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New study suggests weight loss drugs like Ozempic could help with knee pain. Here’s why there may be a link

<a href="https://theconversation.com/profiles/giovanni-e-ferreira-1030477">Giovanni E. Ferreira</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/christina-abdel-shaheed-425241">Christina Abdel Shaheed</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> The drug semaglutide, commonly known by the brand names Ozempic or Wegovy, was <a href="https://theconversation.com/the-rise-of-ozempic-how-surprise-discoveries-and-lizard-venom-led-to-a-new-class-of-weight-loss-drugs-219721">originally developed</a> to help people with type 2 diabetes manage their blood sugar levels. However, researchers have discovered it may help with other health issues, too. Clinical trials show semaglutide can be effective for <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2032183">weight loss</a>, and hundreds of thousands of people around the world are using it <a href="https://theconversation.com/considering-taking-a-weight-loss-drug-like-ozempic-here-are-some-potential-risks-and-benefits-219312">for this purpose</a>. Evidence has also shown the drug can help manage <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2306963">heart failure</a> and <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2403347">chronic kidney disease</a> in people with obesity and type 2 diabetes. Now, a study published in the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2403664">New England Journal of Medicine</a> has suggested semaglutide can improve knee pain in people with obesity and osteoarthritis. So what did this study find, and how could semaglutide and osteoarthritis pain be linked? <h2>Osteoarthritis and obesity</h2> Osteoarthritis is a common joint disease, affecting <a href="https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/osteoarthritis">2.1 million Australians</a>. Most people with osteoarthritis <a href="https://theconversation.com/do-you-have-knee-pain-from-osteoarthritis-you-might-not-need-surgery-heres-what-to-try-instead-236779">have pain</a> and find it difficult to perform common daily activities such as walking. The knee is <a href="https://pubmed.ncbi.nlm.nih.gov/37675071/">the joint most commonly affected</a> by osteoarthritis. Being overweight or obese is a <a href="https://pubmed.ncbi.nlm.nih.gov/25447976/">major risk factor</a> for osteoarthritis in the knee. The link between the two conditions <a href="https://pubmed.ncbi.nlm.nih.gov/26821091/">is complex</a>. It involves a combination of increased load on the knee, <a href="https://www.nature.com/articles/s41413-023-00301-9">metabolic factors</a> such as high cholesterol and high blood sugar, and inflammation. For example, elevated blood sugar levels increase the production of inflammatory molecules in the body, which can damage the cartilage in the knee, and lead to the <a href="https://pubmed.ncbi.nlm.nih.gov/30712918/">development of osteoarthritis</a>. Weight loss is strongly recommended to reduce the pain of knee osteoarthritis in people who are overweight or obese. <a href="https://pubmed.ncbi.nlm.nih.gov/31908149/">International</a> and <a href="https://www.safetyandquality.gov.au/sites/default/files/2024-08/osteoarthritis-knee-clinical-care-standard-2024.pdf">Australian guidelines</a> suggest losing as little as 5% of body weight can help. But losing weight with just diet and exercise can be difficult for many people. <a href="https://pubmed.ncbi.nlm.nih.gov/26180980/">One study</a> from the United Kingdom found the annual probability of people with obesity losing 5% or more of their body weight was less than one in ten. Semaglutide has recently entered the market as a potential alternative route to weight loss. It comes from a class of drugs known as GLP-1 receptor agonists and works by increasing a person’s sense of fullness. <h2>Semaglutide for osteoarthritis?</h2> The rationale for the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2403664">recent study</a> was that while we know weight loss alleviates symptoms of knee osteoarthritis, the effect of GLP-1 receptor agonists was yet to be explored. So the researchers set out to understand what effect semaglutide might have on knee osteoarthritis pain, alongside body weight. They randomly allocated 407 people with obesity and moderate osteoarthritis into one of two groups. One group received semaglutide once a week, while the other group received a placebo. Both groups were treated for 68 weeks and received counselling on diet and physical activity. At the end of the treatment phase, researchers measured changes in knee pain, function, and body weight. As expected, those taking semaglutide lost more weight than those in the placebo group. People on semaglutide lost around 13% of their body weight on average, while those taking the placebo lost around 3% on average. More than 70% of people in the semaglutide group lost at least 10% of their body weight compared to just over 9% of people in the placebo group. The study found semaglutide reduced knee pain significantly more than the placebo. Participants who took semaglutide reported an additional 14-point reduction in pain on a 0–100 scale compared to the placebo group. This is much greater than the pain reduction in another <a href="https://pubmed.ncbi.nlm.nih.gov/36511925/">recent study</a> among people with obesity and knee osteoarthritis. This study investigated the effects of a diet and exercise program compared to an attention control (where participants are provided with information about nutrition and physical activity). The results here saw only a 3-point difference between the intervention group and the control group on the same scale. The amount of pain relief reported in the semaglutide trial is also larger than that reported with commonly used pain medicines such as <a href="https://pubmed.ncbi.nlm.nih.gov/35442752/">anti-inflammatories</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/35137418/">opioids</a> and <a href="https://www.bmj.com/content/372/bmj.m4825">antidepressants</a>. Semaglutide also improved knee function compared to the placebo. For example, people who took semaglutide could walk about 42 meters further than those on the placebo in a six-minute walking test. <h2>How could semaglutide reduce knee pain?</h2> It’s not fully clear how semaglutide helps with knee pain from osteoarthritis. One explanation may be that when a person loses weight, there’s less stress on the joints, which reduces pain. But recent studies have also suggested semaglutide and other GLP-1 receptor agonists might have <a href="https://www.sciencedirect.com/science/article/pii/S1043661822002651">anti-inflammatory</a> properties, and could even protect against <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC6731440/">cartilage wear and tear</a>. While the results of this new study are promising, it’s too soon to regard semaglutide as a “miracle drug” for knee osteoarthritis. And as this study was funded by the drug company that makes semaglutide, it will be important to have independent studies in the future, to confirm the findings, or not. The study also had strict criteria, excluding some groups, such as those taking opioids for knee pain. One in seven Australians seeing a GP for their knee osteoarthritis <a href="https://pubmed.ncbi.nlm.nih.gov/34527976/">are prescribed opioids</a>. Most participants in the trial were white (61%) and women (82%). This means the study may not fully represent the average person with knee osteoarthritis and obesity. It’s also important to consider semaglutide can have a range of <a href="https://theconversation.com/considering-taking-a-weight-loss-drug-like-ozempic-here-are-some-potential-risks-and-benefits-219312">side effects</a>, including gastrointestinal symptoms and fatigue. There are some concerns that semaglutide could reduce <a href="https://www.sciencealert.com/experts-are-concerned-drugs-like-ozempic-may-cause-muscle-loss">muscle mass</a> and <a href="https://www.healthline.com/health-news/ozempic-muscle-mass-loss">bone density</a>, though we’re still learning more about this. Further, it can be difficult to access. <h2>I have knee osteoarthritis, what should I do?</h2> Osteoarthritis is a disease caused by multiple factors, and it’s important to take <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard/information-consumers-osteoarthritis-knee-clinical-care-standard">a multifaceted approach</a> to managing it. Weight loss is an important component for those who are overweight or obese, but so are other aspects of <a href="https://theconversation.com/do-you-have-knee-pain-from-osteoarthritis-you-might-not-need-surgery-heres-what-to-try-instead-236779">self-management</a>. This might include physical activity, pacing strategies, and other positive lifestyle changes such as improving sleep, healthy eating, and so on.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/243159/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/giovanni-e-ferreira-1030477">Giovanni E. Ferreira</a>, NHMRC Emerging Leader Research Fellow, Institute of Musculoskeletal Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/christina-abdel-shaheed-425241">Christina Abdel Shaheed</a>, Associate Professor, School of Public Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Shutterstocl This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/new-study-suggests-weight-loss-drugs-like-ozempic-could-help-with-knee-pain-heres-why-there-may-be-a-link-243159">original article</a>.

Body

Having the ‘right’ friends may hold the secret to building wealth, according to new study on socioeconomic ties

<a href="https://theconversation.com/profiles/brad-cannon-2216202">Brad Cannon</a>, <a href="https://theconversation.com/institutions/binghamton-university-state-university-of-new-york-2252">Binghamton University, State University of New York</a> Having wealthy people in your social network significantly boosts the likelihood that you’ll participate in stock markets and savings plans, according to a new working paper I co-authored. My colleagues and I <a href="https://www.nber.org/system/files/working_papers/w32186/w32186.pdf">recently conducted research</a> on social finance to understand the ways in which social networks affect stock market participation and savings behavior. This is important because a substantial fraction of households in the U.S., particularly <a href="https://www.axios.com/2023/10/18/percentage-americans-own-stock-market-investing">lower-income families, do not own stocks</a>. Given that the total return to the U.S. stock market from 1980 through September 2024 has been over 12,000% – for example, US$1,000 <a href="https://ofdollarsanddata.com/sp500-calculator/">invested in the S&P 500</a> in 1980 would be worth $121,350 today – this creates a disparity in wealth for those who participate relative to those who do not. Understanding why some people invest and others don’t is important for addressing social concerns such as rising inequality. In our study, we looked at <a href="https://academic.oup.com/ej/advance-article/doi/10.1093/ej/ueae074/7720537">social capital</a>, which is a measure of the value that comes from being in a group or having dense social networks. Researchers have found that social capital can have positive impacts on individuals and communities, spurring innovation, <a href="https://www.nature.com/articles/s41586-022-04996-4">economic prosperity</a> and better health outcomes. We used friendship data from Facebook to measure different aspects of social networks by county in the U.S. We combined this data with tax information from the Internal Revenue Service about investments and savings. We found that in counties where friendships with prosperous individuals are more common, investment and savings tend to be higher. Moreover, we found that having these friendships with wealthy individuals plays a more important role in shaping financial behaviors than two other aspects of social capital we looked at in our study: having a tight group of friends and living in a community with strong civic engagement. Of course, making wealthy friends alone does not guarantee you’ll invest or save more. But perhaps knowing people who invest makes it less daunting and fraught, particularly if those friends can serve as a resource and sounding board. “Friends with Benefits: Social Capital and Household Financial Behavior” was co-authored by <a href="https://www.marshall.usc.edu/personnel/david-hirshleifer">David Hirshleifer</a> and <a href="https://hankamer.baylor.edu/person/joshua-thornton">Joshua Thornton</a>.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/239370/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/brad-cannon-2216202">Brad Cannon</a>, Assistant Professor of Finance, <a href="https://theconversation.com/institutions/binghamton-university-state-university-of-new-york-2252">Binghamton University, State University of New York</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/having-the-right-friends-may-hold-the-secret-to-building-wealth-according-to-new-study-on-socioeconomic-ties-239370">original article</a>.

