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Tuesday, 15 April 2025

in an uncertain world, ‘green relief’ offers respite, healing and beauty

Annie Spratt/Unsplash
Carol Lefevre, University of Adelaide

Have you ever sat with a cup of tea at the end of a weeding session, with a feeling close to happiness? Or returned from the local garden centre with a bag of potting mix and some plants – and soon the sight of your newly planted herbs or flowers makes your heart feel inexplicably lighter?

Perhaps you’re in hospital recovering from surgery, as I was only a little time ago. I regained consciousness in an advanced recovery unit, a dimly lit space with no windows where everything felt slightly surreal and too intense.

I was receiving the best possible care, yet I had a desperate sense of having been cut loose from my life, and even from my body, as it was monitored and medicated throughout the night. Who knows where things might go from here, I thought. Yet I almost didn’t care.

Carol after surgery, with flowers. Carol Lefevre

In the morning, I was wheeled away to a room on an upper floor. It was a space flooded with natural light and with a view of a wintry, cloudy sky and distant treetops.

When a friend arrived with a posy of flowers, I found myself smiling for the first time since leaving home. As well as the pleasure of her company, there was a surge of delight at the presence of flowers. Their soft colours soothed something in me that had been clutched tight in fear since my first glimpse of the stark, frankly terrifying operating theatre.

A history of healing

Perhaps now, more than ever, we could all use some green relief, as we deal with a world that seems to only grow more anxiety-inducing and uncertain.

In May, Australians will vote in what has been called “the cost-of-living election”. Housing prices (and homelessness) have soared, too, with one study putting the rise in housing value between March 2020 and February 2024 at 32.5%.

Elsewhere, war rages in Ukraine, Gaza, and other countries, and the world order is wobbling in the wake of the US elections – particularly this week, when Donald Trump’s tariffs sparked a stock market crash not seen since COVID (until he changed his mind yesterday and it recovered) and led to predictions of a recession.

What evidence is there that the natural world can have a healing effect?

Green relief can help us deal with an uncertain world. Annie Spratt/Unsplash

In most cultures throughout history, medicine and botany have been closely entwined, and gardens have been associated with healing the body, mind, and spirit. From around the 4th century BCE, Greece had healing centres known as “asclepieia”, after the god of medicine, Asclepius.

In medieval Europe, monasteries kept medicinal gardens. In England, hospitals and asylums were set within landscaped grounds in the belief the tranquillity of the setting played an important role in lifting patients’ mood. Both male and female inmates of 19th-century asylums often worked in the gardens, in what was seen as a healing process administered by the place itself.

Inevitably, the creep of urbanisation saw the garden landscapes of many such institutions greatly reduced, yet the health benefits to patients of connecting with nature remains undiminished.

Flowers and healing

An explanation for the uplifting effect of those flowers in my hospital room may be found in numerous studies that have shown, post-surgery, patients in rooms with plants and flowers have shorter recovery times, require fewer analgesics, and experience lower levels of anxiety. Partly, it is a response to beauty.

As psychiatrist Sue Stuart-Smith writes in The Well Gardened Mind, the human response to beauty involves brain pathways “associated with our dopamine, serotonin, and endogenous opioid systems and damp down our fear and stress responses”. She continues: “Beauty calms and revitalises us at the same time.” We humans have an affinity for patterns and order, she writes. “The simple geometrics we find in nature are perhaps most concentrated and compelling in the beauty of a flower’s form.”

There has been a trend towards banning flowers from hospital wards, on health grounds. Reasons include a suspicion bacteria lurk in the flower water, as well as safety concerns around patients or nursing staff knocking over vases during night shifts.

Florence Nightingale, in her Notes on Nursing, commented on the beneficial effects of flowers on her patients. She added that they recovered more quickly if they could spend time outside, or at least had a room with adequate natural light. “It is a curious thing to observe how almost all patients lie with their faces turned to the light, exactly as plants always make their way towards the light.” Even if lying on a particular side caused pain, patients still preferred it, Nightingale noted – because “it is the side towards the window”.

Our compulsion to turn towards the natural world is known as “biophilia”. The term was first coined in the 1960s, by German–American social psychologist and psychoanalyst, Erich Fromm. He described it as “the passionate love of life and all that is alive”, speculating that our separation from nature brings about a level of unrecognised distress.

In the 1980s, biologist and ecologist Edward O. Wilson, in his book Biophilia, asserted that all humans share an affinity with the natural world. “The urge to affiliate with other forms of life is to some degree innate,” he wrote.

In hospital, as my body began its tentative recovery from the shock of surgery, I remembered a line popularly attributed to the French Impressionist painter, Claude Monet: “What I need most are flowers, always, and always.” Through his paintings, notably his studies of waterlilies, and the garden he established at Giverny, which welcomes visitors to the present day, Monet’s flowers continue to calm and revive us with their transcendent beauty.

Perhaps the simplest way to forge a connection with nature lies in our own suburban gardens, if we are lucky enough to have them. Aside from the pleasure of creating pleasing spaces, contact with the soil bacteria Mycobacterium vaccae has been shown to trigger the release of serotonin in the brain. Serotonin, a natural antidepressant, strengthens the immune system. An added bonus is that when we harvest edible plants, our brain releases dopamine, flushing our systems with a gentle rush of satisfaction and pleasure.

Regular doses of serotonin and dopamine were never more needed than during the pandemic, when lockdowns unleashed a sudden fervour for gardening.

In her book The Garden Against Time, Olivia Laing writes that “over the course of 2020, three million people in Britain began to garden for the first time, over half of them under forty-five”. And it wasn’t just in Britain, where garden centres ran out of plants and compost as people set to work transforming the spaces where they were confined.

Australia experienced a similar surge in interest, with the ABC reporting sales of herb and vegetable plants shot up 27%, joining toilet paper and pasta on the list of panic buys. In the United States, Laing writes, 18.3 million people started gardening, “many of them millennials”. American seed company W. Atlee Burpee “reported more sales in the first March of lockdown than at any other time in its 144-year history”.

Laing writes:

crouched on the threshold of unimaginable disaster, death toll soaring, no cure in sight – it was reassuring to see the evidence of time proceeding as it was meant to, seeds unfurling, buds breaking, daffodils pushing through the soil; a covenant of how the world should be and might again.

