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There is a lack of awareness in the community about how serious infection with the bacterium Streptococcus pneumoniae (the pneumococcus) can be as you get older. The evidence for that is lower than ideal immunisation rates. As people age, immune systems become less effective, which means increased vulnerability to infections. Worldwide, pneumococcal infections are a common cause of illness, increased frailty, dependence and death. Pneumococcal disease can go unrecognised until too late because it can present with vague symptoms such as fever and general unwellness before a rapid decline.
Why would you take this risk if it's preventable with vaccination?
Pneumococcal disease can go unrecognised until too late because it can present with vague symptoms such as fever and general unwellness before a rapid decline
From 1 July 2026, the government has changed the adult pneumococcal vaccination program. The new preferred vaccine, Capvaxive, is a 21-valent pneumococcal conjugate vaccine — meaning it covers 21 strains of the pneumococcus, replacing the previous combination of Prevenar 13 and Pneumovax 23 on the NIP. The design of the conjugate vaccine is also thought to deliver a stronger immune response, and it is needed as a single shot. It is not known at this stage whether or when a booster might be needed.
The eligibility changes are significant. Adults aged 65 and over are now eligible for a free shot — the eligible age has dropped from 70 — as are First Nations people from the age of 25, down from 50. Adults aged 18 and over who are at particular risk of serious consequences from pneumococcal infection are also eligible. This includes people with poorly functioning immune systems, previous serious pneumococcal infections, some chronic lung diseases including COPD, heart disease, and chronic liver or kidney disease. In total, around five million Australians are now eligible for NIP-funded vaccination, up from 3.2 million under the old schedule. You can find the full list of eligible risk conditions here.
References
Immunisation Coalition. New adult pneumococcal vaccine now available through the National Immunisation Program. July 2026.
https://immunisationcoalition.org.au/new-adult-pneumococcal-vaccine-now-available-through-the-national-immunisation-program/
Australian Immunisation Handbook. Pneumococcal disease. Department of Health, Disability and Ageing.
https://immunisationhandbook.health.gov.au/pneumococcal-disease
NCIRS. Annual Immunisation Coverage Report 2025 Summary.
https://ncirs.org.au/immunisation-coverage-data-and-reports/annual-immunisation-coverage-report-2025-summary
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You might wonder why the experts go on so much about diet as an important factor in dementia prevention. The reasons are very straightforward. As you age, you need your brain to be at peak performance. It needs to be plastic — to be able to adapt to the normal and expected processes of ageing — and you don't want preventable disease getting in the way of that adaptation. Diet can also act like a medication, reducing inflammation in the brain.
You can think about diet in layers when it comes to the brain. The foundation is a diet that prevents your arteries narrowing with atherosclerosis, the cause of heart disease, stroke, and vascular dementia. That means an unprocessed diet with a large variety of vegetables, red meat perhaps once a week, as little processed red meat as possible (bacon, ham and so on), and protein from legumes like chickpeas and lentils, fish and some poultry. The fat should ideally be monounsaturated, preferably from extra virgin olive oil. Keeping salt intake down matters too, and a portion-controlled unprocessed diet helps with that.
The higher the quality of the diet the lower the risk of developing dementia, and if they did develop dementia, it came on later than in those not adhering to a protective diet
The cuisine counts as well. Cooking at moderate heat or slow cooking with herbs and garlic allows the preservation, or even the development, of brain-protective substances in the pot.
The next layer is what observations and some trials of dementia prevention have found: loading that foundation with unsweetened yoghurt, leafy greens like kale, and berries such as strawberries and blueberries further reduces dementia risk. This combination is sometimes called the MIND diet.
Strong support for a high-quality diet has recently come from a Swedish study of nearly 1,900 older people who had no signs of dementia at the start. Researchers assessed their biological risk of developing dementia using blood tests, and then followed them for up to 15 years, tracking how closely their diets adhered to what is known about dementia prevention — particularly through the anti-inflammatory effect. They found that the higher the quality of the diet, the lower the risk of developing dementia over that period. And if participants did develop dementia, it came on later than in those not following a protective diet. This was particularly true for people whose blood tests suggested an elevated risk of dementia to begin with, a finding that gives the dietary message a new dimension — it is not just prevention for the general population, but potentially meaningful protection even for those who may already be on a trajectory toward cognitive decline.
The mechanisms aren't fully understood, but chronic low-grade inflammation appears to be a key pathway. A diet low in inflammatory potential consistently showed the strongest associations, in line with what we know about inflammation as a driver of neurodegeneration.
References
Mrhar A, Carballo-Casla A, Grande G, et al. Diet quality and dementia risk in older adults with Alzheimer pathology. JAMA Network Open, June 2026;9(6):e2620254. doi:10.1001/jamanetworkopen.2026.20254
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2850780
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A US survey of young people aged 12 to 21 found that nearly one in five have used AI chatbots for assistance with mental health issues. Most of them kept it to themselves. Many found it useful. Around 43 per cent used chatbots for mental health advice at least monthly, and many had already seen a doctor. The older the young person, the more likely they were to have used AI for this purpose. Females were more likely to use it than males.
This could be good news, if the advice being given is reliable and the systems have adequate guardrails in place for young people who may be at risk of self-harm. The trouble is that AI chatbots as mental health interventions have not been well studied, and there have been high-profile cases of young people finding ways around inbuilt safety systems, with the chatbot subsequently facilitating rather than preventing harm.
Chatbots are designed to be friendly, engaging and empathic, whereas clinical psychologists are trained to be objective and focussed on the real problems of the person.
The problems with AI chatbots in this context are more fundamental than safety settings. The way these systems are trained to conduct therapeutic-style conversations is not transparent. More importantly, chatbots are designed to be friendly, engaging and empathic, whereas clinical psychologists are trained to be objective and focussed on the real problems of the person, steering them towards a clear therapeutic strategy. These are not the same thing, and in some presentations they are directly at odds. A system optimised for engagement may keep a distressed young person talking without ever moving them towards help.
There is also the question of what happens when a young person develops a reliance on a chatbot as their primary source of emotional support. Research on parasocial relationships with AI is still in its early stages, but the concern is that chatbot interaction may substitute for rather than supplement professional help-seeking and real-world connection, particularly in young people who are already socially withdrawn or anxious.
For general practice, the practical implication is straightforward but easy to overlook. Young people presenting with mental health concerns may already be using AI tools regularly, and they are unlikely to volunteer this information. Asking directly and non-judgementally about AI use opens the conversation. The goal is not to discourage it categorically, but to understand what they are using, how they are using it, and whether it is complementing or replacing professional support.
References
Ryan K et al. AI chatbot use and disclosure for mental health among US adolescents and young adults. JAMA Pediatrics, June 2026. RAND Corporation. https://www.rand.org/news/press/2026/06/nearly-1-in-5-us-adolescents-and-young-adults-use-ai.html
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July asks some questions worth sitting with. How well do you know your own gut? What does it take to start over in your 40s? And why are so many women still waiting years for a diagnosis that changes everything?
Dr Norman Swan tackles lactose intolerance, Kayta Hackman Riley makes the case for a late career leap, and Health News shines a light on PMDD.
On AHTV, Nathan Blacklock joins host Isabelle for an honest conversation about quitting smoking and the community work driving him forward.
LIVE NOW ON TONIC TVMore of Us Are Lactose Intolerant Than We ThinkFrom ethnicity to ageing to a bout of gastro, Dr Norman Swan explains why lactose intolerance is more widespread than most realise and what to do about it.
She Changed Careers in Her 40s and Never Looked BackKayta Hackman Riley swapped an established marketing career for software engineering. Her advice for anyone sitting on the fence? Just do it.
The Condition That's Still Being MissedAfter more than a decade of dismissed symptoms, Chris Stanley finally got answers. Her story is putting Premenstrual Dysphoric Disorder (PMDD) on the radar for women and clinicians who treat them.
LIVE NOW ON ABORIGINAL HEALTH TELEVISIONQuit SmokingThis month AHTV is featuring an honest conversation about quitting smoking for good. Host Isabelle sits down with rugby league legend Nathan Blacklock to talk about what drives his work in community, the personal loss behind it, and the support available to quit smoking.
LIVE NOW ON TONIC BROCHURE BOARD & PHARMACYHealth headlines that make you think.
On our digital panels and brochure boards this month, we're covering why cold, dry air compromises the nose's natural defences against winter illness, the evidence behind salt substitutes for blood pressure and stroke risk reduction, and the growing body of research linking ultra-processed food diets to depression.
From GP waiting room to pharmacy, we're delivering timely, actionable content that sparks curiosity and supports healthier decision-making at every touchpoint on the healthcare journey.
Get in touchThe post July 2026 appeared first on Tonic Media Network.
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HPV vaccination was initially seen as a program for girls, and for good reason. The human papilloma virus is the primary cause of cervical cancer, and the early vaccination programs were designed with that in mind. Then it became clear that boys needed to be included too, since they could transmit the virus when they became sexually active. Australia was ahead of the curve here, adding boys to the National Immunisation Program in 2013. But the case for vaccinating boys has just become considerably stronger.
It is now well established that males are susceptible to HPV-related cancers in their own right. These include cancers of the throat and pharynx, which are rising in Australian men, as well as penile and anal cancers, and evidence suggesting oesophageal cancer may be linked to HPV as well. Oropharyngeal cancer rates have been increasing steeply in Australian males for decades, and HPV is now understood to be the dominant driver.
There is a double benefit in vaccinating boys. It reduces their own cancer risk at multiple sites, and it brings Australia closer to making cervical cancer a disease of the past.
A large study published in JAMA Oncology followed over 615,000 boys who had been vaccinated against HPV and compared them to over two million who had not, tracking cancer outcomes up to the age of 26. What makes this finding particularly striking is the timeframe. HPV-related cancers typically have a latency period of 20 years or more, meaning the full protective effect of vaccination in adolescence won't be visible for decades. Yet even within this relatively short follow-up period, vaccination was associated with a 46 per cent lower risk of developing HPV-related cancers. Among boys vaccinated between the ages of nine and 14, the reduction was 42 per cent. Among those vaccinated between 15 and 26, it reached 50 per cent.
The cancers assessed included head and neck, oesophageal, anal and penile cancers. The consistency of the protective effect across all of these sites strengthens the case considerably.
There is also the bigger picture to consider. Australia has set itself the goal of eliminating cervical cancer entirely, and vaccination of boys is a critical part of getting there. Boys and men transmit HPV to women, so male vaccination reduces the viral load circulating in the population, directly lowering women's risk of cervical cancer. The vaccine's reach doesn't stop there. Cervical screening in Australia now tests for the virus itself rather than just abnormal cells, with five-yearly screening for those who test negative and closer monitoring for those who don't. Vaccination combined with high screening participation and prompt treatment of early findings is what makes elimination genuinely achievable.
There is a double benefit in vaccinating boys. It reduces their own cancer risk at multiple sites, and it brings Australia closer to making cervical cancer a disease of the past. Given that the protective effect seen in this study is almost certainly the floor rather than the ceiling, the argument for early vaccination in both sexes has rarely been stronger.
References
Kitano T, Yoshida S. Nine-valent human papillomavirus vaccination and related cancers in males. JAMA Oncology, 2026. DOI: 10.1001/jamaoncol.2026.0496 https://jamanetwork.com/journals/jamaoncology/fullarticle/2847524
Fan K et al. Rates of oropharyngeal cancer continue to rise steeply amongst Australian men. Oral Diseases, April 2022. https://onlinelibrary.wiley.com/doi/10.1111/odi.14202
Tonic Health News. Cervical cancer elimination with Dr Norman Swan. Tonic Media Network. June 2025.
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This month's content is about staying protected, active and connected as winter sets in. On Tonic TV, we cut through the headlines on the Super K flu strain, meet the adaptive skaters finding freedom at the skate park, and explore how our dogs really see us. And on Aboriginal Health Television, Dance with Tom heads to South East Queensland to learn the mangara, the gum tree dance.
LIVE NOW ON TONIC TVWhat Super K Flu means
Super K has been all over the news, so here's what it actually means. It's a new variant of the H3N2 flu virus with the same symptoms but unusual timing. The 2026 vaccine has been updated to match it.
Anything feels possible
Custom frames, harnesses and sheer determination are getting wheelchair users flying around the skate park. Eight years on, hundreds of people living with disability have found the freedom and friendship of adaptive skating.
How dogs really see us
Loyal, loving and a little goofy, dogs have spent 30,000 years learning to read us. We explore what they can really feel, and the story of one dog whose persistence helped her owner catch cancer in time.
LIVE NOW ON ABORIGINAL HEALTH TELEVISIONDancing the Mangara
Tom takes young viewers into the Yugambeh language region of South East Queensland to learn the mangara, the gum tree dance, and what the great trees teach us about standing strong and looking after one another.
LIVE NOW ON TONIC BROCHURE BOARD & PHARMACYHealth headlines that make you think.
On our digital panels and in pharmacies this month, we're highlighting the role of nutrition and exercise in everyday health.
