Oral retinoids can harm unborn babies. But many women taking them for acne may not be using contraception
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Oral retinoids are a type of medicine used to treat severe acne. They’re sold under the brand name Roaccutane, among others.
While oral retinoids are very effective, they can have harmful effects if taken during pregnancy. These medicines can cause miscarriages and major congenital abnormalities (harm to unborn babies) including in the brain, heart and face. At least 30% of children exposed to oral retinoids in pregnancy have severe congenital abnormalities.
Neurodevelopmental problems (in learning, reading, social skills, memory and attention) are also common.
Because of these risks, the Australasian College of Dermatologists advises oral retinoids should not be prescribed a month before or during pregnancy under any circumstances. Dermatologists are instructed to make sure a woman isn’t pregnant before starting this treatment, and discuss the risks with women of childbearing age.
But despite this, and warnings on the medicines’ packaging, pregnancies exposed to oral retinoids continue to be reported in Australia and around the world.
In a study published this month, we wanted to find out what proportion of Australian women of reproductive age were taking oral retinoids, and how many of these women were using contraception.
Our results suggest a high proportion of women are not using effective contraception while on these drugs, indicating Australia needs a strategy to reduce the risk oral retinoids pose to unborn babies.
Contraception options
Using birth control to avoid pregnancy during oral retinoid treatment is essential for women who are sexually active. Some contraception methods, however, are more reliable than others.
Long-acting-reversible contraceptives include intrauterine devices (IUDs) inserted into the womb (such as Mirena, Kyleena, or copper devices) and implants under the skin (such as Implanon). These “set and forget” methods are more than 99% effective.
The effectiveness of oral contraceptive pills among “perfect” users (following the directions, with no missed or late pills) is similarly more than 99%. But in typical users, this can fall as low as 91%.
Condoms, when used as the sole method of contraception, have higher failure rates. Their effectiveness can be as low as 82% in typical users.
Oral retinoid use over time
For our study, we analysed medicine dispensing data among women aged 15–44 from Australia’s Pharmaceutical Benefit Scheme (PBS) between 2013 and 2021.
We found the dispensing rate for oral retinoids doubled from one in every 71 women in 2013, to one in every 36 in 2021. The increase occurred across all ages but was most notable in young women.
Most women were not dispensed contraception at the same time they were using the oral retinoids. To be sure we weren’t missing any contraception that was supplied before the oral retinoids, we looked back in the data. For example, for an IUD that lasts five years, we looked back five years before the oral retinoid prescription.
Our analysis showed only one in four women provided oral retinoids were dispensed contraception simultaneously. This was even lower for 15- to 19-year-olds, where only about one in eight women who filled a prescription for oral retinoids were dispensed contraception.
A recent study found 43% of Australian year 10 and 69% of year 12 students are sexually active, so we can’t assume this younger age group largely had no need for contraception.
One limitation of our study is that it may underestimate contraception coverage, because not all contraceptive options are listed on the PBS. Those options not listed include male and female sterilisation, contraceptive rings, condoms, copper IUDs, and certain oral contraceptive pills.
But even if we presume some of the women in our study were using forms of contraception not listed on the PBS, we’re still left with a significant portion without evidence of contraception.
What are the solutions?
Other countries such as the United States and countries in Europe have pregnancy prevention programs for women taking oral retinoids. These programs include contraception requirements, risk acknowledgement forms and regular pregnancy tests. Despite these programs, unintended pregnancies among women using oral retinoids still occur in these countries.
But Australia has no official strategy for preventing pregnancies exposed to oral retinoids. Currently oral retinoids are prescribed by dermatologists, and most contraception is prescribed by GPs. Women therefore need to see two different doctors, which adds costs and burden.
Rather than a single fix, there are likely to be multiple solutions to this problem. Some dermatologists may not feel confident discussing sex or contraception with patients, so educating dermatologists about contraception is important. Education for women is equally important.
A clinical pathway is needed for reproductive-aged women to obtain both oral retinoids and effective contraception. Options may include GPs prescribing both medications, or dermatologists only prescribing oral retinoids when there’s a contraception plan already in place.
Some women may initially not be sexually active, but change their sexual behaviour while taking oral retinoids, so constant reminders and education are likely to be required.
Further, contraception access needs to be improved in Australia. Teenagers and young women in particular face barriers to accessing contraception, including costs, stigma and lack of knowledge.
