Will a vegetarian diet increase your risk of stroke?



This is the first study to link a vegetarian diet to an increased risk of stroke. But the evidence isn’t strong enough to cause alarm.
From shutterstock.com

Evangeline Mantzioris, University of South Australia

Research Checks 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.

A UK study finding vegetarianism is associated with a higher risk of stroke than a meat-eating diet has made headlines around the world.

The study, published in the British Medical Journal last week, found people who followed vegetarian or vegan diets had a 20% higher risk of having a stroke compared to those who ate meat.

But if you’re a vegetarian, there’s no need to panic. And if you’re a meat eater, these results don’t suggest you should eat more meat.

While we don’t fully understand why these results occurred, it’s important to note the study only showed an association between a vegetarian diet and increased stroke risk – not direct cause and effect.




Read more:
Clearing up confusion between correlation and causation


What the study did and found

The researchers looked at 48,188 men and women living in Oxford, following what they ate, and whether they had heart disease or a stroke, over 18 years. The researchers grouped the participants according to their diets: meat eaters, fish eaters (pescatarians) and vegetarians (including vegans).

While vegan diets are quite different to vegetarian diets, the investigators combined these two groups as there were very small numbers of vegans in the study.

In their analysis, the researchers accounted for variables which are known risk factors for heart disease and stroke, including education level, smoking status, alcohol consumption, and physical activity.




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They found vegetarians had a 22% lower risk of heart disease than meat eaters. This is equivalent to ten fewer cases of heart disease per 1,000 vegetarians than in meat eaters over ten years.

Yet the vegetarians had a 20% higher rate of stroke, equivalent to three more strokes per 1,000 vegetarians compared to the meat eaters over ten years.

The decrease in heart disease risk seemed to be linked to lower body mass index (BMI), cholesterol levels, incidence of diabetes, and blood pressure. These benefits are all known to be associated with a healthy vegetarian diet, and are protective factors
against heart disease.

This study showed fish eaters (who did not consume meat) had a 13% lower risk of heart disease, but no significant increase in the rate of stroke when compared to meat eaters.

As with any study, there are strengths and weaknesses

The main strength of this study is that it closely followed a very large group of people over a long period of time.

The major weakness is that being an observational study, the researchers were not able to determine a cause and effect relationship.

So this study is not showing us vegetarian diets lead to increased risk of stroke; it simply tells us vegetarians have an increased risk of stroke. This means the association may be linked to other factors, aside from diet, which may be related to the lifestyle of a vegetarian.

The study’s authors suggest a difference in vitamin B12 levels between the vegetarian and meat-eating groups may have contributed to the results.
From shutterstock.com

And while vegetarian and vegan diets may be seen as generally healthier, vegetarians still may be eating processed and ultra-processed foods. These foods can contain high levels of added salt, trans fat and saturated fats. This study did not report on the whole dietary pattern – just the major food groups.

Another major weakness of this study is that vegans and vegetarians were grouped together. Vegetarian and vegan diets can vary considerably in nutrient levels.

So why would the vegetarian group have a higher stroke risk?

These kind of observational studies are unable to provide what scientists call “a mechanism” – that is, a biological explanation as to why this association may exist.

But researchers will sometimes offer a potential biological explanation. In this case, they suggest the differences in nutrient intakes between the different diets may go some way to explaining the increased risk of stroke in the vegetarian group.

They cite a number of Japanese studies which have shown links between a very low intake of animal products and an increased risk of stroke.




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One nutrient they mention is vitamin B12, as it’s found only in animal products (meat, fish, dairy products and eggs). Vegan sources are limited, though some mushroom varieties and fermented beans may contain vitamin B12.

Vitamin B12 deficiency can lead to anaemia and neurological issues, including numbness and tingling, and cognitive difficulties.

The authors suggest a lack of vitamin B12 may be linked to the increased risk of stroke among the vegetarian group. This deficiency could be present in vegetarians, and even more pronounced in vegans.

But this is largely speculative, and any associations between a low intake of animal products and an increased risk of stroke remain to be founded in a strong body of evidence. More research is needed before any recommendations are made.

What does this mean for vegetarians and vegans?

Vegetarians and vegans shouldn’t see this study as a reason to change their diets. This is the only study to date to have shown an increased risk of stroke with vegetarian or vegan diets.

Further, this study has shown overall greater benefits are gained by being vegetarian or vegan in its association with reduced risk of heart disease.

Meanwhile, other studies have shown meat eaters – particularly people who eat large amounts of red and processed meats – have higher risk of certain cancers.




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Whether you’re an omnivore, pescatarian, vegetarian or vegan, it’s important to consider the quality of your diet. Focus on eating whole foods, and including lots of vegetables, fruits, cereals and grains.

It’s equally important to minimise the intake of processed foods high in added sugars, salt, saturated and trans fats. Diets high in these sorts of foods have well-established links to increased risk of heart disease and stroke. –Evangeline Mantzioris


Blind peer review

The analysis presents a fair and balanced assessment of the study, accurately pointing out that no meaningful recommendations can be drawn from the results. This is particularly so since the majority of the data was collected via self-reported questionnaires, which reduces the reliability of the results.

While in many cases the media has reported an increased stroke risk in vegetarians, total stroke risk was not actually statistically different between the groups. The researchers looked at two types of stroke: ischaemic stroke (where a blood vessel supplying blood to the brain is obstructed) and haemorrhagic stroke (where a blood vessel leaks or breaks).

A statistically significant increased risk in the vegetarian group was only seen in haemorrhagic stroke – and even there it’s marginal. Statistically, and in total numbers of people affected, the reduced heart disease risk in the vegetarian group is more convincing. –Andrew CareyThe Conversation

Evangeline Mantzioris, Program Director of Nutrition and Food Sciences, University of South Australia

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

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Here’s what you can eat and avoid to reduce your risk of bowel cancer



It’s not certain why, but fibre has protective effects against bowel cancer.
http://www.shutterstock.com

Suzanne Mahady, Monash University

Australia has one of the highest rates of bowel cancer in the world. In 2017, bowel cancer was the second most common cancer in Australia and rates are increasing in people under 50.