Money & Banking

Breakthrough study finds genetic link to Parkinson's and ADHD

A major scientific study has found a surprising link between the genes that control brain size and the risk of brain-related conditions. A Queensland Institute of Medical Research Associate Professor Miguel Renteria led an international team of experts who scanned DNA data and MRI scans from 76,000 participants. “Genetic variants associated with larger brain volumes in key brain regions also increase the risk of Parkinson’s disease, while variants linked to smaller brain volumes in key regions are associated with an increased risk of ADHD,” Renteria said. “It brings us closer to answering key questions about how genetics influence brain structure, and how we can potentially treat these conditions in future.” Parkinson’s Australia CEO Olivia Nassaris has celebrated the results of the study, saying the surprising results open the door to future treatment options for Parkinson’s, which currently has no cure or cause. “The more answers we have the closer we are to understanding this condition,” she said. Michael Wiseman, who has been living with Parkinson’s for eight years, said he is pleased more research is being done about the neurodegenerative condition. “I know it’s not going to benefit me in any way, as far as a cure or anything … I just hope they keep going, kicking some goals and finding results because it’s an insidious sort of thing, it’s a passenger I’ll have until I go to the grave.” Image credits: Shutterstock

Caring

New study finds epilepsy drug could reduce sleep apnoea symptoms

New research has found that a drug used for epilepsy could be used to reduce the symptoms of sleep apnoea. Obstructive sleep apnoea, which affects about one in 20 people, according to the National Institute for Health and Care Excellence in England, includes symptoms like snoring and it causes a person's breathing to start and stop during the night, with many requiring an aid to help keep their airways open. An international study has identified that taking sulthiame, a drug sold under the brand name Ospolot in Europe, may help prevent patients' breathing from temporarily stopping. This provides an additional option for those unable to use mechanical breathing aids like the Cpap machines. “The standard treatment for obstructive sleep apnoea is sleeping with a machine that blows air through a face mask to keep the airways open. Unfortunately, many people find these machines hard to use over the long term, so there is a need to find alternative treatments,” Prof Jan Hedner from Sahlgrenska university hospital and the University of Gothenburg in Sweden said. Researchers conducted a randomised controlled trial of almost 300 obstructive sleep apnoea patients across Europe, who did not use Cpap machines. They were divided into four groups and given either a placebo or different strengths of sulthiame. The study measured patients’ breathing, oxygen levels, heart rhythm, eye movements, as well as brain and muscle activity while asleep. It found after 12 weeks, those taking sulthiame had up to 50% fewer occasions where their breathing stopped, and higher levels of oxygen in their blood. However, a bigger study needs to be done to confirm the beneficial effects on a larger group. The findings, were presented at the European Respiratory Society Congress in Vienna, Austria. Erika Radford, the head of health advice at Asthma + Lung UK said the findings were a positive step forward in moving away from having to rely on mechanical breathing equipment. “This potential alternative to the current main treatment would make it easier for people to manage their condition,” she said. Image: Shutterstock

Body

Constipation increases your risk of a heart attack, new study finds – and not just on the toilet

<a href="https://theconversation.com/profiles/vincent-ho-141549">Vincent Ho</a>, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a> If you Google the terms “constipation” and “heart attack” it’s not long before the name Elvis Presley crops up. Elvis had a longstanding history of chronic constipation and <a href="https://www.pbs.org/newshour/health/elvis-addiction-was-the-perfect-prescription-for-an-early-death">it’s believed</a> he was straining very hard to poo, which then led to a fatal heart attack. We don’t know what really happened to the so-called King of Rock “n” Roll back in 1977. There were likely several contributing factors to his death, and this theory is one of many. But after this famous case researchers took a strong interest in the link between constipation and the risk of a heart attack. This includes a recent <a href="https://journals.physiology.org/doi/abs/10.1152/ajpheart.00519.2024">study</a> led by Australian researchers involving data from thousands of people. <h2>Are constipation and heart attacks linked?</h2> Large <a href="https://www.nature.com/articles/s41598-023-38068-y">population</a> <a href="https://pubmed.ncbi.nlm.nih.gov/32873621/">studies</a> show constipation is linked to an increased risk of heart attacks. For example, an <a href="https://www.nature.com/articles/s41598-023-38068-y">Australian study</a> involved more than 540,000 people over 60 in hospital for a range of conditions. It found constipated patients had a higher risk of high blood pressure, heart attacks and strokes compared to non-constipated patients of the same age. A <a href="https://pubmed.ncbi.nlm.nih.gov/32873621/">Danish study</a> of more than 900,000 people from hospitals and hospital outpatient clinics also found that people who were constipated had an increased risk of heart attacks and strokes. It was unclear, however, if this relationship between constipation and an increased risk of heart attacks and strokes would hold true for healthy people outside hospital. These Australian and Danish studies also did not factor in the effects of drugs used to treat high blood pressure (hypertension), which can make you constipated. <h2>How about this new study?</h2> The recent <a href="https://journals.physiology.org/doi/abs/10.1152/ajpheart.00519.2024">international study</a> led by Monash University researchers found a connection between constipation and an increased risk of heart attacks, strokes and heart failure in a general population. The researchers analysed data from the <a href="https://www.ukbiobank.ac.uk">UK Biobank</a>, a database of health-related information from about half a million people in the United Kingdom. The researchers identified more than 23,000 cases of constipation and accounted for the effect of drugs to treat high blood pressure, which can lead to constipation. People with constipation (identified through medical records or via a questionnaire) were twice as likely to have a heart attack, stroke or heart failure as those without constipation. The researchers found a strong link between high blood pressure and constipation. Individuals with hypertension who were also constipated had a 34% increased risk of a major heart event compared to those with just hypertension. The study only looked at the data from people of European ancestry. However, there is good reason to believe the link between constipation and heart attacks applies to other populations. A <a href="https://pubmed.ncbi.nlm.nih.gov/26812003/">Japanese study</a> looked at more than 45,000 men and women in the general population. It found people passing a bowel motion once every two to three days had a higher risk of dying from heart disease compared with ones who passed at least one bowel motion a day. <h2>How might constipation cause a heart attack?</h2> Chronic constipation can lead to straining when passing a stool. This can result in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8030287/">laboured breathing</a> and can lead to a rise in blood pressure. In <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8030287/">one Japanese study</a> including ten elderly people, blood pressure was high just before passing a bowel motion and continued to rise during the bowel motion. This increase in blood pressure lasted for an hour afterwards, a pattern not seen in younger Japanese people. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8030287/">One theory</a> is that older people have stiffer blood vessels due to atherosclerosis (thickening or hardening of the arteries caused by a build-up of plaque) and other age-related changes. So their high blood pressure can persist for some time after straining. But the blood pressure of younger people returns quickly to normal as they have more elastic blood vessels. As blood pressure rises, the risk of heart disease increases. The risk of developing heart disease <a href="https://pubmed.ncbi.nlm.nih.gov/12493255/">doubles</a> when systolic blood pressure (the top number in your blood pressure reading) rises permanently by 20 mmHg (millimetres of mercury, a standard measure of blood pressure). The systolic blood pressure rise with straining in passing a stool has been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8030287/">reported to be</a> as high as 70 mmHg. This rise is only temporary but with persistent straining in chronic constipation this could lead to an increased risk of heart attacks. <a href="https://pubmed.ncbi.nlm.nih.gov/22256893/">Some people</a> with chronic constipation may have an impaired function of their vagus nerve, which controls various bodily functions, including digestion, heart rate and breathing. This impaired function can result in abnormalities of heart rate and over-activation of the flight-fight response. This can, in turn, lead to elevated blood pressure. Another intriguing avenue of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6399019/">research</a> examines the imbalance in gut bacteria in people with <a href="https://pubmed.ncbi.nlm.nih.gov/3596341/">constipation</a>. This imbalance, known as dysbiosis, can result in microbes and other substances leaking through the gut barrier into the bloodstream and triggering an immune response. This, in turn, can lead to low-grade inflammation in the blood circulation and arteries becoming stiffer, increasing the risk of a heart attack. This latest study also explored genetic links between constipation and heart disease. The researchers found shared genetic factors that underlie both constipation and heart disease. <h2>What can we do about this?</h2> Constipation affects around <a href="https://pubmed.ncbi.nlm.nih.gov/36826591/">19% of the global population</a> aged 60 and older. So there is a substantial portion of the population at an increased risk of heart disease due to their bowel health. Managing chronic constipation through dietary changes (particularly increased dietary fibre), increased physical activity, ensuring adequate hydration and using medications, if necessary, are all important ways to help improve bowel function and reduce the risk of heart disease.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/237209/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/vincent-ho-141549">Vincent Ho</a>, Associate Professor and clinical academic gastroenterologist, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/constipation-increases-your-risk-of-a-heart-attack-new-study-finds-and-not-just-on-the-toilet-237209">original article</a>.

