Sweet power: the politics of sugar, sugary drinks and poor nutrition in Australia

 The sugar industry has a lot of influence over  
health policy. from shutterstock.com

Unhealthy diets and poor nutrition are leading contributors to Australia’s burden of disease and burgeoning health-care costs. In 1980, just 10% of Australian adults were obese, today that figure is 28% – among the highest in the world.

And yet, as shown on Monday night’s Four Corners’ episode – which was a stunning expose of food, nutrition and health politics in Australia – successive governments have done little to address it.

What the program highlighted was as important as what it did not. It showed a clear need for a sugar-sweetened beverage tax and a national strategy with a comprehensive package of measures to reduce obesity.

What we also urgently need (and which wasn’t noted in the program) is a national nutrition policy, based on the Australian Dietary Guidelines, to promote healthy diets and good nutrition more broadly. It is long overdue – we haven’t had one since 1992.

Arguably the most important reason for why none of this currently exists is the gorilla in the policy-making room: the political might of Big Food to undermine support for policy reform. Why does Big Food hold such a powerful grip on Australian food and nutrition policy

The political power of Big Food

The Four Corners program is consistent with our prior research showing that Big Food’s power to obfuscate, delay and undermine food and nutrition policy reform stems from several sources. These include its economic importance as an industry and employer, access to and influence with political decision makers, and the adoption of self-regulatory codes (for instance on marketing and food labelling) as a means to pre-empt, and substitute for, government regulation.

Many tactics used by these transnational, economic titans sway public policy against what health research shows is the best way forward. Among these are lobbyists disputing the evidence base, companies like Coca-Cola funding research to confuse the science and deflect blame away from dietary intake, and donations by companies to political parties to gain access and influence.

Companies like Coca-Cola have in the past funded research to influence the results. from shutterstock.com

Four Corners showed Big Sugar’s power also comes through its economic and political importance in the swing “sugar states” of Northern Australia. It came as no surprise to hear from George Christensen – member for one of these states, Dawson – that a sugar tax will impact on the sugar industry (in his electorate) but do “absolutely nothing to impact on obesity”.

Evidence for a sugar tax

Geoff Parker, CEO of the Australian Beverages Council, told Four Corners that policymakers have not implemented a sugary drinks tax because they “look to the evidence base”. That such a tax is overly-simplistic – it would be a “silver bullet and white knight” solution to a complex problem. This tactic of disputing the evidence and obfuscating it with claims of complexity is a lobbying classic.

Let’s be clear – comprehensive systematic reviews clearly demonstrate a link between free dietary sugars, sugary drink consumption and obesity. So much so that in 2015, the World Health Organisation made a “strong recommendation” to limit free sugars to less than 10% of total energy intake (12 teaspoons per day for the average sized adult).

By far the main source of free sugars in the Australian diet – an estimated 81% – comes from energy-dense, nutrient poor “discretionary” (i.e. _junk _foods). Over half of free sugars is estimated to come from sugary drinks.

With regards to sugary drinks taxes, the evidence is strong and continues to grow. Such taxes work to drive down consumption, incentivise manufacturers to put less sugar in their products, and generate revenue for investment in public health programs.

An evaluation of Mexico’s sugary drinks tax, for example, demonstrates a clear reduction in sugary drink purchases since the tax was introduced in 2013.

Of course a sugary drinks tax is no silver bullet. It is just one intervention among several that would act synergistically to drive health-promoting changes throughout the food supply and consumer food environment.

The way forward

A sugar tax is a good start for tackling the obesity problem. Australia is lagging behind the 28 jurisdictions with such a tax already in place. But it is only one among many actions needed to prevent obesity. Obesity is in-turn only one among several nutrition problems that will need to be tackled if Australia’s overall disease burden is to be reduced.

Going forward, the most effective and efficient activity to promote good nutrition and prevent diet-related diseases, is a coherent national nutrition policy based on the Australian Dietary Guidelines.

Such a policy will involve governments, nutrition scientists, industry and civil society working together across the food system – from food production through to retail – to promote consumption of five food group foods and the avoidance of discretionary foods.

Big Food should be consulted in relation to policy implementation. But it should not have a seat at the policy-making table nor a role in setting Australia’s food and nutrition policy agenda.


This article was co-authored by:

Image of Phillip BakerPhillip Baker – [Alfred Deakin Post-Doctoral Research Fellow, Institute for Physical Activity and Nutrition, Deakin University]

and

Image of Mark LawrenceMark Lawrence – [Professor of Public Health Nutrition, Deakin University]


Read more: 

Yes, too much sugar is bad for our health – here’s what the science says
White, brown, raw, honey: which type of sugar is best?
We know too much sugar is bad for us, but do different sugars have different health effects?

 

 

 

This article is part of a syndicated news program via

 

Earlybird registrations are open for the Melbourne International Singers Festival 2018

From the 7th to the 11th of June. Proudly presented by the School of Hard Knocks

Now in its 9th consecutive year, Melbourne International Singers Festival will be led by Guest Conductor RICHARD GILL AO and Australia’s finest conductors, musicians and singers including: The Song Company, Choir of Hard Knocks, MEN ALOUD!, XL Arts, Warren Wills, Claire Patti and Dr Jonathon Welch AM.

BE CHALLENGED, INSPIRED & ENTERTAINED!

JOIN one of our wonderful Festival Choruses, led by Richard Gill, Claire Patti and Dr Jonathon Welch respectively.

BRING your School or Community Choir to a workshop or masterclass with Richard Gill, one of Australia’s finest, and funniest music educators.

SEE the internationally acclaimed, award winning The Song Company with Artistic Director, Antony Pitts, in “True Love Story” …. AND the exciting young talents of XL Arts under the artistic direction of Liane Keegan, as they perform in recital!