Up to 35% of cancers worldwide might be caused by lifestyle factors such as diet and smoking. So how can we go about reducing our risk of bowel cancer?




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What’s behind the increase in bowel cancer among younger Australians?


What to eat

Based on current evidence, a high fibre diet is important to reduce bowel cancer risk. Fibre can be divided into 2 types: insoluble fibre, which creates a bulky stool that can be easily passed along the bowel; and soluble fibre, which draws in water to keep the stool soft.

Fibre from cereal and wholegrains is an ideal fibre source. Australian guidelines suggest aiming for 30g of fibre per day for adults, but fewer than 20% of Australian adults meet that target.

Wheat bran is one of the richest sources of fibre, and in an Australian trial in people at high risk of bowel cancer, 25g of wheat bran reduced precancerous growths. Wheat bran can be added to cooking, smoothies and your usual cereal.

It’s not clear how fibre may reduce bowel cancer risk but possible mechanisms include reducing the time it takes food to pass through the gut (and therefore exposure to potential carcinogens), or through a beneficial effect on gut bacteria.

Once bowel cancer is diagnosed, a high fibre diet has also been associated with improved survival.

Dairy is ‘probably’ protective against bowel cancer.
from http://www.shutterstock.com



Read more:
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Milk and dairy products are also thought to reduce bowel cancer risk. The evidence for milk is graded as “probably protective” in current Australian bowel cancer guidelines, with the benefit increasing with higher amounts.

Oily fish may also have some protective elements. In people with hereditary conditions that make them prone to developing lots of precancerous growths (polyps) in the bowel, a trial where one group received a daily supplement of an omega 3 polyunsaturated fatty acid (found in fish oil) and one group received a placebo, found that this supplement was associated with reduced polyp growth. Whether this is also true for people at average risk of bowel cancer, which is most of the population, is unknown.

And while only an observational study (meaning it only shows a correlation, and not that one caused the other), a study of bowel cancer patients showed improved survival was associated with daily consumption of coffee.

What to avoid

It’s best to avoid large quantities of meat. International cancer authorities affirm there is convincing evidence for a relationship between high meat intake and bowel cancer. This includes red meat, derived from mammalian muscle such as beef, veal, lamb, pork and goat, and processed meat such as ham, bacon and sausages.

Processed meats have undergone a preservation technique such as smoking, salting or the addition of chemical preservatives which are associated with the production of compounds that may be carcinogenic.

Evidence also suggests a “dose-response” relationship, with cancer risk rising with increasing meat intake, particularly processed meats. Current Australian guidelines suggest minimising intake of processed meats as much as possible, and eating only moderate amounts of red meat (up to 100g per day).

What else can I do to reduce the risk of bowel cancer?

The key to reducing cancer risk is leading an overall healthy lifestyle. Adequate physical activity and avoiding excess fat around the tummy area is important. Other unhealthy lifestyle behaviours such as eating lots of processed foods have been associated with increased cancer risk.

And for Australians over 50, participating in the National Bowel Cancer Screening program is one of the most effective, and evidence-based ways, to reduce your risk.




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The Conversation


Suzanne Mahady, Gastroenterologist & Clinical Epidemiologist, Senior Lecturer, Monash University

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

Vital Signs: economically, Australia is at risk of becoming Germany, and not in a good way



Once, emulating Germany would be something to be proud of. Not at the moment.
Shutterstock

Richard Holden, UNSW

It’s four years since then Prime Minister Tony Abbott warned Australia had been heading to “a Greek-style economic future”.

He was referring to what he said had been happening under the previous Labor government.

When Labor left office in 2013 the federal government’s budget deficit had been 3% of gross domestic product. The Greek government’s had been 7%.

The Australian government’s debt to GDP ratio was 20%. The Greek government’s was 177%.

Australia was never on the path to becoming an economic basket case like Greece, but right now we are on the road to becoming like another European nation.

It also starts with “G”.

Becoming economically like Germany isn’t as scary. But it is genuinely troubling nevertheless.

Germany is not in good shape

Germany’s GDP growth in the June quarter was minus 0.1%. That means economic activity shrank.

Its central bank, the Bundesbank, doesn’t see things getting better any time soon, saying growth “is probably set to remain lacklustre in the third quarter of 2019”.

Interest rates have fallen so low that investors are now paying the German government to take their money. The nominal interest rate on 2-year German government debt is -0.90%, and on extremely long-term 30-year bonds is -0.15%.




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That’s right: even for 30 years into the future, investors think its safer to lose money by parking funds with the German government than to try to make money by using them in other investments.

Put another way, markets think the German economy will be in trouble for decades, meaning short-term German interest rates will have to remain ultra-low for decades.

The German penchant for balanced budgets became (there’s really no other way to put it) fanatical in the wake on the financial crisis of 2008.

Like centre-right governments around the world – Britain was a leading example – a dark fiscal austerity took hold, at precisely the wrong time.




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2009 was a time of chronically weak private demand that required both lower interest rates and, as monetary policy was running out of steam, continuing budget deficits.

Instead Germany cut government spending, pushing the budget back into surplus
from 2014.

It didn’t get everything wrong.

As I wrote at the time, Germany was largely right to insist that Greece get its out-of-control spending and government debt under control.

But Germany’s approach to its own economy hurt it and other European economies such as Italy and Spain.

We’re turning German…

With apologies to British 1980s band The Vapors, we’re at risk of “Turning Germanese”.

Like Germany, our interest rates are getting close to zero. OK, Germany has negative nominal 30-year interest rates, but we’ve got negative real 10-year bond interest rates, and zero 30-year bond rates.

Both of our major political parties are gripped by balanced-budget fetishism, appearing to want to balance the budget regardless of the economic context.




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Again, here we are not quite as fanatical as Germany, but Labor seems determined to “out-surplus” the Coalition to prove its economic management credentials. And the government has made delivering a surplus the centrepiece of its economic agenda.

And, like in Germany, our economic growth is slowing. We don’t yet have negative GDP growth like in Germany, but we do have negative per capita GDP growth.

…but there’s time to pull back

RBA Governor Philip Lowe in a staged photo op with Treasurer Josh Frydenberg, July 11, 2019.
David Geraghty/AAP

Poor old Reserve Bank governor Philip Lowe has been pleading over and again for more aggressive government spending, particularly on infrastructure, to help complement what he is doing on interest rates.