In 2020, sales of herb and vegetable plants soared 27% in Australia. Annie Spratt/Unsplash

It is precisely this “evidence of time proceeding as it was meant to” that has the power to hold humans calmly in place. We may imagine we want more than this from life; despising dullness, we think we crave excitement and change. But given the option, few would choose to wake to an Orwellian “bright cold day in April” to find “the clocks were striking thirteen”, which is how it felt during those nightmarish early days of the COVID-19 crisis.

Life on earth does still feel somewhat bright and cold, its future somewhat bleak; it is as if Orwell’s dystopian vision is at last catching up with us.

Who would believe an activity so apparently humble as gardening could come to the rescue of millions of stressed and fearful people? Yet gardeners seem to know this instinctively.

Tending ourselves

In the book In Kiltumper: a Year in an Irish Garden, co-written with her husband, Niall Williams, Irish writer and gardener Christine Breen describes the ordeal of undergoing cancer treatment through the Irish healthcare system. Following an oncology appointment in Galway, the couple drives home towards west Clare, or as Christine puts it: “back to the garden, where there is safety”.

Christine’s husband Niall confirms that, although the medical community might dismiss the healing power of working in a garden as “airey-fairy”, in Christine’s case, even while weak from chemotherapy, “going about the flower beds, trying to do exactly the same work she had always done” meant continuity.

It represented “carrying on living, because that is one of the prime lessons any garden teaches you: the garden grows on”. He speculates that after many years together, garden and gardener become one: “when we tend it, we tend some part of ourselves”.

If we know this, we too often forget. Consequently, garden centres rarely top the list of most desirable destinations, and gardening has been traditionally represented as fussy and domestic. Weeding and mowing are seen as chores that, if possible, are to be avoided.

When we tend a garden, we tend some part of ourselves. Benjamin Combs/Unsplash

In her book Why Women Grow, Alice Vincent writes that gardening has “so many associations, of neatness and nicety; a prissiness that feels deeply removed […] from the sex and death and life on show in every growing thing.” She writes: “When we garden, we change how a small part of the world works.”

Doubtless, it was this sense of being able to change one’s world, of seizing control, that appealed to so many of us during the pandemic. And if we got our hands into the soil, we were rewarded with much-needed infusions of serotonin.

In literature, too, people suffering physically or mentally, or both, have often sought refuge or found solace in a garden.

For many readers, their first encounter with the transformative nature of gardening was Frances Hodgson Burnett’s classic children’s book, The Secret Garden. In it, a spoilt yet neglected child, Mary Lennox, is orphaned in India when her parents and their servants succumb to cholera. She is bundled off to Yorkshire, England, to a daunting atmosphere of secrecy and neglect at Misselthwaite Manor, into the care of an uncle she has never met. There, Mary soon discovers the key to a garden that has been locked for years following her aunt’s death.

In her efforts to restore life to the neglected garden, Mary herself is restored, gradually shedding the lonely, helpless persona of her Indian childhood. When she discovers the manor’s other tightly held secret – her sickly, bedridden cousin, Colin – Mary manages to get him, too, out of the house and into the garden. The outcome is healing for the children, and eventually for Mary’s grieving uncle.

Green prescriptions

For a real-life example of green relief, in The Well Gardened Mind, Sue Stuart-Smith describes how her grandfather – a submariner in the first world war – was taken prisoner during the Gallipoli campaign. After a series of brutal labour camps in Turkey, the last of them in a cement factory, he eventually escaped.

But after the long journey home he was so severely malnourished he was given only a few months to live. Crucial to regaining his health was the devoted nursing by his fiancée, followed by a year-long horticultural course set up to rehabilitate ex-servicemen.

A psychiatrist as well as a gardener, Stuart-Smith writes of the therapeutic effects of working with our hands in a protected space. She describes how gardening allows our inner and outer worlds “to coexist free from the pressures of everyday life”.

Gardens, she writes, are an “in-between space which can be a meeting place for our innermost, dream-infused selves and the real physical world”. In a garden, we are able to hear and process our own, sometimes turbulent, thoughts.

In 1986, after being diagnosed HIV positive, the English artist and filmmaker Derek Jarman retreated to the Kent coast near the nuclear power station at Dungeness. In The Garden Against Time, Olivia Laing writes that at Prospect Cottage, Jarman

began with stones, not plants: the grey flints he called dragon’s teeth, revealed by the tide on morning walks.

Prospect Cottage, former home of filmmaker Derek Jarman, Dungeness. Poliphilo/Wikimedia Commons, CC BY

Gradually he established a garden in the inhospitable soil, seeing it as “a therapy and a pharmacopoeia” – and “a place of total absorption”.

It was this capacity to slow or stop time, as much as its wild and sportive beauty, that made it such a paradise-haunted place.

The pandemic spread waves of turbulence across the globe. In April 2021, as part of its post-COVID recovery plan, the government of the United Kingdom launched a two-year green social prescription pilot.

Project-managed by the National Health Service, the program worked across seven test sites: areas disproportionately affected by the pandemic. These included people living in deprived areas and people with mental health conditions, many of them from ethnic minority communities.

Over the course of the two-year program, more than 8,500 people were referred to a green social prescribing activity. Green networks were established in all seven test sites. Findings showed positive improvements in mental health and wellbeing – and green social prescribing is ongoing, proof of the program’s lasting impact.

In recent times, doctors in some countries are writing green prescriptions, rather than scripts for medication. And not just for mental health problems, but for physical conditions such as high blood pressure, diabetes and lung diseases.

In the late 1990s, New Zealand became one of the first countries where GPs used green prescriptions to encourage patients to increase their levels of physical activity. Japanese clinicians have been advocating “shinrin-yoku”, or forest bathing for decades. In Finland, with its long dark winters, five hours a month is regarded as a “minimum dose” of contact with nature.

New Zealand was one of the first countries where GPs used green prescriptions to encourage patients to boost their physical activity. Kari Kittlaus/Pexels

Aside from the physical benefits, time spent in a garden can provide a mood boost for those of us who feel oppressed by calendars, and by clock time’s relentless march. In her 2018 memoir Life in the Garden, Penelope Lively writes:

To garden is to elide past, present and future; it is a defiance of time. You garden today for tomorrow, the garden mutates from season to season, always the same but always different.