SING in a Festival Showcase Concert with your choir.

MISF has a proud history of presenting new Australian works, and will present TWO WORLD PREMIERES in 2018 under the inspiring creative direction of Olivier nominated composer, music theatre producer and performer Warren Wills with the School of Hard Knocks MEN ALOUD! and award winning CHOIR OF HARD KNOCKS.

For more information about the Festival program please go to http://schoolofhardknocks.org.au

We can’t wait to see you all at MISF 2018 for another extraordinary weekend of workshops, educational experiences and performances that will leave you challenged, inspired and entertained! Dr Jonathon Welch AM, Founding Artistic Director

Book Now! Earlybird registrations apply if registered by May 25th!

An unforgettable weekend at #MISF18

Proceeds support the School of Hard Knocks in providing arts and cultural programs to the vulnerable and marginalised in our community.

Contact misf@schoolofhardknocks.org.au OR 0419 337 283

Evidence-based parenting: how to deal with aggression, tantrums and defiance

 Children can become more and more skilled in the 
art of oppositional behaviour, and increasingly harder to discipline. 
Suzanne Tucker/Shutterstock

Anyone who has raised children or grown up with siblings knows there are some bumpy times in a child’s life. When the smallest upset causes a major tantrum. Or when it’s close to impossible to get them out the door on time for school. Or when your adorable angel acts like a wild animal.

But some children’s tantrums, irritability and defiance well exceed that typically found among healthy children of the same age. This can be overwhelming for the best of parents, especially as children advance in age.

And it doesn’t help that reactions from loved ones and strangers often leave parents feeling judged for their defeats in the disciplinary arena.

Over the past decade, our research team at the The University of Sydney’s Child Behaviour Research Clinic (CBRC) has treated aggression, non-compliance, rule-breaking and excessive tantrums in children aged two to 16. We’ve used these insights to develop a free online program of evidence-based strategies for parents, called ParentWorks.

The good news is, programs such as ours can help most children with problem behaviours too better control their emotions and, therefore, their behaviour.

Such treatment has the strongest effects in the preschool to early primary school years. Relatively brief interventions of around eight weeks at this age often produce greater gains than those achieved with more complex interventions delivered later in adolescence.

What types of behaviour are we talking about?

Common warning signs that you child’s behaviour may be getting out of control include:

1) When oppositional behaviour not only occurs regularly, but also interferes with family life. This might cause the family to constantly be late because of delays leaving the house, or to avoid social events where tantrums might occur.

2) When stress arising from child issues spills over into the rest of the family, such as the parents’ own relationship.

3) When the child’s behaviour leaves parents feeling flooded by emotions that overwhelm their usual coping skills.

4) When children seem driven to elicit escalating and emotionally charged parental reactions, even when punitive or distressing to all.

A child’s oppositional behaviour is a problem when it affects the whole family. Mrfiza/Shutterstock

We now understand these “behavioural” problems are often just as equally “emotional” problems.

This means that the best interventions not only reduce problem behaviours, but also help children build solid skills in self-regulation. Such foundations form the base of their mental health in childhood, adolescence and adulthood.

Overcoming persistent problems

Ironically, the more stress the child’s behaviour places on parents, the more parents find themselves relying on practices that work to manage it in the moment, yet play into daily cycles of parent-child conflict and stress in the long term.

As such conflict continues, children often become more and more skilled in the art of oppositional behaviour, and therefore increasingly harder to discipline.

Child behavioural problems often become so embedded in family life, shifting them requires new strategies to be incorporated into the day-to-day routine at home. This is why the most powerful interventions are those that train parents as therapists, so to speak.

So what can you do?

The earlier you can intervene in behavioural problems, the better. Use parenting strategies that take the emotion out of discipline and put it back into the rest of family life.

For example, you might try:

1) Rewarding good behaviour (such as cooperatively playing with a sibling) with rewards based in the parent-child relationship (such as physical affection and short bursts of parent-child time) given at the time of the good behaviour.

2) Rewarding good behaviours even in the context of discipline. This might mean enthusiastically praising a child for helping to pack away toys, having disciplined him or her for being destructive with those toys just moments earlier.

Reward good behaviour at the time, even if it comes after bad behaviour. By NadyaEugene

3) Responding to misbehaviour immediately, with a calm and clear instruction that directs the child to what they should instead be doing. For instance, get the child’s attention and say, “The way you are speaking is very rude, you need to use a nice voice”, following the first instance of such behaviour.

4) Responding immediately to escalations with a consequence, such as a brief time-out or quiet time. This is where the child sits alone somewhere safe and boring and is only permitted to leave once they have been quiet for a period; say, two minutes.

These strategies can act as an effective circuit-breaker for cycles of parent-child escalation. They also provide young children with opportunities to develop vital skills in self-regulation.

With simple strategies such as these, parents can avoid accidentally rewarding misbehaviour, which is easy to do when these behaviours demand so much time and attention.

Getting help

You can find more evidence-based strategies for preventing and reducing oppositional behaviour at the ParentWorks online program.

However, when child behaviour problems are significant, parents may need the support of psychologists or other professionals at a clinic such as the CBRC. More severe oppositional behaviour can often occur alongside other emotional and developmental disorders, so it’s important such children have a comprehensive assessment.

If you are seeking assistance for oppositional and aggressive child behaviour, don’t stop until you find the help that is right for you.


Read more: Acting out, acting their age or something more serious? Dealing with difficult behaviour in children


This article was written by:
Image of David J HawesDavid J Hawes – [Associate Professor of Clinical Psychology, University of Sydney]

 

 

 

This article is part of a syndicated news program via

 

Mind-bending drugs and devices: can they make us smarter?