A couple of cheesy photo ops with Treasurer Josh Frydenberg aside, there’s no evidence of him gaining any traction in Canberra.

Structurally balanced budgets are important, and thinking government debt doesn’t matter is deeply misguided.

But this is the situation we face:

  • private demand is chronically weak

  • our physical infrastructure has not kept pace with population growth and modern needs

  • our social infrastructure (including all levels of education) is not up to standard

  • interest rate cuts are running out of puff

  • the government can borrow in its own currency, long-term, for close to nothing

Any government that won’t borrow and spend up big and smart in these circumstances is making a huge mistake – one for which we and our children will pay dearly.

If we’re not careful the old Abbott narrative of “we’re about to become Greece” will become true, except about another country whose shoes we would rather not be in.




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Vital Signs: Amid talk of recessions, our progress on wages and unemployment is almost non-existent


The Conversation


Richard Holden, Professor of Economics, UNSW

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

India revokes Kashmir’s autonomy, risking yet another war with Pakistan


Kamran Khalid, University of Sydney

Tensions are on the rise in Jammu and Kashmir, an Indian state situated mostly in the Himalayas. For decades, it has had constitutional autonomy from India.

The region is an area of major territorial conflict between India and Pakistan. Parts of the Kashmir valley have been under Pakistan’s control since the 1948 Indo-Pakistani war and both India and Pakistan have since fought two more wars claiming title to Jammu and the whole of Kashmir.

But yesterday, the Indian Home Minister Amit Shah announced the government’s decision to take away Jammu and Kashmir’s special status. This status gave it the independence to have its own constitution, flag and the ability to make its own laws for its residents.




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To do this, the government has abolished Articles 370 and 35A of the Indian constitution, and announced a plan to divide the Indian state of Jammu and Kashmir into two union territories.

In recent weeks, India has discharged some 35,000 troops to the Indian parts of Kashmir, adding to the 500,000 troops already stationed in the territory. India also cancelled a major Hindu pilgrimage, asked tourists to leave and imposed curfews in parts of the state.

What’s more, major Jammu and Kashmir politicians, including two former chief ministers, have been arrested, schools and colleges have shut, and communication facilities have been suspended.

India cites the threat of militancy in the territory emanating from Pakistan as the reason for recent lockdown and security measures.

So what happens now?

From now on, Jammu and Kashmir will be considered a part of India, the same as other Indian states. It will be subject to the Indian constitution in its entirety.

The Indian government, following its election promises, claims that removing the special status will provide better economic and political opportunities in Jammu and Kashmir, the same as those available in mainland India.




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But skeptics believe that such a rushed move is merely a cover for changing the demographics of the Muslim-majority Kashmir to make it more Hindu, in the same way Israel expanded into Palestinian territories.

The abolition of Article 35A removes a constitutional hurdle for foreigners to buy land, settle in Jammu and Kashmir and increase the non-Muslim population there.

Until now, the expansion of the non-Muslim population was restricted due to strict property, political and entrepreneurial state laws for non-residents.

What does Article 370 do?

Adopted in 1949, Article 370 grants Jammu and Kashmir an autonomous status under the Indian constitution.

The article exempts the state from the terms of the constitution and limits the Indian Parliament in making laws for Jammu and Kashmir, except on matters of defence, external affairs and communications.

The Jammu and Kashmir legislature must approve any other law the Indian Parliament passes before it takes effect.

The article states that specific provisions in the Indian constitution can be extended to Jammu and Kashmir through presidential orders. But this can only happen with the agreement of the state government.

One such provision is Article 35A, which was passed through a presidential order in 1954. It allowed the Jammu and Kashmir legislature to define rights and privileges for the permanent residents of the territory.




Read more:
Kashmir conflict is not just a border dispute between India and Pakistan


Article 370 was first adopted as a temporary term under the “Temporary, Transitional and Special Provisions” section of India’s constitution when India had committed to holding a plebiscite in the territory to let the residents decide their political future.

But how valid is India’s move?

According to India’s constitution, Article 370 could only be modified or revoked at the recommendation of Jammu and Kashmir’s constituent assembly. The constituent assembly, however, dissolved itself in the 1950s, arguably entrenching Jammu and Kashmir’s autonomy in the Indian constitution permanently.

This means that abolishing Article 370 through yesterday’s presidential notification may be unconstitutional. And if this is the case, revoking the existing constitutional authority means India would be ruling Jammu and Kashmir by force.

Is conflict likely?

The predominantly Muslim Kashmiri population has strong reservations about an influx of Indians into their homelands, particularly since 2008. Then, the Jammu and Kashmir government agreed to grant 40 hectares of forestland to a Hindu pilgrimage site to provide for housing facilities for pilgrims, but was met with strong public protests against the idea.

Over the years, despite the Kashmiris’ concerns, the Indian right-wing groups, with the help of central government, have been encouraging Hindus to undertake the pilgrimage in big numbers.

Recently, US President Donald Trump offered to mediate the territorial conflict between Pakistan and India for a solution to the decades-old crises.

India has always maintained the dispute to be a bilateral issue between the two countries and refused to accept any third party’s involvement. Pakistan, on the other hand, regards it an international issue which, similar to the Israel-Palestine conflict, requires the UN and other international players to play their parts.




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But bringing Jammu and Kashmir under India’s rule means this dispute will become more internalised between the two countries. This is concerning to Pakistan and could, once again, reignite border tensions between the two countries.The Conversation

Kamran Khalid, PhD Candidate, University of Sydney

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

Are there certain foods you can eat to reduce your risk of Alzheimer’s disease?



Eating healthy foods doesn’t just improve our physical health. It can benefit our mental health, too.
From shutterstock.com

Ralph Martins, Macquarie University

With the rise of fad diets, “superfoods”, and a growing range of dietary supplement choices, it’s sometimes hard to know what to eat.

This can be particularly relevant as we grow older, and are trying to make the best choices to minimise the risk of health problems such as high blood pressure, obesity, type 2 diabetes, and heart (cardiovascular) problems.