Many doctors and women are doing the right thing. But every woman should have an effective contraception plan in place well before starting oral retinoids. Only if this happens can we reduce unintended pregnancies among women taking these medicines, and thereby reduce the risk of harm to unborn babies.
Dr Laura Gerhardy from NSW Health contributed to this article.
Antonia Shand, Research Fellow, Obstetrician, University of Sydney and Natasha Nassar, Professor of Paediatric and Perinatal Epidemiology and Chair in Translational Childhood Medicine, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Applesauce vs Cranberry Sauce – Which is Healthier?
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Our Verdict
When comparing applesauce to cranberry sauce, we picked the applesauce.
Why?
It mostly comes down to the fact that apples are sweeter than cranberries:
In terms of macros, they are both equal on fiber (both languishing at a paltry 1.1g/100g), and/but cranberry sauce has 4x the carbs, of which, more than 3x the sugar. Simply, cranberry sauce recipes invariably have a lot of added sugar, while applesauce recipes don’t need that. So this is a huge relative win for applesauce (we say “relative” because it’s still not great, but cranberry sauce is far worse).
In the category of vitamins, applesauce has more of vitamins B1, B2, B5, B6, B9, and C, while cranberry sauce has more of vitamins E, K, and choline. A more moderate win for applesauce this time.
When it comes to minerals, applesauce has more calcium, copper, magnesium, phosphorus, and potassium, while cranberry sauce has more iron, manganese, and selenium. Another moderate win for applesauce.
Since we’ve discussed relative amounts rather than actual quantities, it’s worth noting that neither sauce is a good source of vitamins or minerals, and neither are close to just eating the actual fruits. Just, cranberry sauce is the relatively more barren of the two.
While cranberries famously have some UTI-fighting properties, you cannot usefully gain this benefit from a sauce that (with its very high sugar content and minimal fiber) actively feeds the very C. albicans you are likely trying to kill.
All in all, a pitiful show of nutritional inadequacy from these two products today, but one is relatively less bad than the other, and that’s the applesauce.
Want to learn more?
You might like to read:
From Apples to Bees, and High-Fructose Cs: Which Sugars Are Healthier, And Which Are Just The Same?
Enjoy!
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Artichoke vs Heart of Palm– Which is Healthier?
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Our Verdict
When comparing artichoke to heart of palm, we picked the artichoke.
Why?
If you were thinking “isn’t heart of palm full of saturated fat?” then no… Palm oil is, but heart of palm itself has 0.62g/100g fat, of which, 0.13g saturated fat. So, negligible.
As for the rest of the macros, artichoke has more protein, carbs, and fiber, thus being the “more food per food” option. Technically heart of palm has the lower glycemic index, but they are both low-GI foods, so it’s really not a factor here.
Vitamins are where artichoke shines; artichoke has more of vitamins A, B1, B2, B3, B5, B6, B9, C, E, K, and choline, while heart of palm is not higher in any vitamins.
The minerals situation is more balanced: artichoke has more copper, magnesium, phosphorus, and potassium, while heart of palm has more iron, manganese, selenium, and zinc.
Adding up the categories, the winner of this “vegetables with a heart” face-off is clearly artichoke.
Fun fact: in French, “to have the heart of an artichoke” (avoir le coeur d’un artichaut) means to fall in love easily. Perfect vegetable for a romantic dinner, perhaps (especially with all those generous portions of B-vitamins)!
Want to learn more?
You might like to read:
Artichoke vs Cabbage – Which is Healthier?
Take care!
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What is childhood dementia? And how could new research help?
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“Childhood” and “dementia” are two words we wish we didn’t have to use together. But sadly, around 1,400 Australian children and young people live with currently untreatable childhood dementia.
Broadly speaking, childhood dementia is caused by any one of more than 100 rare genetic disorders. Although the causes differ from dementia acquired later in life, the progressive nature of the illness is the same.
Half of infants and children diagnosed with childhood dementia will not reach their tenth birthday, and most will die before turning 18.
Yet this devastating condition has lacked awareness, and importantly, the research attention needed to work towards treatments and a cure.
More about the causes
Most types of childhood dementia are caused by mutations (or mistakes) in our DNA. These mistakes lead to a range of rare genetic disorders, which in turn cause childhood dementia.
Two-thirds of childhood dementia disorders are caused by “inborn errors of metabolism”. This means the metabolic pathways involved in the breakdown of carbohydrates, lipids, fatty acids and proteins in the body fail.
As a result, nerve pathways fail to function, neurons (nerve cells that send messages around the body) die, and progressive cognitive decline occurs.
