We looked at over 166,000 psychiatric records. Over half showed people were admitted against their will
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Picture two people, both suffering from a serious mental illness requiring hospital admission. One was born in Australia, the other in Asia.
Hopefully, both could be treated on a voluntary basis, taking into account their individual needs, preferences and capacity to consent. If not, you might imagine they should be equally likely to receive treatment against their will (known colloquially as being “sectioned” or “scheduled”).
However, our research published in British Journal of Psychiatry Open suggests this is not the case.
In the largest study globally of its kind, we found Australians are more likely to be treated in hospital for their acute mental illness against their will if they are born overseas, speak a language other than English or are unemployed.
What we did and what we found
We examined more than 166,000 episodes of voluntary and involuntary psychiatric care in New South Wales public hospitals between 2016 and 2021. Most admissions (54%) included at least one day of involuntary care.
Being brought to hospital via legal means, such as by police or via a court order, was strongly linked to involuntary treatment.
While our study does not show why this is the case, it may be due to mental health laws. In NSW, which has similar laws to most jurisdictions in Australia, doctors may treat a person on an involuntary basis if they present with certain symptoms indicating serious mental illness (such as hallucinations and delusions) which cause them to require protection from serious harm, and there is no other less-restrictive care available. Someone who has been brought to hospital by police or the courts may be more likely to meet the legal requirement of requiring protection from serious harm.
The likelihood of involuntary care was also linked to someone’s diagnosis. A person with psychosis or organic brain diseases, such as dementia and delirium, were about four times as likely to be admitted involuntarily compared to someone with anxiety or adjustment disorders (conditions involving a severe reaction to stressors).
However, our data suggest non-clinical factors contribute to the decision to impose involuntary care.
Compared with people born in Australia, we found people born in Asia were 42% more likely to be treated involuntarily.
People born in Africa or the Middle East were 32% more likely to be treated this way.
Overall, people who spoke a language other than English were 11% more likely to receive involuntary treatment compared to those who spoke English as their first language.
Some international researchers have suggested higher rates of involuntary treatment seen in people born overseas might be due to higher rates of psychotic illness. But our research found a link between higher rates of involuntary care in people born overseas or who don’t speak English regardless of their diagnosis.
We don’t know why this is happening. It is likely to reflect a complex interplay of factors about both the people receiving treatment and the way services are provided to them.
People less likely to be treated involuntarily included those who hold private health insurance, and those referred through a community health centre or outpatients unit.
Our findings are in line with international studies. These show higher rates of involuntary treatment among people from Black and ethnic minority groups, and people living in areas of higher socioeconomic disadvantage.
A last resort? Or should we ban it?
Both the NSW and Australian mental health commissions have called involuntary psychiatric care an avoidable harm that should only be used as a last resort.
Despite this, one study found Australia’s rate of involuntary admissions has increased by 3.4% per year and it has one of the highest rates of involuntary admissions in the world.
Involuntary psychiatric treatment is also under increasing scrutiny globally.
When Australia signed up to the UN Convention on the Rights of Persons with Disabilities, it added a declaration noting it would allow for involuntary treatment of people with mental illness where such treatments are “necessary, as a last resort and subject to safeguards”.
However, the UN has rejected this, saying it is a fundamental human right “to be free from involuntary detention in a mental health facility and not to be forced to undergo mental health treatment”.
Others question if involuntary treatment could ever be removed entirely.
Where to from here?
Our research not only highlights concerns regarding how involuntary psychiatric treatment is implemented, it’s a first step towards decreasing its use. Without understanding how and when it is used it will be difficult to create effective interventions to reduce it.
But Australia is still a long way from significantly reducing involuntary treatment.
We need to provide more care options outside hospital, ones accessible to all Australians, including those born overseas, who don’t speak English, or who come from disadvantaged communities. This includes intervening early enough that people are supported to not become so unwell they end up being referred for treatment via police or the criminal justice system.