We now have evidence these health problems also all affect brain function: they increase nerve degeneration in the brain, leading to a higher risk of Alzheimer’s disease and other brain conditions including vascular dementia and Parkinson’s disease.

We know a healthy diet can protect against conditions like type 2 diabetes, obesity and heart disease. Fortunately, evidence shows that what’s good for the body is generally also good for the brain.




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Oxidative stress

As we age, our metabolism becomes less efficient, and is less able to get rid of compounds generated from what’s called “oxidative stress”.

The body’s normal chemical reactions can sometimes cause chemical damage, or generate side-products known as free radicals – which in turn cause damage to other chemicals in the body.

To neutralise these free radicals, our bodies draw on protective mechanisms, in the form of antioxidants or specific proteins. But as we get older, these systems become less efficient. When your body can no longer neutralise the free radical damage, it’s under oxidative stress.

The toxic compounds generated by oxidative stress steadily build up, slowly damaging the brain and eventually leading to symptoms of Alzheimer’s disease.




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To reduce your risk, you need to reduce oxidative stress and the long-term inflammation it can cause.

Increasing physical activity is important. But here we are focusing on diet, which is our major source of ANTIoxidants.

Foods to add

There are plenty of foods you can include in your diet that will positively influence brain health. These include fresh fruits, seafood, green leafy vegetables, pulses (including beans, lentils and peas), as well as nuts and healthy oils.

Fish

Fish is a good source of complete protein. Importantly, oily fish in particular is rich in omega-3 fatty acids.

Laboratory studies have shown omega-3 fatty acids protect against oxidative stress, and they’ve been found to be lacking in the brains of people with Alzheimer’s disease.

They are essential for memory, learning and cognitive processes, and improve the gut microbiota and function.

Oily fish, like salmon, is high in omega-3 fatty acids, which research shows can benefit our brain health.
From shutterstock.com

Low dietary intake of omega-3 fatty acids, meanwhile, is linked to faster cognitive decline, and the development of preclinical Alzheimer’s disease (changes in the brain that can be seen several years before for onset of symptoms such as memory loss).

Omega-3 fatty acids are generally lacking in western diets, and this has been linked to reduced brain cell health and function.

Fish also provides vitamin D. This is important because a lack of vitamin D has been linked to Alzheimer’s disease, Parkinson’s disease, and vascular dementia (a common form of dementia caused by reduced blood supply to the brain as a result of a series of small strokes).

Berries

Berries are especially high in the antioxidants vitamin C (strawberries), anthocyanins (blueberries, raspberries and blackberries) and resveratrol (blueberries).

In research conducted on mouse brain cells, anthocyanins have been associated with lower toxic Alzheimer’s disease-related protein changes, and reduced signs of oxidative stress and inflammation specifically related to brain cell (neuron) damage. Human studies have shown improvements in brain function and blood flow, and signs of reduced brain inflammation.




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Red and purple sweet potato

Longevity has been associated with a small number of traditional diets, and one of these is the diet of the Okinawan people of Japan. The starchy staple of their diet is the purple sweet potato – rich in anthocyanin antioxidants.

Studies in mice have shown this potato’s anthocyanins protect against the effects of obesity on blood sugar regulation and cognitive function, and can reduce obesity-induced brain inflammation.

Green vegetables and herbs

The traditional Mediterranean diet has also been studied for its links to longevity and lower risk of Alzheimer’s disease.

Green vegetables and herbs feature prominently in this diet. They are rich sources of antioxidants including vitamins A and C, folate, polyphenols such as apigenin, and the carotenoid xanthophylls (especially if raw). A carotenoid is an orange or red pigment commonly found in carrots.

Green vegetables and herbs provide us with several types of antioxidants.
From shutterstock.com

The antioxidants and anti-inflammatory chemicals in the vegetables are believed to be responsible for slowing Alzheimer’s pathology development, the build up of specific proteins which are toxic to brain cells.

Parsley is rich in apigenin, a powerful antioxidant. It readily crosses the barrier between the blood and the brain (unlike many drugs), where it reduces inflammation and oxidative stress, and helps brain tissue recovery after injury.




Read more:
What is the Mediterranean diet and why is it good for you?


Beetroot

Beetroot is a rich source of folate and polyphenol antioxidants, as well as copper and manganese. In particular, beetroot is rich in betalain pigments, which reduce oxidative stress and have anti-inflammatory properties.

Due to its nitrate content, beetroot can also boost the body’s nitric oxide levels. Nitric oxide relaxes blood vessels resulting in lowered blood pressure, a benefit which has been associated with drinking beetroot juice.

A recent review of clinical studies in older adults also indicated clear benefits of nitrate-rich beetroot juice on the health of our hearts and blood vessels.

Foods to reduce

Equally as important as adding good sources of antioxidants to your diet is minimising foods that are unhealthy: some foods contain damaged fats and proteins, which are major sources of oxidative stress and inflammation.

A high intake of “junk foods” including sweets, soft drinks, refined carbohydrates, processed meats and deep fried foods has been linked to obesity, type 2 diabetes and cardiovascular disease.

Where these conditions are are all risk factors for cognitive decline and Alzheimer’s disease, they should be kept to a minimum to reduce health risks and improve longevity.




Read more:
Health check: can eating certain foods make you smarter?


The Conversation


Ralph Martins, Professor, Department of Biomedical Sciences, Macquarie University

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

Risk of shooting war with Iran grows after decades of economic warfare by the US



Iranian officials show off the U.S. drone they shot out of the sky.
Meghdad Madadi/Tasnim News Agency

David Cortright, University of Notre Dame

Many are worried about the risk of war between the U.S. and Iran. But the truth is, the U.S. has been fighting with Iran for decades in an economic war waged via sanctions – which is about to get a lot worse.

Concerns about a war of guns, warplanes and missiles grew after Iran shot down a U.S. spy drone amid already worsening tensions. President Donald Trump says he ordered a retaliatory strike in response – only to reverse course at the last minute.

Whether or not a shooting war does break out, the United States’ economic war has already been intensifying over the past year. On June 24, Trump imposed “hard-hitting” new sanctions on Iran in response to the attack on the drone.

Existing sanctions have already devastated innocent Iranians. Not only that, they’ve undermining long-accepted principles of international cooperation and diplomacy, a topic I’ve been researching for the past 25 years.