Perhaps no group of people stands in greater need of time-defiance than those of us entering the final decades of our lives. Time is short, and we know it. But as now 92-year-old Lively wrote seven years ago: “A garden is never just now; it suggests yesterday and tomorrow; it does not allow time its steady progress.”

A garden is a ‘defiance of time’. Pexels

Gardening as defiance

My mother pottered in her garden until she was in her early 90s, pruning roses, pulling weeds, planting annuals and throwing down fertiliser. She’d wrestle her walker across the lawn to perch on its seat while she did the watering, before retreating to an armchair in the back room of her house, from where she could admire her achievements.

Gardening in extreme old age was, for her, an act of defiance – against time, and against her children, who nagged about the possibility of a fall and insisted she wear an emergency call button. It was a defiance, too, of the common view that old people should relinquish their homes with gardens and move into something more manageable.

On the face of it, not having a garden to maintain in old age makes perfect sense, but it may come at the expense of our human impulse to seek connection with living things, specifically those in the natural world. So ingrained is our instinct to connect with nature, it appears to survive even when other systems and connections have broken down.

Carol’s mother in her garden, where she pottered until her early 90s. Carol Lefevre

A friend whose Alzheimer’s-afflicted husband is in residential care reports he is constantly finding odd containers, filling them with soil, and planting cuttings gathered from the care home’s garden. He crams them onto his windowsill, even planting in teacups when there is nothing else to hand.

Accustomed to gardening throughout his adult life, his impulse to work with living things persists in defiance of dementia. My friend reflects her mother used to do the same, only she would take pieces from the home’s fake indoor plants, then complain bitterly when they did not grow.

In the care facility my friend visits daily, women pick flowers in the grounds to decorate their walkers, and when there are no flowers they’ll use pictures of flowers cut from magazines. Cutting out paper flowers seems like the action of someone whose garden has been lost, but who still feels a powerful desire to connect with beauty and the natural world.

Imagined gardens

The theories of 20th-century historian Theodore Roszak, in his book The Voice of The Earth, founded the ecopsychology movement.

He believed “humans connect with nature through the ecological unconscious, which is the core of human identity”. Human nature, he wrote, is “densely embedded in the world we share with animal, vegetable, mineral”. He believed reconnecting with nature helps people become more aware of their connection to all living things.

So what are we to do if the garden has been lost?

The French writer Colette, whose books were full of botanical detail, did not cease gardening even when age and arthritis kept her bedridden. Rather than physical gardens, Colette roamed imagined gardens.

There is nothing so terrible about not having a garden any more. The worrying thing would be if the future garden, whose reality is of no importance, were beyond my grasp. But it is not.

Colette tended an ‘imagined garden’ when bedridden. Henri Manuel/Wikimedia Commons

Colette planned her “tomorrow garden”, specifying pansies “with wide faces, beards, and moustaches – that look like Henry VIII”. Nothing is too difficult for the imaginative gardener. “An arbour? Naturally I shall have an arbour. I’m not down to my last arbour yet.”

Imagining a garden may seem fanciful. Yet it is less so if considered in the context of embodied semantics – a process where brain connectivity during a thought-about action mirrors the connectivity that occurs during the actual action. (For example, thinking about running or swimming can trigger some of the same neural connections as the physical actions.)

It’s been shown that habitual negativity rewires the brain. Ultimately, it damages it by shrinking the hippocampus: one of the main areas destroyed by Alzheimer’s disease.

But gardens, with their earth-centred sense of time and season, are optimistic places. Watching things grow, deadheading spent flowers and saving seed for the return of spring, are just some of the forward-looking aspects of gardening and perhaps it works as well if the plants and flowers are imagined.

Gardening can persist throughout an adult life. Centre for Ageing Better/Pexels

It is logical to go further and ask whether a positive habit, such as imagining a garden, has the potential to help rewire one’s brain in a good way. Imagined gardening is really a form of self-guided imagery, a practice with many applications in the treatment of pain, stress, anxiety and depression.

As we age, ideally we would find ways of getting our hands into the healing soil. Suggestions for gardening in old age, and extreme old age, include introducing raised beds to reduce bending, or working with potted plants.

A friend in her late 70s, with an enviable garden, swears by her Garden Group. Around a dozen friends come together for working bees in each other’s gardens. “You can get a huge amount done in an hour-and-a-half,” she says. Afterwards, they share morning tea – so it is a social as well as practical endeavour. My own best tip is to garden little and often. Committing to half an hour a day, or even 15 minutes, adds up nicely over the course of a week.

American poet May Sarton wrote of gardening as “an instrument of grace”. She regarded the natural world as the great teacher. From the Benedictine Monastery of Saint Paul de Mausole at Saint-Remy-de-Provence, Vincent Van Gogh wrote to his mother: “But for one’s health, as you say, it is very necessary to work in the garden and see the flowers growing.”

Like Monet, Van Gogh needed flowers. We all do. It’s just that many of us forget this during the push and pull of daily life. And in forgetting, we lose touch with our biophilic natures.The Conversation

Carol Lefevre, Visiting Research Fellow, Department of English and Creative Writing, University of Adelaide

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

Tuesday, 11 March 2025

10-Year-old Paramedic Teaches Adults Lifesaving Skills and CPR as ‘The Mini Medic’

10-yo paramedic Jack Dawson teaches lifesaving skills – SWNS

Meet the 10-year-old paramedic who teaches adults life-saving procedures as an in-demand mini-medic.

Jack Dawson was just two-years-old when it became obvious he was interested in becoming a paramedic.

His grandfather owns a first response company in Staffordshire, England, and Jack would ride along in his ambulances with the flashing blue lights. By age three, he would start “randomly performing CPR on his teddies, pumping the bear’s chest”.

“So, at the same time he was learning to speak, my husband and I decided to teach him first aid,” said his mother, Danielle. “He was like a sponge. He just picked everything up so quickly.”

Jack, quickly grasped the act of CPR, understanding the different recovery positions, and learned how to use a defibrillator.

Then, at age seven, the youngster started to lead workshop sessions of his own, overseen by his father and other trainers for their charity, Tamworth Have A Heart, which aims to make automatic defibrillators publicly accessible and train people to use them confidently.

