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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

<div class="theconversation-article-body"> <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>. </div>

Body

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

<div class="theconversation-article-body"><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>. </div>

Money & Banking

New research calls for later-in-life driving lessons

New research has shown that older drivers should be coming forward to test and update their driving skills to keep people safer on the road, and keep senior drivers behind the wheel for longer. A new website launched by the University of New South Wales (UNSW) and neuroscience institute NeuRA aims to help drivers aged in their 50s and above stay safe when driving, while also helping to update their skills to keep them on the roads for longer. Cognitive aging expert and UNSW professor Kaarin Anstey told <a href="https://www.9news.com.au/national/how-old-is-too-old-to-drive-in-australia-new-research-shows-ageing-motorists-should-have-driving-lessons/6a470fa9-f0c3-4571-a229-672e689f1e76" target="_blank" rel="noopener">9News</a> later-in-life driving lessons were crucial as our population grows and ages. "We obviously want people to stay on the road as long as it's safe for them to do so. And that's the issue: they have to be safe on the road," Anstey explained. "That's the point of the website, to empower older drivers, family members and health professionals." "We've been working on this issue of older drivers for over 20 years because the second biggest cause of injury in older adults is motor vehicle accidents or crashes (after falls)." Anstey said her research in <a href="https://www.unsw.edu.au/newsroom/news/2024/11/should-age-determine-how-long-drive-car" target="_blank" rel="noopener">The Better Drive Study</a> analysed how the driving habits of older motorists changed if they had a refresher course. "A lot of people got their licence in an era where the cars were different, the roads were different, the road rules were different," she said. "We just feel there's a certain amount of improvement that probably all of us, not just the older age group but lots of people, could benefit in refreshing their driving skills." Anstey's pilot study, that followed motorists aged over 65 over 12 months, found older people were more likely to develop bad habits such as not checking blind spots or not keeping up to date with key road rules. She said people who did the driving lessons had a "big improvement" in their safety on the road. Later-in-life lessons could also identify if a person should be looking at giving up their licence, as Anstey added, "Sometimes there's people who we find who are not very safe drivers, or who have an impairment that they may not have been aware of." When asked what they thought of the initiative, some older drivers told 9News, "I think it's a good idea, there are some older people who definitely need a refresher but there are some that are still quite good." "I'd rather not go through those grills but I guess for everyone's safety it's a very good thing," another added. Image credits: Shutterstock

Travel Trouble

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

<div class="theconversation-article-body"><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>. </div>

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

<div class="theconversation-article-body"> <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>. </div>

Mind

Walking can prevent low back pain, a new study shows

<div class="theconversation-article-body"><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>. </div>

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.com.au/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.com.au/healthsmart/want-to-reduce-your-dementia-risk-eat-these-4-foods-says-new-study" target="_blank" rel="noopener">Reader's Digest</a>.

Mind

Study finds new link for increased risk of Alzheimer’s

A new study has found that people suffering from anxiety disorders could be more likely to develop Alzheimer's disease. The study, which was published by brain researchers The Florey, analysed data from 2443 older Australians from Melbourne and Perth, who are part of a cohort for dementia research. Study leads Dr Yijun Pan and Dr Liang Jin found that anxiety and other neurological disorders are linked to an increased likelihood of developing Alzheimer's disease. "People with anxiety and neurological disorders are 1.5 and 2.5 times more likely to have Alzheimer's disease," Dr Pan said. "For people with anxiety, males have higher odds than females of developing Alzheimer's disease." They also found a few other medical conditions which were linked to a decreased risk of Alzheimer's, including arthritis, cancer, gastric complaints, and high cholesterol. The study leads said that the p53 protein - which causes neuron dysfunction and cell death in Alzheimer's patients - loses its function when someone has cancer, which could possibly explain the link between the two conditions. "We need further research to understand whether these diseases interfere with the evolution of Alzheimer's or whether there might be other reasons," Dr Pan said. "The medications or treatments used for these diseases may possibly contribute to this observation." The study however, did not find a link between Alzheimer's and depression, falls or strokes. "This is the first study to assess 20 comorbidity associations with cognitive impairment using a single Australian dataset, which allowed us to fully consider how these conditions affect the likelihood of developing Alzheimer's disease," Dr Pan said. "We also studied whether age, gender, smoking, education, alcohol consumption, and the APOE gene – believed to be connected to Alzheimer's - affects these associations. "Our study indicates a new opportunity for biologists to study the links between these 20 conditions with Alzheimer's disease. "This work also provides valuable epidemiological evidence to clinicians, which may help them to evaluate one's risk of developing Alzheimer's disease." Image: Nine