Carrots and sticks

Many nations have recognized that sanctions work best as tools of persuasion rather than punishment.

Sanctions by themselves rarely succeed in changing the behavior of a targeted state. They are often combined with diplomacy in a carrots-and-sticks bargaining framework designed to achieve negotiated solutions.

Indeed, the offer to lift sanctions can be a persuasive inducement in convincing a targeted regime to alter its policies, as was the case when successful negotiations involving the U.S. and Europe led to the Iran nuclear deal in 2015. That deal ended sanctions in exchange for Tehran shutting down much of its nuclear production capacity.

A year ago Trump withdrew the U.S. from that accord and not only reimposed previous sanctions but added further restrictions, including so-called secondary sanctions that penalize other countries for continuing to trade with Iran.

Protesters hold anti-war signs outside the White House.
AP Photo/Jacquelyn Martin

Multilateral vs unilateral sanctions

In an increasingly globalized world, unilateral sanctions like these – in which one country goes it alone – are rarely effective at achieving their end result, which in this case is regime change.

Multilateral sanctions involving several or many countries have greater impact and make it more difficult for targeted individuals or regimes to find alternative sources of oil or other goods. And getting authorization through the United Nations or regional organizations provides legal and political cover.

When the U.N. Security Council imposed targeted sanctions on Iran in 2006 over its illicit nuclear activities, for example, members of the European Union were able to join the U.S. and other countries in applying pressures that brought Iran to the bargaining table. That’s what led to the negotiated nuclear deal nine years later.

The U.S. circumvented this voluntary multilateral process when it withdrew from the accord and unilaterally imposed “extraterritorial secondary sanction.” These barred nations or companies that buy Iranian oil or other sanctioned products from doing business in the U.S.

Although most countries disagree with the U.S. withdrawal from the Iran deal and some reject such sanctions as an infringement on their own sovereignty, they are powerless. They cannot afford to lose access to dollar financing and the U.S. economy and thus are forced against their will to do Washington’s bidding.

Iranians pay the price

And the Iranian people are paying the price.

Oil exports and national income are dropping, inflation is rising and economic hardships are mounting. The Iranian rial lost more than 60% of its value in the last year, eroding the savings of ordinary Iranians.

Life is becoming increasingly difficult for working families struggling to make ends meet. There are indications that the new sanctions are inhibiting the flow of humanitarian goods and contributing to shortages in specialized medicines to treat ailments such as multiple sclerosis and cancer.

Cargill and other global food giants have halted shipments to Iran because of the lack of available financing.

Punishment of the Iranian people seems to be a deliberate policy. When asked recently how the administration expects sanctions to change the behavior of the Iranian government, Secretary of State Mike Pompeo acknowledged they won’t be able to do that and instead suggested it’s up to the people to “change the government.”

In other words, the pain of sanctions will force people to rise up and overthrow their leaders. This is as naïve as it is cynical. It reflects the long-discredited theory that sanctioned populations will direct their frustrations and anger at national leaders and demand a change in policy or the regime. Sanctions have never worked for this purpose.

The more likely result is the classic “rally around the flag” effect. Iranians are critical of their government’s economic policies, but they also blame Trump for the hardships resulting from sanctions. Governments subjected to sanctions are adept at blaming economic hardships on their external adversaries, as Iran’s religious and elected leaders are doing now against the United States.

Tehran is likely to respond to tightening sanctions by giving greater authority to companies associated with the Iranian Revolutionary Guard Corps, a major branch of the Iranian military, further empowering the very hard-line forces Washington claims to oppose.

The White House is ignoring these realities and adding to the already draconian sanctions, while threatening and making preparations for military strikes, hoping that economic pain and military pressure will make Iran’s leaders cry uncle. There is no sign of surrender yet from Tehran, nor is there likely to be, until the two sides pull back from the brink and agree to negotiate a diplomatic settlement.

This is an updated version of an article originally published on May 23, 2019.The Conversation

David Cortright, Director of Policy Studies, Kroc Institute for International Peace Studies, University of Notre Dame

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

Had gestational diabetes? Here are 5 things to help lower your future risk of type 2 diabetes



For women who have had gestational diabetes, maintaining a healthy diet can help lower the risk of developing type 2 diabetes later on.
From shutterstock.com

Clare Collins, University of Newcastle; Hannah Brown, University of Newcastle, and Megan Rollo, University of Newcastle

Gestational diabetes is a specific type of diabetes that occurs in pregnancy.

Once you’ve had gestational diabetes, your risk of having it again in your next pregnancy is higher. So too is your lifetime chance of developing type 2 diabetes and heart disease.

The good news is taking steps such as adopting a healthier diet and being more active will lower those risks, while improving health and well-being for you and your family.




Read more:
Gestational diabetes in the mother increases Type 1 and Type 2 diabetes risks for the whole family


What is gestational diabetes?

Gestational diabetes affects about one in seven to eight pregnant women in Australia.
Women are screened for gestational diabetes at around 24 to 28 weeks gestation using a glucose tolerance test. Gestational diabetes is diagnosed when blood glucose levels, also called blood sugar levels, are higher than the normal range.

Screening is designed to ensure women with gestational diabetes receive treatment as early as possible to minimise health risks for both the mother and the baby. Risks include having a baby born weighing more than four kilograms, and the need to have a caesarean section. Management of gestational diabetes includes close monitoring of blood glucose levels, a healthy diet, and being physically active.

The risk of developing type 2 diabetes increases markedly in the first five years following gestational diabetes, with risk plateauing after ten years. Women who have had gestational diabetes have more than seven times the risk of developing type 2 diabetes in the future than women who haven’t had the condition.

Type 2 diabetes

If type 2 diabetes goes undiagnosed, the impact on your health can be high – especially if it’s not detected until complications arise.

Early signs and symptoms of type 2 diabetes include extreme thirst, frequent urination, blurred vision, frequent infections and feeling tired and lethargic.

Doing regular exercise can lessen the risk of developing type 2 diabetes.
From shutterstock.com

Long-term complications include an increased risk of heart disease and stroke, damage to nerves (especially those in the fingers and toes), damage to the small blood vessels in the kidneys, leading to kidney disease, and damage to blood vessels in the eyes, leading to diabetes-related eye disease (called diabetic retinopathy).