 Could it be this easy? from www.shutterstock.com

Demand for drugs and devices that can enhance brain functions such as memory, creativity, attention and intelligence, is on the rise. But could the long-term side-effects outweigh the benefits of being “smarter”?

Known as “smart drugs” or “neuroenhancers”, the field of nootropics (literally translated as mind-bending) is one of the most debated topics in neuroscience. Healthy people of all ages are seeking cognitive enhancement for personal improvement, athletic performance, academic success, professional advantage and to maintain function into old age.

Demand is driven by a changing work environment that increasingly requires use of the mind and not the muscles, heavier workloads, pressure to succeed and an ageing population seeking to reduce the risk of dementia.

Strategies for cognitive enhancement are diverse, ranging from brain training programs to physical activity, drugs and brain stimulation devices. It’s well known neuroenhancers such as lifelong learning, brain training and physical activity have positive effects on memory and attention. These strategies are also safe and inexpensive. The downside? They require substantial time and effort.

Most of us already use brain stimulation

Neuroenhancers that can be swallowed (pills, liquids) or devices that can be worn, are appealing because they require much less effort. In fact, most of us already use a daily smart drug to improve alertness and attention: coffee.

The effects of caffeine on mental function have been known for centuries, and high levels of caffeine consumption (equivalent to five to six cups of coffee per day) were once banned in Olympic competition. Studies have shown alertness and attentiveness are increased and reaction times shortened, when caffeine is consumed.

These effects are greater in people who are sleep-deprived. With approximately 1.6 billion cups of coffee consumed worldwide every day, it’s clear cognitive enhancement is something most of us welcome.

Most of us drink a cup of brain stimulation every day. Danielle Macinnes/Unsplash

The risks

The case in favour of smart drugs becomes murkier as the level of risk becomes greater. Methylphenidate (MPH, also called Ritalin) is commonly prescribed for adolescents with attention deficit-hyperactivity disorder (ADHD). However, MPH can also improve working memory, attention, alertness and reaction times in healthy individuals.

The drug is sold on the black market to high school and university students as a study and examination aid. Students report taking the drug for its performance enhancing effects and not for recreational or medicinal use.

The use of MPH, a prescription-only drug, in healthy individuals is not without risk. At high doses, MPH can interfere with cognition and produce side effects that impair athletic performance.


Read more: We can change our brain and its ability to cope with disease with simple lifestyle choices


Other possible side-effects include anxiety, irritability, nausea, abdominal pain, heart palpitations and blurred vision. Concerns have also been raised about the potential for MPH to disrupt the development of the adolescent brain, with lasting behavioural consequences.

The risks associated with smart drugs raise an important ethical question. What level of risk should people who are otherwise healthy be willing to accept in pursuit of cognitive enhancement?

All drugs have side-effects. But when a drug is medically indicated, there is generally agreement the benefits outweigh the risks. Making this judgement in healthy individuals is much more complex. Where do we draw the line between the desire for improved cognition (and potentially greater productivity and success) and health? As the field of nootropics grows, this is a question we’ll need to ponder.

Non-invasive brain stimulation, where magnetic fields or electrical currents are applied to the brain using a device worn on the head, is another potential method of cognitive enhancement. These currents are thought to alter the activity of brain cells but, high quality evidence is lacking and long-term safety studies are yet to be completed.

Despite this, the simplicity of the technology (you can build a device with a 9V battery and a handful of cords) makes it difficult to regulate. There is a growing market for DIY brain stimulation and devices are available for purchase via the internet.

You can even find online instructions on how to build a brain stimulation device of your own. A key concern is healthy individuals using these devices could produce detrimental, long-lasting brain effects that are difficult to reverse.

There is no denying neuroenhancers exist and are widely used: the question is to what extent we will be able to make ourselves smarter in future, and at what cost?


This article was written by:
Image of Siobhan SchabrunSiobhan Schabrun – [Research Fellow in Brain Plasticity and Rehabilitation, Western Sydney University]

 

 

 

This article is part of a syndicated news program via

 

Cannabis and psychosis: what is the link and who is at risk?

 Only certain compounds in cannabis are at fault. 
from www.shutterstock.com

There has been a recent global rise in “green fever”, with various jurisdictions either decriminalising or legalising cannabis.

But alongside relaxing the rules comes concern about the health implications of cannabis use. We often hear of a link between cannabis use and psychosis. So how strong is the link, and who is at risk?

What is psychosis?

There’s consistent evidence showing a relationship over time between heavy or repeated cannabis use (or those diagnosed with cannabis use disorder) and an experience of psychosis for the first time.

Psychotic disorders are severe mental health conditions. They’re characterised by a “loss of contact with reality”, where the individual loses the ability to distinguish what’s real from what’s not. Psychotic symptoms can include visual hallucinations, hearing voices, or pervasive delusional thinking.

These can often present as a “psychotic episode” – which is a relatively sudden worsening of psychotic symptoms over a short time-frame, frequently resulting in hospitalisation.

The heaviest users of cannabis are around four times as likely to develop schizophrenia (a psychotic disorder that affects a person’s ability to think, feel and behave clearly) than non-users. Even the “average cannabis user” (for which the definition varies from study to study) is around twice as likely as a non-user to develop a psychotic disorder.

Furthermore, these studies found a causal link between tetrahydrocannabinol (THC – the plant chemical which elicits the “stoned” experience) and psychosis. This means the link is not coincidental, and one has actually caused the other.

Who is at risk?

People with certain gene variants seem to be at higher risk. However our understanding of these factors is still limited, and we’re unable to use genetic information alone to determine if someone will or won’t develop psychosis from cannabis use.