From GP waiting room to pharmacy, we're delivering timely, actionable content that sparks curiosity and supports healthier decision-making at every touchpoint on the healthcare journey.
Get in touchThe post June 2026 appeared first on Tonic Media Network.
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When you hear about billionaire biohackers claiming they are years younger than their chronological age, they are sometimes referring to their epigenetic clocks. These are measures of chemical reactions around our genes called DNA methylation, which can turn genes off or change their level of activity. The most reliable clocks have been calibrated against large populations of people whose health and wellbeing are tracked in detail over time.
The result is a tool that can measure your DNA methylation and indicate, on average, how typical that pattern is for a person of a certain age. You might be 50 but your DNA methylation might resemble that of a 48-year-old or a 53-year-old. That gap between chronological and biological age turns out to matter quite a lot for health outcomes.
The more exercise people did, the younger their biological age.
These clocks have made it possible to study whether specific interventions are associated with being biologically younger or older, in a way that goes beyond the usual self-reported health measures. A recent meta-analysis published in The Lancet brought together 44 studies of exercise involving over 145,000 people to ask exactly that question.
What they found was that the more exercise people did, the younger their biological age. The association held across different types of exercise, different age groups, and different populations. People who exercised regularly showed DNA methylation patterns that were, on average, several years younger than their non-exercising counterparts of the same chronological age.
The important caveat is that the study could not prove cause and effect, and many of the individual associations across the 44 studies did not reach statistical significance. People who choose to exercise may be biologically younger to begin with, for reasons unrelated to the exercise itself. Genetics, socioeconomic factors, diet, sleep, and a range of other variables all influence both exercise behaviour and biological ageing. Further research, ideally using randomised designs, is needed to establish how much of the effect is directly caused by exercise and how much is explained by the kinds of people who exercise.
That said, the consistency of the finding across a very large, combined sample is not easily dismissed. Exercise is already associated with reduced risks of cardiovascular disease, type 2 diabetes, depression, and a range of cancers. The possibility that it is also slowing biological ageing at a cellular level adds another dimension to a conversation that GPs are already well placed to have.
References
Shan et al. Physical activity and biological age measured by DNA methylation clocks: a systematic review and meta-analysis. The Lancet Healthy Longevity, April 2026. https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(26)00019-X/fulltext
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Vaccination during adulthood is associated with significantly reduced risks of dementia. The evidence is as powerful as it is surprising.
A large study found that adults aged 65 and over who had received the adult tetanus, diphtheria and pertussis (whooping cough) vaccine had a 42 per cent lower risk of developing dementia during follow-up. Pneumococcal vaccination is associated with nearly a 30 per cent reduction in dementia incidence. Evidence from nearly 300,000 older people who started off dementia-free showed a 30 per cent reduction in the risk of dementia over the next ten years if they'd had the influenza vaccine. A review of over 100,000 people found around a 24 per cent reduction in dementia incidence in those immunised against shingles (Varicella zoster).
It's hard to find another intervention that's associated with such powerful effects, and the evidence suggests that the benefit starts from about the age of 50.
It's hard to find another intervention that's associated with such powerful effects, and the evidence suggests that the benefit starts from about the age of 50. It could be earlier. All of the above findings allow for other factors that could explain the effect, such as differences between people who are more or less likely to be vaccinated in the first place.
The question is why?
Varicella zoster virus is a herpes virus, and researchers have long wondered whether herpes infections are a trigger for cognitive decline leading to dementia, given their affinity for the nervous system. At least one of the ways the zoster vaccine works to prevent dementia appears to be by keeping the virus at bay.
But there also seems to be a separate effect on the immune system, and this may help explain why influenza, pneumococcal, and tetanus/whooping cough vaccines appear to have a preventive effect as well. The leading theory is that chronic low-grade inflammation, driven in part by persistent viral activity, is a key pathway in dementia development. Vaccination may reduce that inflammatory burden over time, offering protection that goes well beyond the infections they were designed to prevent.
COVID-19 is relevant here too. A meta-analysis of over 800,000 people found that 65 per cent of those aged 65 and over who were hospitalised with COVID-19 developed new symptoms of cognitive impairment. A UK Biobank study comparing people aged over 50 who had COVID with those who had not found a 58 per cent increased risk of all-cause new onset dementia, particularly vascular dementia. COVID-19 vaccination reduces the risk of Long COVID significantly, and while direct evidence on cognitive outcomes is still emerging, the overall picture strongly favours vaccination.
With flu season underway, it is worth having these conversations proactively, particularly with adults over 50 who may be behind on pneumococcal, shingles, or Tdap vaccines. The dementia prevention angle gives the conversation a new dimension that many people have not yet considered.
References
Scherrer JF et al. Lower risk for dementia following adult tetanus, diphtheria, and pertussis (Tdap) vaccination. The Journals of Gerontology: Series A, Volume 76, Issue 8, August 2021. https://doi.org/10.1093/gerona/glab115
Veronese N et al. Influenza vaccination reduces dementia risk: a systematic review and meta-analysis. Ageing Research Reviews, January 2022. https://www.sciencedirect.com/science/article/abs/pii/S1568163721002816
Capriglione S et al. Association between vaccinations and risk of dementia: a systematic review and meta-analysis. Age and Ageing, Volume 54, Issue 11, November 2025. https://academic.oup.com/ageing/article/54/11/afaf331/8339764
Leng F et al. COVID-19 infection associated with increased risk of new-onset vascular dementia in adults aged 50 years and over. npj Dementia, October 2025. https://www.nature.com/articles/s44400-025-00034-y
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A recent Four Corners investigation has put adult ADHD diagnosis rates in Australia under the microscope, and what it found is harder to summarise than a simple overdiagnosis story. Working with data experts at UNSW Sydney, the program analysed prescription fill rates for ADHD medications, currently the only available proxy for diagnosis given there is no national register, and the variation by postcode is striking.
What's showing up in practice looks different depending on the patient. Some arrive with a diagnosis already in hand, obtained through a telehealth service, sometimes without what most clinicians would consider a thorough assessment. Others have been living with significant symptoms for years, never assessed, never treated. One patient is asking you to renew a script for a diagnosis you had no part in making. Another is describing something that has never been named. Both are common. Both require a different response.
In parts of Australia, an estimated 90% of people with ADHD are not being treated, missing out on treatment that could make a significant difference to their lives.
The clinical conversation worth having right now isn't about validating or challenging an existing diagnosis. It's about what a thorough assessment actually involves, and why it matters. That means taking a full history, ruling out other explanations for the symptoms, and not rushing. For patients who've had a quick telehealth consultation, that's worth naming directly: not as a challenge to their experience, but as a way of making sure nothing else is being missed. Depression and anxiety can present in ways that look a lot like ADHD, and if they're mislabelled, they go untreated.
The accepted adult prevalence of ADHD is around 3%. In parts of Fremantle, Western Australia, up to 8% of women under 44 have received a diagnosis, a figure that has emerged rapidly over just five or six years. Marrickville in Sydney and Brunswick in Melbourne also show elevated rates.
It is hard to explain why rates are so high in these areas. Social influencers have raised awareness, and it seems some telehealth psychiatrists are quick to write a script without a proper assessment. But the data cuts the other way too. In parts of Southwest Sydney, an estimated 90% of people with ADHD are not being treated, missing out on treatment that could make a significant difference to their lives. Overdiagnosis in one suburb and significant underdiagnosis in another are both failures of the same system.
On the other hand, there are many parts of Australia where diagnostic rates are so low that people with genuine ADHD are missing out on treatment that could make a significant difference to their lives. There are parts of Southwest Sydney where 90% of people with ADHD are not being treated. Overdiagnosis in one suburb and significant underdiagnosis in another are both failures of the same system.
Proper adult ADHD assessment is time-consuming and, without public sector options, expensive. There are no shortcuts that serve the patient well. The picture may shift as more GPs are trained to diagnose and prescribe. Queensland GPs can already do so without specialist referral, though the safety and effectiveness of that model is yet to be formally evaluated. What's clear is that the right diagnosis, made carefully and thoroughly, is the thing most likely to change the outcome for the person sitting across from you.
References
References Four Corners. ADHD diagnosis rates in adults: Australia. ABC News, April 2026. https://www.abc.net.au/news/2026-04-20/adhd-diagnosis-rates-adults-australia-data-four-corners/106557646
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The human papilloma virus vaccine is, at its core, a cancer prevention vaccine. HPV causes cervical cancer, pharyngeal cancer (especially in boys), probably oesophageal cancer, and anal cancer. The question that has hung over the program since its introduction has always been durability: how long does the protection actually last?
A large Swedish study of over 900,000 women, many followed for 18 years, now provides a clear answer. There was no reduction in cancer protection over that time. The greatest benefit was seen in girls vaccinated under the age of 17, presumably because they were less likely to have been exposed to HPV through sexual contact before vaccination.
Self-collected cervical samples were more likely to detect HPV infection and proved popular with underserved groups who avoid traditional screening.
The second study shifts focus to screening, specifically the uptake and reliability of self-collection of cervical samples, which is increasingly becoming standard practice. One of the persistent problems with cervical cancer screening has been reach. Women living in disadvantage, in remote and rural areas, and older women have historically been under-screened because they find the traditional screening process uncomfortable or culturally inappropriate.
Australian researchers investigated whether self-collection could close that gap. It did. Self-collection proved popular particularly among these underserved groups, significantly extending screening reach across populations that had previously fallen through the cracks. Critically, the self-collected samples were, if anything, more likely to detect HPV infection than practitioner-collected samples, making it not just more accessible but more effective.
Australia has set itself the goal of eliminating cervical cancer. It is a particularly aggressive malignancy, and elimination is an ambitious target. But with an HPV vaccine that holds its protection for nearly two decades and a screening method that reaches women who were previously unreachable, the pathway is clearer than it has ever been.
References
Lei J et al. Long-term effectiveness of HPV vaccination against cervical cancer: Swedish population-based cohort study. BMJ, 2025. https://www.bmj.com/content/392/bmj-2025-087326
Sultana F et al. Self-collection for HPV-based cervical screening in Australia. The Lancet Public Health, 2025. https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(25)00304-4/fulltext
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The Australian organic industry is worth $2.6 billion according to the latest Australian Organic Market Report.
Just in case the message gets buried in the detail, here are the main takeaways. You’re much better eating any vegetables than avoiding them because they might not be ‘organic’. And with vegetables and fruit, ‘fresh’ beats organic every time. That’s because the fresher a food, the more nutrients it has – and that includes snap frozen fruit and vegetables available at/or near a farm.
You’ve got to be careful when buying foods that are labelled organic. The term isn’t well regulated in Australia, and you can only be sure it’s organic if there’s a certified organic badge on the packaging by one of the Department of Agriculture, Fisheries and Forestry accredited certifying organisations.
What is organic?There’s pretty much no evidence of nutritional benefit from buying organic. Organic farming is the production of food without the use of synthetic chemicals or genetically modified components. Organic foods are not necessarily completely chemical free, but the pesticide residues will be considerably lower than those found in produce manufactured with synthetic chemicals. In animals it does mean that antibiotics haven’t been used. The farming techniques also need to be focussed on renewable resources, environmental conservation and animal welfare. With pesticides, you can have organic pesticides rather than synthetic ones.
So, there are many reasons why you might choose organic foods. It’s true that the safety of some synthetic pesticides hasn’t been proven. You might want peace of mind that you’re minimising the environmental impact of the products you’re eating. So consuming organic food for its health benefits is an act of faith with little or no evidence, but it could be so in the long term.
There is one-way organic foods can be harmful. They’re expensive and not always available. If an obsession with organic means you eat fewer vegetables, then that would not be good for you.
What do I do? Well, what I’m about to say is pretty much evidence free.
I buy organic foods which are up the food chain where pesticides and other chemicals may accumulate. That means organic chicken, beef and lamb as well as organic dairy products. I’m also careful about farmed fish. I rarely buy organic vegetables. You can wash them and peel them, and the high-level accumulation of chemicals is less likely.
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Your mum probably told you to rug up in winter because otherwise you’ll catch your death of cold. Was she right or not and why do we call colds, colds?
Well, she might have been partly right, but I’ll come back to that.
It’s not clear why we call colds, colds but when you go back a century or two, the term seems to have been used quite commonly. It’s likely to be because when we go out into the cold, especially if we have sensitive airways or asthma, we start to cough, and our nose runs with exercise. And when you have a respiratory virus, those are the kinds of symptoms you get.
So that’s probably why colds are called colds.
There’s no doubt that respiratory infections are more common in winter. Influenza is a seasonal virus although outbreaks have been known in late summer/early autumn. Non-COVID coronaviruses and rhinoviruses – the so called common cold viruses – are also seasonal and more common in winter.
The reasons as with all infections is an interaction between the virus, the environment, our behaviour and our bodies.