Jack teaches both children and adults how to perform CPR and use defibrillators, while also patrolling his town centre and checking that the public defibrillators’ pads and batteries are up to date and fit for use. (Watch a demonstration at the end of the article…)

“His motto was ‘if I can save a life, then you can’,” says Danielle.

The sessions often draw 20-40 people and sometimes Jack gives presentations teaching in front of 100 people.

10-yo mini-medic Jack Dawson teaches lifesaving skills to adults – SWNS

He does step-by-step walkthroughs on how to perform CPR with practice dummies laid on the floor, informing people about the dangers—including “looking into patients airways before pumping, in case of vomit or blood”. He gives tutorials on how to operate defibrillators which are used to revive someone from sudden cardiac arrest.

“He absolutely loves teaching,” Danielle told SWNS news agency. “I’ve never seen him so confident before and the fact he’s helping people to save a life determines him even more.”

“People are very surprised. He gets a lot of positive feedback and even special requests to teach people.

“I think people appreciate the information coming from a child, as it makes them think that if a 10-year-old can do it, then they can.”

Under the name ‘Mini Medic’, Jack has a YouTube channel and a page on TikTok posting medical tutorials and training nights for those unable to attend.

As a result of his community work, the 10-year-old is a finalist for Children of Courage Birmingham Awards.

Looking forward, Danielle said he’s enthusiastic about going to university and being a paramedic. “It’s all he thinks about!”WATCH the video below from the news agency SWNS.com… 10-Year-old Paramedic Teaches Adults Lifesaving Skills and CPR as ‘The Mini Medic’

Monday, 3 February 2025

Three Children Receive ‘the Best Christmas Present Ever’ – Bionic Arms

Colette Baker, Finley Jarvis, and Zoey Pidgeon-Hampton with their new Open Bionics arms – credit: SWNS

Three children were overjoyed after receiving ‘the best Christmas present in the world’—bionic arms.

Zoey Hampton-Pigeon, Finley Jarvis, and Colette Baker were given their new ‘life-changing’ Hero Arms on December 12th thanks to the fundraising work of a woman whose own child needed a prosthetic years ago.

Sarah Lockey saw her daughter Tilly lose both hands to meningitis. Today though, Tilly is a confident young woman who wears two Hero Arms daily, who hosts, together with her mom, a fundraising campaign every year called the Big Hero 3, which selects three random children across the UK to receive a prosthetic made by the Open Bionics Foundation.

Advanced, intuitive, robust, and light, the Hero Arm is “the world’s most affordable advanced multi-grip prosthetic arm,” according to the Foundation. The Hero Arm is available in over 801 locations across the US for below-elbow amputee adults and children aged 8 and above, and all throughout the UK where it is manufactured.

This year, the Big Hero 3 campaign raised £20,000. Two other charitable foundations, along with an anonymous donor, made up the rest of the £40,000 required, allowing Finley, Colette, and Zoey to have what will probably be the best Christmas ever.

To wit, Colette’s mom Alyse said her daughter ‘screamed’ when she found out she was not only receiving a Hero Arm, but would get one before Christmas.

“For Ettie, she’s excited about being able to do things like handstands, ride her bike without an adaption, and tying her shoes,” she said. “As parents, we are excited about these things too, but also all the other ways the Hero Arm will change Ettie’s life.”

Zoey was born with a missing limb, which the family discovered during an ultrasound in the 20th week.

“When Zoey was born she saw several specialists but there are no answers about why this happened to Zoey, it’s just one of those things,” said her father Thomas.

His daughter is an active young girl and member of a gymnastics club. She goes to swimming lessons and loves trampolining, but she’s most looking forward to being able to use a jump rope.

“A Hero Arm will make such a massive difference to her independence enabling her to do all these tasks, as well as her beloved skipping, without relying on help from others.”

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The last child is Finley Jarvis—born with no hand due to his mom being involved in a serious car accident whilst carrying him.

“Finn is a happy-go-lucky boy—he is kind, fearless, and extremely switched on,” said his father Ben. “He is now 11 and about to attend Brymore Academy secondary school—an agricultural school. With this opportunity of a Big Hero Arm the possibilities for him to excel are endless.”

MORE HERO ARM RECIPIENTS:

Lockey said she and Tilly are hoping to do another campaign next year if any donors who want to get involved to help are interested.“It is just incredible for three children to benefit and for their families all to meet and fundraise together,” Lockey said. Three Children Receive ‘the Best Christmas Present Ever’ – Bionic Arms

Tuesday, 21 January 2025

Vaccination rates among Australian teens are dropping. Here’s how we can get back on track

Australia has a successful adolescent immunisation program, routinely achieving high vaccine coverage for teenagers.

However, recent data shows the number of Australian teens receiving the recommended vaccines for their age group has fallen over three years during the COVID pandemic.

So how much have adolescent vaccination rates dropped, and why might this be? And how can we get back on track?

The vaccines teens need – and why they need them

The National Immunisation Program provides a series of free vaccinations for Australian teenagers. These are:

  • a booster vaccine for diphtheria, tetanus and pertussis (dTpa), usually offered in year 7
  • the human papillomavirus (HPV) vaccine, also usually offered in year 7
  • a meningococcal ACWY vaccine, offered in year 10.

These vaccines are primarily delivered through school-based immunisation programs and health services such as general practices.

They protect teenagers themselves from diseases, but also help reduce the spread of these diseases in the community.

For example, 2024 has seen a surge in whooping cough (pertussis) cases nationally. Although adolescents won’t necessarily get very sick with whooping cough, they can spread the disease. So the dTpa vaccine helps to protect vulnerable populations, including young babies.

HPV is a leading cause of genital warts and cervical cancer. Giving the HPV shot to young teenagers, before they might be exposed to the virus through sexual activity, provides the best protection against cervical cancer.

And older teenagers and young adults are among those at highest risk of meningococcal disease, which can be fatal. They’re also most likely to carry meningococcal bacteria in their nose and throat, and to spread it to others.

A modest but concerning decline

The most recent Annual Immunisation Coverage Report from the National Centre for Immunisation Research and Surveillance (NCIRS) shows a drop in vaccination coverage among teenagers between 2022 and 2023, while the previous report shows a drop from 2021 to 2022.

