uterine tissue growing inconveniently, often in places where it shouldn’t, and sometimes quite far from the uterus (if present, or its usual location, if absent). However, the risk of this happening is far lower than if you actually have a uterus:

    What you need to know about endometriosis

    Back to “you have a uterus and it’s making you wish you didn’t”:

    This bleeding should, however, be light. It’ll probably be oriented around a 28-day cycle even if you are taking your hormones at the same dose every day of the month, and the bleeding will probably taper off after about 6 months of this.

    If the bleeding is heavier, all the time, or persists longer than 6 months, then speak to your gynecologist about it. Any of those three; it doesn’t have to be all three!

    Bleeding outside of one’s normal cycle can be caused by anything from fibroids to cancer; statistically speaking it’s probably nothing too dire,but when your safety is in question, don’t bet on “probably”, and do get it checked out:

    When A Period Is Very Late (i.e., Post-Menopause)

    Dr. Hirsch recommends, as possible remedies to try (preferably under your gynecologist’s supervision):

    • lowering your estrogen dose
    • increasing your progesterone dose
    • taking progesterone continuously instead of cyclically

    And if you’re not taking progesterone, here’s why you might want to consider taking this important hormone that works with estrogen to do good things, and against estrogen to rein in some of estrogen’s less convenient things:

    Progesterone Menopausal HRT: When, Why, And How To Benefit

    (the above link contains, as well as textual information, an explanatory video from Dr. Hirsch herself)

    Get the best of the breast

    Calm your tits. Soothe your boobs. Destress your breasts. Hakuna your tatas. Undo the calamity beleaguering your mammaries.

    Ok, more seriously…

    Breast tenderness is another very common symptom when starting to take estrogen. It can worry a lot of people (à la “aagh, what is this and is it cancer!?”), but is usually nothing to worry about. But just to be sure, do also check out:

    Keeping Abreast Of Your Cancer Risk: How To Triple Your Breast Cancer Survival Chances

    Estrogen can cause feelings of breast fullness, soreness, nipple irritation, and sometimes lactation, but this later will be minimal—we’re talking a drop or two now and again, not anything that would feed a baby.

    Basically, it happens when your body hasn’t been so accustomed to normal estrogen levels in a while, and suddenly wakes up with a jolt, saying to itself “Wait what are we doing puberty again now? I thought we did menopause? Are we pregnant? What’s going on? Ok, checking all systems!” and then may calm down not too long afterwards when it notes that everything is more or less as it should be already.

    If this persists or is more than a minor inconvenience though, Dr. Hirsch recommends looking at the likely remedies of:

    • Adjust estrogen (usually the cause)
    • Adjust progesterone (less common)
    • If it’s progesterone, changing the route of administration can ameliorate things

    What if it’s not working? Is it just me?

    Dr. Hirsch advises the most common reasons are simply:

    • wrong formulation (e.g. animal-derived estrogen or hormone analog, instead of bioidentical)
    • wrong dose (e.g. too low)
    • wrong route of administration (e.g. oral vs transdermal; usually transdermal estradiol is most effective but many people do fine on oral; progesterone meanwhile is usually best as a pessary/suppository, but many people do fine on oral)

    Writer’s example: in 2022 there was an estrogen shortage in my country, and while I had been on transdermal estradiol hemihydrate gel, I had to go onto oral estradiol valerate tablets for a few months, because that’s what was available. And the tablets simply did not work for me at all. I felt terrible and I have a good enough intuitive sense of my hormones to know when “something wrong is not right”, and a good enough knowledge of the pharmacology & physiology to know what’s probably happening (or not happening). And sure enough, when I got my blood test results, it was as though I’d been taking nothing. It was such a relief to get back on the gel once it became available again!

    So, if something doesn’t seem to be working for you, speak up and get it fixed if at all possible.

    See also: What You Should Have Been Told About Menopause Beforehand

    Want to know more from Dr. Hirsch?

    You might like this book of hers, which we haven’t reviewed yet, but present here for your interest:

    Unlock Your Menopause Type: A Personalized Guide to Managing Your Menopausal Symptoms and Enhancing Your Health – by Dr. Heather Hirsch

    Enjoy!

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