Caring

New studies suggest millions with mild cognitive impairment go undiagnosed, often until it’s too late

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/soeren-mattke-1484707">Soeren Mattke</a>, <a href="https://theconversation.com/institutions/university-of-southern-california-1265">University of Southern California</a> and <a href="https://theconversation.com/profiles/ying-liu-1221170">Ying Liu</a>, <a href="https://theconversation.com/institutions/usc-dornsife-college-of-letters-arts-and-sciences-2669">USC Dornsife College of Letters, Arts and Sciences</a> Mild cognitive impairment – an early stage of dementia – is widely underdiagnosed in people 65 and older. That is the key takeaway of two recent studies from our team. In the first study, we used Medicare data for about 40 million beneficiaries age 65 and older from 2015 to 2019 to estimate the prevalence of mild cognitive impairment in that population and to identify what proportion of them had actually been diagnosed. Our <a href="https://doi.org/10.1186/s13195-023-01272-z">finding was sobering</a>: A mere 8% of the number of cases with mild cognitive impairment that we expected based on a statistical model had actually been diagnosed. Scaled up to the general population 65 and older, this means that approximately 7.4 million cases across the country remain undiagnosed. In the second study, we analyzed data for 226,756 primary care clinicians and found that <a href="https://doi.org/10.14283/jpad.2023.131">over 99% of them underdiagnosed mild cognitive impairment</a> in this population. <h2>Why it matters</h2> Mild cognitive impairment is an early symptom of Alzheimer’s disease in <a href="https://doi.org/10.1001/jama.2019.2000">about half of cases</a> and progresses to dementia <a href="https://www.alz.org/alzheimers-dementia/what-is-dementia/related_conditions/mild-cognitive-impairment">at a rate of 10% to 15% per year</a>. It includes symptoms such as losing the ability to remember recent events and appointments, make sound decisions and master complex tasks. Failure to detect it might deprive patients of an opportunity to get treated and to slow down disease progression. Mild cognitive impairment can sometimes be caused by easily addressable factors, such as medication side effects, thyroid dysfunction or <a href="https://theconversation.com/vitamin-b12-deficiency-is-a-common-health-problem-that-can-have-serious-consequences-but-doctors-often-overlook-it-192714">vitamin B12 deficiency</a>. Since mild cognitive impairment has <a href="https://doi.org/10.1016/j.amjopharm.2008.06.004">the same risk factors as cardiovascular disease</a>, such as high blood pressure and cholesterol, medication management of these risks combined with diet and exercise <a href="https://doi.org/10.1016/S0140-6736(15)60461-5">can reduce the risk of progression</a>. In 2023, the Food and Drug Administration <a href="https://www.fda.gov/news-events/press-announcements/fda-converts-novel-alzheimers-disease-treatment-traditional-approval">approved the drug lecanemab</a> as the <a href="https://theconversation.com/what-the-fdas-accelerated-approval-of-a-new-alzheimers-drug-could-mean-for-those-with-the-disease-5-questions-answered-about-lecanemab-197460">first disease-modifying treatment</a> <a href="https://www.nia.nih.gov/health/alzheimers-causes-and-risk-factors/what-happens-brain-alzheimers-disease">for Alzheimer’s disease</a>, the most common cause of mild cognitive impairment. In contrast to previous drugs, which can temporarily improve symptoms of the disease, such as memory loss and agitation, this new treatment addresses the underlying cause of the disease. Lecanemab, a monoclonal antibody, <a href="https://www.news-medical.net/health/What-are-Amyloid-Plaques.aspx">reduces amyloid plaques</a> in the brain, which are toxic protein clumps that are believed to contribute to the progression of the disease. In a large clinical trial, lecanemab was able to <a href="https://doi.org/10.1056/NEJMoa2212948">reduce the progression</a> of early-stage Alzheimer’s disease. A similar drug, donanemab, also <a href="https://doi.org/10.1001/jama.2023.13239">succeeded in a clinical trial</a> and is expected to be <a href="https://www.medicalnewstoday.com/articles/fda-delays-approval-of-alzheimers-drug-donanemab-what-experts-think">approved sometime in 2024</a>. However, these drugs must be used in the early stages of Alzheimer’s disease, ideally when a patient has only mild cognitive impairment, as there is <a href="https://www.alz.org/alzheimers-dementia/treatments/lecanemab-leqembi">no evidence that they are effective in advanced stages</a>. <figure><iframe src="https://www.youtube.com/embed/w3IbAscNjsQ?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>An earlier diagnosis leads to early treatment and better outcomes.</figcaption></figure> <h2>What still isn’t known</h2> Many factors contribute to the <a href="https://doi.org/10.1002/alz.13051">lack of timely detection</a>. But researchers don’t have a good understanding of the relative importance of those individual factors or how to reduce the high rate of underdiagnosis. While distinct, symptoms are subtle and their slow progression means that they can be overlooked or misinterpreted as normal aging. A neurologist in China told our research team that diagnosis rates spike in China after the New Year’s holiday, when children who haven’t seen their parents for a year notice changes that are harder to pick up when interacting with someone daily. Doctors also commonly discount memory concerns as normal aging and doubt that much can be done about it. While cognitive tests to distinguish mild cognitive impairment from pathologic decline do exist, they take about 15 minutes, which can be hard to come by during the limited time of a doctor’s visit and may require a follow-up appointment. <h2>What’s next</h2> People, particularly those in their 60s and beyond, as well as their families and friends need to be vigilant about cognitive decline, bring it up during doctor’s appointments and insist on a formal assessment. The <a href="https://www.medicare.gov/coverage/yearly-wellness-visits">Medicare yearly “wellness” visit</a> is an opportunity to explore such concerns, but only about half of beneficiaries <a href="https://doi.org/10.1377/hlthaff.2019.01795">take advantage of it</a>. Just as physicians ask patients about unexplained weight loss and take those concerns seriously, we believe questions that explore a patient’s cognitive state need to become the norm. The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take on interesting academic work.<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/216892/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/soeren-mattke-1484707">Soeren Mattke</a>, Director of the USC Dornsife Brain Health Observatory, <a href="https://theconversation.com/institutions/university-of-southern-california-1265">University of Southern California</a> and <a href="https://theconversation.com/profiles/ying-liu-1221170">Ying Liu</a>, Research Scientist, Center for Economic and Social Research, <a href="https://theconversation.com/institutions/usc-dornsife-college-of-letters-arts-and-sciences-2669">USC Dornsife College of Letters, Arts and Sciences</a> Image credits: Getty Images 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-studies-suggest-millions-with-mild-cognitive-impairment-go-undiagnosed-often-until-its-too-late-216892">original article</a>. </div>