For example, the proportion of teens who had received their adolescent dose of dTpa in the year they turned 15 decreased from 87.3% in 2021, to 86.9% in 2022, to 85.5% in 2023.

Meanwhile, the proportion who had received one dose of meningococcal ACWY vaccine by age 17 fell from 76.1% in 2021, to 75.9% in 2022, to 72.8% in 2023.

Vaccination coverage among Indigenous teenagers dropped by similar amounts. For example, the proportion of Indigenous teens who had received one dose of meningococcal ACWY vaccine by age 17 fell from 66.7% in 2021 to 65.6% in 2022 to 62.3% in 2023.

Overall, in 2023, around one in four 18-year-olds hadn’t received all three of the nationally recommended adolescent vaccines.

Adolescent vaccinations are primarily delivered through school-based programs. VH-studio/Shutterstock

These figures show a decline in vaccination coverage among teenagers over three years. This comes after several years of generally increasing coverage before the COVID pandemic.

While the decline has been modest, the downward trend is concerning. It leaves more teenagers – and members of the wider community – vulnerable to serious infectious diseases.

Why is vaccination coverage decreasing among teenagers?

There are likely to be many contributing factors.

Although extended school closures and consequent disruption to school vaccination programs at the height of the pandemic likely played a role, these occurred almost exclusively in Victoria and New South Wales. So they can’t fully explain the ongoing drop in adolescent vaccination coverage across the country.

We don’t have good published data on what influences vaccine acceptance among teenagers. But given parents or guardians need to complete a consent form for their child to get vaccinated at school, we may be able to extrapolate from some of the challenges relating to childhood vaccination uptake.

The trends among teenagers have been consistent with a fall in the rates of younger children who are fully vaccinated. In 2023, 92.8% of one-year-olds were fully vaccinated, down from 94.8% in 2020. At five years old, the coverage rate in 2023 was 93.3%, down also from 94.8% in 2020.

A recent survey into barriers to childhood vaccination in Australia indicates a high proportion of parents who choose not to vaccinate young children have concerns about vaccine safety (48%) and effectiveness (40%). It’s possible the COVID pandemic has hindered vaccine acceptance.

Practical access barriers may also be hampering adolescent immunisation coverage. These might include lack of knowledge among parents about vaccines or immunisation schedules, complicated parental consent processes, school absenteeism, and lack of awareness of immunisation services outside school-based programs.

The NCIRS report for 2023 showed low HPV coverage for adolescents living in socioeconomically disadvantaged and remote locations. This suggests logistics such as transport may also play a role, especially for teens who miss vaccination during the school-based program.

How can we improve things? And what can parents do?

We need research to better understand the factors influencing vaccine uptake among adolescents. This can help us design and implement strategies to improve vaccination coverage in this age group.

For example, understanding the factors influencing HPV vaccination uptake among Indigenous adolescents and ensuring equitable access to targeted and culturally appropriate HPV vaccine education strategies has significantly improved vaccination coverage for this group. HPV vaccine coverage for Indigenous women aged 17 to 25 is now higher than for the general population.

We need to better understand the barriers to vaccination among adolescents. SeventyFour/Shutterstock

Parents can support their teenagers by talking to them about the importance of immunisation, listening to their concerns and answering any questions they may have. Consent forms will generally include information about the vaccine and the disease it protects against.

If your child misses out on receiving their vaccinations at school or doesn’t attend school, families can access free National Immunisation Program vaccines from their GP, pharmacy, local council or other health services.

Specialist immunisation services are also available in most states and territories. These services are for children and adolescents who are in high-risk groups or for families who are concerned about vaccinating their children.

Teenagers are the next generation of parents, and their attitudes towards immunisation will influence coverage rates of their children in the future. This is yet another reason we need to successfully address any concerns or barriers for this group around vaccination.The Conversation

Archana Koirala, Paediatrician and Infectious Diseases Specialist, University of Sydney; Bianca Middleton, Senior Research Fellow, Menzies School of Health Research; Fiona Russell, Senior Principal Research Fellow; paediatrician; infectious diseases epidemiologist; vaccinologist, The University of Melbourne; Katrina Clark, Aboriginal Immunisation Manager at Hunter New England Population Health, Indigenous Knowledge, and Sophie Wen, Senior Lecturer, Faculty of Medicine, The University of Queensland

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

Tuesday, 7 January 2025

Five healthy diet staples that may interact with prescription drugs

Grapefruit juice may cause some prescription drugs to accumulate in the body. KudPhotoCreate/ Shutterstock Dipa Kamdar, Kingston University

One of the most popular new year’s resolutions is making a commitment to healthier eating. Whether that’s eating more fruits and vegetables, cutting down on meat consumption or even becoming a vegetarian or vegan a few days a week.

While there are many benefits that can come from following a healthier diet, it’s important that any diet changes are made carefully. This is especially true if you’re someone who takes a prescription drug, as many health food staples can negatively interact with them.

Here are some common foods and drinks interactions you should know about:

1. Grapefruit juice:

To break down some prescription drugs in the body, the liver uses enzymes called cytochrome P450. But grapefruit juice contains chemical compounds called furanocoumarins which can block the action of these enzymes. If this happens, some drugs can accumulate in the body.

This includes ciclosporin, a drug that’s commonly used to prevent organ transplant rejection and manage symptoms of rheumatoid arthritis and skin conditions such as psoriasis. A build-up of ciclosporin can cause many side-effects, ranging from mild nausea and vomiting to kidney and liver damage.

Statins, often used to treat high cholesterol levels and prevent heart attacks and strokes, can also be affected by grapefruit juice through the same mechanism. Increased statin levels in the body can raise the risk of side-effects, including muscle breakdown, which is rare but serious.

Many other drugs can potentially interact with grapefruit juice as well – including amlodipine (a common high blood pressure drug) and sildenafil (an erectile dysfunction drug). If you take any of these prescriptions drugs, it’s best to talk to your doctor or pharmacist before drinking even small amounts of grapefruit juice. It may even be best to avoid it altogether.

2. Pomegranate and cranberry juice:

Many fruits and fruit juices – especially from the citrus family – can affect the breakdown of drugs in the liver.

Pomegranate juice is also shown to block the liver enzymes which break down the anticoagulant drug warfarin. The drug is used to prevent blood clots from forming in people with heart arrhythmias such as atrial fibrillation or deep vein thrombosis.

