Folic acid: Why scientists want it added to flour

Scientists hope folic acid in flour could lower the number of babies born with birth defects. via BBC News - Health Read More Here..

Can you freeze your body?

Arizona-based company Alcor offers cryonic preservation in the hope of reviving you in the future. via BBC News - Health Read More Here..

"The health system cannot sustain current rates of clinician burnout and continue to deliver safe, high-quality care". What to do?

From the NEJM:

More than half of U.S. physicians report significant symptoms of burnout — a rate more than twice that among professionals in other fields. Medical students and residents have higher rates of burnout and depression than their peers who are pursuing nonmedical careers. Physicians with symptoms of burnout are twice as likely to leave an organization as those without such symptoms

"The health system cannot sustain current rates of clinician burnout and continue to deliver safe, high-quality care". What to do?

Here are some examples (more reading available at the reference links below):

- To prevent burnout, Mayo Clinic has leadership-effectiveness scores for every division head and department chair.

- University of Colorado health uses medical assistants to set the agenda for patient visits and write the notes (almost 3 assistants per physician)

References:

http://bit.ly/2rFjlxx
http://bit.ly/2DFQ0sz

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Just promising NHS money 'not good enough'

More reform - not just extra money - is needed to ensure the NHS stays relevant, says Lord Darzi. via BBC News - Health Read More Here..

Amazon joins up with US firms to enter healthcare sector

Amazon, JP Morgan and Berkshire are looking at ways to subsidise healthcare costs for US employees. via BBC News - Health Read More Here..

Japanese woman sues government over forced sterilisation

A Japanese woman who was forcibly sterilised at 15 sues the government in the first case of its kind. via BBC News - Health Read More Here..

Stephen Hawking to take Hunt to court over NHS

A judicial review is granted over government health policy plans. via BBC News - Health Read More Here..

Vaginal mesh: England review into scale of harm

The audit will reveal how many women have suffered ill consequences from the controversial treatment. via BBC News - Health Read More Here..

Brain 'pacemaker' for Alzheimer's

Electrical brain stimulation may help dementia patients keep their independence for longer, scientists say. via BBC News - Health Read More Here..

Who, or what, defines you as a woman?

Why some feminists and trans activists are clashing over the way people legally change gender. via BBC News - Health Read More Here..

Hadiza Bawa-Garba: Medics rally behind struck off doctor

Thousands sign a letter criticising the case and more than £200,000 is raised for legal costs. via BBC News - Health Read More Here..

Tens of millions of prescription drugs on the black market

Criminal gangs smuggle 160 million tablets out of the UK's protected supply chain over three years. via BBC News - Health Read More Here..

Irish abortion referendum: Vote to be held in May

The May vote will decide whether to change the constitution to reform a near-total ban. via BBC News - Health Read More Here..

'Period ban is ruining my education'

Ghanaian schoolgirls have been banned from crossing a river to get to school while they are menstruating - and on Tuesdays. via BBC News - Health Read More Here..

Handheld device sequences human genome

Reading human DNA used to take laboratories, a pile of cash and a long time. via BBC News - Health Read More Here..

German shock at car exhaust tests on humans and monkeys

The government denounces "abominable" tests of diesel fumes on humans and monkeys. via BBC News - Health Read More Here..

High levels of antibiotic resistance found worldwide, new data shows

WHO’s first release of surveillance data on antibiotic resistance reveals high levels of resistance to a number of serious bacterial infections in both high- and low-income countries. via WHO news Read More Here..

Scientists discover how giardia parasite makes you ill

Giardia parasites mimic human cells to help bacteria feed off nutrients in the gut, a study says. via BBC News - Health Read More Here..

London Underground noise could damage hearing, says academic

A BBC investigation reveals parts of the Underground network exceed noise safety levels. via BBC News - Health Read More Here..

Stop prescribing 'precious' antibiotics for sore throats, GPs told

GPs should instead be recommending pain relief drugs like paracetamol, new guidelines say. via BBC News - Health Read More Here..

'I was addicted to pulling my hair out'

Megan Malone says it stopped her doing things she loved. via BBC News - Health Read More Here..