Mind

Science finally proves "Money doesn't buy happiness"

A new study has proven that the old adage "money can't buy you happiness" is true. Historically, economic wealth and higher income households are often seen to have an increased level of wellbeing and happiness, with the extra money making way for less stress and more general comfortability. However, researchers from Canada and Spain have concluded this may not be true, with such surveys often including responses from people in industrialised areas only. People in small-scale societies where money does not play a central role in every day life are often excluded from these studies, as the livelihood of residents in these small communities usually depend more on nature. Now, 2,966 people from Indigenous and local communities in 19 locations across the globe have been included in a study, with researchers now finding that societies of Indigenous people and those in small, local communities report living very satisfying lives despite not having a lot of money. The researchers wrote, "The striking aspect of our findings... is that reported life satisfaction in very low-income communities can meet and even exceed that reported at the highest average levels of material wealth provided by industrial ways of life." Researchers concluded the findings are strong evidence that economic growth is not needed to be happy, with only 64 percent of households included in the survey reported having any cash income. Eric Galbraith, lead author of the study, said, "Surprisingly, many populations with very low monetary incomes report very high average levels of life satisfaction, with scores similar to those in wealthy countries." Researchers added that high life satisfaction is shown in these communities "despite many of these societies having suffered histories of marginalisation and oppression." Galbraith added, "I would hope that, by learning more about what makes life satisfying in these diverse communities, it might help many others to lead more satisfying lives while addressing the sustainability crisis." Image credits: Shutterstock

Money & Banking

After a lifetime studying superannuation, here are 5 things I wish I knew earlier