Some reported cases suggest that pomegranate juice might increase the international normalised ratio (INR – the time taken for blood to clot) in patients taking warfarin. This means patients may be at higher risk of bleeding.

Pomegranate juice may also affect other drugs, such as tacrolimus, an anti-rejection drug used in organ transplants.

Similarly, a number of case reports suggest cranberry juice can also affect warfarin. There has been one reported death of a patient from bleeding after they had drunk cranberry juice for two weeks prior while taking warfarin.

But results from various studies are mixed – with some showing cranberry affects warfarin in the body while others don’t show any effect. Because of this, it may be worth checking the INR more often if you drink these juices or consider that any fluctuations in INR may be due to fruit juices.

3. Green leafy vegetables:

Spinach, broccoli and kale are often hailed as healthy foods because they’re filled with nutrients while being low in calories. However, they’re also high in vitamin K, which is needed to activate certain clotting factors (proteins in the blood which help it clot).

This may be problematic for patients taking warfarin. Warfarin works by blocking vitamin K in order to prevent blood clots from forming. But eating foods rich in vitamin K can lower your INR and increase the risk of developing a blood clot.

The vitamin K in leafy green vegetables, such as kale, may counteract warfarin. masa44/ Shutterstock

It’s important to have a healthy diet – but be sure to monitor your INR levels or speak to your doctor if you do introduce more vitamin K-rich foods into your diet.

4. Milk:

Milk and dairy-rich foods such as cheese and yoghurt are all good sources of protein and calcium – a mineral required for healthy bones.

But these foods can affect the absorption of some drugs in the gut. This includes antibiotics such as some tetracyclines and ciprofloxacin. The calcium in the milk can bind to the antibiotic, meaning it cannot be absorbed into the bloodstream. This means the body will not get the full dose of antibiotic – making it harder for it to fight the infection.

Other drugs affected by dairy include levothyroxine, a drug used for patients with low thyroid levels.

But as these interactions happen in the gut, this means you can still have dairy even if you take these drugs. In most cases, you just need to leave at least a two-hour gap either before or after taking the drug before consuming dairy.

5. Beans:

Beans are considered healthy as they’re high in fibre and vitamins and minerals. Beans are also a great source of plant-based protein.

But soybeans, broad beans (fava beans) and snow peas may be high in tyramine. While tyramine is a substance naturally found in the body and in certain foods (such as aged cheeses, cured meats and fermented foods), it can interact with the antidepressant phenelzine.

Phenelzine is a monoamine oxidase inhibitor antidepressant (MAOI), which is less commonly used nowadays. The drug blocks enzymes which break down tyramine in the body. If patients eat tyramine-rich foods, this may result in high levels of tyramine, potentially leading to a dangerous rise in blood pressure. Only MAOI antidepressants, such as phenelzine, isocarboxazid, tranylcypromine, are affected by tyramine.

A healthy diet can improve your overall health in many ways. Just be sure to consult with a doctor of pharmacist before drastically changing your diet – particularly if you take prescription medications.The Conversation

Dipa Kamdar, Senior Lecturer in Pharmacy Practice, Kingston University

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

Wednesday, 1 January 2025

Drug companies pay doctors over A$11 million a year for travel and education. Here’s which specialties received the most

Monster Ztudio/Shutterstock Barbara Mintzes, University of Sydney and Malcolm Forbes, Deakin University

Drug companies are paying Australian doctors millions of dollars a year to fly to overseas conferences and meetings, give talks to other doctors, and to serve on advisory boards, our research shows.

Our team analysed reports from major drug companies, in the first comprehensive analysis of its kind. We found drug companies paid more than A$33 million to doctors in the three years from late 2019 to late 2022 for these consultancies and expenses.

We know this underestimates how much drug companies pay doctors as it leaves out the most common gift – food and drink – which drug companies in Australia do not declare.

Due to COVID restrictions, the timescale we looked at included periods where doctors were likely to be travelling less and attending fewer in-person medical conferences. So we suspect current levels of drug company funding to be even higher, especially for travel.

What we did and what we found

Since 2019, Medicines Australia, the trade association of the brand-name pharmaceutical industry, has published a centralised database of payments made to individual health professionals. This is the first comprehensive analysis of this database.

We downloaded the data and matched doctors’ names with listings with the Australian Health Practitioner Regulation Agency (Ahpra). We then looked at how many doctors per medical specialty received industry payments and how much companies paid to each specialty.

We found more than two-thirds of rheumatologists received industry payments. Rheumatologists often prescribe expensive new biologic drugs that suppress the immune system. These drugs are responsible for a substantial proportion of drug costs on the Pharmaceutical Benefits Scheme (PBS).

The specialists who received the most funding as a group were cancer doctors (oncology/haematology specialists). They received over $6 million in payments.

This is unsurprising given recently approved, expensive new cancer drugs. Some of these drugs are wonderful treatment advances; others offer minimal improvement in survival or quality of life.

A 2023 study found doctors receiving industry payments were more likely to prescribe cancer treatments of low clinical value.

Our analysis found some doctors with many small payments of a few hundred dollars. There were also instances of large individual payments.

Why does all this matter?

Doctors usually believe drug company promotion does not affect them. But research tells a different story. Industry payments can affect both doctors’ own prescribing decisions and those of their colleagues.

A US study of meals provided to doctors – on average costing less than US$20 – found the more meals a doctor received, the more of the promoted drug they prescribed.

Pizza anyone? Even providing a cheap meal can influence prescribing. El Nariz/Shutterstock

Another study found the more meals a doctor received from manufacturers of opioids (a class of strong painkillers), the more opioids they prescribed. Overprescribing played a key role in the opioid crisis in North America.

Overall, a substantial body of research shows industry funding affects prescribing, including for drugs that are not a first choice because of poor effectiveness, safety or cost-effectiveness.

Then there are doctors who act as “key opinion leaders” for companies. These include paid consultants who give talks to other doctors. An ex-industry employee who recruited doctors for such roles said:

Key opinion leaders were salespeople for us, and we would routinely measure the return on our investment, by tracking prescriptions before and after their presentations […] If that speaker didn’t make the impact the company was looking for, then you wouldn’t invite them back.