The viruses seem to survive longer outside the body in cold weather. We stay indoors more with closed windows and limited air circulation, and our immune systems are affected by cold weather, particularly in the nose. The lining of the nose is our first defence against viruses and there are complex interactions between white blood cells, antibodies and physical barriers like mucus. Cold weather is often associated with low humidity and that dries our nose and makes defensive action less efficient. It also may reduce the effectiveness of our white blood cells circulating in our bloodstream – although that’s controversial.
Even so, your mum might have been right. If you’re warm, then you’re more likely to have blood circulating to extremities like the nose. You might also have a more effective immune system.
But there are other things you can do.
Keep air circulating indoors. Wear an N95 mask if you think you’re coming down with something or in contact with others who are sneezing and coughing. And make sure you’re well hydrated so important bits don’t dry out.
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Around 1 in every 20 Australians has attention deficit hyperactivity disorder (ADHD). While ADHD is more common in boys, it’s under diagnosed in girls and adults. Interestingly, more than 3 in 4 children diagnosed with ADHD still have symptoms as an adult.
The number of states planning or implementing ADHD diagnosis and prescribing in general practice is growing. At the time of writing South Australia (SA) is the latest state to announce that next year GPs will be able to take up training to allow them to diagnose and treat ADHD in children and adults. This builds on SA’s decision in 2023 to have ADHD shared care programs for GPs which was focussed on adolescents moving into adult care.
In May 2025, the NSW Government announced changes which allowed GPs to prescribe ADHD medications for patients already on stable treatment. The second tier of the strategy involves a smaller group of GPs, around 1000, being trained to diagnose and initiate treatment.
The Western Australian government declared in early 2025 that they would institute a similar scheme to SA and NSW and it’s a promise by both major parties in the Tasmanian state election. The ACT is yet to make an announcement (again at the time of writing) despite it being an election promise last year.
Queensland GPs are already able to initiate stimulants for children and prescribe for those already on treatment. To assist the safe and effective implementation, there has been a focus on shared care with non-GP specialists, for example a recently announced collaboration across Brisbane’s six public paediatric hospitals.
The Federal Government has said it would like a consistent nationally but there are still variations, with Victoria allowing repeat prescriptions but in a more restrictive framework than SA, NSW and QLD.
The catches here for GPs undergoing training in the diagnosis and treatment of ADHD, is that a thorough assessment of a child takes a lot of time and effort involving parents, carers and schools. It’s much more than just administering a Conners Rating Scale. The question will be how remuneration will match the time spent and the teamwork required.
Further information
Attention Deficit Hyperactivity Disorder – ADHD: https://mydr.com.au/mental-health/attention-deficit-hyperactivity-disorder-adhd/
A new, collaborative approach to paediatric ADHD: https://www.metrosouth.health.qld.gov.au/about-us/news/a-new,-collaborative-approach-to-paediatric-adhd
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The prevalence of chronic conditions is increasing in Australia. According to the Australian Institute of Health and Welfare almost 1 in 6 (16%; 4.1 million) Australians claimed a Chronic Disease Management service in the past year.
From 1 July 2025, the new GP Chronic Condition Management Plan (GPCCMP) came into effect, bringing new item numbers, workflows and changes to how GPs care for patients with chronic conditions.
The GPCCMP replaced the existing GP Management Plans (GPMP) and Team Care Arrangements (TCA) and review items.
Four new MBS items are now billable. These items replace the previous items used for GP Management Plans (229, 721, 92024, 92055), Team Care Arrangements (230, 723, 92025, 92056) and reviews (233, 732, 920278, 92059).
Patients that had a GP Management Plan or Team Care Arrangement in place prior to 1 July 2025 will be able to continue to access referred allied health services consistent with those plans for two years.
Although these changes primarily affect medical practitioners, allied health professionals providing MBS services should also be aware of the changes to plan and referral requirements
For more information, the Department of Health, Disability and Ageing has produced the following fact sheets:
- an overview of the changes
- transition arrangements for existing patients
- referral arrangements for allied health services
- MBS items for GP chronic condition management plans.
How Tonic screens are simplifying GPCCMP and MyMedicare patient commsWe know how dedicated your team is, and how important the new GP Chronic Condition Management Plan (GPCCMP) and MyMedicare registration updates are for the practice and for your patients.
If your practice has a Tonic screen, we have developed a series of concise and friendly practice slides designed to deliver clear messages directly to your patients as they wait in your practice’s reception area.
We use eye-catching visuals that explain what the new GPCCMP means for them ahead of their appointment. This helps your team be proactive and have more focused and efficient conversations, ensuring patients get the answers they need quickly.
What do you need to?
Absolutely nothing. Unless you tell us you’d rather not have the slides, we have put them on your screen.
For more information click here
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You’d think it was uncontroversial that we need eight hours sleep a night. You hear that everywhere you go, but it turns out that it may be a myth.
Canadian research has called this into question, particularly looking at the impact of shorter duration sleep on health. Some nations tend to sleep less than others. So do the countries which sleep less, have poorer health statistics than those who sleep longer?
Researchers collected data on people’s health and their sleep duration from people in 20 different countries, based on the autumnal equinox, September 21, when the length of the day and night is about the same all around the world. They had four different measures of health and wellbeing including mental health, chronic diseases, overall physical health and how people in those countries perceived their own health.
What they found was that within each country, people who were sleeping shorter durations had worse health than those who were sleeping moderate sleep durations. In addition, people within those countries who were sleeping very long sleep durations also had worse health outcomes. That wasn’t because long sleep hurts people’s health, but when people aren’t healthy, they’re often sleeping longer.
If you imagine a graph of people’s sleep in each country, there was a sweet spot for maximum health and wellbeing. As sleep duration gets longer, people’s health tends to get better till it reaches a peak, and then it gets worse again.
That’s where the eight hours a day being a bit of a myth comes in. The sweet spot varied between countries. For example, Japan is a nation of short sleepers on average, yet Japan is one of the healthiest countries on earth with the longest-lived people. Australians sleep longer than Japanese and Australia is less healthy even though it’s also a long-lived nation.
So, for some reason that’s not clear, but may have something to do with culture and expectations, eight hours is not necessarily the perfect sleep duration. There’s a lot else going on.
Other research suggests that what really matters is sleep quality, meaning getting off to sleep quickly and sleeping through and feeling refreshed in the morning. That’s what insomnia therapy is good at delivering.
Researchers also looked at napping times in each country but that didn’t seem to affect the findings.
Further informationImproving Your Sleep – Dr. Norman Swan: myDoctor https://mydr.com.au/sleep/improving-your-sleep/
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If you find a food reliably brings on a symptom like a headache or a rash, or worsening acne, then for you that food is probably a trigger. In consultation with your GP, it may be worthwhile avoiding it to see if it makes a difference.
With acne though, the commonly assumed food triggers are dairy and chocolate. The question is whether the evidence supports the belief?
Acne is common and results from skin pores becoming blocked with all sorts of things but mainly fatty secretions, skin cells and bacteria which causes the well-known pimples, whiteheads, and blackheads.
The fatty secretion is called sebum and in most people with acne they carry genes that produce thick sebum which is more likely to get stuck in the pores. Conditions such as polycystic ovarian syndrome increase the chances of having acne probably due to excessive male hormones (androgens). The Western diet is also a risk factor and interestingly people who grow up in a society with low levels of refined carbohydrates have lower levels of acne but when they move to a country with an unhealthy diet, their acne risk goes up. Oral contraception may also be weakly linked to acne risk.
The strength of genes illustrated by the fact that identical twins are much more like to both have acne that fraternal twins.
For those who follow social media, you’ll find plenty of people who swear their changed diet has cured them of acne. What you don’t see are all the people for whom dietary change has made no difference. Nonetheless people with acne when asked, do feel that nutritional advice has been neglected by their health practitioner.
So what about dairy and chocolate?Studies have not been high quality but the better ones suggest that if dairy does make acne worse, it’s not all dairy products. If there is a link it seems to be with milk consumption, particularly skim milk, which may have something to do with the carbohydrates rather than the dairy itself.
What has better evidence is the glycaemic index (GI) which is about the speed that your blood sugar goes up after eating the food. And when you boil down the evidence on chocolate, it looks as though the effect on acne is more about it being a high GI food.
So, a Mediterranean style diet has more chance of helping you than avoiding the occasional chocolate.
Although – if chocolate is your trigger, then what harm is there in avoiding it?
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Prostate cancer screening comes closer.It is estimated that there were 26,368 new cases of prostate cancer diagnosed in Australia last year. According to Cancer Australia, a male has a 1 in 6 (or 18%) risk of being diagnosed with prostate cancer by the age of 85.
Many men and their partners are puzzled by the fact that while there’s screening for bowel, breast and cervical cancer, there’s no official screening programme for prostate cancer. That’s because there hasn’t been a reliable test for the prostate as blood in the poo, mammography or cervical smears. The blood test that’s done for prostate cancer – the PSA or prostate specific antigen – is not actually a test for cancer. It goes up when the prostate is enlarged or inflamed and with cancer while it usually is high, that’s not always the case. So, by itself it’s problematic and in the past has usually led to a biopsy and sometimes surgery when they might not have been needed.
All that has changed significantly with the recognition that in expert hands, an MRI scan of the prostate for men with a raised or rising PSA test can tell you with much more accuracy what’s going on. PSA testing followed by MRI when needed, has cut the need for biopsies by up to 50%, which means many men don’t have to subject themselves to an invasive test. When the biopsy is needed, the surgeon knows exactly where to go and the seriousness of the cancer, if it is present can be better assessed. This has cut the need for radical surgery because men can be monitored with both PSA tests and repeat MRI’s if appropriate.
The bottom line is that while costly, it means that the reliability of the process is much higher and offers peace of mind to both doctors and men.
The Prostate Cancer Foundation has recently released recommendations along these lines and is encouraging GPs to offer testing to men from the age of 40 on. There are still issues around out of pocket costs and availability of MRI prostate scanning in regional and rural areas, although Medicare Benefits are available if the man meets certain criteria.
Use your Tonic TV to remind patients about prostate cancer screeningIf your practice has a Tonic TV, we can help you promote screening and other services.
You have access to 3 minutes every hour to promote your practice using either static slides or supplying us with videos of a 30 or 60 second duration.
A slide appears on screen for 15 seconds and can promote important information such as:
- Operating hours
- Services offered such as screening
- Local health updates
- Seasonal vaccination reminders
- New staff
- Special events and clinics
We can create the slides for you. Simply contact us with the information you’d like to share on screens, and we will design slides to promote your practice.
Further informationProstate Cancer – Cancer Council: https://www.cancer.org.au/cancer-information/types-of-cancer/prostate-cancer
Prostate Cancer – causes and symptoms – my Doctor https://mydr.com.au/cancer-care/prostate-cancer-causes-and-symptoms/#:~:text=Prostate%20cancer%20is%20the%20most,prostate%20cancer%20increases%20with%20age.
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Metformin is a commonly used drug in people with type 2 diabetes. It’s cheap and safe. But it’s also known to have effects on the immune system dampening inflammation and maybe even on the brain affecting pain perception.
It’s also known that people with knee osteoarthritis tend to be overweight or obese and have some of the metabolic abnormalities that go along with diabetes.
That’s why a group of Melbourne researchers did a six month trial of metformin compared to placebo in overweight and obese people with knee osteoarthritis.
The people who received the metformin had noticeable reductions in pain and stiffness. Some had side effects such as abdominal discomfort and diarrhoea, but nobody stopped the medication because of side effects.
The lead researcher, Professor Flavia Ciccutini believes that metformin along with exercise and muscle strengthening, could significantly help people, and delay or avoid the need for a knee replacement.
Further informationMetformin for Knee Osteoarthritis in Patients with Overweight or Obesity: JAMA Network
Metformin as a potential disease-modifying drug in osteoarthritis: a systematic review of pre-clinical and human studies: National Library of Medicine
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A new study from the Garvan and Kirby Institutes in Sydney has looked at whether it makes a difference which arm gets your booster shot i.e. subsequent vaccinations to the first one.
It turns out the immune response is much more effective if the second shot is given into the same arm.
The researchers studied mice then verified their findings in humans and published in the prestigious journal Cell.
What appears to happen is that after the first immunisation, macrophages (see How safe are tattoos – really? story) gather in the local lymph nodes carrying the history of the vaccine with them and pass on the immune message to special memory cells which line up at the surface of that node. When the second immunisation is given, the macrophages are ready for action – primed to respond to the vaccine from the previous dose. They then pass on the message to the memory white blood cells which then throw the switch to producing the antibodies to whatever virus the vaccine is designed to combat.
The trial in humans was done using the COVID-19 vaccine. The main difference was the speed of antibody production. In the end it didn’t matter which arm was injected because eventually the antibody levels were the same. However, the response was much faster in the same arm group. This matters when there’s a lot of viruses around as is the case with both COVID and flu or if you’re in the middle of an outbreak.
It’s usually not too difficult to remember which arm you were jabbed in last. Most of us have vaccinations in our non-dominant arm (left arm for right handers and vice versa).