<a href="https://theconversation.com/profiles/susan-thorp-214">Susan Thorp</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Amassing the wealth needed to support retirement by regular saving is a monumental test of personal planning and discipline. Fortunately for most Australian workers, the superannuation system can help. Superannuation uses the carrot of tax incentives, and the sticks of compulsion and limited access, to make us save for retirement. There are benefits to paying timely attention to your super early in your working life to get the most from this publicly mandated form of financial self-discipline. I’ve been researching and thinking about superannuation for most of my career. Here’s what I wish I knew at the beginning of my working life. <h2>1. Check you’re actually getting paid super</h2> First, make sure you are getting your dues. If you are working, your employer must contribute <a href="https://www.ato.gov.au/businesses-and-organisations/super-for-employers/paying-super-contributions/how-much-super-to-pay">11% of your earnings</a> into your superannuation account. By July 2025 the rate will increase to 12%. This mandatory payment (the “<a href="https://www.ato.gov.au/tax-rates-and-codes/key-superannuation-rates-and-thresholds/super-guarantee">superannuation guarantee</a>”) may look like yet another tax but it is an important part of your earnings (would you take an 11% pay cut?). It is worth checking on, and worth <a href="https://www.ato.gov.au/calculators-and-tools/super-report-unpaid-super-contributions-from-my-employer">reporting</a> if it is not being paid. The Australian Tax Office <a href="https://oia.pmc.gov.au/sites/default/files/posts/2023/05/Impact%20Analysis%20-%20Unpaid%20Superannuation%20Guarantee%20package.pdf">estimates</a> there is a gap between the superannuation employers should pay and what they do pay of around 5% (or $A3.3 billion) every year. Failing to pay is <a href="https://oia.pmc.gov.au/sites/default/files/posts/2023/05/Impact%20Analysis%20-%20Unpaid%20Superannuation%20Guarantee%20package.pdf">more common</a> among the accommodation, food service and construction industries, as well as small businesses. Don’t take your payslip at face value; cross-check your super account balance and the annual statement from your fund. <h2>2. Have just one super account</h2> Don’t make personal donations to the finance sector by having more than one superannuation account. Two super accounts mean you are donating unnecessary administration fees, possibly redundant insurance premiums and suffering two times the confusion to manage your accounts. The superannuation sector does not need your charity. If you have more than one super account, please consolidate them into just one today. You can do that <a href="https://moneysmart.gov.au/how-super-works/consolidating-super-funds">relatively easily</a>. <h2>3. Be patient, and appreciate the power of compound interest</h2> If you’re young now, retirement may feel a very distant problem not worth worrying about until later. But in a few decades you’re probably going to appreciate the way superannuation works. As a person closing in on retirement, I admit I had no idea in my 20s how much my future, and the futures of those close to me, would depend on my superannuation savings. Now I get it! <a href="https://www.nber.org/papers/w27459">Research</a> <a href="https://economics.mit.edu/sites/default/files/publications/pandp.20221022.pdf">shows</a> the strict rules preventing us from withdrawing superannuation earlier are definitely costly to some people in preventing them from spending on things they really need. For many, however, it stops them spending on things that, in retrospect, they would rate as less important. But each dollar we contribute in our 30s is worth around three times the dollars we contribute in our 50s. This is because of the advantages of time and <a href="https://moneysmart.gov.au/saving/compound-interest">compound interest</a> (which is where you earn interest not just on the money initially invested, but on the interest as well; it’s where you earn “interest on your interest”). For some, adding extra “voluntary” savings can build up retirement savings as a buffer against the periods of unemployment, disability or carer’s leave that most of us experience at some stage. <h2>4. Count your blessings</h2> If you are building superannuation savings, try to remember you’re among the lucky ones. The benefits of super aren’t available to those who can’t work much (or at all). They face a more precarious reliance on public safety nets, like the Age Pension. So aim to maintain your earning capacity, and pay particular attention to staying employable if you take breaks from work. What’s more, superannuation savings are invested by (usually) skilled professionals at rates of return hard for individual investors to achieve outside the system. Many larger superannuation funds offer members types of investments – such as infrastructure projects and commodities – that retail investors can’t access. The Australian Prudential Regulation Authority (APRA) also <a href="https://www.apra.gov.au/industries/superannuation">checks</a> on large funds’ investment strategies and performance. <h2>5. Tough decisions lie ahead</h2> The really hard work is ahead of you. The saving or “accumulation” phase of superannuation is mainly automatic for most workers. Even a series of non-decisions (defaults) will usually achieve a satisfactory outcome. A little intelligent activity will do even better. However, at retirement we face the challenge of making that accumulated wealth cover our needs and wants over an uncertain number of remaining years. We also face variable returns on investments, a likely need for aged care and, in many cases, declining cognitive capacity. It’s helpful to frame your early thinking about superannuation as a means to support these critical decades of consumption in later life. At any age, when we review our financial management and think about what we wish we had known in the past, we should be realistic. Careful and conscientious people still make mistakes, procrastinate and suffer from bad luck. So if your super isn’t where you had hoped it would be by now, don’t beat yourself up about it. <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/217922/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/susan-thorp-214">Susan Thorp</a>, Professor of Finance, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Getty Images 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/after-a-lifetime-studying-superannuation-here-are-5-things-i-wish-i-knew-earlier-217922">original article</a>.