Body

New study links Ozempic and Wegovy to suicidal thoughts

A new study has found a link between weight reduction drugs and reports of suicidal thoughts. Semaglutide, the drug sold under the brand names Ozempic and Wegovy, has been widely used for weight loss despite only being approved for the treatment of diabetes. An analysis of data on the adverse drug reactions database of the World Health Organisation found a disproportionate number of people reporting suicidal thoughts while using semaglutide. The research published in JAMA Network also found that the effect was "significant" compared to other diabetes medication, and that people with anxiety and depression were more likely to report suicidal thoughts when taking the drug. The researches have called for "urgent clarification" and larger studies around how semaglutide medications impact the brain. "The study raises key questions about whether additional precautions are needed when prescribing semaglutide," Trevor Steward, a neurobiology researcher from the University of Melbourne said. However, there are a few limitations with the study as there were a lack of information about the dosages, and did not adjust for things like alcohol and substance misuse and off-label use. While the study did not find a direct cause between suicidal thoughts and the use of semaglutide, it is important to raise concerns, especially for those who may want to use these drugs based on information they found on social media, and therefore do not fully understand the risks. The use of semaglutide for weight loss in Australia is considered 'off label', meaning that it has been prescribed for purposes outside of its approved use. The Therapeutic Goods Administration (TGA) believes that these prescriptions have been driving shortages, which they are trying to address and believe will last until 2025. Images: Shutterstock

Caring

Food and exercise can treat depression as well as a psychologist, our study found. And it’s cheaper

<a href="https://theconversation.com/profiles/adrienne-oneil-268324">Adrienne O'Neil</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> and <a href="https://theconversation.com/profiles/sophie-mahoney-1557294">Sophie Mahoney</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> Around <a href="https://www.aihw.gov.au/getmedia/6b19e493-0ebe-420f-a9a3-e48b26aace9f/aihw-aus-249-ib.pdf?v=20240628145747&inline=true">3.2 million</a> Australians live with depression. At the same time, <a href="https://www.aihw.gov.au/getmedia/6b19e493-0ebe-420f-a9a3-e48b26aace9f/aihw-aus-249-ib.pdf?v=20240628145747&inline=true">few</a> Australians meet recommended dietary or physical activity guidelines. What has one got to do with the other? Our world-first trial, <a href="https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065%2824%2900136-6/fulltext">published this week</a>, shows improving diet and doing more physical activity can be as effective as therapy with a psychologist for treating low-grade depression. Previous studies (including <a href="https://link.springer.com/article/10.1186/s12916-017-0791-y">our own</a>) have found “lifestyle” therapies are effective for depression. But they have never been directly compared with psychological therapies – until now. Amid a nation-wide <a href="https://www.health.gov.au/sites/default/files/2023-10/national-mental-health-workforce-strategy-2022-2032.pdf">shortage</a> of mental health professionals, our research points to a potential solution. As we found lifestyle counselling was as effective as psychological therapy, our findings suggest dietitians and exercise physiologists may one day play a role in managing depression. <h2>What did our study measure?</h2> During the prolonged COVID lockdowns, Victorians’ distress levels were <a href="https://onlinelibrary.wiley.com/doi/full/10.5694/mja2.50831">high and widespread</a>. Face-to-face mental health services were limited. Our trial targeted people living in Victoria with elevated distress, meaning at least mild depression but not necessarily a diagnosed mental disorder. Typical symptoms included feeling down, hopeless, irritable or tearful. We partnered with our <a href="https://www.barwonhealth.org.au/mhdas/">local mental health service</a> to recruit 182 adults and provided group-based sessions on Zoom. All participants took part in up to six sessions over eight weeks, facilitated by health professionals. Half were randomly assigned to participate in a program co-facilitated by an accredited practising dietitian and an exercise physiologist. That group – called the lifestyle program – developed nutrition and movement goals: <ul> <li>eating a wide variety of foods</li> <li>choosing high-fibre plant foods</li> <li>including high quality fats</li> <li>limiting discretionary foods, such as those high in saturated fats and added sugars</li> <li>doing enjoyable physical activity.</li> </ul> The second group took part in psychotherapy sessions convened by two psychologists. The psychotherapy program used cognitive behavioural therapy (CBT), the gold standard for treating depression in <a href="https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2730724">groups and when delivered remotely</a>. In both groups, participants could continue existing treatments (such as taking antidepressant medication). We gave both groups <a href="https://link.springer.com/article/10.1186/s12888-022-03840-3">workbooks and hampers</a>. The lifestyle group received a food hamper, while the psychotherapy group received items such as a colouring book, stress ball and head massager. <h2>Lifestyle therapies just as effective</h2> We found similar results in each program. At the trial’s beginning we gave each participant a score based on their self-reported mental health. We measured them again at the end of the program. Over eight weeks, those scores showed symptoms of depression reduced for participants in the lifestyle program (42%) and the psychotherapy program (37%). That difference was not statistically or clinically meaningful so we could conclude both treatments were as good as each other. There were some differences between groups. People in the lifestyle program improved their diet, while those in the psychotherapy program felt they had increased their social support – meaning how connected they felt to other people – compared to at the start of the treatment. Participants in both programs increased their physical activity. While this was expected for those in the lifestyle program, it was less expected for those in the psychotherapy program. It may be because they knew they were enrolled in a research study about lifestyle and subconsciously changed their activity patterns, or it could be a positive by-product of doing psychotherapy. There was also not much difference in cost. The lifestyle program was slightly cheaper to deliver: A$482 per participant, versus $503 for psychotherapy. That’s because hourly rates differ between dietitians and exercise physiologists, and psychologists. <h2>What does this mean for mental health workforce shortages?</h2> Demand for mental health services is increasing in Australia, while at the same time the workforce <a href="https://www.health.gov.au/sites/default/files/2023-10/national-mental-health-workforce-strategy-2022-2032.pdf">faces worsening nation-wide shortages</a>. Psychologists, who provide <a href="https://www.aihw.gov.au/getmedia/6b19e493-0ebe-420f-a9a3-e48b26aace9f/aihw-aus-249-ib.pdf?v=20240628145747&inline=true">about half</a> of all mental health services, can have long wait times. Our results suggest that, with the appropriate training and guidelines, allied health professionals who specialise in diet and exercise could help address this gap. Lifestyle therapies can be combined with psychology sessions for multi-disciplinary care. But diet and exercise therapies could prove particularly effective for those on waitlists to see a psychologists, who may be receiving no other professional support while they wait. Many dietitians and exercise physiologists already have advanced skills and expertise in motivating behaviour change. Most accredited practising dietitians are trained in managing <a href="https://link.springer.com/content/pdf/10.1007/978-3-030-67929-3_38-1.pdf">eating disorders</a> or <a href="https://www.nature.com/articles/s41572-020-0200-2">gastrointestinal conditions</a>, which commonly overlap with depression. There is also a cost argument. It is <a href="https://journals.sagepub.com/doi/full/10.1177/1355819616668202">overall cheaper</a> to train a dietitian ($153,039) than a psychologist ($189,063) – and it takes less time. <h2>Potential barriers</h2> Australians with chronic conditions (such as diabetes) can access subsidised dietitian and exercise physiologist appointments under various Medicare treatment plans. Those with eating disorders can also access subsidised dietitian appointments. But mental health care plans for people with depression do not support subsidised sessions with dietitians or exercise physiologists, despite <a href="https://dietitiansaustralia.org.au/sites/default/files/2024-04/Dietitians%20Australia%20Mental%20Health%20Evidence%20Brief%202024.pdf">peak bodies</a> urging them to do so. Increased training, upskilling and Medicare subsidies would be needed to support dietitians and exercise physiologists to be involved in treating mental health issues. <a href="https://foodandmoodcentre.com.au/academy">Our training</a> and clinical <a href="https://www.tandfonline.com/doi/full/10.1080/15622975.2022.2112074">guidelines</a> are intended to help clinicians practising lifestyle-based mental health care within their scope of practice (activities a health care provider can undertake). <h2>Future directions</h2> Our trial took place during COVID lockdowns and examined people with at least mild symptoms of depression who did not necessarily have a mental disorder. We are seeking to replicate these findings and are now running <a href="https://foodandmoodcentre.com.au/projects/the-harmone-trial/">a study</a> open to Australians with mental health conditions such as major depression or bipolar disorder. If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/235952/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/adrienne-oneil-268324">Adrienne O'Neil</a>, Professor, Food & Mood Centre, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> and <a href="https://theconversation.com/profiles/sophie-mahoney-1557294">Sophie Mahoney</a>, Associate Research Fellow, Food and Mood Centre, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/food-and-exercise-can-treat-depression-as-well-as-a-psychologist-our-study-found-and-its-cheaper-235952">original article</a>.