US flu outbreak is worst since 2009 swine pandemic

Thirty-seven children have died and nearly 12,000 patients been admitted to hospital nationwide. via BBC News - Health Read More Here..

Calls for mandatory health information on alcohol labels

The Royal Society for Public Health claims an "awareness vacuum" exists about the risks of alcohol. via BBC News - Health Read More Here..

Carer filmed slapping Kettering dementia patient

The 78-year-old is slapped and told she stinks by the carer, who was given a police caution. via BBC News - Health Read More Here..

Cure hope for Berkshire woman with vomiting condition

Rebecca Griffiths suffering from a debilitating syndrome may finally be about to get the cure she needs. via BBC News - Health Read More Here..

Dietary Supplements for Exercise and Athletic Performance

Source: National Institutes of Health, Office of Dietary Supplements -

via Exercise and Physical Fitness New Links: MedlinePlus RSS Feed Read More Here..

One cigarette a day 'increases heart disease and stroke risk'

Smoking even one cigarette a day increases the risk of heart disease and stroke, a study finds. via BBC News - Health Read More Here..

Why stress makes you fat

Dr Michael Mosley explores the link between stress and over-eating - and the best stress-busting techniques. via BBC News - Health Read More Here..

Charlotte's search

Charlotte Church finds groundbreaking brain imaging and psychoactive drugs could treat mental illness. via BBC News - Health Read More Here..

First monkey clones created in Chinese laboratory

Two monkeys have been cloned using the technique that produced Dolly the Sheep. via BBC News - Health Read More Here..

Theresa May urged to extend smear tests to under 25s

The prime minister says she will look at the rules and urges women not to avoid the tests. via BBC News - Health Read More Here..

Young people fear lack of job prospects

Young people share their worries, as a survey suggests youth confidence and happiness is declining. via BBC News - Health Read More Here..

Sugar tax: Drinks becoming pricier and in smaller bottles

Those who like a fizzy drink will soon be paying more to enjoy them, when the sugar tax comes into force in April this year. via BBC News - Health Read More Here..

Dr Carissa Etienne elected for a second term as WHO Regional Director for the Americas

The WHO Executive Board, currently holding its 142nd session in Geneva, has appointed Dr Carissa Etienne for a second term as Regional Director for the Americas of the World Health Organization (WHO). via WHO news Read More Here..

Asthma patients 'not receiving basic care'

Majority of patients do not get the basic care which could prevent two out of three asthma deaths via BBC News - Health Read More Here..

Catholic deacon accused of murder by air injection in Belgium

A Catholic deacon and former nurse is accused of at least 10 murders, using injections of air. via BBC News - Health Read More Here..

The good A&E forced to turn patients away

How a hospital with some of the best NHS waiting times ended up with patients waiting in corridors and queuing ambulances. via BBC News - Health Read More Here..

Backpack midwife

For many people in remote regions access to healthcare is limited, so tech is coming to their aid. via BBC News - Health Read More Here..

The key to digital media use and happiness is limited use: less than 1 hour per day plus exercise and real-life interaction

In a recent study, playing computer games, using social media, texting and video chatting were all associated with less happiness.

“The advent of the smartphone is the most plausible explanation for the sudden decrease in teens’ psychological well-being.”

The happiest teenagers were those who used digital media a little less than an hour a day.

The key to digital media use and happiness is limited use.

Here is the 2-step solution:

1. Aim to spend no more than one hour a day on digital media
2. Increase the amount of time you spend seeing friends face-to-face and exercising – two activities reliably linked to greater happiness

Prof Jean Twenge has made a whole career of this topic (http://www.psychology.sdsu.edu/people/jean-twenge). Here is a recent interview: Are smartphones making a generation unhappy?



References:

Teenage screen addicts lose out on happiness, study shows http://bit.ly/2rt9TNR

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What happens during a smear test?

Doctor Philippa Kaye talks us through what's involved during a cervical screening test. via BBC News - Health Read More Here..

Deadly experiment

Lamin Ceesay was lucky to survive when the Gambian president took away his drugs and tried to cure him with a paste of herbs. An unknown number died. via BBC News - Health Read More Here..