Retirement Income

Can a daily multivitamin improve your memory?

<a href="https://theconversation.com/profiles/jacques-raubenheimer-1144463">Jacques Raubenheimer</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> <a href="https://theconversation.com/au/topics/research-check-25155">Research Checks</a> interrogate newly published studies and how they’re reported in the media. The analysis is undertaken by one or more academics not involved with the study, and reviewed by another, to make sure it’s accurate. <hr /> Don’t we all want to do what we can to reduce the impact of age-related decline on our memory? A new study suggests a daily multivitamin and mineral supplement is a simple and inexpensive way to help older adults slow the decline in some aspects of memory function. The <a href="https://ajcn.nutrition.org/article/S0002-9165(23)48904-6/fulltext">new study</a>, which comes from a <a href="https://www.clinicaltrials.gov/ct2/show/NCT02422745?term=NCT02422745&draw=2&rank=1">long-running clinical trial</a>, shows there may be a small benefit of taking a daily multivitamin and mineral supplement for one type of cognitive task (immediate word recall) among well-functioning elderly white people. At least in the short term. But that doesn’t mean we should all rush out and buy multivitamins. The results of the study don’t apply to the whole population, or to all types of memory function. Nor does the study show long-term benefits. <h2>How was the study conducted?</h2> The overarching COSMOS study is a well-designed double-blind randomised control trial. This means participants were randomly allocated to receive the intervention (a daily multivitamin and mineral supplement) or a placebo (dummy tablet), but neither the participants nor the researchers knew which one they were taking. This type of study is considered the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5654877/">gold standard</a> and allows researchers to compare various outcomes. Participants (3,562) were older than 64 for women, and 59 for men, with no history of heart attack, invasive cancer, stroke or serious illness. They couldn’t use multivitamins or minerals (or <a href="https://www.pnas.org/doi/10.1073/pnas.2216932120">cocoa extract</a> which they also tested) during the trial. Participants completed a <a href="https://www.clinicaltrials.gov/ct2/show/NCT04582617?term=NCT04582617&draw=2&rank=1">battery of online cognitive tests</a> at the start of the study (known as baseline), then yearly for three years, of which only three were reported in this paper: <ul> <li> ModRey, measuring immediate recall. Participants were shown “a list of 20 words, one at a time, for three seconds each,” and then had to type the list from memory </li> <li> ModBent, measuring object recognition. Participants were given 20 prompts with a shape and then had to select the correct match from a pair of similar prompts. After this, they were prompted with 40 shapes in turn, and had to indicate whether each was included in the original 20 or not </li> <li> Flanker, measuring “executive control”. Participants had to select a coloured block that corresponded to an arrow in a matrix of arrows, which could have the same (or different) colour to the surrounding arrows, and the same (or different) direction as the prompt block. </li> </ul> <h2>What did the researchers find?</h2> Of all the tests the researchers performed, only immediate recall (ModRey) at one year showed a significant effect, meaning the result is unlikely to just be a result of chance. At two and three years, the effect was no longer significant (meaning it could be down to chance). However they added an “overall estimate” by averaging the results from all three years to arrive at another significant effect. All the effect sizes reported are very small. The largest effect is for the participants’ immediate recall at one year, which was 0.07 – a value that is <a href="https://academic.oup.com/jpepsy/article/34/9/917/939415">generally considered very small without justification</a>. Also of note is that both the multivitamin and placebo groups had higher immediate word recall scores at one year (compared to baseline), although the multivitamin group’s increase was significantly larger. <a href="https://www.pnas.org/doi/epdf/10.1073/pnas.2216932120">In the researchers’ prior study</a>, the increase in word recall scores was described as a “typical learning (practice) effect”. This means they attributed the higher scores at one year to familiarisation with the test. For some reason, this “learning effect” was not discussed in the current paper, where the treatment group showed a significantly larger increase compared to those who were given the placebo. <h2>What are the limitations of the study?