We know about payments to US doctors

The best available evidence on the effects of pharmaceutical industry funding on prescribing comes from the US government-run program called Open Payments.

Since 2013, all drug and device companies must report all payments over US$10 in value in any single year. Payment reports are linked to the promoted products, which allows researchers to compare doctors’ payments with their prescribing patterns.

Analysis of this data, which involves hundreds of thousands of doctors, has indisputably shown promotional payments affect prescribing.

Medical students need to know about this. LightField Studios/Shutterstock

US research also shows that doctors who had studied at medical schools that banned students receiving payments and gifts from drug companies were less likely to prescribe newer and more expensive drugs with limited evidence of benefit over existing drugs.

In general, Australian medical faculties have weak or no restrictions on medical students seeing pharmaceutical sales representatives, receiving gifts, or attending industry-sponsored events during their clinical training. They also have no restrictions on academic staff holding consultancies with manufacturers whose products they feature in their teaching.

So a first step to prevent undue pharmaceutical industry influence on prescribing decisions is to shelter medical students from this influence by having stronger conflict-of-interest policies, such as those mentioned above.

A second is better guidance for individual doctors from professional organisations and regulators on the types of funding that is and is not acceptable. We believe no doctor actively involved in patient care should accept payments from a drug company for talks, international travel or consultancies.

Third, if Medicines Australia is serious about transparency, it should require companies to list all payments – including those for food and drink – and to link health professionals’ names to their Ahpra registration numbers. This is similar to the reporting standard pharmaceutical companies follow in the US and would allow a more complete and clearer picture of what’s happening in Australia.

Patients trust doctors to choose the best available treatments to meet their health needs, based on scientific evidence of safety and effectiveness. They don’t expect marketing to influence that choice.The Conversation

Barbara Mintzes, Professor, School of Pharmacy and Charles Perkins Centre, University of Sydney and Malcolm Forbes, Consultant psychiatrist and PhD candidate, Deakin University

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

Friday, 27 December 2024

Weight-loss drugs draw Americans back to the doctor

FILE PHOTO: Injection pens and boxes of Novo Nordisk’s weight-loss drug Wegovy are shown in this photo illustration in Oslo, Norway, November 21, 2023. REUTERS/Victoria Klesty/Illustration

By Deena Beasley

(Reuters) -Powerful weight-loss drugs are expanding use of U.S. health care as patients starting prescriptions are diagnosed with obesity-related conditions or take the drugs to become eligible for other services, health records and discussions with doctors show.

An exclusive analysis of hundreds of thousands of electronic patient records by health data firm Truveta found slight, but measurable, increases in first-time diagnoses of sleep apnea, cardiovascular disease, and type 2 diabetes within 15 days of an initial prescription for a GLP-1 weight-loss drug between 2020 and 2024.

In addition to obesity-related conditions, some patients are being prescribed the drugs to lose weight and become eligible for services, including organ transplants, fertility treatments or knee replacements, according to interviews with seven doctors and five other health experts.

Lung transplant patient Bensabio Guajardo and the team at UChicago Medicine’s ACTNOW weight loss clinic pose for a picture at the clinic, in Chicago, March 2023. Mark Black/UChicago Medicine/Handout via REUTERS

“This is a population that previously felt stigmatized by health care providers and often didn’t return. But now that they’re actually seeing themselves get healthier, asking clinicians questions and engaging more, I do think we’re seeing new patients,” said Dr. Rekha Kumar, a New York endocrinologist and obesity medicine specialist.

Novo Nordisk’s Wegovy and Ozempic and Eli Lilly’s Zepbound and Mounjaro have been shown to lead to average weight loss of at least 15%.

Andrew Friedson, director of health economics at the Milken Institute and three other experts said the impact of the drugs on overall healthcare use is not yet clear. The new diagnoses could mean higher initial spending, but early detection could save costs down the line, he said.

Dr. Courtney Younglove, an obesity medicine specialist and founder of Heartland Weight Loss clinic in Overland Park, Kansas, said she has referred obesity patients for long-delayed pap smears and other routine care, including colonoscopies. Many overweight patients avoid doctors and routine tests for years due to the stigma and bias they often encounter, she said. “A lot of people with obesity don’t do a lot of preventive health maintenance.”

‘THE COURAGE TO ASK’

Phil, a 43-year-old Chicago technology executive who asked for his full name to be withheld for privacy reasons, generally avoided doctors before receiving a GLP-1 prescription from a telehealth provider in early 2023.

He said he told his regular physician about the medication months later, after he had lost more than 30 lbs, and was taken aback by her supportive response. He decided then to advocate more for himself and ask for help with other conditions, including addiction and mental health.

“It gave me the courage to ask,” he said.

The Truveta analysis found that for every 1,000 patients with a first-time GLP-1 prescription, 42 were diagnosed with type 2 diabetes within 15 days in 2024, up from 32 in 2020. Over the same period, the number of sleep apnea diagnoses per 1,000 patients rose to 11 from 8 and the number of cardiovascular disease diagnoses increased to 15 from 13.

The most obese patients were twice as likely as people who were less overweight to receive a type 2 diabetes diagnosis, and three times as likely to be diagnosed with sleep apnea, the Truveta data showed.

The analysis was based on 33,630 first-time GLP-1 prescriptions for overweight or obese patients in 2020 and 224,496 in the first 10 months of 2024.

Lilly declined to directly comment on the data, saying in an emailed statement “it is important that adults living with obesity receive appropriate diagnosis and access to evidence-based care.”

Novo Nordisk also declined to comment directly, noting its aim “to address unmet needs for a wider range of patients.”

QUALIFYING FOR SURGERIES

ResMed, which sells sleep apnea devices, had revenue growth of 11% for its fiscal year ending in June – a trend the company attributed in part to the GLP-1 drugs.

The medications are “bringing people into primary care like never before,” ResMed CEO Michael Farrell said at the company’s recent shareholder meeting.

A Truveta analysis earlier this year found that since 2020 people were being started on GLP-1s despite having less severe markers of disease, including BMI, which suggested the drugs are becoming more broadly used as preventative tools.

In addition to treatment of things like sleep apnea, the weight-loss drugs could lead to more joint replacements, said Sara Mallatt, director of healthcare research at market analysis firm AlphaSense.