Those with these genetic variants who have also experienced childhood trauma, or have a paranoid personality type, are even more at-risk. So too are adolescents and young adults, who have growing brains and are at an age where schizophrenia is more likely to manifest.

The type of cannabis material being used (or the use of synthetic cannabinoids, known as “spice”) may also increase the risk of psychosis. As mentioned above, this is due to the psychological effects of the chemical THC (one of over 140 cannabinoids found in the plant).

Even healthy people given THC can experience psychotic symptoms including paranoia. from www.shutterstock.com

This compound may actually mimic the presentation of psychotic symptoms, including paranoia, sensory alteration, euphoria, and hallucinations. In laboratory-based research, even healthy people may exhibit increased symptoms of psychosis when given THC compounds, with more severe effects observed in people with schizophrenia.

Many cannabis strains contain high amounts of THC, found in plant varieties such as one called “skunk”. These are popular with consumers due to the “high” it elicits. However with this goes the increased risk of paranoia, anxiety, and psychosis.

But can’t cannabis also be good for mental health?

Ironically, one compound found in cannabis may actually be beneficial in treating psychosis. In contrast to THC, a compound called cannabidiol (CBD) may provide a buffering effect to the potentially psychosis-inducing effects of THC.

This may occur in part due to its ability to partially block the same brain chemical receptor THC binds with. CBD can also inhibit the breakdown of a brain chemical called “anandamide,” which makes us feel happy. Incidentally, anandamide is also found in chocolate and is aptly named after the Sanskrit word meaning “bliss”.

CBD extracted from cannabis and used in isolation is well-tolerated with minimal psychoactive effects. In other words, it doesn’t make a person feel “high”. Some studies have found CBD is actually beneficial in improving the symptoms of schizophrenia. But one more recent study showed no difference in the effects of CBD compared to a dummy pill on symptoms of schizophrenia.

Perhaps this means CBD benefits a particular biological sub-type of schizophrenia, but we’d need further study to find out.

Would legalising make a difference?

It’s important to note most studies finding a causal link between cannabis use and psychosis examined the use of illicit cannabis, usually from unknown origins. This means the levels of THC were unrestricted, and there’s a possibility of synthetic adulterants, chemical residues, heavy metals or other toxins being present due to a lack of quality assurance practices.


Read more: Legal highs: arguments for and against legalising cannabis in Australia


In the future, it’s possible that standardised novel “medicinal cannabis” formulations (or isolated compounds) may have negligible effects on psychosis risk.

Until then though, we can safely say given the current weight of evidence, illicit cannabis use can increase the risk of an acute psychotic episode. And this subsequently may also increase the chances of developing schizophrenia. This is particularly true when high-THC strains (or synthetic versions) are used at high doses in growing adolescent brains.


This article was co-authored by:
Image of Jerome SarrisJerome Sarris – [Professor of Integrative Mental Health; NICM Deputy Director, Western Sydney University]
and
Image of Joe FirthJoe Firth – [Postdoctoral Research Fellow at NICM Health Research Institute, Western Sydney University]

 

 

 

This article is part of a syndicated news program via
 

We can change our brain and its ability to cope with disease with simple lifestyle choices

 Lifestyle factors such as meditation can 
change our brain for the better. gGuilherme Romano

Our life expectancy has increased dramatically over the past several decades, with advances in medical research, nutrition and health care seeing us live well into our 80s. But this longer life expectancy has also come at a cost, as the longer we live, the more likely we are to develop neurodegenerative diseases such as dementia.

Despite the lack of treatments for these diseases, there’s now a growing body of research to suggest there are a range of lifestyle changes we can adopt to help enhance our brain function. And even prevent brain disease.

Exercise

The effects of physical activity, particularly aerobic exercise, on brain health have been well studied. There’s now evidence to suggest engaging in physical activity can improve brain health through a phenomenon called neuroplasticity. This is where brain cells can more easily respond to disease or injury.

Physical activity can induce a cascade of biological processes that improve function of brain regions responsible for memory, and things such as decision making.

In particular, going for a run or bike ride (as opposed to only strength exercises such as weight training) have been shown to increase levels of “brain-derived neurotrophic factor”, a protein central to the growth and survival of brain cells. Brain imaging studies are also starting to confirm exercise training can result in a bigger hippocampus (the brain region responsible for memory) and improvements in memory.

Just as protein shakes may help muscles grow after exercise, the brain-derived neurotrophic factor may help to strengthen and generate brain cells. This in turn can increase the brain’s ability to cope with injury or disease.

Exercise strengthens our brains as well as our muscles. Kyle Kranz/Unsplash

Meditation

Over the past decade, there’s been an explosion of interest in meditation and mindfulness as a treatment of mental health disorders, particularly depression and anxiety.

Some studies have suggested long-term engagement in meditation is associated with physiological brain changes (such as larger brain volumes and higher brain activity).

But the extent to which meditation is associated with better memory, or with long-term protection against brain diseases, remains to be determined.

Hypnosis

Hypnosis is one of the oldest forms of psychotherapy. It is typically used as an adjunct treatment for pain, and a range of anxiety disorders, including post-traumatic stress. Recent studies show that during hypnosis, changes in brain activity are detected in brain regions that govern attention and emotional control.

One small study (18 patients) suggested hypnosis substantially improved the quality of life of dementia patients after 12 months, with patients experiencing higher levels of concentration and motivation. But this result is very preliminary, and requires independent replication with larger numbers of patients.

It’s likely hypnosis plays an important role in reducing stress and anxiety, which may in turn improve focus, attention and wellbeing in general.

So what works?

The challenge with studying the effects of lifestyle changes on brain health, particularly over a long period of time, is the large degree of overlap across all lifestyle factors. For example, engaging in physical activity will be related to better sleep and less stress – which also improve our memory and thinking function.