Embarrassment makes women avoid smear tests, charity says

Cervical cancer is the most common cancer in women under 35 but a majority are not aware of the risk. via BBC News - Health Read More Here..

Brazil declares yellow fever emergency in Minas Gerais

Minas Gerais is one of several southern states hit by an outbreak ahead of the carnival season. via BBC News - Health Read More Here..

Disabilities caused in babies by epilepsy drug a 'scandal'

It is thought 20,000 children have been left with disabilities caused by sodium valproate. via BBC News - Health Read More Here..

The Ilford woman who carries her heart in a rucksack

Selwa Hussain is the first woman in the UK to leave hospital with an artificial heart. via BBC News - Health Read More Here..

Boxer Bradley Smith: 'How anxiety nearly ruined me'

Bradley Smith, 20, from St Ives, people should talk more about mental health. via BBC News - Health Read More Here..

Persian shallot 'could help fight TB antibiotic resistance'

Properties in Persian shallots could boost the effects of antibiotic treatment, a study says. via BBC News - Health Read More Here..

Horse trampling woman's face rebuilt

Libby Keating's face was repaired by experts at St George's Hospital in Tooting. via BBC News - Health Read More Here..

'The infection took my nose and legs'

Oxford professor Liz Frood was fit and healthy until she was struck by what she thought was a stomach bug. via BBC News - Health Read More Here..

Cancer blood test ‘enormously exciting’

Scientists move nearer to one of the biggest goals in medicine - a universal blood test for cancer. via BBC News - Health Read More Here..

Should there be a right to die?

Two women explain their opposing views on the contentious right-to-die issue. via BBC News - Health Read More Here..

The choir helping people with dementia

"He comes alive when he's here." via BBC News - Health Read More Here..

Chemistry 'Van Gogh' could help with cancer

Scientists capture "incredible" images of instructions contained in DNA being read via BBC News - Health Read More Here..

Angelina Jolie gene testing for all?

Testing everyone for cancer risk genes would save lives and is cost effective say doctors. via BBC News - Health Read More Here..

Using cannabis helped ease 'frightening' tremors

A mother-of-two from Pembroke Dock wants to see cannabis legalised to help ease symptoms like hers. via BBC News - Health Read More Here..

How community spirit helps a girl with autism and severe anxiety

A scheme to let parents close their streets to cars so children can play is hugely beneficial to one young resident, who has autism and severe anxiety. via BBC News - Health Read More Here..

How nursing in the UK has changed

Nurses haven been an integral part of the NHS since its inception. Here they talk about what has changed. via BBC News - Health Read More Here..

Why are so many nurses quitting the NHS?

Why are so many nurses quitting the NHS? via BBC News - Health Read More Here..

In-person clinic visits are being replaced with virtual visits at a rapid pace

From the NEJM:

What if health care were designed so that in-person visits were the second, third, or even last option for meeting routine patient needs, rather than the first?

At Kaiser Permanente, 52% of 100 million patient encounters each year are now “virtual visits”. It spends 25% of its annual $3.8 billion budget on information technology.

"Payment models are an obvious barrier to deemphasizing in-person visits, but every provider’s business success depends on market share. The best way to win market share is to design and deliver better care, then modify the payment system to support it. Moreover, payment systems are already evolving to support nonvisit care. For example, use of bundled payment programs and accountable care organizations — which reward nontraditional care delivery models that reduce spending and meet patients’ needs — is growing."

Patients are increasingly asking, “Isn’t there a way to do this without my having to drive to your office?”

References:

In-Person Health Care as Option B — NEJM http://bit.ly/2ASHHTZ
NEJM Interview — In-Person Health Care as Option B http://bit.ly/2D8we8w
5% of patients account for 50% of healthcare costs http://bit.ly/2CVtvLR

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Cost legacy of decades-old NHS blunders begins to rise

Experts say maternity wards are still making the same "avoidable errors". via BBC News - Health Read More Here..

Employers urged to 'normalise' menopause in the workplace

A BBC survey found 70% of women did not tell their employers about their menopause symptoms. via BBC News - Health Read More Here..