More broadly, we need to do more to reduce stigma surrounding mental illness and to ensure poverty and discrimination are tackled to help prevent more people becoming unwell in the first place.
Our study also shows we need to do more to respect the autonomy of someone with serious mental illness to choose if they are treated. That’s whether they are in NSW or other jurisdictions.
And legal reform is required to ensure more states and territories more fully reflect the principal that people who have the capacity to make such decisions should have the right to decline mental health treatment in the same way they would any other health care.
If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.
Amy Corderoy, Medical doctor and PhD candidate studying involuntary psychiatric treatment, School of Psychiatry, UNSW Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Why do I keep getting urinary tract infections? And why are chronic UTIs so hard to treat?
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Dealing with chronic urinary tract infections (UTIs) means facing more than the occasional discomfort. It’s like being on a never ending battlefield against an unseen adversary, making simple daily activities a trial.
UTIs happen when bacteria sneak into the urinary system, causing pain and frequent trips to the bathroom.
Chronic UTIs take this to the next level, coming back repeatedly or never fully going away despite treatment. Chronic UTIs are typically diagnosed when a person experiences two or more infections within six months or three or more within a year.
They can happen to anyone, but some are more prone due to their body’s makeup or habits. Women are more likely to get UTIs than men, due to their shorter urethra and hormonal changes during menopause that can decrease the protective lining of the urinary tract. Sexually active people are also at greater risk, as bacteria can be transferred around the area.
Up to 60% of women will have at least one UTI in their lifetime. While effective treatments exist, about 25% of women face recurrent infections within six months. Around 20–30% of UTIs don’t respond to standard antibiotic. The challenge of chronic UTIs lies in bacteria’s ability to shield themselves against treatments.
Why are chronic UTIs so hard to treat?
Once thought of as straightforward infections cured by antibiotics, we now know chronic UTIs are complex. The cunning nature of the bacteria responsible for the condition allows them to hide in bladder walls, out of antibiotics’ reach.
The bacteria form biofilms, a kind of protective barrier that makes them nearly impervious to standard antibiotic treatments.
This ability to evade treatment has led to a troubling increase in antibiotic resistance, a global health concern that renders some of the conventional treatments ineffective.
Some antibiotics no longer work against UTIs.
Michael Ebardt/ShutterstockAntibiotics need to be advanced to keep up with evolving bacteria, in a similar way to the flu vaccine, which is updated annually to combat the latest strains of the flu virus. If we used the same flu vaccine year after year, its effectiveness would wane, just as overused antibiotics lose their power against bacteria that have adapted.
But fighting bacteria that resist antibiotics is much tougher than updating the flu vaccine. Bacteria change in ways that are harder to predict, making it more challenging to create new, effective antibiotics. It’s like a never-ending game where the bacteria are always one step ahead.
Treating chronic UTIs still relies heavily on antibiotics, but doctors are getting crafty, changing up medications or prescribing low doses over a longer time to outwit the bacteria.
Doctors are also placing a greater emphasis on thorough diagnostics to accurately identify chronic UTIs from the outset. By asking detailed questions about the duration and frequency of symptoms, health-care providers can better distinguish between isolated UTI episodes and chronic conditions.
The approach to initial treatment can significantly influence the likelihood of a UTI becoming chronic. Early, targeted therapy, based on the specific bacteria causing the infection and its antibiotic sensitivity, may reduce the risk of recurrence.
For post-menopausal women, estrogen therapy has shown promise in reducing the risk of recurrent UTIs. After menopause, the decrease in estrogen levels can lead to changes in the urinary tract that makes it more susceptible to infections. This treatment restores the balance of the vaginal and urinary tract environments, making it less likely for UTIs to occur.
Lifestyle changes, such as drinking more water and practising good hygiene like washing hands with soap after going to the toilet and the recommended front-to-back wiping for women, also play a big role.
Some swear by cranberry juice or supplements, though researchers are still figuring out how effective these remedies truly are.
