Attention-deficit hyperactivity disorder (ADHD) can have a considerable impact on the day-to-day functioning and overall wellbeing of people affected. It causes a variety of symptoms including difficulty focusing, impulsivity and hyperactivity.

For many, a diagnosis of ADHD, whether in childhood or adulthood, is life changing. It means finally having an explanation for these challenges, and opens up the opportunity for treatment, including medication.

Although ADHD medications can cause side effects, they generally improve symptoms for people with the disorder, and thereby can significantly boost quality of life.

Now a new study has found being treated for ADHD with medication reduces the risk of early death for people with the disorder. But what can we make of these findings?

A large study from Sweden

The study, published this week in JAMA (the prestigious journal of the American Medical Association), was a large cohort study of 148,578 people diagnosed with ADHD in Sweden. It included both adults and children.

In a cohort study, a group of people who share a common characteristic (in this case a diagnosis of ADHD) are followed over time to see how many develop a particular health outcome of interest (in this case the outcome was death).

For this study the researchers calculated the mortality rate over a two-year follow up period for those whose ADHD was treated with medication (a group of around 84,000 people) alongside those whose ADHD was not treated with medication (around 64,000 people). The team then determined if there were any differences between the two groups.

What did the results show?

The study found people who were diagnosed and treated for ADHD had a 19% reduced risk of death from any cause over the two years they were tracked, compared with those who were diagnosed but not treated.

In understanding this result, it’s important – and interesting – to look at the causes of death. The authors separately analysed deaths due to natural causes (physical medical conditions) and deaths due to unnatural causes (for example, unintentional injuries, suicide, or accidental poisonings).

The key result is that while no significant difference was seen between the two groups when examining natural causes of death, the authors found a significant difference for deaths due to unnatural causes.

So what’s going on?

Previous studies have suggested ADHD is associated with an increased risk of premature death from unnatural causes, such as injury and poisoning.

On a related note, earlier studies have also suggested taking ADHD medicines may reduce premature deaths. So while this is not the first study to suggest this association, the authors note previous studies addressing this link have generated mixed results and have had significant limitations.

In this new study, the authors suggest the reduction in deaths from unnatural causes could be because taking medication alleviates some of the ADHD symptoms responsible for poor outcomes – for example, improving impulse control and decision-making. They note this could reduce fatal accidents.

The authors cite a number of studies that support this hypothesis, including research showing ADHD medications may prevent the onset of mood, anxiety and substance use disorders, and lower the risk of accidents and criminality. All this could reasonably be expected to lower the rate of unnatural deaths.

Strengths and limitations

Scandinavian countries have well-maintained national registries that collect information on various aspects of citizens’ lives, including their health. This allows researchers to conduct excellent population-based studies.

Along with its robust study design and high-quality data, another strength of this study is its size. The large number of participants – almost 150,000 – gives us confidence the findings were not due to chance.

The fact this study examined both children and adults is another strength. Previous research relating to ADHD has often focused primarily on children.

One of the important limitations of this study acknowledged by the authors is that it was observational. Observational studies are where the researchers observe and analyse naturally occurring phenomena without intervening in the lives of the study participants (unlike randomised controlled trials).

The limitation in all observational research is the issue of confounding. This means we cannot be completely sure the differences between the two groups observed were not either partially or entirely due to some other factor apart from taking medication.

Specifically, it’s possible lifestyle factors or other ADHD treatments such as psychological counselling or social support may have influenced the mortality rates in the groups studied.

Another possible limitation is the relatively short follow-up period. What the results would show if participants were followed up for longer is an interesting question, and could be addressed in future research.

What are the implications?

Despite some limitations, this study adds to the evidence that diagnosis and treatment for ADHD can make a profound difference to people’s lives. As well as alleviating symptoms of the disorder, this study supports the idea ADHD medication reduces the risk of premature death.

Ultimately, this highlights the importance of diagnosing ADHD early so the appropriate treatment can be given. It also contributes to the body of evidence indicating the need to improve access to mental health care and support more broadly.

Hassan Vally, Associate Professor, Epidemiology, Deakin University

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

Six passengers from the hantavirus cruise ship have started their quarantine at Australia’s purpose-built facility in Western Australia.

Over the next three weeks, the Australians and one New Zealander will be housed at the 500-bed Bullsbrook facility north-east of Perth, one of three purpose-built “centres for national resilience” around the country.