Man ruptures throat by stifling a sneeze

Clamping your nose and mouth shut when you need to sneeze is dangerous, doctors warn the public. via BBC News - Health Read More Here..

Black Death 'spread by humans not rats'

Human body lice, rather than rat fleas, spread plague during the Black Death, a study simulating the outbreak suggests. via BBC News - Health Read More Here..

What does NHS compensation pay for?

The Hord family were given an £8m settlement after an NHS mistake. But what does it pay for? via BBC News - Health Read More Here..

What 'Beads of Courage' mean to young cancer patients

Children undergoing cancer treatment receive beads to document their journey and one mum wants to expand the scheme. via BBC News - Health Read More Here..

UK sends medics to halt Rohingya diphtheria outbreak

There have been 4,000 suspected cases of diphtheria in the overcrowded refugee camps and at least 31 deaths. via BBC News - Health Read More Here..

Smartphone and Social Media Use in Lectures Makes Your Learn Less

Several studies have shown that problematic smartphone use (PSU) is related to detrimental outcomes, such as:

- worse psychological well-being
- higher cognitive distraction
- poorer academic outcomes

Problematic smartphone use (PSU) is strongly related to social media use.

The study participants were 415 Estonian university students aged 19-46 years (79% females).

Problematic smartphone use (PSU) and the frequency of social media use in lectures were negatively correlated with a deep approach to learning (defined as learning for understanding) and positively correlated with a surface approach to learning (defined as superficial learning).

Mediation analysis showed that social media use in lectures completely mediates the relationship between PSU and approaches to learning. These results indicate that the frequency of social media use in lectures might explain the relationships between poorer academic outcomes and PSU.

References:

Problematic Smartphone Use, Deep and Surface Approaches to Learning, and Social Media Use in Lectures. Int J Environ Res Public Health. 2018 Jan 8;15(1). pii: E92. doi: 10.3390/ijerph15010092.
https://www.ncbi.nlm.nih.gov/pubmed/29316697?dopt=Abstract

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Coca-Cola to cut bottle size but increase price in face of sugar tax

Bottles of the famous fizzy drink will be smaller and more expensive from March onwards. via BBC News - Health Read More Here..

London's January air quality 'best in 10 years'

The capital has breached air pollution limits by 6 January every year since 2008. via BBC News - Health Read More Here..

'Being a teenage mother is so lonely'

New guidelines aim to cut UK teenage pregnancy rates which remain among the highest in Europe. via BBC News - Health Read More Here..

French salmonella baby milk scandal 'affects 83 countries'

The boss of French firm Lactalis says up to 12 million boxes of formula are now subject to a recall. via BBC News - Health Read More Here..

Sri Lanka's president rejects move to allow women to buy alcohol

The president overrules a government decision to let women buy alcohol for the first time in decades. via BBC News - Health Read More Here..

Weston's tribute to 'remarkable' Falklands surgeon

The Falkands veteran says Surgeon Captain Rick Jolly saved his life and transformed field medicine. via BBC News - Health Read More Here..

'Floating on air' after surgeons remove 19kg tumour

Watch surgeons as they remove a 19.5kg tumour from a woman's body. via BBC News - Health Read More Here..

Living with Alzheimer's at the age of 30

"I'm not going to get better, I'm just going to get worse," says Daniel Bradbury. via BBC News - Health Read More Here..

Personality issue

Professionals are asking for earlier and better treatment for this poorly understood condition. via BBC News - Health Read More Here..

The 3,000-mile trip for mental health

Jake Tyler began his epic expedition after suffering a "breakdown" in April 2016. via BBC News - Health Read More Here..

Magician Dynamo surprises Hampshire youth club

The world famous magician performs tricks at a youth club and offers its members some advice. via BBC News - Health Read More Here..

CES 2018: Willow and Freemie breast pumps offer mums freedom

The battery-powered devices are designed to be worn more discreetly than traditional pumps. via BBC News - Health Read More Here..

Driving away depression

Like Minds: The little yellow car that's tackling depression. via BBC News - Health Read More Here..