Childhood dementia is linked to rare genetic disorders. maxim ibragimov/Shutterstock What happens to children with childhood dementia?
Most children initially appear unaffected. But after a period of apparently normal development, children with childhood dementia progressively lose all previously acquired skills and abilities, such as talking, walking, learning, remembering and reasoning.
Childhood dementia also leads to significant changes in behaviour, such as aggression and hyperactivity. Severe sleep disturbance is common and vision and hearing can also be affected. Many children have seizures.
The age when symptoms start can vary, depending partly on the particular genetic disorder causing the dementia, but the average is around two years old. The symptoms are caused by significant, progressive brain damage.
Are there any treatments available?
Childhood dementia treatments currently under evaluation or approved are for a very limited number of disorders, and are only available in some parts of the world. These include gene replacement, gene-modified cell therapy and protein or enzyme replacement therapy. Enzyme replacement therapy is available in Australia for one form of childhood dementia. These therapies attempt to “fix” the problems causing the disease, and have shown promising results.
Other experimental therapies include ones that target faulty protein production or reduce inflammation in the brain.
Research attention is lacking
Death rates for Australian children with cancer nearly halved between 1997 and 2017 thanks to research that has enabled the development of multiple treatments. But over recent decades, nothing has changed for children with dementia.
In 2017–2023, research for childhood cancer received over four times more funding per patient compared to funding for childhood dementia. This is despite childhood dementia causing a similar number of deaths each year as childhood cancer.
The success for childhood cancer sufferers in recent decades demonstrates how adequately funding medical research can lead to improvements in patient outcomes.
Dementia is not just a disease of older people. Miljan Zivkovic/Shutterstock Another bottleneck for childhood dementia patients in Australia is the lack of access to clinical trials. An analysis published in March this year showed that in December 2023, only two clinical trials were recruiting patients with childhood dementia in Australia.
Worldwide however, 54 trials were recruiting, meaning Australian patients and their families are left watching patients in other parts of the world receive potentially lifesaving treatments, with no recourse themselves.
That said, we’ve seen a slowing in the establishment of clinical trials for childhood dementia across the world in recent years.
In addition, we know from consultation with families that current care and support systems are not meeting the needs of children with dementia and their families.
New research
Recently, we were awarded new funding for our research on childhood dementia. This will help us continue and expand studies that seek to develop lifesaving treatments.
More broadly, we need to see increased funding in Australia and around the world for research to develop and translate treatments for the broad spectrum of childhood dementia conditions.
Dr Kristina Elvidge, head of research at the Childhood Dementia Initiative, and Megan Maack, director and CEO, contributed to this article.
Kim Hemsley, Head, Childhood Dementia Research Group, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University; Nicholas Smith, Head, Paediatric Neurodegenerative Diseases Research Group, University of Adelaide, and Siti Mubarokah, Research Associate, Childhood Dementia Research Group, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Managing Sibling Relationships In Adult Life
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Managing Sibling Relationships In Adult Life
After our previous main feature on estrangement, a subscriber wrote to say:
❝Parent and adult child relationships are so important to maintain as you age, but what about sibling relationships? Adult choices to accept and move on with healthier boundaries is also key for maintaining familial ties.❞
And, this is indeed critical for many of us, if we have siblings!
Writer’s note: I don’t have siblings, but I do happen to have one of Canada’s top psychologists on speed-dial, and she has more knowledge about sibling relationships than I do, not to mention a lifetime of experience both personally and professionally. So, I sought her advice, and she gave me a lot to work with.
Today I bring her ideas, distilled into my writing, for 10almonds’ signature super-digestible bitesize style.
A foundation of support
Starting at the beginning of a sibling story… Sibling relationships are generally beneficial from the get-go.
This is for reasons of mutual support, and an “always there” social presence.
Of course, how positive this experience is may depend on there being a lack of parental favoritism. And certainly, sibling rivalries and conflict can occur at any age, but the stakes are usually lower, early in life.
Growing warmer or colder
Generally speaking, as people age, sibling relationships likely get warmer and less conflictual.
Why? Simply put, we mature and (hopefully!) get more emotionally stable as we go.
However, two things can throw a wrench into the works:
- Long-term rivalries or jealousies (e.g., “who has done better in life”)
- Perceptions of unequal contribution to the family
These can take various forms, but for example if one sibling earns (or otherwise has) much more or much less than another, that can cause resentment on either or both sides:
- Resentment from the side of the sibling with less money: “I’d look after them if our situations were reversed; they can solve my problems easily; why do they resent that and/or ignore my plight?”