</h2> The team used a suitable statistical analysis. However, it did not adjust for demographic characteristics such as age, gender, race, and level of education. The authors detail their study’s major limitation well: it is not very generalisable, as it used “mostly white participants” who had to be very computer literate, and, one could argue, would be quite well-functioning cognitively. <figure class="align-center "><figcaption></figcaption>Another unmentioned limitation is the advanced age of their sample, meaning long-term results for younger people can’t be assessed.</figure> Additionally, the baseline diet score for their sample was abysmal. The researchers say participants’ diet scores “were consistent with <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1899558">averages from the US population</a>” but the cited study noted “the overall dietary quality… [was] poor.” And they didn’t measure changes in diet over the three years, which could impact the results. <h2>How should we interpret the results?</h2> The poor dietary quality of the sample raises the question: can a better diet be the simple fix, rather than multivitamin and mineral supplements? Even for the effect they observed, which micronutrient from the supplement was the contributing factor? The researchers speculate about vitamins B12 and D. But you can find research on cognitive function for any arbitrarily chosen <a href="https://www.centrum.com/content/dam/cf-consumer-healthcare/bp-wellness-centrum/en_US/pdf/lbl-00000775-web-ready-centrum-silver-adults-tablets-(versio.pdf">ingredient</a>, including <a href="https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=selenium+cognitive+function">selenium</a>, which can be <a href="https://www.sciencedirect.com/science/article/pii/S0048969720378608">toxic at high levels</a>. <h2>So should I take a multivitamin?</h2> <a href="https://newsinhealth.nih.gov/2013/08/should-you-take-dietary-supplements">Health authorities advise</a> daily multivitamin use isn’t necessary, as you can get all the nutrients you need by eating a wide variety of healthy foods. However, supplementation may be appropriate to meet any specific nutrient gaps an individual has. Using a good quality multivitamin at the recommended dose shouldn’t do any harm, but at best, this study shows well-functioning elderly white people might show some additional benefit in one type of cognitive task from using a multivitamin supplement. The case for most of the rest of the population, and the long-term benefit for younger people, can’t be made. <hr /> <h2>Blind peer review</h2> Clare Collins writes: I agree with the reviewer’s assessment, which is a comprehensive critique of the study. The key result was a small effect size from taking a daily multivitamin and mineral (or “multinutrient”) supplement on memory recall at one year (but not later time points) and is equivalent to a training effect where you get better at taking a test the more times you do it. It’s also worth noting the study authors received support and funding from commercial companies to undertake the study. While the study authors state they don’t believe background diet quality impacted the results, they didn’t comprehensively assess this. They used a brief <a href="https://pubmed.ncbi.nlm.nih.gov/22513989/">diet quality assessment score</a> only at baseline. Participants may have changed their eating habits during the study, which could then impact the results. Given all participants reported low diet quality scores, an important question is whether giving participants the knowledge, skills and resources to eat more healthily would have a bigger impact on cognition than taking supplements. <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/208114/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> Image credit: Shutterstock <a href="https://theconversation.com/profiles/jacques-raubenheimer-1144463">Jacques Raubenheimer</a>, Senior Research Fellow, Biostatistics, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> 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/can-a-daily-multivitamin-improve-your-memory-208114">original article</a>.