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Apparently one in four Australians has a tattoo. Not sure how reliable that number is but anecdotally you now see a lot more people with tattoos. Anything from fine line art work to dense tattoos covering large areas. There’s a long history of tattoos going back thousands of years with various meanings attached to them from status to occupation and military experience.
Why do tattoos stay put?This is important to know because it could go to the issue of potential for harm. Tattoos involve ink and other substances – which I’ll come to later – being injected into the dermis (the layer under the skin). This causes damage and scarring with white blood cells called macrophages which specialise in chomping up foreign material coming into the area, taking up the ink and seem to become paralysed or die with the ink either still inside them or released into the tissues. Then the immune system seems to ‘wall-off’ the tattoo. Those two phenomena seem to be key to the permanence of tattoos. However, some ink particles do escape, usually into the lymph nodes which drain the inked area and many tattoos become fuzzy over the years because the immune system eats away at them.
What’s in tattoo ink?These products are poorly regulated. There are dyes of various colours and chemistry; alcohols to prevent infection and other chemicals like glycerol to thicken the fluid. There are also contaminants and a study of tattoo inks in the United States found that often you can’t trust the ingredient list on the packet. The concerns are that an additive or adulterant such as polyethylene glycol (PEG) could damage the kidneys. Carcinogens such as polycyclic aromatic hydrocarbons are also found in tattoo inks and there are also worries about the risk of either cancer or the ink misleading pathologists looking at tissue samples.
Potential harmsInfection is always a risk such as from blood borne viruses or bacterial infection from the wound. Tattoo parlours usually take safety precautions but if you’re puncturing the skin multiple times, the risk never totally disappears. You can get an allergic reaction especially to red dyes, sometimes years after the tattoo was created. Kidney damage due to PEG is possible but rare.
A study of twins with and without tattoos in Denmark suggested a small increase in the risk of skin cancer and lymphomas, especially for large, densely inked tattoos. There’s also the potential for misdiagnosis. One case study of a man with a chest tattoo got the doctors worried about breast cancer when there was none and ink particles in lymph nodes can lead doctors to think that a melanoma has spread when it hasn’t.
The bottom line with tattoos is to be careful. Choose a tattoo artist who takes pride in cleanliness. Maybe avoid large, dense tattoos.
Further informationHow safe are tattoos – really?: UCSF Synapse
What’s in my ink: an analysis of commercial tattoo ink on the US market: National Library of Medicine
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Microplastics are small particles of plastics under 5mm in size. Some are tiny (less than 0.1 of a micrometre) and are often referred to as nanoplastics. In general, the smaller the particle, the more worried experts tend to be because that’s when they can be absorbed into the bloodstream and potentially enter organs like the lungs, heart and brain. You might also have heard of nurdles. They’re plastic pellets used in manufacturing processes. Microbeads are plastic particles used in exfoliants and abrasives. Then there are microfibres of plastic often shed from synthetic fabrics. What you hear about most though are microplastic particles from packaging, bottles and containers, which can pollute the environment when they break down, especially at sea and one way or other get into the water supply or food chain.
Are we really consuming a credit card a week?The uncomfortable reality is that we’re all exposed to microplastics and have them to a varying extent in our bodies. However, sometimes the headlines have been misleading. One study which is often quoted, estimated that we consume one credit card equivalent of plastics every week. The problem with that study is they made a major miscalculation. It turns out to be a credit card every 23 thousand years. That doesn’t mean though that you can relax about whether microplastics are doing you harm. For that you need to take into account the shape and size of particles and what they’re made of.
Having absorbed microplastics can we get rid of them?Nanoparticles are more likely to be filtered from the blood by the kidneys and expelled in your urine. Studies have shown that our urine can contain microplastics. Larger particles while still tiny, may be trapped in our bodies.
So here are the concerns about the microplastics that hang around. One is that as foreign material, they trigger our immune system and cause inflammation in the blood or wherever they land. Inflammation is best described as like a poorly targeted artillery barrage by the immune system and because of that there can be collateral damage to our arteries, brain tissues and other organs, speeding up the ageing process and perhaps accelerating problems like atherosclerosis which is the process which can eventually block arteries. The other process that’s thought to be triggered is oxidative stress – also related to organ damage and accelerated ageing.
Harms?The research into the human effects of microplastics has focussed on fertility, the digestive system, the lungs, heart and brain.
FertilityThe theoretical concern is what’s called endocrine disruption – the potential to affect how our hormones control egg and sperm production. The evidence that this actually happens is current not strong despite microplastics being found in the fluids carrying eggs and sperm.
Heart and arteriesThe way atherosclerosis blocks arteries is by the accumulation of what’s called plaque which ruptures causing a blood clot and sudden blockage and then a heart attack or stroke. There have been studies which have found higher than average levels of microplastics in the artery plaque of people who’ve had a stroke or heart attack. Whether that’s a reflection of diet and lifestyle or a real risk in itself isn’t known.
BrainThe evidence is solid that brains today have more microplastics in them than previous generations and it looks as though people with dementia have higher than average levels. Again, it’s not known whether the particles play any role in cause.
So what should we do?Bottom line is that we all have microplastics in our bodies. The research isn’t conclusive about the harms, but the potential is real. What some researchers in the field are doing in their own lives is minimising their exposure by trying to avoid plastic containers, packaging and exposure in cooking from non stick surfaces and plastic chopping boards. That’s not easy. Glass containers are more expensive and they break and are hard to use in kids’ lunchboxes. Cast iron cookware can also be pricey. But I must say that’s what I’m doing even though it’s impossible to avoid microplastics.
What’s needed is environmental control and ways of minimising their use in manufacturing.
Further information
Ingested microplastics: Do humans eat one credit card per week? ScienceDirect
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Acai berries are everywhere. Your gym might offer acai shakes. Your favourite café almost certainly has acai bowls on the menu somewhere. It’s definitely a thing. People love acai and fork out serious money for their daily hit. The Australian Financial Review estimated that acai is a $750 million market.
Acai is marketed as hotching with bioactive compounds like flavonoids, anthocyanins and polyphenols which reduce biological rusting (oxidative stress) and have other beneficial effects on the body, which indeed they do. But acai berries aren’t the only source.
The acai berry comes from a tropical palm tree native to the Amazon and most of the world’s supply originates in Brazil, where there have been accusations of using child labour on the plantations. Acai usually comes as pulp or powder.
So here are a few caveats which might – in addition to the allegations of child labour, might make you pause for thought.
One is that any agricultural product varies in content according to changes in climate, soil quality, harvesting and transportation times before freezing. So, what’s on the packet may not reflect what you’re eating on that day. But that’s true of most fruits and vegetables.
You’re not doing yourself any harm with an acai breakfast assuming you’re not loading up on sugar and refined carbs in the bowl along with the berries. The question is whether acai berries are any better than other dark red or purple berries. And the answer may be no. Comparative analyses from reliable labs suggest that in fact blueberries may have a wider range of anthocyanins and raspberries and blackberries may have more bioactives as well.
The point is you will probably gain the same benefits from these berries at a lower cost. But hey, they’re not as exotic are they?
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With Daylight Saving Time (DST) ending recently, it’s timely we look at the available evidence to determine whether it’s good or bad for our health.
When was DST introduced?DST was originally introduced during World War I as a wartime measure to conserve fuel and energy by extending daylight hours into the evening, reducing the need for artificial lighting.
DST operated nationally during World War I from 1 January 1917 to 25 March 1917 and during World War II for three summers, beginning on 1 January 1942. It was introduced again in NSW on 31 October 1971 after the Standard Time Act 1971 was passed by the NSW Parliament. Now on the first Sunday in October, people living in New South Wales, Victoria, South Australia, Tasmania and the Australian Capital Territory set their clocks forward by one hour to extend daylight hours after the working day. On the first Sunday in April, we set them back.
If you look at a world map, tropical regions have generally never had daylight saving and many other parts have stopped using it. Australia, New Zealand (which has probably had the longest continuous experience of DST), Europe and North America still put their clocks forward in spring and back in autumn.
The great debateThere are fierce debates about daylight saving in Australia. Western Australia, Queensland and the Northern Territory don’t have it. They claim that longer days in hot summers is oppressive, and farmers generally dislike the change in routine. Eastern and more southern states like the lifestyle benefits of being able to get outdoors or go to the beach after they come home from work.
Opponents of daylight-saving claim it’s bad for your health. So, what’s the evidence?
It swings about and is complicated by the effects of more hours of sunlight in summer and fewer in winter.
There’s some evidence of a small increase in heart attacks in the week after the clocks go forward in spring. Out of hospital cardiac arrests also go up after the spring shift but they go down after the autumn clock change, tending to balance it out. There is some evidence of injuries due to human error, but it may be more that the real shift is in time of day when injuries occur.
On the positive side, physical activity levels go up in areas with daylight saving.
So, the bottom line is that depending on your personal opinions for or against daylight saving, you can find evidence to support your position
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Most of us will have an episode of acute back pain in our lives and in some of us, the pain will last for weeks and months. The discomfort is such that you want something done about it and the professionals you see want to help you. Which is why various therapies and interventions are on offer.
A review of the available evidence from randomised trials has looked at the outcomes in people the back pain that’s gone on for at least three months where the cause wasn’t an infection, cancer or say an autoimmune disease. The pain could either be confined to the back or radiating down the leg. The studies involved nearly 8000 people across 13 procedures or combinations of procedures.
Let’s start with people whose pain was confined to the back. Injections of local anaesthetic into the epidural space around the spinal column had little or no effect, nor did epidural local anaesthetic with steroids, epidural steroids by themselves, targeted injections of steroids or local anaesthetic into the joints around the spine. Local anaesthetic injections into the muscles appeared to make the pain worse and trying to destroy the nerves (radiofrequency ablation) to the joints was of little help.
With pain that was going down the leg, the lack of beneficial results was similar, including one targeted at the roots of the nerves in the spine called radiofrequency dorsal root ganglion which tries to change the way the nerves transmit their messages.
It is possible that there are small groups of people who will benefit from one or another of these procedures, but the research wasn’t able to identify who they might be. The problem for the person with chronic back pain is that these interventions are not harm free, may involve travel to a specialist centre and cost you a lot of money. The risks include worsening pain, nerve damage and infection.
Yes, it’s frustrating but the thing to be aware of is that this isn’t the first study to show that these injections don’t work, yet they continue to be offered.
So what does work? Well in many people the pain will go after a few months no matter what you do, including spinal surgery which has doubtful evidence of benefit in most people. There is some evidence that Pilates and the McKenzie method from well-trained clinicians can help restore function and reduce pain and at the very least keep you in some shape to assist with recovery. Opioid pain killers do not help chronic pain and can be disastrous if they cause addiction.
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As we get older, we tend to accumulate medications that have been prescribed over the course of adulthood, often leading to polypharmacy (defined as taking five or more medications concurrently).
Research in 2017 found that almost a million Australians over the age of 70 were affected by polypharmacy – with women more likely to be using multiple medications than men.
Polypharmacy is linked to increased risks of side effects, medication errors, interactions and poor medication adherence. But are there risks associated with reducing polypharmacy?
In a new study, Western Australia researchers updated a 2016 systematic review and performed a meta-analysis looking at deprescribing and found that careful deprescribing can improve survival rates in older people.
Researchers looked at participants 65 years and older in studies from 2015 to 2024, specifically focussed on deprescribing (rather than optimising medications, which is more about adding or changing medications). 259 studies were included, of which 95 were randomised controlled trials (RCTs).
Data mostly came from the United States, Canada, the United Kingdom and Australia. A subgroup analysis was also performed, looking at the age of the participants and the different types of intervention (deprescribing single medications vs multiple medications).
The data from RCTs showed that deprescribing had a survival benefit when implemented in people aged 65-79.
The research highlights the value of regular and proactive medication review, with the aim of deprescribing to reduce inappropriate polypharmacy. Such changes often occur on an ad-hoc basis, such as during unplanned hospital admissions, but could have a significant benefit if conducted routinely and early on once patients reach the age of 65.
While the authors acknowledge that there can be issues posed by deprescribing – such as the exacerbation of symptoms or rebound phenomena, which need to be managed with a tailored and patient-specific approach.
Further information
The effect of deprescribing interventions on mortality and health outcomes in older people – An updated systematic review and meta-analysis: British Journal of Pharmacology
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Vaginismus is a sexual pain disorder that can have a profound impact on wellbeing and sense of self. It is due to the pelvic floor muscles spasming and can result in vaginal penetration being painful to impossible. It is reported to affect between one and seven per cent of women, but this is likely an underrepresentation due to limited awareness, shame or stigma, and a perceived lack of treatment options.
New research from Western Sydney University has explored the relationship between patients seeking help for this condition and their sense of self.
Authors conducted a qualitative study using semi-structured interviews, with 21 participants between the ages of 19 and 37 who had received a diagnosis of vaginismus. Researchers collected and coded the transcript data to identify patterns and commonalities across interviewees.