Similarly, better sleep is related to improved mood. It may make people feel more motivated to exercise, which may also lead to better memory and thinking function.

The extent to which we can truly determine the contribution of each lifestyle factor (sleep, physical activity, diet, social engagement) to our brain health remains limited.

But a wide range of lifestyle factors that are highly modifiable such as physical inactivity, obesity, chronic stress and high blood pressure can have far-reaching effects on our brain health. After all, it is mid-life high blood pressure, obesity and physical inactivity that can increase our risk of dementia in later life.

Recently, a large study of 21,000 American adults aged over 65 suggested the prevalence of dementia fell significantly from 11.6% to 8.8% (nearly a 25% reduction) over 12 years (from 2000 to 2012). The researchers suggested this decrease in prevalence may be due to increases in education and better control of risk factors for high cholesterol and high blood pressure.

This provides some hope that we can, to a certain extent, take charge of our brain health through engagement in a wide range of beneficial activities that seek to improve mental function, improve heart health, or reduce stress.

It’s never too early to start investing in the health of our brains, particularly when these lifestyle changes are easily implemented, and readily accessible to most of us.


If you are interested in being a part of a study on brain health in middle-aged Australians, please join us at the Healthy Brain Project.


This article was written by:

Image of Yen Ying LimYen Ying Lim – [Research Fellow, Florey Institute of Neuroscience and Mental Health]

 

 

 

This article is part of a syndicated news program via

 

 

Explainer: what’s new about the 2018 flu vaccines, and who should get one?

 The flu shot is free for at-risk groups, and  
available to others for around $10-$25. Shutterstock

As winter draws closer, many Australians are wondering whether this year’s influenza season will be as bad as the last, and whether they should get vaccinated.

For most of us, influenza (the flu) is a mild illness, causing fever, chills, a cough, sore throat and body aches, that lasts several days. But some people – especially the elderly, young children and those with chronic diseases – are at risk of serious and potentially deadly complications.

While not perfect, the seasonal influenza vaccine is the best way to protect against influenza viruses. It’s free for at-risk groups, and available to others for around A$10A$25 (plus a consultation fee if your GP doesn’t bulk bill). In some states people can also get influenza vaccines from pharmacies.

Different viruses

There are four influenza viruses that cause epidemics: two type A viruses, called A/H1N1 and A/H3N2 and two type B influenza viruses, called B/Yamagata and B/Victoria viruses. All four cause a similar illness called influenza.

In any season, one of the viruses may dominate, or two or even three viruses could circulate.

Last year’s influenza seasons in Australia and the United States were caused by A/H3N2, while B/Yamagata viruses predominated in Asia, and a mix occurred in Europe.

Influenza A/H3N2 viruses cause more severe epidemics that affect the entire population, from the very young to the very old.

In contrast, influenza B and A/H1N1 viruses tend to cause disease in children and young adults, respectively, sparing the elderly.

Developing the vaccine

Although influenza activity around the world is monitored throughout the year, influenza viruses mutate continuously and we can’t predict which virus will dominate. For this reason, the influenza vaccine includes components that are updated to protect against all four influenza A and B viruses.

Vaccination is the best option to prevent influenza and is offered in the autumn, in anticipation of influenza season in the winter. Typically, the influenza season begins in June, peaks by September and can last until November.

For best protection, you need a flu vaccine each year. 
Roberty Booy, Head of the Clinical Research team at the 
National Centre for Immunisation Research and Surveillance, 
explains why (via the Australian Academy of Science).

It takes about two weeks for the vaccine to induce immunity and the resulting protection lasts about six months.

The 2017 influenza season was severe in all states except WA. The epidemic began earlier than usual, there were more reported cases than in previous years, and there were a large number of outbreaks in residential care facilities in several jurisdictions.

Who is most affected?

People of all ages can get influenza but some people are at greater risk of severe illness and complications that require hospitalisation. These groups include:

  • older adults who are over 65 years of age
  • children aged under five years and especially children under one
  • pregnant women
  • Aboriginal and Torres Strait Islander persons
  • people with severe asthma or underlying health conditions such as heart or lung disease, low immunity or diabetes.

Anyone can get a flu vaccine but some people have to pay for it. Shutterstock

While the National Immunisation Program provides vaccines free of charge for the groups listed above, anyone who wants to reduce their risk of influenza can get vaccinated.

What’s new this year?

There are two notable changes.

One change is that several states (Tasmania, Victoria, New South Wales, Queensland, Western Australia and the ACT) are now offering free vaccination for children under five years of age.

This is important because children are prone to severe illness and they spread the virus to their contacts, at home and in daycare. Previously, only WA offered children the influenza vaccine free of charge.

The second change is “enhanced” vaccines are available for adults over the age of 65. The standard influenza vaccine is not optimally effective in older adults.

Two products have been developed to improve the immunity offered by the vaccine: one is a high-dose vaccine four times the strength of the standard vaccine and the second is an “adjuvanted” vaccine, that contains an additive that boosts the immune response to the vaccine.


Read more: Here’s what you need to know about the new flu vaccines for over-65s


These vaccines have been available in other countries for many years but are being introduced in Australia for the first time in 2018. Older adults will be offered one of the two enhanced vaccines for free.

What happens if you still get influenza?

Even if you’re vaccinated, you can still get influenza.

The effectiveness of the seasonal influenza vaccine varies and is usually around 40-50%. But last year’s vaccine was only around 33% effective overall, because it was not effective against the A/H3N2 virus though it was effective against the A/H1N1 and influenza B viruses.