Body

Count Nikolai shares Princess Mary's "survival list" for living abroad

Count Nikolai has shared the "survival list" his Australian-born aunt, Princess Mary, gave him before his big move Down Under. The Count, 24, who is currently undertaking his studies at University of Technology in Sydney, shared the advice his aunt gave him in an interview with The Daily Telegraph on Monday. "She gave me a long list, an itinerary of what to do and what not to do, I can't remember it now but I have it at home," he said. Princess Mary, who was born in Hobart and spent a majority of her life in Australia, knows a few "basic survival skills" to prevent unwanted animals from lurking. "Basic 'survival skills', I would say clap your boots before putting them on, stuff like that, flush the toilet before you use it. I do not (want a snake or spider)," he added. Count Nikolai is currently studying here with his girlfriend Benedikte Thoustrup. The Count, is studying sales management, while Thoustrup is studying economics and business administration at the Copenhagen Business School, which is one of UTS' exchange partners for it's study abroad program. The young royal has been enjoying his time in Australia, having recently celebrated <a href="https://www.oversixty.com.au/lifestyle/family-pets/count-nikolai-s-aussie-birthday-bash" target="_blank" rel="noopener">his birthday</a> in Byron Bay. Images: Instagram/ Getty

International Travel

"Touchdown": Count Nikolai arrives in Sydney to begin studies

Denmark's Count Nikolai has arrived in Sydney where he is set to begin a new chapter at the University of Technology (UTS) in Ultimo. Just one day before commencing his studies, the 23-year-old royal explored the city and took to his Instagram stories to share a photo of the iconic Sydney Tower Eye, in the CBD. "Touch down," he captioned the photo. The young royal and his girlfriend Benedikte Thoustrup are both enrolled in UTS, where they'll commence their studies for one semester. The pair are in Sydney as part of Copenhagen Business School's study abroad exchange program and they are both working towards their Master's Degree, with Nikolai studying Sales Management. Thoustrup is studying economics and business administration, specifically in brand and communications management. The course is expected to begin from today, August 1 and runs until the 30th of November. Just last week, Nikolai, who is the grandson of Queen Margrethe II shared that he was "stoked to begin and super excited" about moving to Australia. "The choice fell on Australia because it is very foreign for a Dane like me," he told Numéro magazine. "I have never been that far away and I believe seeing that corner of the world takes more than two weeks holiday, hence I want to try and move there." Images: Instagram

International Travel

Australians are living and working longer – but not necessarily healthier, new study show