If you’ve ever been diagnosed with gestational diabetes, here are five things you can do to lower your risk of developing type 2 diabetes.

1. Monitor your diabetes risk

Although gestational diabetes is a well-known risk factor for type 2 diabetes, some women have not been informed of the increased risk. This means they may not be aware of the recommendations to help prevent type 2 diabetes.

All women diagnosed with gestational diabetes should have a 75g oral glucose tolerance test at 6–12 weeks after giving birth. This is to check how their body responds to a spike in blood sugar after they’ve had the baby, and to develop a better picture of their likelihood of developing type 2 diabetes.

From that point, women who have had gestational diabetes should continue to have regular testing to see whether type 2 diabetes has developed.

Talk to your GP about how to best monitor diabetes risk factors. Diabetes Australia recommends a blood glucose test every one to three years.

2. Aim to eat healthily

Dietary patterns that include vegetables and fruit, whole grains, fish and foods rich in fibre and monounsaturated fats are associated with a lower risk of developing type 2 diabetes.

In more than 4,400 women with prior gestational diabetes, those who had healthier eating patterns, assessed using diet quality scoring tools, had a 40-57% lower risk of developing type 2 diabetes compared with women with the lowest diet quality scores.




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Are you at risk of being diagnosed with gestational diabetes? It depends on where you live


Glycaemic index (GI) ranks carbohydrate-containing foods according to their effect on blood glucose levels. The lower the GI, the slower the rise in blood sugar levels after eating. Research suggests that a higher GI diet, and consuming lots of high GI foods (glycaemic load), is associated with a higher risk of developing type 2 diabetes, while a lower GI diet may lower the risk of type 2 diabetes.

Take our Healthy Eating Quiz to check how healthy your diet is and receive personal feedback and suggestions on how to boost your score.

3. Be as active as possible

Increasing your physical activity level can help lower your risk of developing type 2 diabetes.

Engaging in 150 minutes of moderate-intensity exercise per week, such as walking for 30 minutes on five days a week; or accumulating 75 minutes of vigorous-intensity physical activity a week by swimming, running, tennis, cycling, or aerobics, is associated with a 45% lower risk of developing type 2 diabetes after having had gestational diabetes. Importantly, both walking and jogging produced a similar lower risk of type 2 diabetes.

In contrast, prolonged time spent watching TV was associated with a higher risk of type 2 diabetes in women with a history of gestational diabetes.

Strength training is also important. A large study of 35,754 healthy women found those who engaged in any type strength training, such as pilates, resistance exercise or weights, had a 30% lower rate of developing type 2 diabetes compared to women who did not do any type of strength training.

Women who did both strength training and aerobic activity had an even lower risk of developing either type 2 diabetes or heart disease.

Breastfeeding has been shown to reduce the risk of type 2 diabetes, even in mums who haven’t had gestational diabetes.
From shutterstock.com

4. Breastfeed for as long as you can

Research shows breastfeeding for longer than three months reduces the risk of developing type 2 diabetes by about 46% in women who have had gestational diabetes. It is thought that breastfeeding leads to improved glucose and fat metabolism.

The Nurses Health Study followed more than 150,000 women over 16 years. It found that for every additional year of breastfeeding, the risk of developing type 2 diabetes was reduced by 14-15% – even in mothers who had not been diagnosed with gestational diabetes.

Organisations such as the Australian Breastfeeding Association and lactation consultants offer support to help all women, including those who have had gestational diabetes, to breastfeed their infants for as long as they choose.




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5. Keep an eye on your weight

Weight gain is a known risk factor for developing type 2 diabetes. In a study of 666 Hispanic women with previous gestational diabetes, a weight gain of 4.5kg during 2.2 years follow-up increased their risk of developing type 2 diabetes by 1.54 times.

Another study saw 1,695 women with previous gestational diabetes followed up between eight to 18 years after their diagnosis. This research found that for each 5kg of weight gained, the risk of developing type 2 diabetes increased by 27%.

Aiming to modify your eating habits and being as active as you can will help with weight management and lower the risk of developing type 2 diabetes. Within interventions that support people to adopt a healthy lifestyle, one review found every extra kilogram lost by participants was associated with 43% lower odds of developing type 2 diabetes.




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The Conversation


Clare Collins, Professor in Nutrition and Dietetics, University of Newcastle; Hannah Brown, PhD Candidate Nutrition and Dietetics, University of Newcastle, and Megan Rollo, Postdoctoral Research Fellow, Nutrition & Dietetics, University of Newcastle

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

Obesity has become the new normal but it’s still a health risk



Exercise is good for you, no matter what your weight.
Pressmaster/Shutterstock

Tim Olds, University of South Australia

Nike’s London store recently introduced a plus-sized mannequin to display its active clothing range which goes up to a size 32.

The mannequin triggered a cascade of responses ranging from outrage to celebration. One side argues that the mannequin normalises obesity and leads obese people to feel that they are healthy when in fact they are not.

The other side argues the representations are inclusive, combat fat stigma and encourage fat women to exercise.

Both arguments have some merit.

The representations of bodies we see around us — including shop mannequins – affect the way we calibrate our sense of what is normal and acceptable. And obesity is indeed associated with a greater risk of heart disease, stroke, type 2 diabetes and early death.

It is possible to be metabolically healthy and fat. But even metabolically healthy obese people may still have a shorter life expectancy than their lean peers.

On the other hand, exercise is almost universally beneficial, and people of all shapes and sizes should be encouraged to participate.




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Overweight and obesity have become the new normal

Based on body mass index (BMI), about two-thirds of Australian adults and one-quarter of kids are overweight or obese. While this proportion has flattened out for children in the last 20 years, it continues to rise for adults.

There is strong evidence parents consistently misjudge the weight status of their children because they see more and more fat kids.

The same is true for adults: a recent study from the United Kingdom found 55% of overweight men and 31% of overweight women considered their weight to be in the healthy range.




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I would guess the Nike mannequin is close to 100 kg, with a BMI maybe in the low 30s, well into the obese category.