What treatments might we see in the future?
Scientists are currently working on new treatments for chronic UTIs. One promising avenue is the development of vaccines aimed at preventing UTIs altogether, much like flu shots prepare our immune system to fend off the flu.
Emerging treatments could help clear chronic UTIs.
guys_who_shoot/ShutterstockAnother new method being looked at is called phage therapy. It uses special viruses called bacteriophages that go after and kill only the bad bacteria causing UTIs, while leaving the good bacteria in our body alone. This way, it doesn’t make the bacteria resistant to treatment, which is a big plus.
Researchers are also exploring the potential of probiotics. Probiotics introduce beneficial bacteria into the urinary tract to out-compete harmful pathogens. These good bacteria work by occupying space and resources in the urinary tract, making it harder for harmful pathogens to establish themselves.
Probiotics can also produce substances that inhibit the growth of harmful bacteria and enhance the body’s immune response.
Chronic UTIs represent a stubborn challenge, but with a mix of current treatments and promising research, we’re getting closer to a day when chronic UTIs are a thing of the past.
Iris Lim, Assistant Professor, Bond University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Pear vs Prickly Pear – Which is Healthier?
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Our Verdict
When comparing pear to prickly pear, we picked the prickly.
Why?
Both of these fruits are fine and worthy choices, but the prickly pear wins out in nutritional density.
Looking at the macros to start with, the prickly pear is higher in fiber and lower in carbs, resulting in a much lower glycemic index. However, non-prickly pears are already low GI, so this is not a huge matter. Whether it’s pear’s GI of 38 or prickly pear’s GI of 7, you’re unlikely to experience a glucose spike.
In the category of vitamins, pear has a little more of vitamins B5, B9, E, K, and choline, but the margins are tiny. On the other hand, prickly pear has more of vitamins A, B1, B2, B3, B6, and C, with much larger margins of difference (except vitamin B1; that’s still quite close). Even before taking margins of difference into account, this is a slight win for prickly pear.
When it comes to minerals, things are more pronounced; pear has more manganese, while prickly pear has more calcium, iron, magnesium, phosphorus, potassium, selenium, and zinc.
In short, both pears are great (so do enjoy the pair), but prickly pear is the clear winner where one must be declared.
Want to learn more?
You might like to read:
Apple vs Pear – Which is Healthier?
Take care!
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Is chocolate milk a good recovery drink after a workout? A dietitian reviews the evidence
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Whether you enjoy chocolate milk regularly, as a weekend treat, or as an occasional dose of childhood nostalgia, it probably wouldn’t be the first option you think of for post-workout recovery.
Unless you’re on TikTok, perhaps. According to many people on the social media platform, chocolate milk is not only delicious, but it offers benefits comparable to sports drinks after a workout.
So is there any evidence to support this? Let’s take a look.
eldar nurkovic/Shutterstock Rehydrating after a workout is important
Water accounts for somewhere between 50% and 60% of our body weight. Water has many important functions in the body, including helping to keep our body at the right temperature through sweating.
We lose water naturally from our bodies when we sweat, as well as through our breathing and when we go to the toilet. So it’s important to stay hydrated to replenish the water we lose.
When we don’t, we become dehydrated, which can put a strain on our bodies. Signs and symptoms of dehydration can range from thirst and dizziness to low blood pressure and confusion.
Athletes, because of their higher levels of exertion, lose more water through sweating and from respiration (when their breathing rate gets faster). If they’re training or competing in hot or humid environments they will sweat even more.
Dehydration impacts athletes’ performance and like for all of us, can affect their health.
So finding ways to ensure athletes rehydrate quickly during and after they train or compete is important. Fortunately, sports scientists and dietitians have done research looking at the composition of different fluids to understand which ones rehydrate athletes most effectively.
The beverage hydration index
The best hydrating drinks are those the body retains the most of once they’ve been consumed. By doing studies where they give people different drinks in standardised conditions, scientists have been able to determine how various options stack up.