Some key themes that came across in the interviews were a sense that painful sex affected participants’ perception of their womanhood – feeling like ‘less of a woman’ due to the condition.
Importantly for clinicians, participants spoke about factors that encouraged help-seeking, including empathic practitioners who considered patients holistically and recognised the impact the condition could have on mental health, emotional wellbeing and personal relationships.
Participants also spoke to both the physical pain and the experience of seeking help being exhausting and stressful, affecting their sense of agency and mental wellbeing.
Offhand responses by health practitioners could stay with patients for a long time, affecting their sense of self. However, those who demonstrated a willingness to provide support could help empower patients and drive their own sense of self-efficacy.
The authors broadly suggest that concerns about pain during sex are often dismissed/minimised, leading to misdiagnosis, misinformation and incorrect treatment. They saw that sexual pain is often thought of by health professionals as a solely physical issue, with the impact on sense of self and identity not considered.
Given the ongoing stigma associated with raising these topics and help-seeking, discouraging or dismissive offhand comments by health practitioners can have a significant impact and be disempowering – but this also points to the power of well-informed and empathic clinicians in shaping positive outcomes for people experiencing this condition.
Further information
The interrelationship between women’s help-seeking experiences for vaginismus and their sense of self: a qualitative study and abductive analysis: Taylor & Francis Online
The Third Act: My Doctor
Vaginismus fact sheet: Jean Hailes
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Mental health conditions have a significant impact and are common. We also know that some mental health issues are associated with experiences from childhood such as maltreatment and abuse.
Child maltreatment includes experiencing physical and sexual abuse and being exposed to domestic violence. The effects are far-reaching, leading to increased risks of mental illness, physical health issues, emotional and relational problems, as well as educational and occupational underachievement.
Interventions such as parenting skills programs have proven successful in reducing the factors which increase the risk of a child being maltreated.
In a new study researchers looked at one evidence-proven program – the Positive Parenting Program (Triple P), a multi-level, multidisciplinary intervention. The program blends various modes of delivery (online or in person) and it is free to parents because it’s funded by the Australian government.
In this research, they did a study conducted in parallel with the statewide implementation of Triple P in Queensland. The research compared intervention communities from poor socio-economic areas with comparison communities in NSW that received standard care and had not yet had exposure to the program.
Data were collected through parent surveys, administrative records from the Queensland Department of Child Safety, Youth, and Women and the NSW Department of Communities and Justice, comparing notifications and substantiations of child maltreatment both before and after the intervention.
Over a three-year period, the Triple P program reached nearly 6,000 participants, accounting for 13 per cent of the targeted communities. Various organisations, including childcare centres, schools, healthcare providers and sporting clubs helped host the program.
In the intervention communities, the rate of child maltreatment notifications dropped by 10 per cent, while substantiations decreased by 25 per cent. In comparison, communities receiving standard care saw a 54% increase in notifications and a 3% rise in substantiations (though administrative changes in NSW during the study period made it easier to report child maltreatment and may have inflated the notification rate).
While the research design targeted disadvantaged communities more at risk of child maltreatment, these results suggest early referral of parents and children at risk of maltreatment is likely to be beneficial.
Participants and researchers found the flexible delivery of the program fit with the needs of those families who used it and that ought to inform future interventions. Given the strong connection between child maltreatment and adult mental health problems, programs like Triple P can be instrumental in breaking cycles of abuse and fostering healthier communities.
Further information
Parenting, Child Maltreatment, and Social Disadvantage: A Population-Based Implementation and Evaluation of the Triple P System of Evidence-Based Parenting Support: Sage Journals
The impact of childhood trauma: My Doctor
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Tetanus, diphtheria and whooping cough are covered by various combination vaccines in Australia. While part of the routine childhood immunisation schedule, recommended coverage for adults becomes more complex, with varying schemes and rules governing who gets which combination and when. For most adults these vaccines are not covered by Medicare. With this complex framework in mind, researchers wanted to delve into the vaccine coverage of these conditions over time. They looked at data from the Australian Immunisation Register (AIR) from the beginning of 2024, capturing coverage of tetanus, whooping cough and diphtheria in adults aged 50 onwards (divided into age brackets of 50-64, 65-74, 75-84, 85+).
The research found significant rates of under-vaccination in older Australians, with about a third of people over 50 having appropriate coverage for tetanus and diphtheria, and only a fifth for whooping cough. In those covered for tetanus, the most recent vaccine for two thirds of people was dTPa, and a third had dT. Of everyone captured in the study, rates of coverage for tetanus and diphtheria had minimal variation with age, but the proportion of whooping cough coverage consistently declined with age, with only 13.5 per cent of those over 85 up to date. The authors acknowledge that the data may underestimate rates of vaccination, as the AIR only began capturing adult vaccinations in 2016 and reporting these vaccinations to the AIR is not mandatory.
The range of combination vaccines for diphtheria, tetanus and whooping cough means that appropriate vaccine coverage for each disease can make it difficult for patients to keep track of whether their vaccines are up to date. While the aim of routine dTpa boosters in older people is primarily to protect against whooping cough, presentations to emergency for wounds would contribute to coverage rates being higher for diphtheria and tetanus than whooping cough. The authors suggest this means that whooping cough coverage is less comprehensive than it should be. The recommendations for diphtheria, tetanus and whooping cough vaccination are relatively complex, with the study noting practitioners are often not up to date with the recommended schedule.
Furthermore, this research is published at a time when Australians are being urged to get the whooping cough vaccination as infections rise more than tenfold in a year. At the time of writing more than 26,700 cases reported so far in 2024, compared with 2,451 cases for all of 2023.
Further information
Tetanus, pertussis, and diphtheria vaccination coverage in older adults, Australia, 2023 – analysis of Australian Immunisation Register data: MJA
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According to the World Health Organisation, viral hepatitis infections claim the lives of 3,500 people each day worldwide. One of the lesser-known kinds is hepatitis E.
Infection can occur after eating or drinking contaminated food or water in less developed countries, or consuming undercooked pork products in Australia.
Diagnosis is based on symptoms and confirmed by a blood test showing antibodies to hepatitis E.
Most people recover within four to six weeks of contracting hepatitis E. It can be particularly serious for pregnant women, especially during the third trimester, and for people who have existing chronic liver disease.
Dr Richie Madden is co-founder of Hepatitis E International Direct-Action Group. He is based at the Royal Adelaide Hospital and has been looking closely at the disease for 15 years. He recently told ABC Radio National’s Health Report that it’s an emerging threat here in Australia, and we should be paying more attention to it.
“I believe it should be part of the acute liver screen for cases of unexplained hepatitis. For liver inflammation and the liver blood test, we typically test for A, B and C…. I think here in Australia we should test for E, A, B, C.”
What are the symptoms of hepatitis E?
According to NSW Health, the symptoms of hepatitis E include:
- loss of appetite
- nausea
- vomiting
- tiredness
- abdominal/gut pain
- fever
- dark urine
- pale stools
- joint pain
- yellowing of skin and eyeballs (jaundice).
Symptoms normally start 3 to 6 weeks after the infection. For some people, symptoms may occur anywhere from 15 to 64 days after infection.
How is it treated?
There is no specific treatment or commercially available vaccine in Australia for hepatitis E.
Prevention is the most effective way to protect you from hepatitis E.
Further information
Hepatitis E fact sheet: NSW Health
Hepatitis E – including symptoms, treatment and prevention: SA Health
Hepatitis E: a neglected virus: The Lancet
Health Report: ABC Radio National
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Depression affects 1 in 7 people in Australia. Good nutrition, physical activity and having someone you can reach out to are all important when someone is depressed. How do these lifestyle interventions compare though, and which are the most important?
A new study looked at the effectiveness and cost-efficiency of remote-delivered, online lifestyle therapy (focused on nutrition and physical activity) compared to traditional talking therapy (in this case, cognitive behavioural therapy or CBT) for reducing depression. The goal was to determine whether lifestyle therapy could be as effective as psychotherapy.
Researchers conducted a randomised controlled trial involving 182 adults with symptoms of depression. Participants were randomly assigned to one of two groups: one received lifestyle therapy (led by a dietitian and exercise physiologist), while the other underwent psychotherapy (led by psychologists). Both interventions were delivered via video conference for 90 minutes. There were six sessions over two months and the primary outcome measured was depression severity.
Both groups experienced significant and similar reductions in depression over the eight weeks. The study found no significant differences between the two, indicating that lifestyle therapy was similar to psychotherapy. Cost-wise, delivering lifestyle therapy was slightly cheaper, primarily because dietitians and exercise physiologists are paid less than psychologists, but generally the health and societal costs were comparable between the two approaches.
The results suggest that lifestyle therapy could be a viable alternative to psychotherapy for treating depression, particularly in situations where access to psychological services is limited, such as rural areas.
If replicated in larger studies, this approach could help reduce the burden on the mental health system by expanding the types of professionals able to deliver effective treatment for depression.
Further information
Clinical and cost-effectiveness of remote-delivered, online lifestyle therapy versus psychotherapy for reducing depression: results from the CALM non-inferiority, randomised trial: The Lancet
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Bowel cancer is a leading cause of cancer-related deaths, claiming the lives of 5,350 Australians every year (103 a week). That number is even more tragic because many of these deaths could have been prevented through early detection.
The National Bowel Cancer Screening Program (NBCSP) is designed to detect bowel cancer in the general population. Eligible Australians aged 45 to 74 can do a free test at home every two years.
It only works of course if people participate, and the rates of uptake have been lower than desirable.
A study examined the long-term screening habits of Australians who received invitations to screen between 2006 and 2022, focusing on how consistently individuals participated over several screening rounds – which may provide clues as to who should be targeted and how to improve screening rates.
Researchers gathered national data on all the people who were invited to participate in the NBCSP at least once between August 2006 and March 2022. They analysed those who had been invited four times to understand how many consistently participated, how many skipped some rounds, and how many never participated. The study also explored whether past participation could predict future screening behavior.
During the study period, over 8.5 million people received at least one invitation to screen. Out of these, just over half completed at least one screening test. Among the 2.5 million people who received four invitations, a quarter consistently participated in all four rounds, while around 40 per cent never participated, and the remaining participated inconsistently. Importantly, people who had consistently participated in previous rounds were far more likely to continue screening. For example, among those who had completed all three prior screenings, 89 per cent participated in the fourth round. In contrast, only 9.5 per cent of those who had skipped all previous screenings took part in the fourth round.
This indicates that reinforcing the importance of regular screening after someone has initially participated could help improve long-term adherence to the program.
The authors suggest that targeting people who miss screenings, especially those who have skipped their most recent invitation, with tailored reminders or interventions could boost participation rates. They say that these insights are critical for developing strategies to increase screening rates in the NBCSP, ultimately saving more lives through the early detection of colorectal cancer.
Use your Tonic TV to remind patients about bowel cancer screening
If your practice has a Tonic TV, we can help you promote screening and other services.
You have access to 3 minutes every hour to promote your practice using either static slides or supplying us with videos of a 30 or 60 second duration.
A slide appears on screen for 15 seconds and can promote important information such as:
- Operating hours
- Services offered such as screening
- Local health updates
- Seasonal vaccination reminders
- New staff
- Special events and clinics
We can create the slides for you. Simply contact us with the information you’d like to share on screens, and we will design slides to promote your practice.
Further information
Longitudinal screening adherence in the Australian National Bowel Cancer Screening Program from 2006 to 2022: ScienceDirect
www.bowelcanceraustralia.org/
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It’s the in-vogue form of exercising, and now another study suggests it has benefits over and above the everyday activities of jogging, swimming or cycling. High intensity interval training (HIIT) is characterised by periods of intense physical exercise, interposed with short periods of relaxation.
A new study explored the long-term effects of HIIT on learning and memory in healthy, elderly people.
194 participants aged 65 to 85 were randomly put into three groups based on exercise intensity: low-intensity training (LIT), medium-intensity training (MIT), and HIIT.
Over six months, each group attended 72 supervised exercise sessions. Cognitive testing was conducted monthly, focusing on hippocampal function (the part of the brain that manages memories and keeps people from forgetting them) and MRI scans were taken at several time points to measure brain volume and connectivity. Blood samples were also collected to analyse biomarkers associated with brain health.
Results showed that only the HIIT group experienced significant improvements in hippocampal-dependent cognition and that these persisted for years. It wasn’t that low and medium levels of physical exercise were bad for you. They helped to maintain cognitive function, and of course they’d also have flow-on benefits such as heart disease and cancer prevention.
But it was only the HIIT users who saw an improvement in their hippocampal function. MRI data revealed that HIIT halted age-related brain volume loss, particularly in the hippocampus, and enhanced functional connectivity between neural networks. HIIT also correlated with beneficial changes in biomarkers linked to improved cognitive function.
The study underscores the importance of exercise intensity in cognitive health, suggesting that HIIT can protect against hippocampal decline in ageing. It also identified potential biomarkers, like BDNF and cortisol, which could help tailor exercise programs for cognitive improvement.