Gig Buddies helps people with learning difficulties to go out

A charity pairs people with learning difficulties, who feel daunted by going to gigs, with volunteers. via BBC News - Health Read More Here..

We've run out of beds, warn hospital bosses

NHS chiefs say care is being compromised as staff struggle to cope on unsafe and over-crowded wards. via BBC News - Health Read More Here..

Painting over loneliness - how art can beat the blues

A Singapore artist has taken to painting murals across the city to help alleviate her loneliness. via BBC News - Health Read More Here..

UN Environment and WHO agree to major collaboration on environmental health risks

UN Environment and WHO have agreed a new, wide-ranging collaboration to accelerate action to curb environmental health risks that cause an estimated 12.6 million deaths a year.

Today in Nairobi, Mr Erik Solheim, head of UN Environment, and Dr Tedros Adhanom Ghebreyesus, Director-General of WHO, signed an agreement to step up joint actions to combat air pollution, climate change and antimicrobial resistance, as well as improve coordination on waste and chemicals management, water quality, and food and nutrition issues. The collaboration also includes joint management of the BreatheLife advocacy campaign to reduce air pollution for multiple climate, environment and health benefits. via WHO news Read More Here..

Sister shares graveside photo to encourage smear tests

A cancer victim's sister has shared a graveside picture to highlight the importance of smear tests. via BBC News - Health Read More Here..

Pharma giant Pfizer pulls out of research into Alzheimer's

Alzheimer's charities call the news a "heavy blow" to those living with dementia. via BBC News - Health Read More Here..

Bath hospital's giggle doctor making children smile

Dr Ding Dong entertains children in Bath's Royal United Hospital. via BBC News - Health Read More Here..

Doctors wouldn’t let my sister die

A car crash left Polly Kitzinger with devastating brain injuries. Her family was unable to persuade doctors to let her die. via BBC News - Health Read More Here..

Hearing hints

The signs you have a problem - and what you can do about it. via BBC News - Health Read More Here..

Most people who try one cigarette become daily smokers, study says

The study's authors say the research shows the "remarkable hold" cigarettes can establish after one experience. via BBC News - Health Read More Here..

Double amputee teen racing driver makes comeback

Having his legs amputated below the knee hasn't stopped Billy Monger getting back in the driving seat. via BBC News - Health Read More Here..

Is Worthing man the UK's fittest 76-year-old?

Ted Pollard once competed against Arnold Schwarzenegger in Mr Universe. via BBC News - Health Read More Here..

Danielle Lloyd on why she wants to gender select her next child

Danielle Lloyd has told BBC 5 live she wants to pick the gender of her next child. via BBC News - Health Read More Here..

Once-a-week pill for HIV ready for testing in people

Trials will begin in humans after successful tests of a slow-release oral tablet in pigs, say US researchers. via BBC News - Health Read More Here..

Daughter's death from sepsis 'will stay with me forever'

A mother describes the harrowing moment her 17-year-old daughter died suddenly of sepsis. via BBC News - Health Read More Here..

Male suicide: The sisters fighting for their dad

Emma and Toni on the five letters that could save another man like their dad. via BBC News - Health Read More Here..

Singing 'speeds up' recovery from post-natal depression

Mothers in group singing sessions with babies have faster improvement in symptoms, a study suggests. via BBC News - Health Read More Here..

Coconut oil

Coconut oil sales are rocketing, but is it a cholesterol-busting wonder food, or is this dangerous hype? via BBC News - Health Read More Here..

WHO Director-General: invest in health to end plague in Madagascar

The Director-General of WHO has outlined his vision for a Madagascar free of plague epidemics during a three-day visit to the island nation that started on 7 January 2018.

"Madagascar can make plague epidemics a thing of the past through strategic investments in its health system – including better access to healthcare, improving preparedness, surveillance and response capabilities, and implementing the International Health Regulations," said Dr Tedros Adhanom Ghebreyesus. via WHO news Read More Here..

'Raw water': A dangerous new health craze?

Start-ups in the US are charging up to £4 per litre of untreated spring water. via BBC News - Health Read More Here..