To this end, they’ve developed something called the beverage hydration index, which measures to what degree different fluids hydrate a person compared to still water.
According to this index beverages with similar fluid retention to still water include sparkling water, sports drinks, cola, diet cola, tea, coffee, and beer below 4% alcohol. That said, alcohol is probably best avoided when recovering from exercise.
Beverages with superior fluid retention to still water include milk (both full-fat and skim), soy milk, orange juice and oral rehydration solutions.
This body of research indicates that when it comes to rehydration after exercise, unflavoured milk (full fat, skim or soy) is better than sports drinks.
But what about chocolate milk?
A small study looked at the effects of chocolate milk compared to plain milk on rehydration and exercise performance in futsal players (futsal is similar to soccer but played on a court indoors). The researchers found no difference in rehydration between the two. There’s no other published research to my knowledge looking at how chocolate milk compares to regular milk for rehydration during or after exercise.
But rehydration isn’t the only thing athletes look for in sports drinks. In the same study, drinking chocolate milk after play (referred to as the recovery period) increased the time it took for the futsal players to become exhausted in further exercise (a shuttle run test) four hours later.
This was also shown in a review of several clinical trials. The analysis found that, compared to different placebos (such as water) or other drinks containing fat, protein and carbohydrates, chocolate milk lengthened the time to exhaustion during exercise.
What’s in chocolate milk?
Milk contains protein, carbohydrates and electrolytes, each of which can affect hydration, performance, or both.
Protein is important for building muscle, which is beneficial for performance. The electrolytes in milk (including sodium and potassium) help to replace electrolytes lost through sweating, so can also be good for performance, and aid hydration.
Compared to regular milk, chocolate milk contains added sugar. This provides extra carbohydrates, which are likewise beneficial for performance. Carbohydrates provide an immediate source of energy for athletes’ working muscles, where they’re stored as glycogen. This might contribute to the edge chocolate milk appears to have over plain milk in terms of athletic endurance.
The added sugar in chocolate milk provides extra carbohydrates. Brent Hofacker/Shutterstock Coffee-flavoured milk has an additional advantage. It contains caffeine, which can improve athletic performance by reducing the perceived effort that goes into exercise.
One study showed that a frappe-type drink prepared with filtered coffee, skim milk and sugar led to better muscle glycogen levels after exercise compared to plain milk with an equivalent amount of sugar added.
So what’s the verdict?
Evidence shows chocolate milk can rehydrate better than water or sports drinks after exercise. But there isn’t evidence to suggest it can rehydrate better than plain milk. Chocolate milk does appear to improve athletic endurance compared to plain milk though.
Ultimately, the best drink for athletes to consume to rehydrate is the one they’re most likely to drink.
While many TikTok trends are not based on evidence, it seems chocolate milk could actually be a good option for recovery from exercise. And it will be cheaper than specialised sports nutrition products. You can buy different brands from the supermarket or make your own at home with a drinking chocolate powder.
This doesn’t mean everyone should look to chocolate milk when they’re feeling thirsty. Chocolate milk does have more calories than plain milk and many other drinks because of the added sugar. For most of us, chocolate milk may be best enjoyed as an occasional treat.
Evangeline Mantzioris, Program Director of Nutrition and Food Sciences, Accredited Practising Dietitian, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Detox: What’s Real, What’s Not, What’s Useful, What’s Dangerous?
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Detox: What’s Real, What’s Not, What’s Useful, What’s Dangerous?
Out of the subscribers who engaged in the poll, it looks like we have a lot of confidence in at least some detox approaches being useful!
Celery juice is most people’s go-to, and indeed it was the only one to get mentioned in the comments added. So let’s take a look at that first…
Celery juice
Celery juice is enjoyed by many people, with many health benefits in mind, including to:
- reduce inflammation
- lower blood pressure
- heal the liver
- fight cancer
- reduce bloating
- support the digestive system
- increase energy
- support weight loss
- promote good mental health
An impressive list! With such an impressive list, we would hope for an impressive weight of evidence, so regular readers might be wondering why those bullet-pointed items aren’t all shiny hyperlinks to studies backing those claims. The reason is…
There aren’t any high-quality studies that back any of those claims.