Body

Walking can prevent low back pain, a new study shows

<a href="https://theconversation.com/profiles/tash-pocovi-1293184">Tash Pocovi</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>; <a href="https://theconversation.com/profiles/christine-lin-346821">Christine Lin</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>; <a href="https://theconversation.com/profiles/petra-graham-892602">Petra Graham</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>, and <a href="https://theconversation.com/profiles/simon-french-713564">Simon French</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> Do you suffer from low back pain that recurs regularly? If you do, you’re not alone. Roughly <a href="https://pubmed.ncbi.nlm.nih.gov/31208917/">70% of people</a> who recover from an episode of low back pain will experience a new episode in the following year. The recurrent nature of low back pain is a major contributor to the <a href="https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(23)00098-X/fulltext">enormous burden</a> low back pain places on individuals and the health-care system. In our new study, published today in <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00755-4/fulltext">The Lancet</a>, we found that a program combining walking and education can effectively reduce the recurrence of low back pain. <h2>The WalkBack trial</h2> We randomly assigned 701 adults who had recently recovered from an episode of low back pain to receive an individualised walking program and education (intervention), or to a no treatment group (control). Participants in the intervention group were guided by physiotherapists across six sessions, over a six-month period. In the first, third and fifth sessions, the physiotherapist helped each participant to develop a personalised and progressive walking program that was realistic and tailored to their specific needs and preferences. The remaining sessions were short check-ins (typically less than 15 minutes) to monitor progress and troubleshoot any potential barriers to engagement with the walking program. Due to the COVID pandemic, most participants received the entire intervention via telehealth, using video consultations and phone calls. The program was designed to be manageable, with a target of five walks per week of roughly 30 minutes daily by the end of the six-month program. Participants were also encouraged to continue walking independently after the program. Importantly, the walking program was combined with education provided by the physiotherapists during the six sessions. This education aimed to give people a better understanding of pain, reduce fear associated with exercise and movement, and give people the confidence to self-manage any minor recurrences if they occurred. People in the control group received no preventative treatment or education. This reflects what <a href="https://www.sciencedirect.com/science/article/abs/pii/S2468781222001308?via%3Dihub">typically occurs</a> after people recover from an episode of low back pain and are discharged from care. <h2>What the results showed</h2> We monitored the participants monthly from the time they were enrolled in the study, for up to three years, to collect information about any new recurrences of low back pain they may have experienced. We also asked participants to report on any costs related to their back pain, including time off work and the use of health-care services. The intervention reduced the risk of a recurrence of low back pain that limited daily activity by 28%, while the recurrence of low back pain leading participants to seek care from a health professional decreased by 43%. Participants who received the intervention had a longer average period before they had a recurrence, with a median of 208 days pain-free, compared to 112 days in the control group. Overall, we also found this intervention to be cost-effective. The biggest savings came from less work absenteeism and less health service use (such as physiotherapy and massage) among the intervention group. This trial, like all studies, had some limitations to consider. Although we tried to recruit a wide sample, we found that most participants were female, aged between 43 and 66, and were generally well educated. This may limit the extent to which we can generalise our findings. Also, in this trial, we used physiotherapists who were up-skilled in health coaching. So we don’t know whether the intervention would achieve the same impact if it were to be delivered by other clinicians. <h2>Walking has multiple benefits</h2> We’ve all heard the saying that “prevention is better than a cure” – and it’s true. But this approach has been largely neglected when it comes to low back pain. Almost all <a href="https://www.sciencedirect.com/science/article/pii/S0140673618304896?via%3Dihub">previous studies</a> have focused on treating episodes of pain, not preventing future back pain. A limited number of <a href="https://pubmed.ncbi.nlm.nih.gov/26752509/">small studies</a> have shown that exercise and education can help prevent low back pain. However, most of these studies focused on exercises that are not accessible to everyone due to factors such as high cost, complexity, and the need for supervision from health-care or fitness professionals. On the other hand, walking is a free, accessible way to exercise, including for people in rural and remote areas with limited access to health care. Walking also delivers many other <a href="https://www.vichealth.vic.gov.au/sites/default/files/VH_Benefits-of-Walking-Summary2020.pdf">health benefits</a>, including better heart health, improved mood and sleep quality, and reduced risk of several chronic diseases. While walking is not everyone’s favourite form of exercise, the intervention was well-received by most people in our study. Participants <a href="https://pubmed.ncbi.nlm.nih.gov/37271689/">reported</a> that the additional general health benefits contributed to their ongoing motivation to continue the walking program independently. <h2>Why is walking helpful for low back pain?</h2> We don’t know exactly why walking is effective for preventing back pain, but <a href="https://www.e-jer.org/journal/view.php?number=2013600295">possible reasons</a> could include the combination of gentle movements, loading and strengthening of the spinal structures and muscles. It also could be related to relaxation and stress relief, and the release of “feel-good” endorphins, which <a href="https://my.clevelandclinic.org/health/body/23040-endorphins">block pain signals</a> between your body and brain – essentially turning down the dial on pain. It’s possible that other accessible and low-cost forms of exercise, such as swimming, may also be effective in preventing back pain, but surprisingly, <a href="https://pubmed.ncbi.nlm.nih.gov/34783263/">no studies</a> have investigated this. Preventing low back pain is not easy. But these findings give us hope that we are getting closer to a solution, one step at a time.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/231682/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/tash-pocovi-1293184">Tash Pocovi</a>, Postdoctoral research fellow, Department of Health Sciences, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>; <a href="https://theconversation.com/profiles/christine-lin-346821">Christine Lin</a>, Professor, Institute for Musculoskeletal Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, Professor of Physiotherapy, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>; <a href="https://theconversation.com/profiles/petra-graham-892602">Petra Graham</a>, Associate Professor, School of Mathematical and Physical Sciences, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>, and <a href="https://theconversation.com/profiles/simon-french-713564">Simon French</a>, Professor of Musculoskeletal Disorders, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/walking-can-prevent-low-back-pain-a-new-study-shows-231682">original article</a>.

Body

New study reveals people who do this daily make more money over their lifetimes

You’ve heard that regular exercise can help you live richly. Frequent movement, even in short bursts throughout the day, has been linked to lower all-cause mortality rates and reduced risk of heart disease, type-2 diabetes and other age-related conditions, helping you age healthfully and stay independent. Now, new research suggests frequent exercise might help you live well in another meaningful way; in terms of income. In a recent study published in the journal Clinical Orthopaedics and Related Research, doctors from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), which is part of the National Institute of Health (NIH), investigated whether individuals who stayed active would earn more money as a result of their active lifestyle. The researchers’ findings revealed that staying active not only resulted in higher present earnings, but also predicted increased future income throughout one’s life. In essence, the science was clear: Getting more exercise could make you wealthier. <h2>How exercise predicted future earnings</h2> The researchers set out to explore three key correlations: How mobility affected income, how mobility influenced income over time, and whether exercise could help people maintain their mobility as they aged. The team analysed data from the US-federally-supported Health and Retirement Study (HRS), the largest study tracking changes over time in Americans aged 50 and above. This comprehensive study takes into account various life aspects, including work, socio-economic status, health, psychology and family matters, as individuals age. To assess the impact of current mobility on income, the researchers examined data from over 19,000 respondents to determine how well they could perform simple tasks, such as walking several blocks, climbing multiple flights of stairs, or moving around a room. Each person received a numerical score, with 5 indicating full mobility and 0 indicating difficulties with these tasks. <h2>What earnings over time revealed</h2> The researchers found that for each decrease in the mobility category, individuals lost out on an average of US$3000 in annual income compared to their peers. Those who were active were also significantly more likely to remain working for longer than the other group. It appeared that engaging in exercise enabled individuals to maintain mobility and engage in professional life for a longer period of time than those who were less active. Looking at earnings over time revealed even more substantial benefits for those who remained active throughout their lives. Active individuals showed an overall income level that was US$6500 higher, along with higher rates of employment. For the third part of the study, it’s not surprising that those who engaged in exercise continued to maintain their mobility after the age of 55 and had higher employment rates. Even exercising just one day a week showed improvements in mobility outcomes. <h2>Moving more benefits more than just health</h2> While this study doesn’t definitively prove that leading a healthy lifestyle directly leads to higher earnings, it strongly suggests that staying healthy and mobile brings benefits beyond just lower levels of disease (which is a type of wealth in and of itself). NIAMS Director Lindsey A. Criswell, M.D., M.P.H., underscores this point: “We have long understood that greater mobility is an important indicator of good health … The notion that mobility can have economic rewards further extends the evidence for the benefits of exercise and maintaining an active lifestyle.” If this science inspires you to make a healthy lifestyle change, speak with a licensed healthcare provider to determine the right exercise programme for you. Image credits: Shutterstock This article originally appeared on <a href="https://www.readersdigest.co.nz/food-home-garden/money/new-study-reveals-people-who-do-this-daily-make-more-money-over-their-lifetimes" target="_blank" rel="noopener">Reader's Digest</a>.

Body

Want to reduce your dementia risk? Eat these 4 foods, says new study

If you are what you eat, this might make you hungrier for foods that are bright in every sense. Research has shown that living, vibrant foods can slow down aging at a cellular level; while fruit and vegetables in particular have been associated with lower incidence of cognitive decline as individuals age. However, research has been relatively lacking on just how much of these brain-healthy foods you really need and which fruit and vegetables are best for the job. In collaboration with public health experts at Harvard University, medical researchers at China’s Zhejiang University School of Medicine conducted a meta-analysis that’s slated to be published in the June 2024 issue of The Journal of Nutrition, Health, and Aging. They combined data from two large-scale population-representative studies that analysed the diets and cognitive function of more than 10,000 participants ages 55 and older from China and the US. <h2>What daily diets revealed</h2> The data included diet questionnaires that honed in on the average of participants’ total daily intake of several different types of foods, including fruit and vegetables, and also broke them down into sub-types like green leafy vegetables and berries. Over a period of five years, the participants also took part in activities designed to assess their cognitive function and the average rate of cognitive decline. Overall, participants who included the most fruit and vegetables in their daily diets performed best on the brain tests and maintained those results over time. This suggested that both fruit and vegetables had protective elements that slowed cognitive decline. <h2>Vegetables that help protect cognition</h2> Interestingly, certain types of vegetables appeared to be more beneficial than others—say the researchers: “Our findings support the potential beneficial roles of VF, especially cruciferous vegetables, green leafy vegetables, and red and yellow vegetables, in maintaining cognitive function and slowing cognitive decline in middle-aged and older adults.” The researchers pointed to several reasons these particular vegetables might have shown a substantial impact, including anti-inflammatory and antioxidation nutrients like flavonoids and various vitamins or even gut improvements that have been shown to help improve or protect cognition. While beans didn’t figure prominently in both studies, they showed a protective element in the US study, so they are also worth keeping on your plate. (Beans are also thought to be one of the top foods for longevity.) <h2>Fruit that pack a punch</h2> As for fruit, while some didn’t show as much of a protective effect across the board, berries and apples are two examples of fruit that experts have previously said provide major polyphenol and antioxidant effect. Participants whose brains maintained performance were shown to have eaten three or more servings of vegetables and two or more servings of fruit per day. This is on par with the five servings of vegetables and two servings of fruit recommended we eat every day. Image credits: Shutterstock This article originally appeared on <a href="https://www.readersdigest.co.nz/healthsmart/want-to-reduce-your-dementia-risk-eat-these-4-foods-says-new-study" target="_blank" rel="noopener">Reader's Digest</a>.