Apple investors urge action on 'smartphone addiction'

Two major shareholders are urging Apple to address the growing issue of smartphone addiction among youngsters. via BBC News - Health Read More Here..

The child whose skin blisters at the slightest touch

Moin Younis goes through an excruciating skin care routine each day, that can last up to six hours. via BBC News - Health Read More Here..

Gaza conjoined twins survive separation surgery

Baby girls Farah and Haneen, joined at the abdomen, are separated after surgery in Saudi Arabia. via BBC News - Health Read More Here..

What is 'Aussie' flu and should we be worried?

The NHS is braced for a bad flu season as the 'Australian' virus strain H3N2 dominates. via BBC News - Health Read More Here..

Middle-aged can reverse heart risk with exercise, study suggests

But there is a catch - it takes two years of aerobic exercise, four to five days a week, a study says. via BBC News - Health Read More Here..

Fighting ovarian cancer as a student

A student who was diagnosed with ovarian cancer in her first year of university has created videos and animations to help other young people through illness. via BBC News - Health Read More Here..

The women embracing their scars

Women bare their scars and stories behind them. via BBC News - Health Read More Here..

Heart attack care dangerously unequal for women, study finds

Fewer women heart attack victims would die if they were given the same treatments as men, says a study. via BBC News - Health Read More Here..

Teenagers turn to wrestling to help with mental health

Gym staff say wrestling has helped teenagers with a range of conditions to better manage their symptoms. via BBC News - Health Read More Here..

The world's most obese man's attempt to lose weight

Juan Pedro Franco was declared the heaviest man alive in 2017, but he has lost weight since. via BBC News - Health Read More Here..

Proton beam therapy cancer treatment centre opening in UK

The first high-energy proton beam therapy centre run by the NHS is soon to open in Manchester. via BBC News - Health Read More Here..

Breast size dissatisfaction 'affects self-examination'

Women unhappy with their breast size are less likely to carry out regular self-examinations, a study suggests. via BBC News - Health Read More Here..

Thai penis whitening trend raises eyebrows

A hospital said dozens of men had tried the service, though the health ministry says it's "unnecessary". via BBC News - Health Read More Here..

NHS ambulance A&E delays: Stroke patient's hospital wait filmed

Two relatives tell us about their experiences both inside and outside A&E departments this winter. via BBC News - Health Read More Here..

Theresa May sorry for NHS difficulties

The Prime Minster says she knows hospital problems are "disappointing" and "frustrating" for people. via BBC News - Health Read More Here..

'Twice as many die' in Africa after surgery

Surgery is a "silent killer" because of a lack of medical staff for aftercare, researchers say. via BBC News - Health Read More Here..

Andrew Cotton: Surfer who broke back on 60-foot wave vows to return to the water

Devon surfer Andrew Cotton vows to return to the water despite breaking his back trying to ride 'the perfect wave' . via BBC News - Health Read More Here..

What a woman with a bionic hand can feel

Scientists have unveiled the first bionic hand with a sense of touch that can be worn outside the laboratory. via BBC News - Health Read More Here..

New Year's Resolutioners Gym Etiquette Guide

03 January 2018 It's been referred to as the gympocalypse; the beginning of the year when resolutioners join the gym en masse. Having a solid resolution and being serious about change is commendable, and joining a gym is a great way of doing so. Due to the large influx of new members in a small period of time, the gym becomes a Wild West where anything goes. This sort of unorganized environment makes it difficult to properly utilize equipment. Here are a few of the important rules resolutioners should acquaint themselves with before becoming regulars.

via Straight Health RSS Feed More READ

Struggling hospitals facing 'huge tragedy'

Patients left for hours on trolleys and ambulances queuing outside A&E as hospitals run out of beds. via BBC News - Health Read More Here..

How to make your lunchboxes healthier

Parents are being urged to provide healthier snacks to children but which snacks are the most calorific? via BBC News - Health Read More Here..

AI early diagnosis could save heart and cancer patients

The systems will save billions of pounds by enabling the diseases to be picked up much earlier. via BBC News - Health Read More Here..