These findings offer a promising non-invasive strategy to counter cognitive decline, suggesting the long-term benefits of high-intensity exercise.
Further information
Long-Term Improvement in Hippocampal-Dependent Learning Ability in Healthy, Aged Individuals Following High Intensity Interval Training: National Center for Biotechnology Information
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Australians have some of the highest rates of exposure to ultraviolet radiation (UVR) from the sun. This results in a high incidence of skin cancer, including melanoma.
Over the past four decades in particular, skin cancer rates have increased significantly, with two in every three Australians expected to develop some form of skin cancer by 70 years of age.
Despite this, routine skin cancer examinations are only recommended for high-risk individuals. For others, clinicians and outreach bodies provide general information on how to detect a possible melanoma and what things to look out for on the skin. It’s a form of “self-screening.”
Furthermore, the COVID pandemic hasn’t helped, with some diagnoses delayed due to patients not seeing their doctor.
A new Australian study by researchers in New South Wales and Queensland investigated the effectiveness of self-screening for melanoma, focusing particularly on how accurately patients identify lesions of concern.
Participants were recruited from various clinics and screened by experienced skin cancer doctors, each with over five years of experience. The screenings were augmented by high-definition dermatoscopes equipped with artificial intelligence to assist in identifying potential melanomas.
A total of 260 participants with suspect melanoma lesions were biopsied. All collected tissues underwent examination at a professional laboratory. Separate to the testing of whether people did have melanoma, they were also surveyed about whether they had concerns about the lesions of concern and if they thought the lesion was a melanoma. That meant researchers could compare what the study participants thought against the lab results. The study also collected demographic information such as age, gender and skin type.
Out of 260 biopsied lesions, 83 were confirmed as melanomas. Of concern to researchers was the finding that only about 20 per cent of participants thought these lesions were melanomas. The melanomas were most often found on the back (44 per cent), shoulder (11 per cent), and upper leg (11 per cent). The results also showed that physician-detected melanomas tend to be found earlier and thinner than those identified by patients. The study also highlighted that Anglo skin types were overrepresented among participants, limiting the generalisability of these findings in darker-skinned individuals.
The authors say that this study underscores the inadequacy of relying solely on self-screening for early detection of malignant melanomas. While some organisations say a substantial proportion of melanomas are self-detected, the findings suggest fewer than a quarter of participants could accurately identify a lesion of concern.
Researchers suggest a reassessment of skin cancer screening guidelines which currently don’t recommend routine screenings for low-risk or asymptomatic individuals. They say enhanced screening protocols and campaigns emphasising professional skin checks over self-diagnosis are needed to improve early detection rates, particularly in rural and remote regions.
Does your practice offer skin checks?
If your practice has a Tonic TV, we can help you promote skin checks and other services.
You have access to 3 minutes every hour to promote your practice using either static slides or supplying us with videos of a 30 or 60 second duration.
A slide appears on screen for 15 seconds and can promote important information such as:
- Operating hours
- Services offered such as skin checks
- Local health updates
- Seasonal vaccination reminders
- New staff
- Special events and clinics
We can create the slides for you. Simply contact us with the information you’d like to share on screens and we will design slides to promote your practice.
Further information
Patients poorly recognize lesions of concern that are malignant melanomas: is self-screening the correct advice? Peer Journal
Melanoma Institute Australia
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Multivitamins are commonly used in the belief that they prevent disease and maintain health. In fact, approximately 45% of Australians take vitamins, minerals or supplements and it’s estimated to be a $5 billion dollar industry.
But in a new study, their use didn’t make a difference to how long people lived.
Researchers used data from three cohort studies in the United States. Collectively, the studies included almost 400,000 adults with no prior cancer or chronic diseases, assessed between 1993 and 2001, and followed for almost three decades. Participants’ multivitamin use was self-reported at baseline and during follow-ups. Mortality data were obtained from the National Death Index and the researchers adjusted for potential confounders like lifestyle and health status.
Among the 390,124 participants, the median age was 61.5 years, and 55.4 per cent were male. During the follow-up period, 164,762 participants died. The study found no significant association between daily multivitamin use and all-cause mortality. The results were consistent across major causes of death, including cardiovascular disease and cancer. Daily multivitamin users were more likely to be female, college-educated, and less likely to smoke compared to non-users.
The findings suggest that daily multivitamin use does not give a mortality benefit for healthy adults. Despite the widespread belief in their benefits, this study indicates that taking multivitamins may not extend lifespan or reduce the risk of death from major diseases.
Further information
Multivitamin Use and Mortality Risk in 3 Prospective US Cohorts: JAMA Network
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Low back pain is pervasive globally, affecting millions. And though it is usually self-limited, recurring symptoms are common, adding significantly to both personal disability and economic costs. Despite exercise being recommended for prevention, the effectiveness of easy, accessible interventions like walking has been uncertain.
In the WalkBack trial, a randomised controlled study, those enrolled had recently recovered from non-specific low back pain. Participants received either a tailored walking and education program or no treatment. The study tracked outcomes over 1-3 years, focusing on the days until recurrence of activity-limiting low back pain as the primary outcome of interest.
The intervention group (the people with the walking and education program) experienced a significant reduction in low back pain recurrence compared to the control group. Median time to recurrence was much longer in the intervention group (208 days) versus the control group (112 days). Adverse events were similar between groups, though more lower-extremity issues were noted in the intervention group.
This study shows the effectiveness of a structured walking and education program in reducing low back pain recurrence. The findings suggest that such interventions, delivered by physiotherapists, can be scalable and cost-effective, potentially reshaping how low back pain is managed on a broader scale. The focus on empowering individuals to self-manage their condition aligns with current guidelines. Future research could explore adaptations of the intervention and its delivery to optimise outcomes and accessibility, particularly in different demographic groups.
Care Plans
Medicare subsidised Care Plans play an important role in chronic disease management. Patients with eligible chronic medical conditions can receive up to five rebated sessions each year under the supervision of a Exercise Physiologist or Physiotherapist, under an Enhanced Primary Care Plan.
Further information
Effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention for the prevention of low back pain recurrence in Australia (WalkBack): a randomised controlled trial: The Lancet
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Dementia is the leading cause of death for women (second overall for the population) according to Dementia Australia.
There is a lack of knowledge and understanding in the community about dementia, and it can often be a stigmatised or neglected group.
Even the 1.6 million people in Australia involved in the care of someone living with dementia must search far and wide for the right advice, information and support services at the various stages of dementia.
The vital role GPs play
Dr Stephanie Daly is a GP with a special interest in dementia. She believes that GPs have a vital role in brain health and risk reduction.
Age is a big risk. Research suggests that 10% of 75-year-olds have dementia which increases rapidly to 30% for 85-year-olds. An Annual Health Assessment is available to all patients over the age of 75. “More should be made of a brain health check, rather than an opportunity to only perform a mini-mental state examination”.
It’s never too early and never too late’ for dementia risk reduction and dementia prevention, according to a 2020 report from the Lancet Commission.
Dr Daly believes that if dementia risk factors can be targeted in early and mid-life, GPs have an opportunity to make a real difference. “GPs can also include health assessments for 45–49-year-olds at risk of disease, and General Practice Management Plans for any disease that is a risk factor, e.g. hypertension, obesity, or diabetes.”
“Brain health checks do not have their own item number, but many other item numbers can be used to offer brain health advice.”
“We also know there are 14 modifiable risk factors which includes two risk factors, and represent 45% of the risk. They might delay the onset of the disease process, which means that we should be talking about brain health like we talk about heart health and eradicate the stigma of this disease.”
“You or your nurse can also regularly ask patients if they have noticed any issues with their memory or thinking and undertake further investigation where needed.”
“2 in 3 people with dementia are thought to be living in the community and it’s our role as their GP to make sure this time is as fulfilling and enjoyable as possible,” Dr Daly said.
Useful resources
While many GPs know about the support and resources provided by Dementia Australia Dementia Support Australia and Dementia Training Australia, Dr Daly often refers to https://forwardwithdementia.au/ which has resources for people living with dementia, carers and health professionals.
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It’s peak flu season but about 540,000 fewer Australians have had a flu shot compared to this time last year at the time of writing.
A National Centre for Immunisation Research and Surveillance (NCIRS) survey was conducted to find out why people were choosing not to get an influenza jab.
The research identified the main reasons for not vaccinating against flu were that they didn’t think influenza was serious, the vaccine would give them the flu, or it wouldn’t work.
Experts also believe that vaccine fatigue after COVID and cost of living pressures have also played a role.
Queensland passed a milestone recently with more people in hospitals with influenza than with COVID. Furthermore, 80% of hospital admissions for flu are for patients who’ve not been vaccinated, ranging from children to older people.
Doctors are encouraging patients to get the flu vaccine as it reduces the severity of flu and protects people from pneumonia and other illnesses.
Further information
Australian Respiratory Surveillance Report
Qld Health acute respiratory infection surveillance reporting
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According to the Cancer Council about 750 children aged 0-14 are diagnosed with cancer each year in Australia.
Recent advancements in paediatric cancer research have highlighted the potential of precision-guided treatment (PGT) in managing high-risk cases. This study from researchers in New South Wales delves into the efficacy of PGT for children with aggressive cancers, presenting a more targeted approach to therapy that could revolutionise outcomes for this vulnerable group.
The ZERO Childhood Cancer Precision Medicine Program’s PRISM trial conducted a comprehensive analysis on 384 children diagnosed with high-risk paediatric cancers, all of whom had a predicted cure rate of less than 30 per cent. Using whole-genome sequencing and other precision medicine techniques, the trial aimed to pinpoint molecular targets that could inform tailored treatment strategies. Participants were followed for at least 18 months, and the effectiveness of PGT was evaluated against standard treatments and non-guided targeted therapies.
The study found that two thirds of the participants were given PGT recommendations and about a third received the proposed treatments. The effectiveness of PGT was notably superior. PGT led to a significant improvement in two-year progression-free survival rates (26 per cent) compared to the standard care group (12 per cent) and the group receiving unguided targeted therapies (5 per cent). These results underscore the potential of precision medicine in identifying and applying more effective treatment modalities for paediatric cancer patients.
These findings suggest PGT can substantially enhance treatment outcomes for children with high-risk cancers. By adding comprehensive molecular profiling to treatment planning, PGT personalises patient care and could lead to better survival rates and quality of life. However, the study also recognises the need for broader clinical adoption and more extensive research to refine and validate the benefits of precision medicine in paediatric oncology.
Further information
Precision-guided treatment in high-risk pediatric cancers: Nature Medicine
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Our teenage years are often seen as a risky period for developing lifestyle behaviours that are factors for chronic diseases such as type 2 diabetes, cardiovascular disease and mental health disorders. The Health4Life intervention, designed collaboratively by experts in public health, education and youth engagement, aims to mitigate these risks by educating young people about healthy lifestyle choices through a school-based e-health program.
The Health4Life study was structured as a cluster randomised controlled trial involving students aged 11-14 from 71 diverse Australian schools (public, private and religious schools). The intervention consisted of six online video modules supplemented by a smartphone app, integrated into the schools’ health education classes. The effectiveness of this intervention was compared to standard health education, with the aim of modifying twelve risk behaviours linked to chronic diseases. The behaviours were measured at baseline, right after the intervention, and at 12 and 24 months after the intervention.
The trial’s findings indicated that Health4Life did not statistically outperform regular health education in altering any of the twelve evaluated behaviours over the two-year period. Notably, there was no significant difference in behaviors such as inadequate fruit and vegetable intake, physical activity levels and recreational screen time. The intervention also did not reduce the frequency of tobacco and alcohol use among the participants. Despite these outcomes, both students and teachers responded positively to the format and content of the Health4Life program.
The results highlight just how complex influencing adolescent behaviour can be. Although the program was well-received, the study’s authors say its lack of effectiveness in significantly changing health behaviors suggests that future interventions may need to focus more on engagement strategies such as goal setting and perhaps consider the timing, duration and intensity of the content delivery. They suggest these findings underscore the need for continued innovation and evaluation in health education to ensure that interventions are both effective in changing behaviours and adaptable to the needs of young individuals.
Further information
The Health4Life e‐health intervention for modifying lifestyle risk behaviours of adolescents: secondary outcomes of a cluster randomised controlled trial: Medical Journal of Australia
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The COVID-19 pandemic has significantly disrupted routine vaccination services worldwide, leading to a notable decline in childhood vaccination rates. This has been particularly acute in low and middle-income countries, but wealthy countries like Australia aren’t immune. To learn more about the impact of the pandemic, a study was conducted by Victorian researchers to understand how COVID influenced parental perceptions of routine childhood vaccinations in Australia, examining the shifts in attitudes from 2017 to 2023.
Researchers conducted two cross-sectional online surveys. The first survey took place over a month in 2017 and the second over the same period in 2023. These surveys targeted a sample of Australian parents, ensuring a mix that represented various demographics including age, gender and socioeconomic status. The questions explored parents’ beliefs about common vaccination misconceptions and their children’s vaccination status.