But given the average female shop mannequin has a BMI of about 17, there are probably at least ten times as many Australian women like the plus-size mannequins than like the usual minus-size variety.

Obesity is not a lifestyle choice like smoking

Obesity is necessarily the result of behaviours — eating too much, exercising too little — albeit heavily constrained by genetic predispositions, and social and economic pressures.

But unlike, say, smoking, being fat is also part of what a person is: most people who are fat have usually been fat for a long time. It’s not something a person has complete control over.

Divergent paths into fat and lean start very young, and once you’re on the obesity train it’s hard to get off.

While it is possible to “give up obesity”, for many it can be a very hard road, involving a lifelong struggle with hunger and recidivism.




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Empowering vs shaming

Anti-obesity campaigns that are built on disgust, fear or shame – such as Measure Up – have been criticised as being stigmatising, ethically problematic and ineffective.

Australia’s 2009 Measure Up campaign is built on fear and shame.

There has, to my knowledge, been no high-quality research comparing the actual effectiveness of shaming versus empowering anti-obesity, or pro-physical activity, campaigns.

However a number of studies show, unsurprisingly, that obese and inactive people prefer empowering campaigns, find them more motivating and less stigmatising.

Health risks of obesity

It has been argued one can be “fit and healthy at any size”: that an obese person can be as fit and healthy as a lean person.

Depending on definitions, about 25-50% of obese people have “metabolically healthy obesity” – normal levels of inflammation, blood sugar, insulin, blood fats, and blood pressure. Other than being obese, these people appear healthy.

But obese people — fit or unfit, active or not — remain on average at greater risk of heart disease, diabetes and early death than lean people with similar behaviours.

Similarly, the claim that people can be both fit and fat, and that fit, fat people are at less risk than unfit, lean people depends on how we define fitness and fatness.

One study, for example, might compare overweight people in the top 20% of fitness with lean people in the bottom 20%. Because there are modest differences in fatness and big differences in fitness, fat people are much more likely to have a similar risk to lean people.

But if another study compares obese people in the top 50% of fitness to lean people in the bottom 50%, the fatter people will be much less healthy.

What is certain is that whoever you are, exercise will almost certainly improve your health.




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The Nike mannequin controversy is a morality tale of how we navigate between the devil of normalising obesity and the deep blue sea of excluding obese people from the world of exercise.

Obesity has been called both a disability and a disease, and just another way of being in the world. The reality is that for most people, it’s something in between.The Conversation

Tim Olds, Professor of Health Sciences, University of South Australia

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

After the floods come the mosquitoes – but the disease risk is more difficult to predict


Cameron Webb, University of Sydney

We’re often warned to avoid mosquito bites after major flooding events. With more water around, there are likely to be more mosquitoes.

As flood waters recede around Townsville and clean-up efforts continue, the local population will be faced with this prospect over the coming weeks.

But whether a greater number of mosquitoes is likely to lead to an outbreak of mosquito-borne disease is tricky to predict. It depends on a number of factors, including the fate of other wildlife following a disaster of this kind.

Mozzies need water

Mosquitoes lay their eggs in and around water bodies. In the initial stages, baby mosquitoes (or “wrigglers”) need the water to complete their development. During the warmer months, it doesn’t take much longer than a week before they are grown and fly off looking for blood.

So the more water, the more mosquito eggs are laid, and the more mosquitoes end up buzzing about.

But outbreaks of disease carried by mosquitoes are dependent on more than just their presence. Mosquitoes rarely emerge from wetlands infected with pathogens. They typically need to pick them up from biting local wildlife, such as birds or mammals, before they can spread disease to people.




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Mosquitoes and extreme weather events

Historically, major inland flooding events have triggered significant outbreaks of mosquito-borne disease in Australia. These outbreaks have included epidemics of the potentially fatal Murray Valley encephalitis virus. In recent decades, Ross River virus has more commonly been the culprit.

A focal point of the current floods is the Ross River, which runs through Townsville. The Ross River virus was first identified from mosquitoes collected along this waterway. The disease it causes, known as Ross River fever, is diagnosed in around 5,000 Australians every year. The disease isn’t fatal but it can be seriously debilitating.

Following substantial rainfall, mosquito populations can dramatically increase. Carbon dioxide baited light traps are used by local authorities to monitor changes in mosquito populations.
Cameron Webb (NSW Health Pathology)

In recent years, major outbreaks of Ross River virus have occurred throughout the country. Above average rainfall is likely a driving factor as it boosts both the abundance and diversity of local mosquitoes.

Flooding across Victoria over the 2016-2017 summer produced exceptional increases in mosquitoes and resulted in the state’s largest outbreak of Ross River virus. There were almost 1,700 cases of Ross River virus disease reported there in 2017 compared to an average of around 300 cases annually over the previous 20 years.




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Despite plagues of mosquitoes taking advantage of flood waters, outbreaks of disease don’t always follow.

Flooding resulting from hurricanes in North America has been associated with increased mosquito populations. After Hurricane Katrina hit Louisiana and Mississippi in 2005, there was no evidence of increased mosquito-borne disease. The impact of wind and rain is likely to have adversely impacted local mosquitoes and wildlife, subsequently reducing disease outbreak risk.

Applying insect repellent is worthwhile even if the risk of mosquito-borne disease isn’t known.
From shutterstock.com

Australian studies suggest there’s not always an association between flooding and Ross River virus outbreaks. Outbreaks can be triggered by flooding, but this is not always the case. Where and when the flooding occurs probably plays a major role in determining the likelihood of an outbreak.

The difficulty in predicting outbreaks of Ross River virus disease is that there can be complex biological, environmental and climatic drivers at work. Conditions may be conducive for large mosquito populations, but if the extreme weather events have displaced (or decimated) local wildlife populations, there may be a decreased chance of outbreak.

This may be why historically significant outbreaks of mosquito-borne disease have occurred in inland regions. Water can persist in these regions for longer than coastal areas. This provides opportunities not only for multiple mosquito generations, but also for increasing populations of water birds. These birds can be important carriers of pathogens such as the Murray Valley encephalitis virus.