We found one case study (so, a study with a sample size of one; not amazing) that observed a blood pressure change in an elderly man after drinking celery juice.
Rather than trawl up half of PubMed to show the lacklustre results in a way more befitting of Research Review Monday, though, here’s a nice compact article detailing the litany of disappointment that is science’s observations regards celery juice:
Why Are People Juicing Their Celery? – by Allison Webster, PhD, RD
A key take-away is: juicing destroys the fiber that is celery’s biggest benefit, and its phytochemicals are largely unproven to be of use.
If you enjoy celery, great! It (when not juiced) is a great source of fiber and water. If you juice it, it’s a great source of water.
Activated Charcoal
Unlike a lot of greenery—whose “cleansing” benefits mostly come from fiber and disappear when juiced—activated charcoal has a very different way of operating.
Activated charcoal is negatively charged on a molecular level*, and that—along with its porous nature—traps toxins. It really is a superpowered detox that actually works very well indeed.
But…
It works very well indeed. It will draw out toxins so well, that it’s commonly used to treat poisonings. “Wait”, we hear you say, “why was that a but”?
It doesn’t know what a toxin is. It just draws out all of the things. You took medicine recently? Not any more you didn’t. You didn’t even take that medication orally, you took it some other way? Activated charcoal does not care:
- The effect of activated charcoal on drug exposure following intravenous administration: A meta-analysis
- Activated charcoal for acute overdose: a reappraisal
Does this mean that activated charcoal can be used to “undo” a night of heavy drinking?
Sadly not. That’s one of the few things it just doesn’t work for. It won’t work for alcohol, salts, or metals:
The Use of Activated Charcoal to Treat Intoxications
*Fun chemistry mnemonic about ions:
Cations are pussitive
Anions (by process of elimination) are negative
Onions taste good in salad (remember also: Cole’s Law)
Bottom line on detox foods/drinks:
- Fiber is great; juicing removes fiber. Eat your greens (don’t drink them)!
- Activated charcoal is the heavy artillery of detoxing
- Sometimes it will remove things you didn’t want removed, though
- It also won’t help against alcohol, sadly
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Are you over 75? Here’s what you need to know about vitamin D
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Vitamin D is essential for bone health, immune function and overall wellbeing. And it becomes even more crucial as we age.
New guidelines from the international Endocrine Society recommend people aged 75 and over should consider taking vitamin D supplements.
But why is vitamin D so important for older adults? And how much should they take?
OPPO Find X5 Pro/Unsplash Young people get most vitamin D from the sun
In Australia, it is possible for most people under 75 to get enough vitamin D from the sun throughout the year. For those who live in the top half of Australia – and for all of us during summer – we only need to have skin exposed to the sun for a few minutes on most days.
The body can only produce a certain amount of vitamin D at a time. So staying in the sun any longer than needed is not going to help increase your vitamin D levels, while it will increase your risk of skin cancer.
But it’s difficult for people aged over 75 to get enough vitamin D from a few minutes of sunshine, so the Endocrine Society recommends people get 800 IU (international units) of vitamin D a day from food or supplements.
Why you need more as you age
This is higher than the recommendation for younger adults, reflecting the increased needs and reduced ability of older bodies to produce and absorb vitamin D.
Overall, older adults also tend to have less exposure to sunlight, which is the primary source of natural vitamin D production. Older adults may spend more time indoors and wear more clothing when outdoors.
As we age, our skin also becomes less efficient at synthesising vitamin D from sunlight.
The kidneys and the liver, which help convert vitamin D into its active form, also lose some of their efficiency with age. This makes it harder for the body to maintain adequate levels of the vitamin.