Mind

Opioids don’t relieve acute low back or neck pain – and can result in worse pain, new study finds

<a href="https://theconversation.com/profiles/christine-lin-346821">Christine Lin</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/andrew-mclachlan-255312">Andrew McLachlan</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/caitlin-jones-1263090">Caitlin Jones</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/christopher-maher-826241">Christopher Maher</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Opioids are the one of the most prescribed pain-relief for people with low back and neck pain. In Australia, around <a href="https://link.springer.com/article/10.1007/s00586-017-5178-4">40% of people</a> with low back and neck pain who present to their GP and <a href="https://qualitysafety.bmj.com/content/28/10/826">70% of people</a> with low back pain who visit a hospital emergency department are prescribed opioids such as oxycodone. But our <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00404-X/fulltext">new study</a>, published today in the Lancet medical journal, found opioids do not relieve “acute” low back or neck pain (lasting up to 12 weeks) and can result in worse pain. Prescribing opioids for low back and neck pain can also cause <a href="https://www.healthdirect.gov.au/taking-opioid-medicines-safely">harms</a> ranging from common side effects – such as nausea, constipation and dizziness – to <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/opioid-harm-in-australia/summary">misuse, dependency, poisoning and death</a>. Our findings show opioids should not be recommended for acute low back pain or neck pain. A change in prescribing for low back pain and neck pain is urgently needed in <a href="https://www.tga.gov.au/resources/publication/publications/addressing-prescription-opioid-use-and-misuse-australia">Australia</a> and <a href="https://www.thelancet.com/commissions/opioid-crisis">globally</a> to reduce opioid-related harms. <h2>Comparing opioids to a placebo</h2> In our trial, we randomly allocated 347 people with acute low back pain and neck pain to take either an opioid (oxycodone plus naloxone) or <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/placebo-effect">placebo</a> (a tablet that looked the same but had no active ingredients). Oxycodone is an opioid pain medicine which can be given orally. <a href="https://www.nps.org.au/radar/articles/oxycodone-with-naloxone-controlled-release-tablets-targin-for-chronic-severe-pain">Naloxone</a>, an opioid-reversal drug, reduces the severity of constipation while not disrupting the pain relieving effects of oxycodone. Participants took the opioid or placebo for a maximum of six weeks. People in the both groups also received <a href="https://www.sciencedirect.com/science/article/pii/S1836955321000941">education and advice</a> from their treating doctor. This could be, for example, advice on returning to their normal activities and avoiding bed rest. We assessed their outcomes over a one-year period. <h2>What did we find?</h2> After six weeks of treatment, taking opioids did not result in better pain relief compared to the placebo. Nor were there benefits to other outcomes such as physical function, quality of life, recovery time or work absenteeism. More people in the group treated with opioids experienced nausea, constipation and dizziness than in the placebo group. Results at one year highlight the potential long-term harm of opioids even with short-term use. Compared to the placebo group, people in the opioid group experienced slightly worse pain, and reported a higher risk of <a href="https://academic.oup.com/painmedicine/article/20/1/113/4728236#129780622">opioid misuse</a> (problems with their thinking, mood or behaviour, or using opioids differently from how the medicines were prescribed). More people in the opioid group reported pain at one year: 66 people compared to 50 in the placebo group. <h2>What will this mean for opioid prescribing?</h2> In recent years, international low back pain guidelines have shifted the focus of treatment from drug to non-drug treatment due to <a href="https://www.thelancet.com/article/S0140-6736(18)30489-6/fulltext">evidence</a> of limited treatment benefits and concern of medication-related harm. For acute low back pain, <a href="https://link.springer.com/article/10.1007/s00586-018-5673-2">guidelines</a> recommend patient education and advice, and if required, anti-inflammatory pain medicines such as ibuprofen. Opioids are <a href="https://link.springer.com/article/10.1007/s00586-018-5673-2">recommended only</a> when other treatments haven’t worked or aren’t appropriate. Guidelines for <a href="https://pubmed.ncbi.nlm.nih.gov/33064878/">neck</a> pain similarly discourage the use of opioids. Our latest research clearly demonstrates the benefits of opioids do not outweigh possible harms in people with acute low back pain and neck pain. Instead of advising opioid use for these conditions in selected circumstances, opioids should be discouraged without qualification. <h2>Change is possible</h2> Complex problems such as opioid use need smart solutions, and another study we recently conducted provides convincing data opioid prescribing can be successfully reduced. The <a href="https://qualitysafety.bmj.com/content/30/10/825">study</a> involved four hospital emergency departments, 269 clinicians and 4,625 patients with low back pain. The intervention comprised of: <ul> <li>clinician education about <a href="https://aci.health.nsw.gov.au/networks/musculoskeletal/resources/low-back-pain">evidence-based management</a> of low back pain</li> <li>patient education using posters and handouts to highlight the benefits and harms of opioids</li> <li>providing heat packs and anti-inflammatory pain medicines as alternative pain-management treatments</li> <li>fast-tracking referrals to outpatient clinics to avoid long waiting lists</li> <li>audits and feedback to clinicians on information about opioid prescribing rates.</li> </ul> This intervention reduced opioid prescribing from <a href="https://qualitysafety.bmj.com/content/30/10/825">63% to 51% of low back pain presentations</a>. The <a href="https://emj.bmj.com/content/early/2023/04/02/emermed-2022-212874">reduction was sustained for 30 months</a>. Key to this successful approach is that we worked with clinicians to develop suitable pain-management treatments without opioids that were feasible in their setting. More work is needed to evaluate this and other interventions aimed at reducing opioid prescribing in other settings including GP clinics. A nuanced approach is often necessary to avoid causing <a href="https://theconversation.com/opioid-script-changes-mean-well-but-have-left-some-people-in-chronic-pain-156753">unintended consequences</a> in reducing opioid use. If people with low back pain or neck pain are using opioids, especially at higher doses over an extended period of time, it’s important they seek advice from their doctor or pharmacist before stopping these medicines to avoid <a href="https://www.healthdirect.gov.au/opioid-withdrawal-symptoms">unwanted effects when the medicines are abruptly stopped</a>. Our research provides compelling evidence opioids have a limited role in the management of acute low back and neck pain. The challenge is getting this new information to clinicians and the general public, and to implement this evidence into practice.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/203244/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/christine-lin-346821">Christine Lin</a>, Professor, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/andrew-mclachlan-255312">Andrew McLachlan</a>, Head of School and Dean of Pharmacy, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/caitlin-jones-1263090">Caitlin Jones</a>, Postdoctoral Research Associate in Musculoskeletal Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/christopher-maher-826241">Christopher Maher</a>, Professor, Sydney School of Public Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/opioids-dont-relieve-acute-low-back-or-neck-pain-and-can-result-in-worse-pain-new-study-finds-203244">original article</a>.

Body

New study reveals the lifetime health benefits of social interaction

A new meta-analysis study - undertaken by the Centre for Healthy Brain Ageing (otherwise known as the CHeBA) at the University of New South Wales - has revealed that social interaction could have benefits many would never have thought to predict, from a reduced risk of dementia to overall increased longevity. Researches were investigating the link between social connections in senior citizens and the risk of mild cognitive impairment (MCI), as well as dementia and morality, compiling the results from 13 other international studies following individuals aged 65 years and up over extended periods of time - research published in <a href="https://u26892420.ct.sendgrid.net/ls/click?upn=B8NE7CRkW4hCmh1dHfJbPqy22DjCz8-2Bq3ZidKWozGaZDoG-2FmVx-2BVsAja535jGrbQlYGwKkrcgY4HPBHrSRE-2Bpq1fwuJ0AQZcKTgnOiva5gsjqRFzNLSYGGzJ4hgT-2Bp0b-7Jp_W1g0lLgOQvKHpoedb1QOitWbx1JxegS3ChuQBoUMMSvQphp8oKfzCnK1hk7FLUZqqTLorFP-2FYQB6URmHLHx65PjMZSysYz3YQI-2BzvIxBhVdZr2Z1gRzt72cMfkaib4uVOYXTxECJWWsRmLyHtb8tdUoPs6u4lvqr8I7xD4zbJqJTqeP2zMO2vFFc6dcczrApzJnOWkq2tOchRyvzstzbQnlU1N4WSe4ZAMtqjmGx6sSvfxYICFLpppnmosd6kUUL-2B2zjjEQ61i38e9TYUaT6LZA5aIGcpHJw26Ob-2BXzuvv-2BuHbhihyIqh2AUTJ2WAYsCw6hpo5SJ7JKlgCF4nYeiekLQeVVLm4GRjjckYyIIN48-3D">Alzheimer's & Dementia: The Journal of the Alzheimer's Association</a>. As author, clinical psychologist, and researcher Dr Suraj Samtani explained, “we know from previous research that social connections are important for our health and being isolated puts us at higher risk of dementia and death.” “Our goal was to find which social connections protect us from dementia and death.” Researches drew intel from studies in a number of countries - spanning low, middle, and high-income nations - and compiled a study population more diverse than the meta-analyses to come before, including the likes of Australia, European nations, North and South America, Asia, and Africa, as opposed to the previous North America and European study groups. From there, they looked at information about the connections between the participants, paying close attention to the types of social links (whether they were in a relationship, single, or married, or involved with their community), the function of them (whether or not they had social support on hand, or a close confidante), and the quality (how much satisfaction they did - or did not - receive from their relationships). With this information, they sought to find out if the participants had developed either MCI or dementia - as well as whether or not they had passed away. “We looked at social variables across these studies, such as living with others, interacting with friends and family, engaging in community activities, and social support,” Dr Samtani said. “We wanted to know which of these are associated with risk of getting dementia over time or dying.” And from their research, they discovered that positive social connections did appear to be linked to a lower risk of MCI, dementia, and death. “We found that frequent interactions - monthly or weekly - with family and friends and having someone to talk to reduced the risk of getting dementia. We also found that living with others and doing community activities reduced the risk of dying,” Dr Samtani noted. Recommendations from the researchers suggest that people should be prioritising their social connections if they hope to reduce their risk of cognitive decline - with the added benefit of living longer, too. “Try to meet with friends and family at least once a month, take part in community activities like volunteering or a rotary club, and open your heart to someone when you feel stressed,” Dr Samtani said. “Living with others, for example in an intergenerational household, is also helpful. “Connecting with others helps us to keep our bodies and minds healthy. “We hope that helping people to stay engaged in conversations and maintain healthy friendships and relationships will help them to stay healthy and happy.” Images: Getty