Parts of NHS in England on high alert

Milton Keynes University Hospital warns people should only attend for emergency treatment. via BBC News - Health Read More Here..

How to treat dry eyes

How common are dye eyes?

The prevalence of dry eyes has been estimated to be 5-30% percent in persons aged 50 years and older, 7% of US adult population has been diagnosed with dry eye disease. The prevalence increases with age (2.7% in those 18 to 34 years old vs. 19% in those aged 75 years and older). Prevalence is higher in women than men (9% versus 4%).

What are the risk factors for dry eye disease?

- Advanced age
- Female gender
- Hormonal changes (primarily due to decreased androgens)
- Systemic diseases (eg, diabetes mellitus, Parkinson disease)
- Contact lens wear
- Systemic medications (antihistamines, anticholinergics, estrogens, isotretinoin, selective serotonin receptor antagonists, amiodarone, nicotinic acid)
- Ocular medications (especially those containing preservatives)
- Nutritional deficiencies (eg, vitamin A deficiency)
- Decreased corneal sensation, for example, after Laser-assisted in situ keratomileusis (LASIK)
- Ophthalmic surgery (especially corneal refractive surgery)
- Low humidity environments
- Sjögren's syndrome

What are the treatments for dry eyes?

Tear conservation

The use of medications that may worsen symptoms of dryness should be avoided.

Moisture-conserving eyewear

Physical barriers, such as large-frame glasses to minimize tear evaporation, can be helpful. Moisture-conserving eyewear can be employed to conserve the tear film. These may be most helpful in particular situations, such as when traveling into dry and/or windy environments such as airplanes or long air-conditioned car rides, during which humidity is low; and while exercising, especially jogging or biking, during which increased air movement on the ocular surface and decreased blink rate are encountered.

Examples of moisture-conserving eyewear include:

- Side shields, which can be fitted to glasses, reducing the evaporation rate of normal or artificial tears
- Wraparound sunglasses, which are more socially acceptable to many patients than are side shields or goggles
- Ski or swim goggles, which also reduce evaporation

Environmental management

Artificial tears should be used regularly to help prevent complications and to increase comfort before entry into dry environments.

The following environments may be problematic:

- Dry or windy outdoor environments
- Dry indoor environments
- Areas with polluted air and other irritants, including the presence of smokers
- Hospital operating and recovery rooms

Computer use is associated with a decreased blink rate, and extended computer use can be especially problematic and may worsen dry eye. Frequent, short breaks and additional longer breaks may be beneficial.

The use of humidifiers is helpful in bedrooms and other rooms in which the patient spends a lot of time. Here is the best seller from Amazon:



Warm compresses

How to use warm compresses:

- boil water and leave it to cool to a warm temperature
- soak a clean flannel or eye pad in the warm water and gently place this over the eyes for around 10 minutes
- reheat the compress periodically by soaking it in warm water, ensuring the flannel doesn't become cold
- You can also buy a special microwaveable compress for your eyes to use instead of a flannel

The regular use of warm compresses over the eyes can also provide symptomatic relief by improving meibomian gland secretions. Thermalon is one such product:



Eyelid massage

From NIH (http://bit.ly/2libUXE): Gently massage your closed eyes by rolling your little finger in a circular motion. Take a cotton wool bud and, with your eyes shut, gently roll it downwards on the upper eyelid towards the lashes and edges of the eyelids – this helps to push the melted oil out of the glands, although you won't see anything come out. Repeat this process along the whole width of the upper and lower eyelids

This process may cause your eyes to become slightly irritated at first, a bit like getting soap in your eyes, but this is normal and should get better with time.

Diet

There's some evidence to suggest a diet high in omega-3 fats can help improve dry eye syndrome. The best sources of omega-3s are oily fish, such as:

- mackerel
- salmon
- sardines
- herring
- fresh or frozen tuna – not canned, as the canning process sometimes removes the beneficial oils

Aim to eat at least two portions of fish a week, one of which should be oily fish. You can also get omega-3s from various nuts and seeds, vegetable oils, soy and soy products, and green leafy vegetables. Omega-7, or sea buckthorn oil, has also been found to be helpful.