The results showed a concerning trend: a significant increase in vaccine hesitancy among Australian parents. In 2023, 25 per cent of parents believed that children receive too many vaccines, up from 17 per cent in 2017. Beliefs in misconceptions such as vaccines causing autism rose to 14 per cent from 8 per cent, and concerns about harmful ingredients in vaccines increased to 19 per cent from 14 per cent. The study also found a decrease in the vaccination rates reported by parents, with fully vaccinated children dropping from 94% in 2017 to 87% in 2023. These shifts were more pronounced in certain demographic groups, including younger parents, single parents, and those in urban areas.
The findings highlight a growing public health concern regarding the erosion of trust in vaccinations post-pandemic. This decline in vaccination rates and increase in vaccine hesitancy could potentially lead to outbreaks of vaccine-preventable diseases. The study underscores the need for targeted public health campaigns to rebuild trust in vaccines and address the misconceptions that have become more widespread during COVID-19.
Further information
Misperceptions about routine childhood vaccination among parents in Australia, before and after the COVID‐19 pandemic: a cross‐sectional survey study: Medical Journal of Australia
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Before being diagnosed with young onset Dementia, Lisa Campbell a mother of 3 children from Victoria, was working in a senior corporate role. According to her husband Luke, Lisa was a great mum, very intelligent, outgoing, energetic and a happy person. However, overtime things began to change.
“If you spent 5 – 10 minutes with Lisa, you wouldn’t think there was anything wrong. However, if you spent an hour or two, you would see the repetition and concerning behaviours”.
In a raw and frank discussion, Luke shared his experiences of living with his wife’s dementia before diagnosis and the disruptive impact on their lives, home and their young children.
“Lisa started to spend less time with our kids and simple tasks like preparing meals started to drop off,” Luke said.
“She became quite irritable and aggressive. She would deny a lot of things and there were multiple versions of reality occurring for Lisa. Then everything intensified, the hoarding and the obsessive-compulsive type of behaviour, irritability, apathy and depression”.
Luke says that once Lisa’s condition was finally diagnosed at a clinic, they were basically shown the door. “There was no ongoing treatment plan. We were very much left on our own”.
General practice in a rapidly changing world is a webinar series for GPs. It is hosted by Dr Norman Swan and proudly brought to you by Tonic Media Network, in partnership with Dementia Support Australia
This practical webinar focuses on the knowledge and skills required to manage behaviours and psychological symptoms in people living with dementia (BPSD) including:
- a suggested approach that GP’s can adopt that works for the person, their family and carers
- the reality of disease progression and the role of advanced care planning, understanding, psychotic symptoms and delusions specific to BPSD and the limited role of antipsychotics,
- implementation of positive behavior and routines in managing symptoms
- facilitating the ability of GP’s to seek advice when they need it, and being able to call in professional assessment and care strategies.
“Having a good GP, who understands what’s happening with the diagnosis of dementia, and can help facilitate and advocate for some of those post diagnostic supports is what everybody really needs, says Dr Stephanie Daly, a general practitioner with a special interest in Dementia.
“It took a long time, and trial and error to put the support teams in place. Lisa is stabilized and manages the deterioration better because of that network that was created,” Luke added.
Watch the webinar, download the podcast and share with your colleagues.
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In response to the high prevalence of chronic diseases among older adults in Australia, the Health Care Homes (HCH) initiative was implemented as a primary care trial from October 2017 to June 2021. The HCH model aimed to improve the management of patients with multiple chronic conditions by integrating patient-centered medical home principles, which focus on comprehensive and coordinated care facilitated through bundled payments.
This quasi-experimental study analysed data from 227 practices enrolled in the HCH initiative across ten Primary Health Networks. The participant pool consisted of more than 11,000 individuals, matched in a 1:1 ratio with a control group receiving usual care, based on propensity scores. The study assessed various outcomes, including access to care, care processes, and clinical outcomes for chronic conditions like diabetes, using practice data extracts and linked administrative data.
The findings indicated several positive outcomes for patients enrolled in HCH. During the first year, these patients had higher rates of general practitioner encounters and allied health service claims compared to those in usual care. There was also a notable increase in annual influenza vaccinations and routine monitoring of health markers such as blood pressure, blood lipids, and kidney function. However, the data did not show significant improvements in diabetes management or overall reductions in emergency department visits and hospital admissions, except for a slight increase in such events during the first year. Mortality rates between the two groups were similar.
While the HCH model enhanced access to care and improved healthcare processes, it did not significantly affect diabetes outcomes, most hospital use measures, or mortality rates. These findings suggest that while patient-centered medical homes can improve service delivery and patient engagement in care, translating these improvements into better clinical outcomes remains challenging. This highlights the need for further research and potentially longer trial periods to capture the full impact of such models on chronic disease management and to fully assess the effectiveness of patient-centered care initiatives in primary healthcare settings in Australia.
Further information
The Australian Health Care Homes trial: quality of care and patient outcomes. A propensity score‐matched cohort study: MJA
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Atrial fibrillation (AF) and its close cousin atrial flutter are significant causes of hospitalisation, accounting for a substantial portion of AF-related healthcare expenditures. While the immediate outcomes following hospitalisation for these cardiac arrhythmias are well understood, the long-term impacts remain less clear. A new study from researchers at the University of Queensland aimed to shed light on the survival rates, loss of life expectancy, and frequency of hospital re-admissions in patients up to ten years after their initial hospitalisation for AF or flutter.
The study encompassed all public and most private hospitals in Australia and New Zealand, reviewing records from 2008 to 2017. It included more than 260,000 adults hospitalised with a primary diagnosis of AF or flutter, covering more than a million person-years. Researchers modelled survival and life expectancy loss.
During the study period, about 69,000 patients died. The survival probability was 91.2 per cent at one year, dropping to 55.2 per cent by the tenth year. The study calculated an average loss of 2.6 years in life expectancy or 16.8 per cent of expected life duration for these patients compared to the general population. Notably, re-hospitalisations were frequent, with 41.2 per cent of patients readmitted for AF or flutter within ten years. The study also highlighted a low uptake of catheter ablation, a recommended treatment for reducing AF burden, which was performed in only 6.5 per cent of patients over the decade following their initial hospitalisation.
The findings indicate a significant long-term impact on patients hospitalised for AF or flutter, with a marked reduction in life expectancy and high rates of returning to hospital. These outcomes show the need for improved management strategies both in hospital and post-discharge settings to mitigate the long-term effects of these conditions. Catheter ablation being underused points to a potential area for clinical practice improvement. This study not only aids in patient counseling regarding prognosis but also highlights crucial areas for healthcare policy and practice enhancements to better manage the long-term outcomes of AF and flutter.
Further information
Long-term outcomes after hospitalization for atrial fibrillation or flutter: European Heart Journal
Atrial fibrillation: myDr.com.au
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Mental health conditions have a significant impact on people worldwide, with some studies suggesting upwards of 10 per cent of the global population experience a mental health condition at any one time. We also know that some mental health issues are associated with experiences from childhood such as maltreatment and abuse. A recent study from researchers at the University of Sydney has delved into quantifying the extent to which preventing childhood maltreatment could ease the burden of mental ill-health in Australia.
Researchers took data from three large cross-sectional national surveys: the Australian Child Maltreatment Study (ACMS) 2023, the National Study of Mental Health and Well-being 2020-2022, and the Australian Burden of Disease Study 2023. Using this combination of studies, they were able to estimate the prevalence of maltreatment and various mental health issues, and then estimate the proportion of those illnesses attributable to maltreatment. To measure maltreatment, a standardised tool called the Juvenile Victimization Questionnaire was used. It collected data on physical, sexual, and emotional abuse, medical and physical neglect and domestic violence exposure to measure whether children had experienced maltreatment.
Researchers found that childhood maltreatment accounted for substantial portions of mental health conditions, including 21 per cent for depression, 39 per cent for self-harm and up to 41 per cent for suicide attempts. In numbers, this translates to over 1.8 million cases of depressive, anxiety, and substance use disorders.
These results underscore the profound impact that childhood maltreatment has on mental health and the potential benefits of targeted prevention strategies. By comparing the burden of mental health conditions attributable to maltreatment with other health risks, such as tobacco use and its association with cancer, the study advocates for more resources to be directed towards preventing childhood maltreatment.
Lead author Dr Lucinda Grummitt said these results must serve as a ‘wakeup call’.
‘The results are devastating and are an urgent call to invest in prevention – not just giving individual support to children and families, but wider policies to reduce stress experienced by families,’ Dr Grummitt said.
Effective prevention could not only save millions from suffering but also considerably reduce the overall mental health burden on the healthcare system. The study reinforces the need to shift from treating mental health outcomes to preventing their causes and comprehensive policy measures that address the root causes of maltreatment and support families and children at risk.
Further information
Burden of Mental Disorders and Suicide Attributable to Childhood Maltreatment: JAMA Network
The impact of childhood trauma: myDr.com.au
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Antipsychotic medications occasionally need to be used by women of reproductive age and during pregnancy. But this has raised concerns about the impact of these drugs on foetal development and childhood neurodevelopment. The medications, typically prescribed for conditions like schizophrenia and bipolar disorder, play an important role. But the uncertainty surrounding their safety during pregnancy has been a significant cause of anxiety for expectant mothers.
Researchers from Australia and Europe undertook a comprehensive study spanning from 2000 to 2020, across five Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden), using data from national health and social registers, focusing on pregnant women diagnosed with psychiatric disorders and who’d had a single baby.
Data from more than 200,000 births were analysed, including 11,626 (5.5%) where the foetus was prenatally exposed to antipsychotics. These children were followed up for around six years, with the study evaluating their risk of intellectual, speech, language and learning-developmental disorders, as well as their academic performance in mathematics and languages.
The findings indicated no significant increased risk of neurodevelopmental disorders or poor academic performance in children exposed to antipsychotics in utero. The results remained consistent across various medications, time of exposure during pregnancy and various analytical methods, indicating no real effect of antipsychotics on child development across these measures.
The implications of this study are significant for women managing serious mental health issues during pregnancy. The study offers reassurance for clinicians and expectant mothers, providing them with evidence-based guidance for treatment decisions during pregnancy.
Further information
Antipsychotic use during pregnancy and risk of specific neurodevelopmental disorders and learning difficulties in children: a multinational cohort study: The Lancet
Antipsychotic medication: myDr.com.au
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More than four years on from the emergence of COVID-19, in a study from Western Australia, researchers have identified a high prevalence of Long COVID symptoms, affecting the ability of some people to return to work or study. This study focused on the COVID-19 Omicron variant outbreak in 2022 and provides valuable insights into the long-term effects of the virus on a population who were mostly vaccinated before significant outbreaks occurred.
The Australian National University (ANU) spearheaded this comprehensive survey, which included 11,000 Western Australians who tested positive during the Omicron surge.
The results revealed that nearly 20% of the respondents were still experiencing symptoms such as fatigue, memory loss and concentration difficulties three months post-infection. This rate was notably higher than previously reported figures from earlier stages of the pandemic and from other countries. A limitation of the study is the subjective nature of the reporting of symptoms. Participants self-described their symptoms and how they affected their work or study.
While this study had only three months of follow-up, another about the same time involving people in Melbourne found that about a third of participants had at least one symptom under the Long COVID umbrella two years out from an initial infection. Those people though had caught the virus in 2020 and were mostly unvaccinated at time of their first positive test. These studies highlight that the persistence of symptoms is real and can be disabling.
Further information
Long COVID in a highly vaccinated but largely unexposed Australian population following the 2022 SARS‐CoV‐2 Omicron wave: a cross‐sectional survey: Medical Journal of Australia
Don’t believe the headlines, Long-COVID is real: myDr.com.au
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Social prescribing is being increasingly discussed in general practice and perhaps your practice is already deploying it. This concept, centered on holistic healthcare, seeks to connect patients with non-medical resources in their communities to improve overall health and wellbeing. Social prescribing particularly targets health-related social issues such as loneliness and isolation and might include prescribing patients to join a local running group, or to take up community lessons in a language or the arts, to support their physical and mental wellbeing.
This study encompassed a comprehensive analysis of social prescribing schemes in twelve countries, including Australia, Canada, England, Finland, Germany, the Netherlands and United States.
It revealed a diverse landscape of social prescribing practices. While the definition and scale of implementation varied significantly, a common thread was the focus on addressing non-medical causes of illness. Social prescribing generally involves referrals to local, non-clinical services by health professionals, with the aim of promoting physical, psychological and social wellbeing. However, robust evidence on the impact of social prescribing is scarce and often country-specific, with some indications of cost-effectiveness and a positive influence on wellbeing.
This analysis provides valuable insights into the different forms and impacts of social prescribing. It highlights the potential of social prescribing in addressing health-related social factors and enhancing community-based care. As countries grapple with complex health needs, the authors suggest that social prescribing could play a pivotal role. The findings suggest that policies could foster better integration of social prescribing into existing healthcare systems, enhancing collaboration across sectors and improving training for health and social care professionals. While the concept and practice of social prescribing are still evolving, its potential to contribute to holistic healthcare is becoming clearer.