There, staff from the National Critical Care and Trauma Response Centre will monitor the returned passengers’ health, before authorities decide what happens next.

We are both infection prevention and control experts who advised the Victorian government on best-practice quarantine arrangements during COVID. This included the design of a dedicated quarantine facility.

Here’s how the Perth facility – and similar purpose-built ones in Melbourne and Brisbane – have been designed to minimise the spread of infectious diseases.

What actually is quarantine?

The word itself comes from the Italian phrase quaranta giorni, meaning “40 days”. Back during the Black Death, ships had to anchor off the coast for 40 days before they could land in European cities to make sure no one on board was sick.

Today, quarantine is specifically for people who have been exposed to a virus – in this case the Andes strain of hantavirus – but aren’t showing any symptoms yet.

Experience from managing other infectious diseases, including COVID, has taught us that people can spread a virus before they even feel sick. We use quarantine to protect the community and also to make sure the person who was exposed doesn’t catch anything else.

During the early stages of the COVID pandemic, Australia was among countries that used hotels for quarantine purposes. But hotels are designed for comfort, not for stopping airborne pathogens. Shared spaces, inadequate ventilation systems, poor workflow (see points two and three below), and staff often with little or no expertise in infection control contributed to several breaches.

Many of these hotels were in the middle of busy cities. This was risky because any breach could immediately expose a lot of people in a crowded area.

So Australia built three centres for national resilience in Mickleham (near Melbourne), Perth and Brisbane. These were placed outside crowded city centres but still close to airports.

So what are these facilities like?

When architects and health experts design these facilities, they focus on four main things: fresh air, design, workflow and dignity.

1. Fresh air inside and out

These buildings need a constant supply of fresh air. The air is never recirculated (reused). Instead, old air is pushed outside so people aren’t breathing in “re-breathed” particles from someone else. So a lot of thought goes into air handling, that is, stopping germs from hanging around in the air and spreading to others.

That includes designing facilities with verandahs (for residents) and open-air walkways (for staff).

2. Designed with zones

The safest way to run a facility is to split it into three “traffic light” zones:

• the green zone (clean): where staff enter, have their offices, and take breaks
• orange zone (transition): a buffer area, like a verandah or porch, where staff put on their protective gear or hand over meals and medical samples
• red zone (contaminated): the actual room or area where the person stays. Anyone entering this area must wear full personal protective equipment. This often includes properly fitted long-sleeved gowns, gloves, N95 masks and face shields or goggles, combined with mandatory training in “donning and doffing” (putting on and taking off personal protective equipment).

3. One-way workflow

A crucial rule in infection control is that you never move “dirty” items back into “clean” areas. Everything must move in one direction: from clean to dirty.

So staff and supplies follow a strict path to ensure nothing from the “red zone” accidentally moves back into the “green zone”. This could include infectious air, as well as people and objects or equipment.

Sometimes, however, objects from the “red zone” have to move back into other zones, but need to be cleaned and disinfected first. This would be the case for the dirty laundry of people in quarantine. In this case, there are strict protocols to make sure any risk is minimised. Once cleaned and disinfected, these items can then be re-used.

4. Ensuring dignity

One of the hardest parts of quarantine is the mental toll. Staying in a room for weeks is hard. Those in quarantine often experience mental health stressors.

This may include a fear of infection, constantly being on alert for symptoms, and having trouble sleeping.

In the old hotel quarantine, some people couldn’t even go outside. By contrast, purpose-built facilities are designed to be more humane. This means:

• accessing natural light, outdoor space and fresh air
• good quality food and water
• internet and entertainment so they can stay connected
• emotional support to help with the stress of being isolated.

What happens now?

If anyone in the Perth facility does become sick, there is a medical clinic on-site so they can be treated or stabilised before transferring to hospital. People in quarantine also have access to telehealth.

What happens after the three-week period is up has yet to be decided. The World Health Organization recommends active monitoring and home or facility quarantine of high-risk contacts for 42 days after their last potential exposure.

As hantaviruses are rarely transmitted between people, the risk to the general public remains low and the virus is not a pandemic threat.

But this outbreak is a reminder that we need to be prepared for future outbreaks of infectious diseases. So our quarantine facilities need to be ready to go should they be needed again.

Philip Russo, Professor, Director of Research, Nursing and Midwifery, Monash University and Brett Mitchell, Professor of Nursing and Health Services Research, University of Newcastle

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