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In coastal regions like Townsville, where the main concern would be Ross River virus, flood waters may displace the wildlife that carry the virus, such as kangaroos and wallabies. For that reason, the flood waters may actually reduce the initial risk of outbreak.

Protect yourself

There is still much to learn about the ecology of wildlife and their role in driving outbreaks of disease. And with a fear of more frequent and severe extreme weather events in the future, it’s an important area of research.

Although it remains difficult to predict the likelihood of a disease outbreak, there are steps that can be taken to avoid mosquito bites. This will be useful even if just to reduce the nuisance of sustaining bites.

Cover up with long-sleeved shirts and long pants for a physical barrier against mosquito bites and use topical insect repellents containing DEET, picaridin, or oil of lemon eucalyptus. Be sure to apply an even coat on all exposed areas of skin for the longest lasting protection.The Conversation

Cameron Webb, Clinical Lecturer and Principal Hospital Scientist, University of Sydney

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

Why people born between 1966 and 1994 are at greater risk of measles – and what to do about it



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People may unknowingly bring measles back from other countries, including Europe.
Matej Kastelic/Shutterstock

Kristine Macartney, University of Sydney and Lucy Deng, University of Sydney

Australia was declared free of measles in 2014. Yet this summer we’ve seen nine cases of measles in New South Wales, and others in Victoria, Western Australia, South Australia and Queensland.

High vaccination rates in Australia means the measles virus doesn’t continuously spread, but we still have “wildfire” outbreaks when travellers bring measles into the country, often unknowingly.

If you haven’t received two doses of measles vaccine, you are at risk of contracting measles.




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How can you catch it?

Measles is a highly contagious virus that spreads by touching or breathing in the same air as an infected person. The virus stays alive in the air or on infected surfaces for up to two hours.

An infected person is contagious from the first day of symptoms (fever, cough and runny nose). These general symptoms start about four days before the rash develops, meaning contagious people can spread the virus even before they realise they have measles.

If you’re not immune to the virus, through vaccination or past infection, the chance of becoming ill after being near someone with measles is 90%. Being in the same café, waiting in line at the checkout or flying on the same aeroplane as an infected person could be enough to pick up the disease.

Why is it so dangerous?

Measles causes a fever, cough, and a rash that starts around the hairline and then spreads to the whole body.

The red rash starts around the hairline, then spreads.
Phichet Chaiyabin/Shutterstock

It can also cause middle ear infections (otitis media), chest infections (pneumonia), and diarrhoea.

Swelling and inflammation to the brain (encephalitis) occurs in 1 in every 1,000 cases and can lead to permanent brain damage or death. In 2017, 110,000 people died from measles worldwide.

Even after surviving the initial illness, measles can cause a devastating and fatal complication known as subacute sclerosing panencephalitis (inflammation of the brain) many years later.

Why are people in their 20s to 50s more at risk?

To protect yourself against measles, you need two doses of measles-mumps-rubella (MMR) vaccine.

Children in Australia routinely get this vaccine at 12 and 18 months of age. The second dose is given in combination with the chickenpox vaccine.




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It’s important to have two doses of MMR vaccine, especially if you haven’t reached your mid-50s. Most people older than this would have been infected with measles before vaccination was routine.

People aged in their 20s to early 50s (those born from 1966 and 1994) are most likely to have only had one dose of MMR vaccine.

While we’ve had the measles vaccine in Australia since 1968, a two-dose program was only introduced in 1992. A brief school-based catch-up program from 1993 to 1994 offered school children a second dose. Another school-based program provided children with catch-up vaccinations in 1998*.

For those who missed out on the school program, catch-up vaccinations were given on an ad-hoc basis via GP clinics.

So not everyone in this age group would have received two doses of the measles vaccine.

If you are this age, you may not be not fully protected against measles. Checking with a GP or immunisation nurse is the best way to be sure. They will check your records, and may do a blood test if you have no proof of immunisation.

Even if you can’t be sure of past vaccinations, it’s still safe to have an extra vaccine. And it’s free for those who need a catch-up dose.

It’s not harmful to have an additional dose of the MMR vaccine.
Shutterstock

If you have a child under 12 months of age and you’re heading to a country with measles, an early additional vaccine dose can be given to protect your baby from measles. This ideally should be done at least a month before you travel, to ensure an immune response has time to develop. The routine scheduled doses at 12 months and 18 months will still need to be given later.




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What if you’re not protected?

Unfortunately, there is no treatment for measles. Getting adequately vaccinated is the best form of defence against this serious disease.

If you think you’ve been exposed or may be ill from measles, see your GP or call Health Direct or your public health department as soon as possible.

If exposed, but not yet ill, it may not be too late to get a protective vaccine and ensure you don’t spread the disease to others.

If you are unwell, and suspect measles, call ahead to let the clinic know so they can make provisions to keep you away from other patients in the waiting room.

Other, more common, diseases can look like measles, so an urgent specific test (throat swab) must be done to confirm the infection. If measles is proven, public health workers will trace your contacts and your treating doctor will monitor you for complications.

Are we at risk of measles returning in Australia?

Australia currently has all-time high vaccine coverage, with 94.5% of five-year-old children fully immunised at the end of 2017.

By keeping vaccine coverage near or above 95%, herd immunity where there are enough people vaccinated helps prevent measles from spreading to others, including those who cannot be vaccinated.

But in our interconnected world, we must work together to reduce the threat of measles worldwide by boosting immunisation programs in regions with low coverage, including in the Asia Pacific.




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Measles have resurfaced in some countries due to falls in vaccine coverage from unfounded safety concerns as well as weak health systems. In the first six months of last year, for instance, Europe had 41,000 cases of measles, nearly double the total number of the previous year. This, among other factors, has prompted the World Health Organisation to list vaccine hesitancy as a top ten threat to global health in 2019.

A continued global coordinated effort will be required to maintain elimination and prevent resurgence of this deadly disease in Australia.

* Correction: this article has been updated to note a school-based catch-up program also operated in 1998.The Conversation

Kristine Macartney, Professor, Discipline of Paediatrics and Child Health, University of Sydney and Lucy Deng, Staff Specialist Paediatrician, National Centre for Immunisation Research and Surveillance; Clinical Associate Lecturer, Children’s Hospital Westmead Clinical School, University of Sydney

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