Relationships

Why study is the key to keeping your brain healthy as you age

Two Over60 community members talk about studying later in life, how it keeps their mind healthy and why they keep going back for more. The word study for many people conjures up memories of restless school days, strict teachers and homework you had to force yourself to complete. However, education isn’t just limited to schools – if you think about our everyday lives, we are constantly learning new things. Whether it’s trying out a new recipe, learning about historic events through a film or attempting to remember algebra so we can help our grandkids, it’s clear learning is a lifelong process. Research consistently shows that keeping your mind active has many health benefits. For over-60s, it helps to keep your mind stimulated and mental faculties in top condition as well as improving your overall wellbeing. It is why there are increasingly more seniors who are seeking to study later in life – and they’re finding they not only love it, but that it’s rewarding in so many ways. For Bernard Macdougall, 73, from Maryborough, Queensland, taking courses and learning new things has been crucial in keeping his mind astute. It was after searching online that Bernard stumbled across the free Open2Study courses. “A couple of year ago I was starting to get a bit anxious about whether I had any brain damage. I had a bit of numbness on the right side of my body and I felt I had a slight impediment in my speech,” he reveals, continuing, “but when I found I could get high marks in these courses I thought well I don’t have to worry, my brain is working, there hasn’t been any deterioration.” Bernard found there was a great variety in courses offered and the option of short one-month timeframes could be easily managed. He ended up taking three courses through Open2Study and another online course through Charles Darwin University. It was a similar case for Peter Keyes, 78, from Albion Park Rail, New South Wales, who has completed four courses through Open2Study. Peter has worked in education all his life so when retirement came around he wasn’t about to stop learning. “You can’t sit around in retirement and twiddle your thumbs,” he laughs, adding, “I live in a retirement village and I encourage all of [the residents] to do some study rather than sit around and watch TV all day! It keeps the brain kicking.” As well as keeping him busy, Peter also found the courses were helpful and informative. “During my career in education I ended up being an administrator looking after buildings so I was interested in one of the courses ‘Project Management’. It gave me a further insight into the processes that I used in setting up the buildings of school buildings,” he explains, continuing, “In [my] retirement village, management occasionally ask me to go into planning meetings and talk about what things [to consider] in terms of buildings and older people.” Studying is not only about learning new things but as Bernard found, it can be personally fulfilling too. “Back in the 70s, I did an arts degree with major studies in anthropology. I saw that Open2Study had a course called ‘<a href="https://www.open2study.com/courses/becoming-human-anthropology-090913%20" target="_blank" rel="noopener">Becoming Human</a>’. I thought, ‘Right I will have a go at that’,” explains Bernard. He soon found he was not only learning about new theories but about what it means to become human. “I was very emotionally involved as it was about human evolution,” he says. Both Bernard and Peter found the online courses easy to manage – all that was needed was a computer and an internet connection to access the course that you could do in the convenience and comfort of your own home. Lectures were presented through short videos, which Peter found convenient: “You can stop it at any time, make a note and then catch up,” he explains. And for those who are worried that studying means taking exams or doing assessments again, Peter advises you not to worry. “When people hear that they’ve got exams or test or assessment to do, they get a bit frightened. But you teach them there’s nothing to it, you can always stop and go back and have another read,” says Peter. While there are assessments – mainly multiple choice – throughout most courses, it’s not about being competitive but having a barometer for your individual progress. It is simply there so you know how much knowledge you have learnt during the course. Bernard found that although he felt apprehensive sometimes, there was a greatly fulfilling feeling of not only accomplishing the assessment but gaining some high marks. “I put a lot of work into study and when you have to press the final submit button, sometimes I was extremely apprehensive because I was anxious to get good marks,” Bernard explains, adding, “I think one has to devote time to it but it’s time I’m happy to spend.” Both Peter and Bernard are quick to reveal that they are not going to stop studying anytime soon. Peter has just signed up to Open2Study’s ‘Innovation for Powerful Outcomes’ course while Bernard is still half way through the ‘User Experience for the Web’ course. “The course is self-paced so I can start again and there’s no deadline for me, thank goodness,” Bernard smiles. After each completing a number of courses, they can’t speak highly enough about how beneficial studying has been for them. “It keeps the little grey cells going,” states Peter, because as he know only too well, “the pool of knowledge, skill, understanding and wisdom is enormous” in the over-60 community. “For me it is very, very important to keep learning as you age. Partly so that I know my brain is still good and not fading away,” Bernard chuckles, continuing, “it is also just a matter of curiosity. I’m just interested in learning new topics.” Images: Getty

Mind

Study reveals the star sign most likely to be serial killers

Keep your friends close and your Taurus friends even closer as a new study has revealed they’re the most homicidal zodiac sign. The Mirror conducted a murder astrological sign analysis and found the majority of serial killers are born between April 20 to May 20, making them a Taurus. “[Taurus] are devoted, patient and hard-working, traits which can make for a great personality in someone who is stable and good-natured, and an evil manipulator in someone who is not,” the paper reads. Several murderers share the Taurus sign, including America’s first modern serial killer H.H Holmes, Canadian child-killer Karla Homolka and London Mail Bomber David Copeland. Those who share the Cancer star sign were found to be the least likely to be serial killers. However, it's clear that killing is not exclusive to Taurses - here is a list of notable serial killers according to each sign. Aquarius (Jan. 20-Feb. 18): Lee Boyd Malvo, Joel Rifkin, Luis Alfredo Garavito Pisces (Feb. 19-March 20): John Wayne Gacy, Aileen Wuornos Aries (March 21-April 19): Alexander Pichushkin, John Reginald Christie Taurus (April 20-May 20): H.H. Holmes, Michael Ryan, Albert Fish, David Copeland, Levi Bellfield, Robert Black, Steve Wright, Orville Lynn Majors Gemini (May 21-June 20): Jeffrey Dahmer, David Berkowitz, Ted Kaczynski Cancer (June 21-July 22): Robert Maudsley Leo (July 23-Aug. 22): Myra Hindley, Anatoly Onoprienko Virgo (Aug. 23-Sept. 22): Ed Gein, Albert DeSalvo, Henry Lee Lucas Libra (Sept. 23-Oct. 22): Fred West, Beverley Allitt Scorpio (Oct. 23-Nov. 21): Moses Sithole, Robert Pickton, Fritz Haarman Sagittarius (Nov. 22-Dec. 21): Ted Bundy, Dennis Nilsen, Rose West Capricorn (Dec. 22-Jan. 19): John Allen Muhammad, Harold Shipman, Stephen Griffiths Treat your Taurus friends kindly, it’s not their fault they were born on such a “likely to be a serial killer” day! Image credit: Shutterstock

Mind

Anxious dogs have different brains to normal dogs, brain scan study reveals

Dog ownership is a lot of furry companionship, tail wags and chasing balls, and ample unconditional love. However, some dog owners are also managing canine pals struggling with mental illness. A newly published study <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0282087">in PLOS ONE</a> has examined the brain scans of anxious and non-anxious dogs, and correlated them with behaviour. The research team at Ghent University, Belgium, found that our anxious dog friends not only have measurable differences in their brains linked to their anxiety, but these differences are similar to those found in humans with anxiety disorders as well. <h2>Anxious friends</h2> Anxiety disorders in humans are varied and can be categorised into several main types. Overall, they represent high levels of fear, emotional sensitivity and negative expectations. These disorders can be difficult to live with and sometimes difficult to treat, in part due to how varied and complex anxiety is. Researching anxiety in animals can help us to understand what drives it, and to improve treatment for both humans and animals. The new study sought to investigate possible pathways in the brain that are associated with anxiety in dogs. Understanding this could both improve treatment for anxiety in veterinary medicine, and reveal similarities with what we know of human anxiety. Dogs with and without anxiety were recruited for functional magnetic resonance imaging (fMRI) scans of their brains. Dogs have been involved in awake fMRI studies before, but for this one, with dogs that might get easily stressed out, the dogs were under general anaesthesia. Owners of the dogs also filled out surveys on their pets’ behaviour. The researchers performed data analysis and modelling of brain function, focusing on regions of the brain likely to show differences related to anxiety. Based on previous research on animal and human anxiety, the team dubbed these brain regions the “anxiety circuit”. They then analysed whether there were differences between the brain function of anxious and non-anxious dogs, and if those differences actually related to anxious behaviours. <h2>Different brains</h2> The researchers found there were indeed significant differences between anxious and non-anxious dogs. The main differences were in the communication pathways and connection strength within the “anxiety circuit”. These differences were linked with higher scores for particular behaviours in the surveys as well. For example, anxious dogs had amygdalas (an area of the brain associated with the processing of fear) that were particularly efficient, suggesting a lot of experience with fear. (This is similar to findings from human studies.) Indeed, in the behaviour surveys, owners of anxious dogs noted increased fear of unfamiliar people and dogs. The researchers also found less efficient connections in anxious dogs between two regions of the brain important for learning and information processing. This may help explain why the owners of the anxious dogs in the study reported lower trainability for their dog. <h2>A difficult time</h2> Brains are exquisitely complex biological computers, and our understanding of them is far from comprehensive. As such, this study should be interpreted cautiously. The sample size was not large or varied enough to represent the entire dog population, and the way the dogs were raised, housed, and cared for could have had an effect. Furthermore, they were not awake during the scans, and that also may have influenced some of the results. However, the study does show strong evidence for measurable differences in the way anxious dog brains are wired, compared to non-anxious dogs. This research can’t tell us whether changes in the brain caused the anxiety or the other way around, but anxiety in dogs is certainly real. It’s in the interests of our anxious best friends that we appreciate they may be affected by a brain that processes everything around them differently to “normal” dogs. This may make it difficult for them to learn to change their behaviour, and they may be excessively fearful or easily aroused. Thankfully, these symptoms can be treated with medication. Research like this could lead to more finessed use of medication in anxious dogs, so they can live happier and better adjusted lives. If you have a dog you think might be anxious, you should speak to a veterinarian with special training in behaviour. Image credit: Shutterstock This article originally appeared on <a href="https://theconversation.com/anxious-dogs-have-different-brains-to-normal-dogs-brain-scan-study-reveals-201775" target="_blank" rel="noopener">The Conversation</a>.