- Resentment from the side of the sibling with more money: “I shouldn’t be having to look after my sibling at this age”
It’s ugly and unpleasant. Same goes if the general job of caring for an elderly parent (or parents) falls mostly or entirely on one sibling. This can happen because of being geographically closer or having more time (well… having had more time. Now they don’t, it’s being used for care!).
It can also happen because of being female—daughters are more commonly expected to provide familial support than sons.
And of course, that only gets exacerbated as end-of-life decisions become relevant with regard to parents, and tough decisions may need to be made. And, that’s before looking at conflicts around inheritance.
So, all that seems quite bleak, but it doesn’t have to be like that.
Practical advice
As siblings age, working on communication about feelings is key to keeping siblings close and not devolving into conflict.
Those problems we talked about are far from unique to any set of siblings—they’re just more visible when it’s our own family, that’s all.
So: nothing to be ashamed of, or feel bad about. Just, something to manage—together.
Figure out what everyone involved wants/needs, put them all on the table, and figure out how to:
- Make sure outright needs are met first
- Try to address wants next, where possible
Remember, that if you feel more is being asked of you than you can give (in terms of time, energy, money, whatever), then this discussion is a time to bring that up, and ask for support, e.g.:
“In order to be able to do that, I would need… [description of support]; can you help with that?”
(it might even sometimes be necessary to simply say “No, I can’t do that. Let’s look to see how else we can deal with this” and look for other solutions, brainstorming together)
Some back-and-forth open discussion and even negotiation might be necessary, but it’s so much better than seething quietly from a distance.
The goal here is an outcome where everyone’s needs are met—thus leveraging the biggest strength of having siblings in the first place:
Mutual support, while still being one’s own person. Or, as this writer’s psychology professor friend put it:
❝Circling back to your original intention, this whole discussion adds up to: siblings can be very good or very bad for your life, depending on tons of things that we talked about, especially communication skills, emotional wellness of each person, and the complexity of challenges they face interdependently.❞
Our previous main feature about good communication can help a lot:
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Remember – by Dr. Lisa Genova
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Memory is often viewed as one thing—either you have a good memory, or you don’t. At best, a lot of people have a vague idea of selective memory. But, the reality is much more complex—and much more interesting.
Dr. Genova lays out clearly and simply the various different kinds of memory, how they work, and how they fail. Some of these kinds of memory operate on completely different principles than others, and/or in different parts of the brain. And, it’s not just “a memory for faces” or a “memory for names”, nor even “short term vs long term”. There’s working memory, explicit and implicit memory, semantic memory, episodic memory, muscle memory, and more.
However, this is not just an interesting book—it’s also a useful one. Dr. Genova also looks at how we can guard against failing memory in later years, and how we can expand and grow the kinds of memory that are most important to us.
The style of the book is very conversational, and not at all textbook-like. It’s certainly very accessible, and pleasant to read too.
Bottom line: memory is a weird and wonderful thing, and this book shines a clear light on many aspects of it—including how to improve the various different kinds of memory.
Click here to check out Remember (we recommend to do it now before you forget!
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Where to Get Turmeric?
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
“I liked the info on Turmeric. The problem for me is that I do not like black pepper which should be ingested with the turmeric for best results. Is black pepper sold in capsule form?”
Better than just black pepper being sold in capsule form, it’s usually available in the same capsules as the turmeric. As in: if you buy turmeric capsules, there is often black pepper in them as well, for precisely that reason. Check labels, of course, but here’s an example on Amazon.
“I would like to read more on loneliness, meetup group’s for seniors. Thank you”
Well, 10almonds is an international newsletter, so it’s hard for us to advise about (necessarily: local) meetup groups!
But a very popular resource for connecting to your local community is Nextdoor, which operates throughout the US, Canada, Australia, and large parts of Europe including the UK.
In their own words:
Get the most out of your neighborhood with Nextdoor
It’s where communities come together to greet newcomers, exchange recommendations, and read the latest local news. Where neighbors support local businesses and get updates from public agencies. Where neighbors borrow tools and sell couches. It’s how to get the most out of everything nearby. Welcome, neighbor.
Curious? Click here to check it out and see if it’s of interest to you
“It was superb !! Just loved that healthy recipe !!! I would love to see one of those every day, if possible !! Keep up the fabulous work !!!”
We’re glad you enjoyed! We can’t promise a recipe every day, but here’s one just for you:
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