While vaccines are given ahead of time to prevent influenza, antiviral drugs are available via GP prescription for people who get infected.

The antiviral drugs for influenza are most effective when taken within two days of illness and are only effective against influenza viruses. But they’re not effective against other respiratory viruses that cause colds and respiratory symptoms.

Influenza is a contagious virus that spreads through contact with respiratory secretions that are airborne (such as coughs and sneezes) or that contaminate surfaces (after wiping a runny nose, for instance). If you have influenza, stay home to avoid spreading the virus.

Unfortunately, we can’t predict whether the 2018 influenza season will be mild or severe. Once we know which virus or viruses are circulating, we may be in a better position to predict how severe the season will be for older adults.


This article was written by:

Image of Kanta Subbarao
Kanta Subbarao – [Professor, The Peter Doherty Institute for Infection and Immunity]

 

 

 

This article is part of a syndicated news program via

 

Legal highs: arguments for and against legalising cannabis in Australia

 Many of the harms associated with cannabis use 
are to do with its illegality. From www.shutterstock.com

Greens leader Richard Di Natale wants Australia to legalise cannabis for personal use, regulated by a federal agency. This proposal is for legalisation of recreational use for relaxation and pleasure, not to treat a medical condition (which is already legal in Australia for some conditions).

According to the proposal, the government agency would licence, monitor and regulate production and sale, and regularly review the regulations. The agency would be the sole wholesaler, buying from producers and selling to retailers it licences.

The proposed policy includes some safeguards that reflect lessons we’ve learned from alcohol and tobacco. These include a ban on advertising, age restrictions, requiring plain packaging, and strict licensing controls. Under the proposal, tax revenues would be used to improve funding to the prevention and treatment sector, which is underfunded compared to law enforcement.

Cannabis legislation around the world

In Australia, cannabis possession and use is currently illegal. But in several states and territories (South Australia, ACT and Northern Territory) a small amount for personal use is decriminalised. That means it’s illegal, but not a criminal offence. In all others it’s subject to discretionary or mandatory diversion usually by police (referred to as “depenalisation”).

Several jurisdictions around the world have now legalised cannabis, including Uruguay, Catalonia and nine states in the United States. Canada is well underway to legalising cannabis, with legislation expected some time this year, and the New Zealand prime minister has flagged a referendum on the issue.

In a recent opinion poll, around 30% of Australians thought cannabis should be legal. Teenagers 14-17 years old were least likely to support legalistaion (21% of that age group) and 18-24 year olds were most likely to support it (36% of that age group).

In the latest National Drug Strategy Household Survey, around a quarter of respondents supported cannabis legalisation and around 15% approved of regular use by adults for non-medical purposes.

What are the concerns about legalisation?

Opponents of legalisation are concerned it will increase use, increase crime, increase risk of car accidents, and reduce public health – including mental health. Many are concerned cannabis is a “gateway” drug.

The “gateway drug” hypothesis was discounted decades ago. Although cannabis usually comes before other illegal drug use, the majority of people who use cannabis do not go on to use other drugs. In addition, alcohol and tobacco usually precede cannabis use, which if the theory were correct would make those drugs the “gateway”.

Greens leader Richard Di Natale wants Australia to legalise cannabis. AAP/Lukas Coch

There is also no evidence legalisation increases use. But, studies have shown a number of health risks, including:

  • around 10% of adults and one in six teens who use regularly will become dependent
  • regular cannabis use doubles the risk of psychotic symptoms and schizophrenia
  • teen cannabis use is associated with poorer school outcomes but causation has not been established
  • driving under the influence of cannabis doubles the risk of a car crash
  • smoking while pregnant affects a baby’s birth weight.

What are the arguments for legalisation?

Reducing harms

Australia’s official drug strategy is based on a platform of harm minimisation, including supply reduction, demand reduction (prevention and treatment) and harm reduction. Arguably, policies should therefore have a net reduction in harm.

But some of the major harms from using illicit drugs are precisely because they are illegal. A significant harm is having a criminal record for possessing drugs that are for personal use. This can negatively impact a person’s future, including careers and travel. Decriminalisation of cannabis would also reduce these harms without requiring full legalisation.

Reducing crime and social costs

A large proportion of the work of the justice system (police, courts and prisons) is spent on drug-related offences. Yet, as Mick Palmer, former AFP Commissioner, notes “drug law enforcement has had little impact on the Australian drug market”.

Decriminalisation may reduce the burden on the justice system, but probably not as much as full legalisation because police and court resources would still be used for cautioning, issuing fines, or diversion to education or treatment. Decriminalisation and legalistaion both potentially reduce the involvement of the justice system and also of the black market growing and selling of cannabis.

Raising tax revenue

Economic analysis of the impact of cannabis legalisation calculate the net social benefit of legalisation at A$727.5 million per year. This is significantly higher than the status quo at around A$295 million (for example from fines generating revenue, as well as perceived benefits of criminalisation deterring use). The Parliamentary Budget Office estimates tax revenue from cannabis legalisation at around A$259 million.

Civil liberties

Many see cannabis prohibition as an infringement on civil rights, citing the limited harms associated with cannabis use. This includes the relatively low rate of dependence and very low likelihood of overdosing on cannabis, as well as the low risk of harms to people using or others.

Many activities that are legal are potentially harmful: driving a car, drinking alcohol, bungee jumping. Rather than making them illegal, there are guidelines, laws and education to make them safer that creates a balance between civil liberties and safety.

What has happened in places where cannabis is legal?

Legalisation of cannabis is relatively recent in most jurisdictions so the long-term benefits or problems of legalisation are not yet known.

But one study found little effect of legalisation on drug use or other outcomes, providing support for neither opponents nor advocates of legalisation. Other studies have shown no increase in use, even among teens.