Family & Pets

Studies show dogs know exactly what you’re saying

Researchers in Budapest have found man’s best friend processes information in the same way we do, through a combination of tone, words and body language. The study at Hungarian educational institution, Eötvös Loránd University, saw researchers train dogs to sit still in an MRI scanner while their brain activity was monitored. While in the MRI, dogs listened to different combinations of words as well as tones that indicated praise or neutrality. And the results, published in <a href="http://www.http//science.sciencemag.org/" target="_blank" rel="noopener">Science</a>, were fascinating. The study found dogs process both the vocabulary and the intonation of the word they found, much in the same way that humans do. The left hemisphere of dog’s brains typically dealt with vocabulary, while the right hemisphere dealt with intonation. The study’s lead author Attila Andics said in a press release, “This shows… that dogs not only separate what we say from how we say it, but also that they can combine the two for a correct interpretation of what those words really meant.” What’s your take? Do you think your dog understands what you’re saying? Let us know in the comments. Video credit: YouTube / Family Dog Project Image: Getty

News

Cold homes increase the risk of severe mental health problems – new study

Concerns about <a href="https://theconversation.com/energy-crisis-the-uk-is-still-heading-for-widespread-fuel-poverty-despite-the-governments-price-cap-190290" target="_blank" rel="noopener">fuel poverty</a> and people not being able to heat their homes adequately are not new in the UK, but these worries have been <a href="https://www.theguardian.com/uk-news/2022/oct/26/warm-banks-open-wolverhampton-cost-of-living-crisis" target="_blank" rel="noopener">heightened</a> by significant increases in energy costs and the <a href="https://theconversation.com/the-cost-of-living-crisis-has-been-many-years-in-the-making-but-politicians-on-both-sides-ignore-this-189483" target="_blank" rel="noopener">cost-of-living crisis</a>. And as winter approaches, things are about to get a lot worse. Despite a relatively mild climate, the UK has higher levels of excess winter deaths – deaths associated with cold weather – than <a href="https://linkinghub.elsevier.com/retrieve/pii/S0140673614621140" target="_blank" rel="noopener">many colder countries</a>. This greater exposure to cold, despite milder weather, is related to poor housing quality, the high cost of heating homes and poverty. We know quite a lot about how living in a home that you can’t keep warm enough affects your physical health. Colder temperatures <a href="https://www.instituteofhealthequity.org/resources-reports/the-health-impacts-of-cold-homes-and-fuel-poverty/the-health-impacts-of-cold-homes-and-fuel-poverty.pdf" target="_blank" rel="noopener">suppress the immune system</a>, for example. But we know relatively little about the effects on mental health. <a href="https://doi.org/10.1016/j.socscimed.2022.115461" target="_blank" rel="noopener">Our new research</a> shows that living in a cold home is a significant mental health risk. Living in a cold home can affect your mental health in several ways. For many, heating costs are a source of stress and financial strain. Not being able to keep your home and family comfortably warm reduces feelings of control and autonomy over your environment. People who are unable to heat their home often adopt coping mechanisms that <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2524.2005.00558.x" target="_blank" rel="noopener">limit socialising</a> – for example, not inviting friends over and going to bed early to keep warm. And many people are just worn down by the drudgery of a whole winter of being uncomfortably cold. Using <a href="https://www.understandingsociety.ac.uk/" target="_blank" rel="noopener">data</a> from a large representative sample of adults in the UK, we followed people over many years and tracked the effect of being unable to keep your home warm on mental health. When people’s homes became cold, their risk of severe mental distress significantly increased. For people who previously had no mental health problems, the odds of severe mental distress doubled when they had a cold home, while for those who had some (but not severe) mental health symptoms, the risk tripled (see chart below). We found these effects even after taking into account many other factors associated with mental health, including income. Odds of reporting severe mental distress following transition into cold housing compared to those who remained in warm homes <figure class="align-center "><img src="https://images.theconversation.com/files/492381/original/file-20221028-61968-sxkqgr.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/492381/original/file-20221028-61968-sxkqgr.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=483&fit=crop&dpr=1 600w, https://images.theconversation.com/files/492381/original/file-20221028-61968-sxkqgr.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=483&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/492381/original/file-20221028-61968-sxkqgr.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=483&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/492381/original/file-20221028-61968-sxkqgr.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=607&fit=crop&dpr=1 754w, https://images.theconversation.com/files/492381/original/file-20221028-61968-sxkqgr.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=607&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/492381/original/file-20221028-61968-sxkqgr.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=607&fit=crop&dpr=3 2262w" alt="" /><figcaption>author provided</figcaption></figure> Sadly, the risk of living in a cold home differs greatly across the UK population. Lone parents and people who are unemployed or long-term sick are much more likely to live in cold homes. There is also significant inequality across ethnic groups – more than 12% of black people live in cold homes compared with under 6% of white British people, for example. Those who rent rather than own their home are also far more likely to live in cold homes, for social renters this is despite the, on average, <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1088447/EHS_Housing_quality_and_condition_report_2020.pdf" target="_blank" rel="noopener">higher quality and</a><a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1091144/Energy_Report_2020_revised.pdf" target="_blank" rel="noopener">efficiency</a> of social rented homes. Putting on another jumper won’t be enough to get many in the UK through the coming winter. And mental health distress is just one consequence. Cold homes cause issues with significant personal and societal costs – from individual health effects to the increased pressure on the NHS, as well as broader economic loss due to missed work. Rishi Sunak’s new government needs to help people live in adequately warm homes this winter. But how? The older age of housing in the UK is <a href="http://www.instituteofhealthequity.org/projects/the-health-impacts-of-cold-homes-and-fuel-poverty" target="_blank" rel="noopener">heavily implicated</a> in the UK’s high levels of cold. Support for energy efficiency improvements is therefore a possible means of reducing cold homes. This will also mean tackling the so-called “split incentive” in the private rented sector, which houses a significant proportion of households. The split incentive refers to the challenge of the benefits of improvements not being experienced by the property owners but by tenants, reducing the incentive for owners to invest. This results in poorer quality and more expensive homes for renters. Heat or eat? Most can’t afford either The high proportion of cold homes in the social housing sector – despite having the best average energy efficiency due to insulation and building types (flats) – shows that energy efficiency improvements alone will not eliminate cold. <a href="https://www.resolutionfoundation.org/publications/the-living-standards-outlook-2022/" target="_blank" rel="noopener">Incomes in the UK are falling</a>. Benefit levels are <a href="https://theconversation.com/raising-benefits-in-line-with-earnings-will-make-the-poor-worse-off-heres-why-192880" target="_blank" rel="noopener">painfully low</a> and worsened by policies including the benefit cap, two-child limit and sanctions. Years of cuts and <a href="https://www.jrf.org.uk/file/59072/download?token=acsEgZp7&filetype=briefing" target="_blank" rel="noopener">below inflation rises</a> mean that the term “heat or eat”, used to describe difficult spending decisions for low-income households, is now out of date, as <a href="https://www.jrf.org.uk/file/59191/download?token=PCFIM8W9&filetype=briefing" target="_blank" rel="noopener">many can afford neither</a>. The combination of low household incomes with surging energy costs has created devastating pressure on household budgets. While the energy cap has limited energy cost increases below the worst estimates, energy bills have still <a href="https://theconversation.com/energy-crisis-the-uk-is-still-heading-for-widespread-fuel-poverty-despite-the-governments-price-cap-190290" target="_blank" rel="noopener">more than doubled in the past year</a>. And prepayment meters mean that those the with the least end up paying the most. There are, therefore, many areas for potential government intervention, and clear evidence that failing to intervene will cause harm to health.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/193125/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> Writen by Amy Clair. Republished with permission from <a href="https://theconversation.com/cold-homes-increase-the-risk-of-severe-mental-health-problems-new-study-193125" target="_blank" rel="noopener">The Conversation</a>. Image: Getty Images