Artificial tears

Artificial tears generally include 3 agents:

- cellulose to maintain viscosity
- a spreading agent such as polyethylene glycol or polyvinyl alcohol to prevent evaporation
- a preservative to prevent contamination

Different forms of artificial tears

"Artificial tears" come in liquid, gel, and ointment forms. Preservative-free forms of these supplements are often recommended as some individuals with dry eye will have inflammatory reactions to the preservatives. These are often single-use formulations.

Laser-assisted in situ keratomileusis (LASIK) is a refractive procedure that causes dry eyes, in part due to decreased postoperative corneal sensation.

How often to use artificial tears?

A reasonable starting dose for artificial tear administration is one drop in each eye, four times per day. Patients often begin to notice improvement within a few days of initiating treatment but may take up to three to four weeks to note a significant change in their symptoms.

If individuals remain symptomatic, the frequency of artificial tear use can be increased to the level of symptoms, even as frequently as every hour. If used more often than four to six times per day, it is recommended that a preservative-free formulation be used to minimize the potential for toxicity.

Higher-viscosity artificial tear gels and ointments are also commercially available and can be used if patients feel that the eye drops are not providing enough symptomatic relief. Patients should be warned that the gels, and especially ointments, can blur vision temporarily and are often best used at bedtime.

How long to use artificial tears?

Unless there is a specific inciting factor that can be eliminated, dry eyes are most often a chronic condition and require chronic treatment. Patients should be advised that they will need to use artificial tears for relief of dry eye symptoms indefinitely.

Topical cyclosporine

Topical cyclosporine is an immunosuppressive agent that has been found to be relatively safe.

It is important to note that not all patients respond to cyclosporine.

A 0.05% emulsion of cyclosporin is available for treatment of dry eye disease. It may take up to six weeks or longer to achieve noticeable improvement of dryness. In some patients, cyclosporine can result in long-term resolution of dry eye symptoms.

An important limiting factor of cyclosporine use is high cost.

As patients may have other concurrent problems such as infection leading to eye irritation, they should have a complete ophthalmological examination prior to receiving cyclosporine.

Topical lifitegrast

A topical eye drop formulation, lifitegrast 5.0%, an integrin antagonist, was approved by the FDA in 2016. The ophthalmic solution is used twice a day and has known side effects of eye irritation or discomfort and an associated bad taste in approximately 25% of patients.

Adjunctive treatments by eye specialists

- Topical sodium hyaluronate

- Low dose topical glucocorticoids (CS) - only on a short-term basis. CS can have significant side effects with continued use, including cataracts and glaucoma.

- Autologous serum tears – The serum of a patient's blood can be formulated into eye drops.

- Tear stimulation – Systemic pilocarpine (a cholinergic agonist) has been found to improve dry eye symptoms in patients with Sjögren's syndrome but is associated with systemic side effects.

- Topical omega-3 fatty acids

- Oral antioxidants

- Vitamin A – Systemic vitamin A deficiency is associated with severe ocular surface dryness with keratinization of the conjunctiva (Bitot spots) and night blindness. Topical vitamin A eye drops can improve dry eye symptoms.

- Punctal occlusion – Either temporary or permanent occlusion of the openings of the tear drainage system.

- Scleral contact lenses – large-diameter contact lenses can be used to help retain a tear reservoir over the ocular surface. These types of contact lenses require a specialized fitting by an experienced contact lens practitioner.

- Acupuncture

- Surgery – Eyelid abnormalities should be surgically corrected to realign and maintain normal lid architecture.

- Investigational – Diquafosol and rebamipide eye drops

References:

Dry eyes - UpToDate http://bit.ly/2BSmKdc
Treatment of dry eye in Sjögren's syndrome: General principles and initial therapy - UpToDate http://bit.ly/2lkfyA4
Treatment of moderate to severe dry eye in Sjögren's syndrome - UpToDate http://bit.ly/2lisWoe
NIH Self-help http://bit.ly/2libUXE
Using warm compresses to treat meibomian gland disease http://bit.ly/2litJ8G
Simple Solutions for Dry Eye http://bit.ly/2lqQV3S

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