The research to date suggests there is no significant increase (or decrease) in use or other outcomes where cannabis legalisation has occurred. It’s possible the harm may shift, for example from legal harms to other types of harms. We don’t have data to support or dispel that possibility.


This article was co-authored by:

Image of Nicole LeeNicole Lee – [Professor at the National Drug Research Institute, Curtin University]

and

Image of Jarryd Bartle Jarryd Bartle – [Sessional Lecturer in Criminal Law, RMIT University]

 

 

 

This article is part of a syndicated news program via

Other readings on this matter:
Why is it still so hard for patients in need to get medicinal cannabis? 
Hemp can now be sold as a food in Australia (and it’s super good for you) 

 

New blood pressure guidelines may make millions anxious that they’re at risk of heart disease

Millions more Australians will be diagnosed with  
having high blood pressure if the recommendations are followed. 
www.shutterstock.com

Recent recommendations to lower the threshold for diagnosing patients with high blood pressure are likely to harm up to 80% of those newly diagnosed. Our analysis, published today in the journal JAMA Internal Medicine, argues the recommendations from two US bodies to diagnose people with a top blood pressure reading (systolic) of 130mmHg as having hypertension (high blood pressure) may do far more harm than good.

Previously, a person would be diagnosed as having hypertension if their systolic reading was 140mmHg or more. But late last year, the American College of Cardiology and the American Heart Association recommended lowering the threshold to 130mmHg.

High blood pressure is only one risk factor for heart disease and stroke. Other factors such as age, gender, smoking and diabetes also contribute to the overall risk profile. All of these must be considered together for a more accurate assessment of a person’s risk of heart disease and stroke.

The recent recommendations will influence clinical practice worldwide – including in the UK and Australia. This could result in an additional 31 million people in the US, 6.7 million in the UK and 2.4 million Australians being told they have hypertension, implying they are at risk of heart disease and stroke. This may lead to anxiety over their future health and to treatment they might not need.

Why lower the threshold?

Prominent medical groups in the US have expressed concerns about the recommendations. The American College of Physicians said the stated benefits of reducing risk of heart disease and stroke were overestimated and harms underestimated. The American Academy for Family Physicians also raised concerns the harms of lowering the threshold were not assessed.

A key trigger for the decision to lower the diagnostic threshold appears to be the results of the US-based SPRINT trial. This found benefits to reducing blood pressure to a systolic reading of 120mmHg, rather than 140mmHg, for those at high risk of heart disease or stroke.

Even before the new guidelines were released there were concerns that SPRINT would promote a “one size fits all” approach to lowering blood pressure. Other trials, including those done in lower-risk populations, failed to find the same benefits as SPRINT. This underscores the importance of individualising decisions about lowering blood pressure, taking into account both the patient’s overall risk profile and their preferences.

Why is this harmful?

Our analysis found 9% of newly diagnosed hypertensives who are at high risk of a heart event or stroke, or who already have a history of heart disease, might benefit from the tighter guidelines. But the vast majority, which is the 80% of newly diagnosed who are at low risk of a heart event or stroke, will not benefit and may be harmed by the new diagnostic criteria. For the 11% of newly diagnosed who have an intermediate risk of heart disease, the benefits and harms are often in rough balance.

Changing the diagnostic and treatment thresholds for hypertension could put people at risk in three ways:

First, wider disease definitions mean more people are labelled as unwell, even if they have a low risk of a disease. Labelling a person as having hypertension increases their risk of anxiety and depression, as compared to the risk for people with the same blood pressure who aren’t labelled as hypertensive.

Second, more people may experience negative effects from treatments to lower their blood pressure. Even though the new guidelines recommend non-drug interventions first for low-risk people, it seems likely many will be offered drugs to lower blood pressure if their reading remains above 130mmHg.

For example, the latest American College of Cardiology guide for clinicians says that although a person with low risk of heart disease should focus on lifestyle changes first, medication may be needed to achieve the goal of <130mmHg.

Third, in countries without universal health coverage, such as the US, people newly diagnosed with hypertension may face difficulties gaining insurance coverage for a “pre-existing” condition.

More people will be offered blood pressure medication that can lead to serious adverse effects. www.shutterstock.com

How to respond

So what should you and your doctor do in response to the new guidelines? First, you should have your risk of heart disease estimated using a reliable risk calculator (such as this one or this one or this one). This is more important for predicting your chance of a heart attack or stroke than just looking at your blood pressure.

If you are one of the many people who have a systolic blood pressure measurement that is 130-140mmHg, and are otherwise at low risk of heart disease, we believe doctors shouldn’t label you as having hypertension. Doctors should continue to support you to make healthy choices with regard to your diet and physical activity regardless of whether your systolic blood pressure is above or below 130mmHg.

If you are one of the smaller number of people at high risk of heart disease with these systolic readings, medications in addition to a healthy lifestyle are beneficial. The blood pressure target should be individualised and based on your risk profile and preferences. You might discuss with your doctor ways to help make sure you take the medication.

If you are in between these two extremes, the benefits and harms of diagnosis are in rough balance. Some people are willing to adopt or continue a healthy lifestyle and accept a moderate increase in the risk of a heart event to avoid taking daily medications, increased doses or more medications, and others are not. In this situation, informed and shared decision-making between you and your doctor is essential.