All of this combined means older adults need more vitamin D.
Deficiency is common in older adults
Despite their higher needs for vitamin D, people over 75 may not get enough of it.
Studies have shown one in five older adults in Australia have vitamin D deficiency.
In higher-latitude parts of the world, such as the United Kingdom, almost half don’t reach sufficient levels.
This increased risk of deficiency is partly due to lifestyle factors, such as spending less time outdoors and insufficient dietary intakes of vitamin D.
It’s difficult to get enough vitamin D from food alone. Oily fish, eggs and some mushrooms are good sources of vitamin D, but few other foods contain much of the vitamin. While foods can be fortified with the vitamin D (margarine, some milk and cereals), these may not be readily available or be consumed in sufficient amounts to make a difference.
In some countries such as the United States, most of the dietary vitamin D comes from fortified products. However, in Australia, dietary intakes of vitamin D are typically very low because only a few foods are fortified with it.
Why vitamin D is so important as we age
Vitamin D helps the body absorb calcium, which is essential for maintaining bone density and strength. As we age, our bones become more fragile, increasing the risk of fractures and conditions like osteoporosis.
Keeping bones healthy is crucial. Studies have shown older people hospitalised with hip fractures are 3.5 times more likely to die in the next 12 months compared to people who aren’t injured.
People over 75 often have less exposure to sunlight. Aila Images/Shutterstock Vitamin D may also help lower the risk of respiratory infections, which can be more serious in this age group.
There is also emerging evidence for other potential benefits, including better brain health. However, this requires more research.
According to the society’s systematic review, which summarises evidence from randomised controlled trials of vitamin D supplementation in humans, there is moderate evidence to suggest vitamin D supplementation can lower the risk of premature death.
The society estimates supplements can prevent six deaths per 1,000 people. When considering the uncertainty in the available evidence, the actual number could range from as many as 11 fewer deaths to no benefit at all.
Should we get our vitamin D levels tested?
The Endocrine Society’s guidelines suggest routine blood tests to measure vitamin D levels are not necessary for most healthy people over 75.
There is no clear evidence that regular testing provides significant benefits, unless the person has a specific medical condition that affects vitamin D metabolism, such as kidney disease or certain bone disorders.
Routine testing can also be expensive and inconvenient.
In most cases, the recommended approach to over-75s is to consider a daily supplement, without the need for testing.
You can also try to boost your vitamin D by adding fortified foods to your diet, which might lower the dose you need from supplementation.
Even if you’re getting a few minutes of sunlight a day, a daily vitamin D is still recommended.
Elina Hypponen, Professor of Nutritional and Genetic Epidemiology, University of South Australia and Joshua Sutherland, PhD Candidate – Nutrition and Genetic Epidemiology, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The End of Alzheimer’s – by Dr. Dale Bredesen
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This one didn’t use the “The New Science Of…” subtitle that many books do, and this one actually is a “new science of”!
Which is exciting, and/but comes with the caveat that the overall protocol itself is still undergoing testing, but the results so far are promising. The constituent parts of the protocol are for the most already well-established, but have not previously been put together in this way.
Dr. Bredesen argues that Alzheimer’s Disease is not one condition but three (medical consensus agrees at least that it is a collection of conditions, but different schools of thought slice them differently), and outlines 36 metabolic factors that are implicated, and the good news is, most of them are within our control.
Since there’s a lot to put together, he also offers many workarounds and “crutches”, making for very practical advice.
The style of the book is on the hard end of pop-science, that is to say while the feel and tone is very pop-sciencey, there are nevertheless a lot of words that you might know but your spellchecker probably wouldn’t. He does explain everything along the way, but this does mean that if you’re not already well-versed, you can’t just dip in to a later point without reading the earlier parts.
Bottom line: even if you only implement half the advice in this book, you’ll be doing your long-term cognitive health a huge favor.
Click here to check out The End of Alzheimer’s, and keep cognitive decline at bay!
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