Further information
A comparison of social prescribing approaches across twelve high-income countries: ScienceDirect
Can social isolation be linked to early death/heart disease?: myDr.com.au
Is social prescribing just what the doctor ordered? myDr.com.au
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There’s a growing focus on “preconception care” or PCC among healthcare services and in research. PCC involves interventions to manage risk factors before pregnancy and has been shown to be effective in reducing adverse maternal and pregnancy outcomes. This includes mitigating risks associated with obesity, smoking, alcohol consumption, diabetes and mental health issues. But the systematic identification and documentation of these risks, particularly in primary care settings like general practices, is understudied according to researchers.
In an effort to better understand how effectively general practices document preconception health risks, a retrospective audit was conducted in Melbourne using electronic medical records (EMRs) from 10 practices who consented to be part of the study. Researchers wanted to determine the extent to which risk factors were documented in EMRs, to know whether this was a source of good data for identifying women who may have difficulties in pregnancy. This study analysed the EMRs of one thousand women aged 18–44, focusing on the documentation of various preconception risk factors including smoking, alcohol consumption, BMI, blood pressure and general medical history
The results revealed several lifestyle factors were commonly documented in practice EMRs: smoking status was documented for 79% of women, blood pressure for 74%, alcohol consumption for 63% and BMI for 57%. Several other factors were less commonly documented as part of an EMR – diabetes (5%), mental health issues (28%) and history of chronic conditions like asthma (13%) and thyroid issues (6%). Even so, a considerable number of women had conditions that could complicate pregnancy, including mental health issues (28%), obesity (24%), and high blood pressure (7%). Overall, the EMR documentation provided a rich record to help women planning to become pregnant.
Although EMRs are currently underused for this purpose, the authors say that enhancing their documentation could significantly improve the delivery of PCC and lead to targeted interventions for high-risk groups. The authors believe that for EMRs to contribute to preconception care effectively, it’s essential for primary care providers to prioritise the recording of information in structured fields and ensure the regular updating of data.
Further information
Preconception health risk factors documented in general practice electronic medical records: British Medical Journal
Pregnancy planning: myDr.com.au
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The flu season is starting and peaking earlier these days. Based on the Northern Hemisphere experience, health authorities expect this year’s season will be particularly bad and are encouraging Australians, especially the vulnerable, to be vaccinated.
There’s also a new cell-based flu vaccine available, that experts hope will be more effective than the mostly egg-based vaccines many of us relied on in the past.
The Centers for Disease Control and Prevention states, ‘Cell-based’ refers to how the influenza (flu) vaccine is made. Most inactivated flu vaccines are produced by growing flu viruses in chicken embryos. The flu viruses used in the cell-based vaccines are grown in cultured cells of mammals.
The virus is not grown in the yolk of the eggs. The egg is used to create an embryo and the virus is grown on the embryo. That’s why flu vaccines can be used in people with egg allergies unless your doctor advises otherwise.
One rationale for cell-based vaccines is to overcome a dampening of the immune response to egg based vaccines. The science is complicated but it appears that as each year goes by, your immune system adapts to the egg-based vaccine, and you get a slightly lower antibody response. If you have a cell-based vaccine, there’s a slightly better antibody response.
It’s not the Australian recommendation yet, but some experts believe that when a child is having their first vaccine, they should have a cell-based vaccine so that their immune system is not primed with this egg protein.
The Therapeutic Goods Administration (TGA) has approved the vaccine for use in adults and children older than six months. It is available for at risk patients on the National Immunisation Program.
The supply and availability of the cell-based vaccine is patchy, and if only the egg-based vaccine is available, then people are encouraged to continue to get that.
It should also be noted that there are a lot of vaccines available this year and there is a stronger vaccine available for people aged 65 and over, which will ensure they get a good antibody response.
More information
Flu season: cell-based vaccine now available – Health with Dr Norman Swan. ABC Radio National
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Whooping cough, also known as pertussis, is an infection that occurs in the lungs and causes forceful coughing.
It is a highly contagious bacterial infection that can affect people of all ages, but is most severe in babies. The disease causes coughing spasms that can end in a high-pitched whooping sound as the child draws breath. It’s not a benign disease and can cause severe respiratory distress and death.
Australia, like other parts of the world, is experiencing an outbreak. It is known to run in cycles every three to four years and our last cycle was in 2019 according to Queensland’s acting Chief Health Officer Catherine McDougall on the ABC.
At the time of writing, there have been 3263 cases recorded in the National Notifiable Disease Surveillance System. Cases are highest in Queensland (1412) and New South Wales (1303), followed by Victoria with 362 cases.
Vaccination rates are currently lower than they should be and parents are encouraged to vaccinate their children. In Australia, vaccination against whooping cough is recommended at age 2, 4, and 6 months as part of the National Immunisation Program Schedule. The 2-month dose can be given as early as 6 weeks of age.
Two booster doses are recommended – one at 18 months and one at age 4 years. An additional booster dose is recommended for adolescents between 11 and 13 years. This booster can be given as part of a school-based vaccination program. Pregnant women should be vaccinated to protect themselves and their babies once born.
Pertussis vaccination for eligible people is funded under the National Immunisation Program and by states and territories.
Further information
National Immunisation Program Schedule: Department of Health
Whooping cough overview: myDr.com.au
National Notifiable Disease Surveillance System
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According to the Department of Health, more than 3.6 million children take part in sport each year. Sports, particularly team sports, are thought to teach a variety of life skills for kids: working with others to achieve a goal, perseverance, humility and communication. There’s a strong culture of sport and physical activity in Australia – whether it’s chasing the ball at lunchtime or kicking, hitting, or throwing one at the weekend. But is there a connection between sports involvement and academic achievement? That’s what researchers from the University of Sydney set out to discover in a recent study.
Researchers used data from the Longitudinal Study of Australian Children – which follows 10,000 children and their families, beginning in 2003 and has tracked the children into adulthood. It captures a range of data points, including health, physical activity, sport and educational outcomes. One cohort was analysed – about 4,200 kids who were followed from ages four-five to 20-21. Researchers looked at their sport participation, whether it was a team or individual sport (assessed by self-reporting), and educational outcomes such as school absenteeism, attention, working memory, school academic performance and university enrolment. The results were adjusted for factors such as sex, maternal education, socioeconomic status and remoteness.
Researchers found that continuing to participate in sport through a child’s school years had several positive associations. Kids who played sport consistently performed better on memory and attention tasks and had higher numeracy and literacy scores, as well as lower absenteeism. Children weren’t more likely to receive the Higher School Certificate if they played sports, but they did have higher academic performance overall and were also more likely to go on to university. There were slight differences in the results between individual and team sports, but broadly both trended towards having a positive effect on educational outcomes.
Of special note was that sporting activity helped kids in low socio-economic areas to do better in school, but fewer kids from these areas have access to sports. The authors suggest there’s a double benefit from increasing participation in those areas, as well as more broadly across Australia, both to reduce physical inactivity and potentially boost levels of academic achievement.
Further information
Sport Participation for Academic Success: Evidence From the Longitudinal Study of Australian Children Journal of Physical Activity and Health
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Like the rest of the world, cardiovascular disease (CVD) remains the leading cause of death in Australia, accounting for one in four deaths in 2019. According to the Heart Foundation around 120 people in Australia die from CVD each day, or one person every 12 minutes.
In a recent review of the evidence, researchers from New South Wales looked at the risk factors contributing to death and disability in Australia, focusing on the impact of raised systolic blood pressure compared to other major risk factors.
Data from the Global Burden of Disease study (GBD), collected between 1990 and 2019, were analysed to determine the impact of various risk factors on all-cause and cardiovascular deaths and disability-adjusted life-years (DALYs). GBD uses a variety of data sources, including country census records, surveys, and health records to model the impact of various factors on health outcomes over decades.
Raised systolic blood pressure (SBP) emerged as the leading risk factor for premature deaths in Australia, consistently ranking at the top across the period studied. It was also the primary contributor to cardiovascular deaths and DALYs, particularly affecting stroke-related health outcomes. In 1990, elevated SBP was responsible for 24% of all deaths in Australia, or about 29,000 people. This figure declined to 14% (21,845 deaths) in 2010 and was the same again, 14% (25,498 deaths), in 2019 – but was still the number one contributor to death in these time periods despite the overall decline from 1990. Similarly, the contribution of high blood pressure to deaths specifically related to cardiovascular issues followed a similar pattern, with high blood pressure responsible for 54% of CVD deaths in 1990 and 44% in both 2010 and 2019.
The authors say there is an urgent need to refocus healthcare on blood pressure control. They argue that it’s often seen as an “intermediate” factor which gets grouped with other health markers such as overweight or obesity to which lifestyle modifications (chiefly exercise and diet) are seen as the answer. They want to see more focus on blood pressure alone, both through raised awareness of high blood pressure as an issue (with many Australians unaware they have high blood pressure) and combination therapies in a single pill that make adherence easier.
Further information
The contribution of raised blood pressure to all-cause and cardiovascular deaths and disability-adjusted life-years (DALYs) in Australia: Analysis of global burden of disease study from 1990 to 2019: PLOS Journals
Statistics and information on cardiovascular disease in Australia. Heart Foundation
High blood pressure should be treated: myDr.com.au
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ADHD and autism spectrum disorder are neurodevelopmental disorders affecting millions of children worldwide. It is estimated that 1 in 100 people in Australia are on the autism spectrum and around 1 in 30 adults has ADHD.
Both are commonly diagnosed in childhood, with ADHD typically identified between the ages of five to nine and autism between three and six years. Diagnosis is based on observing a child’s behaviours and their developmental history, because there are no physical or biological tests for these disorders. Adding to the complexity is that each condition can present in various ways. Yet timely diagnosis and intervention are crucial for improved outcomes in a child’s social life, mental health and education.
A recent study focusing on Australian children sought to understand these diagnostic delays more comprehensively. The research involved caregivers of almost 700 children with ADHD, autism or both, aged between one and 16. Participants reported when developmental concerns were first detected in their child, when they received an autism or ADHD diagnosis, and who gave that diagnosis. Other demographic data, like socio-economic status, were also recorded.
The study found that most children received their diagnosis in a private setting (more than three quarters). The findings reveal the complex relationships between different developmental disorders – showing children with ADHD and autism received their ADHD diagnosis earlier than those children who just had ADHD, but that the delay for a diagnosis of autism was longer for those children diagnosed autism and ADHD, versus those diagnosed with autism alone. Girls were diagnosed later than boys for both autism and ADHD.
The longer diagnostic delays for children with multiple conditions occurring at the same time, and for young girls, suggests a need for improved education and training for healthcare professionals. GPs are often the first contact for concerned parents and play a crucial role in the referral process. The authors suggest guidelines for diagnosing ADHD and autism where they co-occur are lacking and point to a need for more specialised training and awareness.
Further information
Age at diagnosis and diagnostic delay across attention-deficit hyperactivity and autism spectrums: Sage Journals
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Preterm birth is a major global health issue that can lead to infant mortality and long-term health complications. In Australia more than 26,000 Australian babies are born preterm each year and 15 million babies globally.
Defined as a birth occurring before 37 weeks, premature birth poses challenges for healthcare systems and families. With global warming leading to more extreme heat events, understanding their impact on preterm birth is crucial. A new study led by Monash University researchers examined the association between heat exposure during pregnancy and preterm birth, considering the potential mitigating role of “greenness,” including tree cover and green spaces.
The cohort study analysed birth data from mothers in Sydney, collected as part of the New South Wales Midwives Data Collection (2000-2020), which included more than 60,000 pre-term births over that period. It focused on pregnant mothers’ exposure to extreme heat and greenness during each trimester. The researchers assessed heat exposure using meteorological data to determine patterns of exposure to certain temperatures over time, while greenness was measured by combining measures such as known vegetation in an area and tree cover data, plus the level of “urbanisation” in a given region (or how built up the area was).
The study found a significant association between exposure to extreme heat in the third trimester and increased odds of preterm birth. That meant women who were exposed to extreme temperatures in their third trimester were at a higher risk of preterm birth. Exposure to extreme temperatures in a mother’s first or second trimester did not have the same effect. Researchers also found that the presence of greenness in residential areas had some moderating effect on this association – that is, higher levels of greenness were linked to a reduced risk of preterm birth even when mothers were exposed to extreme heat.
These findings highlight an unusual association – extreme heat and premature birth – and underline the important role of urban planning and public health interventions in mitigating preterm birth risks. The authors suggest that improving strategies to increase green spaces in urban areas could be a significant step towards reducing these impacts of heat on pregnancy outcomes. It’s also another factor clinicians may look to if they have patients who already have risk factors for preterm birth and who have a third trimester that could fall in a period of extreme heat.
Further information
Heat Exposure, Preterm Birth, and the Role of Greenness in Australia: National Center for Biotechnology Information
Preterm labour: myDr.com.au
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