<a href="https://theconversation.com/profiles/kim-kiely-1457635">Kim Kiely</a>, <a href="https://theconversation.com/institutions/university-of-wollongong-711">University of Wollongong</a> and <a href="https://theconversation.com/profiles/mitiku-hambisa-1457669">Mitiku Hambisa</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Australians are living and working longer, but a longer working life doesn’t always come with equivalent gains in healthy life. <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(23)00129-9/fulltext">Our analysis</a> of change in life expectancy, health transitions and working patterns of more than 10,000 middle-aged Australians over the past two decades shows divergences in the number of years they can expect be in good health at work and in retirement. In particular, education matters. Those who left school before year 12 are losing years of healthy life, with their extra years in the workforce mainly comprising years of poor health. This is opposite to the trend among people who completed high school. And while men and women experienced improvements in life expectancy, on average women are not gaining extra healthy life years. Australians are being encouraged to extend their working life. For this to be sustainable and equitable, government and workplaces policies will need to make allowances for the health capacity of mature-age workers. <h2>How we found our results</h2> We’ve calculated <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(23)00129-9/fulltext">healthy working life expectancies</a> – the average number of years a person can expect to work in good health – for 50-year-olds using data from the Household, Income and Labour Dynamics in Australia (HILDA) survey. This is a longitudinal survey, meaning it seeks to interview the same households every year (about 17,000 people), enabling researchers to track life trajectories. We identified two age groups within HILDA’s survey sample and followed each cohort for 10 years. The first group was 4,951 people aged 50 years and older in 2001. The second group was 6,589 people aged 50 years and older in 2011. To estimate a healthy working life expectancy, we looked at how people transitioned in and out of good health and employment each year (based on survey data about their paid employment and long-term health conditions that limited participation in everyday activities). By combining this with deaths data, we have calculated the average duration spent (i) working in good health, (ii) working in poor health, (iii) retired in good health, and (iv) retired in poor health. <h2>Differences by education</h2> The following graphs show our results, based on expectancies at age 50. We show our data in this way, rather than total healthy life and working life expectancies from birth, because we followed people from age 50 and is this is the time from which workers start to plan for and transition into retirement. Typically we understand life expectancies to be calculated from birth, but they can be estimated for any age. If you live to 50, your life expectancy is greater than when you were born. Our first graph shows healthy life expectancies according to school completion. These estimates reflect the cumulative number of years a person will, on average, be healthy or unhealthy from age 50. Across the two cohorts, those with low education lose 0.8 years of healthy life, while those with high education gain 0.8 years of healthy life. As with all statistics, there is uncertainty in these estimates. (Our original analysis includes 95% confidence intervals but we do not show them here.) <hr /> <iframe id="47SIf" class="tc-infographic-datawrapper" style="border: none;" src="https://datawrapper.dwcdn.net/47SIf/2/" width="100%" height="400px" frameborder="0"></iframe> <hr /> These inequities are amplified in working-life expectancies, as the next graph shows. Among early school leavers, at age 50 healthy work years rose from 7.9 to 8.4 years, an increase of six months. But their years working in poor health rose from 2.7 to 3.6 years, a difference of 11 months. In contrast, for those who completed year 12, at age 50 healthy work years rose from 9.6 to 10.5 years, an increase of 11 months. Their years working in poor health rose from 3.1 to 3.5 years, a difference of five months. <hr /> <iframe id="kUCuy" class="tc-infographic-datawrapper" style="border: none;" src="https://datawrapper.dwcdn.net/kUCuy/4/" width="100%" height="400px" frameborder="0"></iframe> <hr /> The next graph illustrates what this means in proportional terms. <hr /> <iframe id="4rBXz" class="tc-infographic-datawrapper" style="border: none;" src="https://datawrapper.dwcdn.net/4rBXz/1/" width="100%" height="400px" frameborder="0"></iframe> <hr /> The next graph shows working life expectancies by sex. Men, on average, will spend 25% of their remaining working years in poor health, and women 24%. These percentages have not changed over time. <hr /> <iframe id="vQ4rK" class="tc-infographic-datawrapper" style="border: none;" src="https://datawrapper.dwcdn.net/vQ4rK/2/" width="100%" height="400px" frameborder="0"></iframe> <hr /> These findings are consistent with <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(22)00026-3/fulltext">previous analyses</a> demonstrating social inequalities in health expectancies to have been maintained over time, and possibly widened in some circumstances. In that study, women with low educational attainment appeared to have had negligible improvements in life expectancy and lost healthy life years. <h2>Implications for governments and employers</h2> Australia has this month raised the age at which people qualify for the <a href="https://theconversation.com/australias-retirement-age-just-became-67-so-why-are-the-french-so-upset-about-working-until-64-208648">age pension to 67</a>. When the pension was introduced in 1908, the qualifying age was 65 for men and 60 for women. At the time, average life expectancy for Australians at birth was about <a href="https://www.aihw.gov.au/reports/life-expectancy-deaths/how-long-can-australians-live/data">55 for men and 59 for women</a>. Now it exceeds 81 for men and 85 for women (though is considerably lower for some groups, notably Indigenous Australians). There’s an obvious rationale to prolong people’s working lives – to meet the challenges posed by population ageing and sustain the social security system. Nevertheless, consideration should be made for inequalities in life expectancy and health expectancy. For many ageing workers, health limitations constrain their capacity and opportunity to work. To achieve longer working lives, workplaces will be need become more supportive of mature-age workers, including accommodating long-term health conditions. This will likely involve addressing ageism in the workplace, increasing employer demand for older workers, creating appropriate work roles to fit the capacities and preferences of older workers, and providing pathways to lifelong education and training. We may also need to rethink our idea of flexible work, which has largely centred around the needs of parents and younger workers. Many older workers will have expectations for an independent and active retirement period, and it should be possible for flexible work arrangements to accommodate this. Finally, we should not discount the unpaid contributions made by many older adults through community service and providing care to loved ones.<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/210542/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/kim-kiely-1457635">Kim Kiely</a>, Lecturer, Statistics and Data Science, <a href="https://theconversation.com/institutions/university-of-wollongong-711">University of Wollongong</a> and <a href="https://theconversation.com/profiles/mitiku-hambisa-1457669">Mitiku Hambisa</a>, Senior Research Associate, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Image credits: Getty Images 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/australians-are-living-and-working-longer-but-not-necessarily-healthier-new-study-shows-210542">original article</a>.

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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>.

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