Real Estate

Big study shows that lowering blood pressure lowers risk of dementia

A study across 20 countries has strengthened a link between lowering blood pressure, and reducing the risk of dementia. The meta-analysis, published in the European Heart Journal, draws on clinical trial data from 28,008 participants, to show the strongest link to date between medication that lowers blood pressure, and reduced dementia risk. “We know that high blood pressure is a risk factor for dementia – especially high blood pressure in midlife, so say 40 to 65 years of age,” says lead author Dr Ruth Peters, an associate professor at the University of New South Wales and program lead for dementia in the George Institute’s Global Brain Health Initiative. “But there has been some uncertainty about whether lowering blood pressure, especially in older adults, would reduce risk of dementia. “What we’ve done is take five really high-quality clinical trials and combine them into one dataset, which gave us the ability to really look at this question and look at the relationship between blood pressure-lowering tablets – antihypertensives – and dementia.” The five studies were all double-blind, randomised clinical trials – the ‘gold standard’ in medical research – with participants hailing from 20 different countries. The average age of the participants was 69, and participants were followed up an average of four years after doing the trial. Participants who took antihypertensives had a significantly lower chance of being diagnosed with dementia than those who took placebos. Dementia affects 50 million people worldwide: a number projected to triple by 2050. According to The Lancet’s 2020 Commission on dementia, treatment for hypertension (high blood pressure) is “the only known effective preventive medication for dementia,” all other methods of reducing your risk come from lifestyle and environment. “The strength of this study is the use of individual patient data in a meta-analysis of data drawn from randomised controlled trials of blood pressure medication. This is the first time such data has been meta-analysed,” says Professor Kaarin Anstey, a senior principal research scientist at Neuroscience Research Australia and the UNSW. “This is important for informing clinical practice,” adds Anstey, who was not involved with the study. Professor Nicolas Cherbuin, head of the Australian National University’s Centre for Research on Ageing, Health and Wellbeing, says that the study is “well-designed”, and reflects research by his team showing that higher blood pressure is linked to lower brain volumes and poorer brain health. “The diagnostic procedure and criteria used are well-established, the sample size is large, those with dementia at baseline were excluded,” says Cherbuin. But he points out that the study didn’t find an effect of blood pressure medication on cognitive decline, and nor did it include participants with mild cognitive impairment, who would be “more likely to convert”. Anstey points out that “inevitably” the participants in the cohort are now quite old, and thus may be different to populations developing dementia now. “Clinical trials involve highly selected samples and often exclude diverse ethnic groups,” she adds. “I hope that this reinforces the importance of blood pressure control for brain health,” says Peters. But she emphasises that, while this is useful news for preventing dementia in mid-life, people of all ages can improve their brain health by other means. “It’s not just blood pressure lowering – it has to be taken in the context of a healthy lifestyle.” This article originally appeared on <a href="https://cosmosmagazine.com/health/dementia-blood-pressure-meta/" target="_blank" rel="noopener">cosmosmagazine.com</a> and was written by Ellen Phiddian. Image: Shutterstock

Body

We studied the ‘bibles’ of jazz standards – and found sexism lurking in the strangest place

We are two female jazz singers, jazz researchers and lovers of jazz. And we have discovered jazz gave us another shared experience – sexism. We’d both experienced garden variety sexism. Wendy was asked by a male school principal if her recent marriage meant she would resign from teaching to start a family. Melissa received passionate advice from a male audience member to swap her comfortable outfit with a “glamorous dress” when she sang jazz. But as university music students, neither of us imagined something as innocent as a key signature in a textbook might be a symptom of gender discrimination. A <a href="https://www.britannica.com/art/key-music">key</a> tells musicians which set of notes a song uses. In singing, a key affects whether the notes will be sung in the low, middle or high part of the voice. But when we looked at what keys the “bibles” of jazz standards used, we found a hidden form of sexism. <h2>The Real books</h2> This unusual story begins in 1975 at the Berklee College of Music in the United States. Two music students, tired of reading shoddy, error-filled song sheets, created The Real Book to accurately notate jazz songs. Sold illegally to avoid copyright fees, it was a phenomenal success. After years in surreptitious worldwide circulation, publisher Hal Leonard transformed The Real Book into a <a href="https://officialrealbook.com/history/">legal edition</a>. In 1988, Sher Music joined the act and produced The New Real Book. Despite similar titles, Sher’s book was unrelated but mimicked the idea of clearly notating jazz songs. Together the two books cornered the market. The real books remain the <a href="https://www.nytimes.com/1994/04/10/arts/pop-music-flying-below-the-radar-of-copyrights.html">bibles of jazz musicians</a> everywhere because they contain hundreds of songs called <a href="https://www.jazzstandards.com/overview.definition.htm">standards</a>. Standards are common jazz songs jazz musicians are expected to know. Knowing them is your ticket to participating in jazz ensembles, and so universities use these books to train students. However, few educators realise one decision in 1975 about notating standards cemented a practice excluding women. Jazz is valued as a “conversational” style of music where musicians express personal ideas and real stories. “Authentic” jazz singing is associated with the lower voice we use when speaking. The human voice is a <a href="https://soundbridge.io/human-voice-instruments/">biological musical instrument</a> coming in a variety of sizes, with the male larynx (or voice box) generally larger than the female. This means men generally sing (and talk) in lower pitches, and keys that sit in the middle of the male voice are usually too low for women to sing. When our Berklee students and Sher Music notated songs, they chose keys used by jazz musicians. And during that era, male instrumentalists and male singers dominated the jazz community. So, when the real books were being developed, the editors didn’t choose keys that suited female voices. <h2>What’s in a key?</h2> <a href="https://www.routledge.com/The-Routledge-Companion-to-Jazz-and-Gender/Reddan-Herzig-Kahr/p/book/9780367534141">Our research</a> examined the recordings of 16 renowned female jazz vocalists, including <a href="https://www.britannica.com/biography/Ella-Fitzgerald">Ella Fitzgerald</a> and <a href="https://www.britannica.com/search?query=sarah+vaughan">Sarah Vaughan</a>. We sampled 20 songs from The Real Book and 20 songs from The New Real Book and compared the keys in the books with the keys of the female recordings. Less than 5% of 248 recordings fully matched the printed key. If women sing songs straight from The Real Book or The New Real Book, they are likely to be singing too low for their voices. And if they shift the male key up one <a href="https://www.britannica.com/art/octave-music">octave</a>, it will be too high. Consequently, female jazz vocal students are disadvantaged. If they comply with the keys of the iconic texts, they won’t sound as “authentically jazz” as male students. The male voice will produce the conversational tone we have come to expect from jazz; the female voice will be too low or too high for this conversational style. The female professional singers we studied <a href="https://en.wikipedia.org/wiki/Transposition_(music)">transposed</a> the standards to keys that suited a jazz style. But this skill takes time for students to learn. Transposing requires understanding music theory and having confidence to advocate for your needs as a singer. Experienced jazz singers inevitably acquire these skills, but what about novice female singers? For many young female singers, their introduction to jazz is coloured by keys ill-suited to their voices. Place them in a band where the instrumentalists are predominantly male with little understanding of voice production, and it is an uncomfortable situation for aspiring singers. Fortunately, technology has advanced to a point where many standards are available on phones and can be transposed instantly. But this won’t happen until music teachers and jazz musicians understand and respect female singers by using the appropriate keys. So, can a key signature be sexist? Yes, it can when it’s presented as the only choice of key for female students learning jazz standards. It’s time to update our jazz bibles with sources including keys used by Ella Fitzgerald and Sarah Vaughan, and acknowledge sexism has been hiding in the strangest place. Image credits: Getty Images This article originally appeared on <a href="https://theconversation.com/we-studied-the-bibles-of-jazz-standards-and-found-sexism-lurking-in-the-strangest-place-189553" target="_blank" rel="noopener">The Conversation</a>.

Music

New study to “give hope” to childhood trauma survivors with depression

A new study has challenged our understanding of how to treat adults with a history of childhood trauma, revealing that using psychotherapy, medication or a combination of the two are effective treatments for those with depression. Childhood trauma, defined as abuse or neglect of a person before they are 18 years old, is a known risk factor for major depressive disorders in adulthood. It often results in symptoms that start earlier, last longer and are more frequent, and increases the risk of developing co-occurring diseases and conditions. The study, published in <a href="https://doi.org/10.1016/S2215-0366(22)00227-9" target="_blank" rel="noopener">The Lancet Psychiatry</a>, found that adult survivors of childhood trauma who receive these common treatments experience improved symptoms at the same rate as those without childhood trauma. While previous studies have indicated that common treatments for major depressive disorders are less effective for people with childhood trauma, the team argues that these findings are inconsistent. The team then examined data from 29 clinical trials of psychotherapy and pharmacotherapy (the use of prescribed medications) among adults with major depressive disorders to determine whether those with trauma were more severely depressed before treatment, had more unfavourable outcomes after treatment, and whether they were less likely to benefit from treatment in comparison to those without trauma. Among the 46 percent of participants with childhood trauma, the team found that they showed more severe symptoms at the start of treatment and after treatment in comparison to the control group (those without trauma). But, they found that both groups experienced an improvement in symptoms at a similar rate. Erika Kuzminskaite, a PhD candidate and the first author of the study, said that this finding could be a source of hope. “Finding that patients with depression and childhood trauma experience similar treatment outcome when compared to patients without trauma can give hope to people who have experienced childhood trauma,” Kuzminskaite said. “Nevertheless, residual symptoms following treatment in patients with childhood trauma warrant more clinical attention as additional interventions may still be needed.” Antoine Yrondi, a professor at the University of Toulouse who wasn’t involved in the research, wrote that the study provides a message of hope for patients. “This meta-analysis could deliver a hopeful message to patients with childhood trauma that evidence-based psychotherapy and pharmacotherapy could improve depressive symptoms,” Dr Yrondi said. “However, physicians should keep in mind that childhood trauma could be associated with clinical features which may make it more difficult to reach complete symptomatic remission and, therefore, have an impact on daily functioning.” According to <a href="https://blueknot.org.au/resources/blue-knot-fact-sheets/trauma-classification/what-is-childhood-trauma/" target="_blank" rel="noopener">Blue Knot</a>, childhood trauma can have a wider and more extreme impact than trauma we experience as adults because a child’s brain is still developing. If the trauma is unresolved, coping strategies developed during childhood can become risk factors for poorer psychological and physical health in adulthood. But, it is possible to recover from childhood trauma, with this latest study going to show that common treatments can be effective. If you’re in need of support, you can contact Lifeline on 13 11 14 or Blue Knot on 1300 657 380. Image: Getty Images

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New study to “give hope” to childhood trauma survivors with depression