This article was jointly authored by:

Image of Katy Bell Katy Bell – [Senior Lecturer in Clinical Epidemiology and Senior Research Fellow in the School of Public Health, University of Sydney];

 

Image of Amir QaseeAmir Qasee – [Adjunct Faculty, Thomas Jefferson University]

 

Image of Jenny DoustJenny Doust – [Professor of Clinical Epidemiology, Bond University]

and

Image of Loai AlbarqouniLoai Albarqouni – [PhD candidate in Evidence-Based Practice, Bond University]

 

 

 

This article is part of a syndicated news program via

 

Flesh-eating bacteria cases on the rise and we need an urgent response

In Australia, cases of Buruli ulcer have  
been associated with coastal areas – like Victoria’s Bellarine Peninsula. 
Bernard Spragg. NZ/Flickr

Victoria is facing a worsening epidemic of flesh-eating bacteria that cause a disease known internationally as Buruli ulcer – and we don’t know how to prevent it. Also called Bairnsdale ulcer or Daintree ulcer, this disease causes destructive skin lesions that can lead to severe illness and occasionally even death.

Buruli ulcer is caused by the bacteria Mycobacterium ulcerans (M. ulcerans) and often results in long-term disability and cosmetic deformity.

An epidemic, or an outbreak, is when cases of a disease occur more often than expected in a given area over a particular period of time.

In 2016, there were 182 new cases in Victoria, which, at the time was the highest number ever reported. But the number of casesreported in 2017 (275) have further increased by 51%, compared with 2016 (182). The cases are also becoming more severe in nature and occurring in new geographical areas.

In Australia, Buruli ulcer is frequently reported from the Daintree region, and less commonly the Capricorn coast, of Queensland. Occasionally we’ve heard of cases from the NT, NSW and WA. But most reports come from Victoria, where the disease has been recognised since 1948.

Despite this, we still don’t know the exact environmental niche where the organism lives and how it is transmitted to humans.

Our article, published today in the Medical Journal of Australia, calls for an urgent investigation to answer some critical questions. These include finding out the natural source of M. ulcerans; how the infection is transmitted to humans; what role possums, mosquitoes and other species play in transmission; why the disease incidence is increasing and spreading into new areas in Victoria; and why cases are becoming more severe.

Why is Buruli ulcer such a problem?

Buruli ulcer occurs most commonly in the tropical regions of West or Central Africa, and is a significant public health problem there.

Ulcers are the most common form of this disease. But it can also manifest as a small swelling or lump below the skin, a plaque or as a cellulitic form, and can be complicated by bone or joint infection. The disease can affect all age-groups, including young children.

Treatment effectiveness has improved in recent years and cure rates have approached 100% with the use of combination antibiotics (rifampicin and clarithromycin). But these are expensive and not subsidised under Australia’s Pharmaceutical Benefits Scheme (PBS).

The treatments are also powerful and about one-quarter of people have severe side-effectsincluding hepatitis, allergy or a destabilisation of other medical conditions such as heart disease or mental illness.

Buruli ulcer usually requires reconstructive surgery, like in the case of this 76-year-old man. Author provided

Many people require reconstructive plastic surgery – sometimes with prolonged hospital admissions. On average it takes four to five months for the disease to heal, and sometimes a year or more.

All of this results in substantial costs through such things as wound dressings, medical visits, surgery, hospitalisation, and time off work or school.

What do we know about the bacteria?

M. ulcerans disease is concentrated in particular sites, and endemic and non-endemic areas are separated by only a few kilometres. In Africa it’s usually associated with wetlands, especially those with slow-flowing or stagnant waters. But in Australia it’s found mostly in coastal regions, like Victoria’s Mornington Peninsula.

We know the risk of infection is seasonal, with an increased risk in the warmer months. Lesions most commonly occur on areas of the body that have been exposed. This suggests bites, environmental contamination or trauma may play a role in infection, and that clothing is protective.

Human-to-human transmission does not seem to occur, although cases are commonly clustered in families, presumably as a result of similar environmental exposure.

The rest is unclear. Possible sources of infection in the environment include the soil, or dead plant material in water bodies such as lakes or ponds.

It may be transmitted to humans though contamination of skin lesions and minor abrasions – through trauma or via the bite of insects such as mosquitoes.

In Victoria, some possums in Point Lonsdale on the Bellarine Peninsula (an endemic area) were found to have Buruli ulcers and have high levels of M. ulcerans in their faeces. The location, proportion and concentration of M. ulcerans in possum faeces was also strongly correlated with human cases. But no M. ulcerans was found in possum faeces in nearby areas with no human cases.

So, it’s thought possum faeces might increase the risk of infection to humans in contact with that environment, or infection could be potentially transmitted by insects biting possums and then humans.

What should we do?

We need to understand the risk factors for M. ulcerans disease by comprehensively analysing human behaviour and environmental characteristics, combined with information on climate and geography.

It’s especially relevant that over the last two years, the number of cases have been increasing in the Mornington Peninsula, while decreasing in the adjacent Bellarine Peninsula. Studying this could allow us to pinpoint the risk factors that underlie the differing incidence patterns.

Once identified, more specific analysis can be performed to further assess the role of these risk factors. We can then explore targeted interventions such as modifying human behaviour, insect control, changes to water use and informed urban planning. Through this we have the best chance to develop effective public health interventions to prevent the disease, and promote more community education and awareness campaigns to help people protect themselves.

It will also facilitate the development of predictive models for non-affected areas that closely monitor these areas for the emergence of the organism. This knowledge can hopefully also be applied globally to benefit those affected overseas.

We need an urgent response based on robust scientific knowledge. Only then can we hope to halt the devastating impact of this disease. We advocate for local, regional and national governments to urgently commit to funding the research needed to help stop Buruli ulcer.


This article was written by:
Image of Daniel O’BrienDaniel O’Brien – [Associate Professor and specialist advisor with the Manson Unit, MSF-UK focusing on HIV/AIDS, tuberculosis and Buruli ulcer, University of Melbourne]

 

 

 

This article is part of a syndicated news program via