“As people’s BMIs come down, they’ll be eligible for surgeries they wouldn’t otherwise,” she said. “No one is saying this is happening in a meaningful way right now, but we think it will.”

University of Chicago Medicine last year launched a weight-loss clinic aimed at helping prospective organ transplant patients lose weight to qualify for surgery, with the GLP-1 drugs playing a key role.

“Before they had a place to send these patients, which is our clinic, the scheduler would just say, ‘hey, what’s your weight, what’s your height, what’s your BMI,’ and if they didn’t fit their criteria, they would just tell them to lose weight on their own,” said Anesia Reticker, the center’s clinical pharmacist specialist.

Retired Indiana steelworker Bensabio Guajardo, 68, was prescribed Ozempic at the clinic in 2023 when he was deemed too obese for a double lung transplant needed to keep him alive after pulmonary fibrosis made breathing increasingly difficult.

“It helped me a lot. It took my cravings away,” Guajardo said. After losing around 90 pounds and stopping the drug ahead of a successful surgery in May, his doctor put him back on it to control high blood sugar.

Reticker said the program has received about 100 referrals over the past year from transplant centers in the Chicago area.(Reporting By Deena Beasley; Additional reporting by Chad Terhune in Los Angeles and Patrick Wingrove in New York; Editing by Caroline Humer and Suzanne Goldenberg)Weight-loss drugs draw Americans back to the doctor

Wednesday, 4 December 2024

Shortsightedness is on the rise in children. There’s more we can do than limit screen time

Myopia in children is on the rise. The condition – also known as shortsightedness – already affects up to 35% of children across the world, according to a recent review of global data. The researchers predict this number will increase to 40%, exceeding 740 million children living with myopia by 2050.

So why does this matter? Many people may be unaware that treating myopia (through interventions such as glasses) is about more than just comfort or blurry vision. If left unchecked, myopia can rapidly progress, increasing the risk of serious and irreversible eye conditions. Diagnosing and treating myopia is therefore crucial for your child’s lifetime eye health.

Here is how myopia develops, the role screen time plays – and what you can do if think your child might be shortsighted.

What is myopia?

Myopia is commonly known as nearsightedness or shortsightedness. It is a type of refractive error, meaning a vision problem that stops you seeing clearly – in this case, seeing objects that are far away.

A person usually has myopia because their eyeball is longer than average. This can happen if eyes grow too quickly or longer than normal.

A longer eyeball means when light enters the eye, it’s not focused properly on the retina (the light-sensing tissue lining the back of the eye). As a result, the image they see is blurry. Controlling eye growth is the most important factor for achieving normal vision.

Myopia is a common vision problem. Alexander_P/Shutterstock

Myopia is on the rise in children

The study published earlier this year looked at how the rate of myopia has changed over the last 30 years. It reviewed 276 studies, which included 5.4 million people between the ages of 5–19 years, from 50 countries, across six continents.

Based on this data, the researchers concluded up to one in three children are already living with shortsightedness – and this will only increase. They predict a particular rise for adolescents: myopia is expected to affect more than 50% of those aged 13-19 by 2050.

Their results are similar to a previous Australian study from 2015. It predicted 36% of children in Australia and New Zealand would have myopia by 2020, and more than half by 2050.

The new review is the most comprehensive of its kind, giving us the closest look at how childhood myopia is progressing across the globe. It suggests rates of myopia are increasing worldwide – and this includes “high myopia”, or severe shortsightedness.

What causes myopia?

Myopia develops partly due to genetics. Parents who have myopia – and especially high myopia – are more likely to have kids who develop myopia as well.

But environmental factors can also play a role.

One culprit is the amount of time we spend looking at screens. As screens have shrunk, we tend to hold them closer. This kind of prolonged focusing at short range has long been associated with developing myopia.

Reducing screen time may help reduce eye strain and slow myopia’s development. However for many of us – including children – this can be difficult, given how deeply screens are embedded in our day-to-day lives.

Green time over screen time

Higher rates of myopia may also be linked to kids spending less time outside, rather than screens themselves. Studies have shown boosting time outdoors by one to two hours per day may reduce the onset of myopia over a two to three year period.

We are still unsure how this works. It may be that the greater intensity of sunlight – compared to indoor light – promotes the release of dopamine. This crucial molecule can slow eye growth and help prevent myopia developing.

However current research suggests once you have myopia, time outdoors may only have a small effect on how it worsens.

Sunlight may play a role in slowing myopia progression. Allan Mas/Pexels

What can we do about it?

Research is rapidly developing in myopia control. In addition to glasses, optometrists have a range of tools to slow eye growth and with it, the progression of myopia. The most effective methods are:

  • orthokeratology (“ortho-K”) uses hard contact lenses temporarily reshape the eye to improve vision. They are convenient as they are only worn while sleeping. However parents need to make sure lenses are cleaned and stored properly to reduce the chance of eye infections

  • atropine eyedrops have been shown to successfully slow myopia progression. Eyedrops can be simple to administer, have minimal side effects and don’t carry the risk of infection associated with contact lenses.

You can monitor your child’s eye health and vision with regular eye tests. 4 PM production/Shutterstock

What are the risks with myopia?

Myopia is easily corrected by wearing glasses or contact lenses. But if you have “high myopia” (meaning you are severely shortsighted) you have a higher risk of developing other eye conditions across your lifetime, and these could permanently damage your vision.

These conditions include:

  • retinal detachment, where the retina tears and peels away from the back of the eye

  • glaucoma, where nerve cells in the retina and optic nerve are progressively damaged and lost

  • myopic maculopathy, where the longer eyeball means the macula (part of the retina) is stretched and thinned, and can lead to tissue degeneration, breaks and bleeds.

What can parents do?

It’s important to diagnose and treat myopia early – especially high myopia – to stop it progressing and lower the risk of permanent damage.

Uncorrected myopia can also affect a child’s ability to learn, simply because they can’t see clearly. Signs your child might need to be tested can include squinting to see into the distance, or moving things closer such as a screen or book to see.

Regular eye tests with the optometrist are the best way to understand your child’s eye health and eyesight. Each child is different – an optometrist can help you work out tailored methods to track and manage myopia, if it is diagnosed.The Conversation

Flora Hui, Honorary Fellow, Department of Optometry and Vision Sciences, Melbourne School of Health Sciences, The University of Melbourne

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