What employers need to know: the legal risk of asking staff to work in smokey air


Elizabeth Shi, RMIT University

Amid thick bushfire smoke in cities including Canberra and Melbourne, employers need to consider their legal obligations.

Some have directed their workers not to turn up in order to avoid to occupational health and safety risks. Among them is the Commonwealth department of home affairs which last week asked most of its staff to stay away from its Canberra headquarters for 48 hours.

Other employers want to know where they stand.



Each state and territory has its own occupational health and safety laws.
However most line up with the so-called Model Act, a federal act of parliament intended to harmonise state laws.

Under section 17 it imposes on employers a duty to, so far as is reasonably practicable, ensure health and safety by eliminating or minimising risks.

This employer’s duty applies not only to its employees, but also to other types of workers including independent contractors.

Meaning of ‘reasonably practical”

Under the section 18 of the Model Act, “reasonably practicable” means

that which is, or was at a particular time, reasonably able to be done in relation to ensuring health and safety, taking into account and weighing up all relevant matters

By themselves, these words aren’t much of a guide, so the Act includes examples of “relevant matters”, among them:

  • the likelihood of a hazard or risk occurring

  • the degree of harm that might result

  • what the employer knows or ought reasonably know about the hazard or risk, and ways of eliminating or minimising hazard or risk

  • the availability and suitability of ways to eliminate or reduce hazard or risk

  • the cost associated with available ways of eliminating or minimising the risk, including whether the cost is grossly disproportionate to the risk

Meaning of ‘likelihood’

Employers should make themselves aware of the risk of an air quality hazard.
This can be achieved by checking the most up to date air quality index in the location on an environment protection authority website:

NSW

Victoria

Queensland

South Australia

Western Australia

Tasmania

Northern Territory

Australian Capital Territory

Workers who work outdoors are more likely to be subject to harmful effects of bushfire smoke than indoor workers.

They are more likely to experience irritation to their airways, nose and eyes.

They might also experience low visibility which might make their work more dangerous.

The machines they operate could also be impacted by the smoke and dust in a way which would make operating them more dangerous.

Special measures should be taken to protect workers who work outdoors, such as providing them with face masks or rescheduling their work.

Smoke emissions from the Australian bushfires from 1 December 2019 to 4 January 2020.

Meaning of ‘degree of harm’

Asthma suffers might be at greater risk.

It is certainly arguable the likelihood of harm for indoor workers is much lower, especially if the air quality in their workplace is the same or even better than the air quality in their homes.

Employers should have up-to-date information about the health of their workers, especially those workers who have pre-existing conditions that might predispose them to harm from smoke.

Among these would be workers who have asthma or other respiratory disorders.

Special steps should be taken to protect them, taking into account their pre-existing conditions.

Meaning of ‘reasonably ought to know’

Employers should be checking up-to-date information on an environment protection authority website and on the website of Safe Work Australia which is the Commonwealth regulator for occupational health and safety laws.

It’s very likely law enforcers will presume the information on these websites constitute information the employer ought to have known in determining the appropriate action to take.

For example, it would be difficult for an employer to argue they didn’t know P2 rated face masks should be provided to workers when the Safe Work Australia website specifically mentions them as an appropriate way of eliminating or reducing air quality hazards.

Meaning of ‘availability of ways to reduce risk’

Safe Work Australia directs employers to have in place measures to manage the risks to health and safety of working outdoors when air quality is reduced, including:

  • working indoors (where possible)

  • rescheduling outdoor work until conditions improve

  • ensuring buildings and equipment are functioning correctly and have not been affected by dust or debris

  • cleaning dust and debris off outdoor surfaces

  • providing personal protective equipment such as eye protection and correctly fitted P2-rated face masks.

Meaning of ‘cost of minimising hazard’

The cost of elimination or minimising hazard will be higher for some measures than others.

For example, it might cost more to direct workers to stay home than to provide face masks.




Read more:
Our buildings aren’t made to keep out bushfire smoke. Here’s what you can do


These costs need to be weighed up against the likelihood and degree of potential harm.

If the likelihood and degree of harm is high, it’s unlikely law enforcers will be particularly sympathetic to arguments about cost.The Conversation

Elizabeth Shi, Senior Lecturer, Graduate School of Business and Law, RMIT University

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

Pregnant women should take extra care to minimise their exposure to bushfire smoke



Pregnant women should try to stay inside when the air pollution is high.
From shutterstock.com

Sarah Robertson, University of Adelaide and Louise Hull, University of Adelaide

Smoke haze from Australia’s catastrophic bushfires is continuing to affect many parts of the country.

Although there’s no safe level of air pollution, the health hazards tend to be greatest for vulnerable groups. Alongside people with pre-existing conditions, smoke exposure presents unique risks for pregnant women.

Research shows prolonged exposure to bushfire smoke increases the risk of pregnancy complications including high blood pressure, gestational diabetes, low birth weight and premature birth (before 37 weeks).

These conditions can have short-term and lifelong effects on a baby’s health, with increased risk of conditions including cerebral palsy and visual or hearing impairment. Even babies born only a few weeks early can experience learning difficulties and behavioural problems, and have an elevated risk of heart disease in later life.

So it’s especially important pregnant women protect themselves from exposure to bushfire smoke.




Read more:
How does poor air quality from bushfire smoke affect our health?


Why are pregnant women at higher risk?

Pregnant women breathe at an increased rate, and their hearts need to work harder than those of non-pregnant people to transport oxygen to the fetus. This makes them particularly vulnerable to the effects of air pollution, including bushfire smoke.

We often measure poor air quality by the presence of ultra-fine particles called PM2.5 (small particles of less than 2.5 micrometres in size). These particles are concerning because they can penetrate into our lungs, and into blood and tissue to cause inflammation throughout the body.

Importantly in pregnant women, environmental pollutants can cause inflammatory damage to the placenta’s blood supply. This can interfere with the placenta’s development and function, which can in turn compromise the growth of the fetus.

What the evidence says

Many studies have linked poor air quality, particularly high PM2.5 levels, to poor pregnancy outcomes. Data from 183 countries showed in 2010, an estimated 2.7 million premature births, 18% of the total, were associated with PM2.5 pollution.

A 2019 study of more than 500,000 pregnant women from Colorado looked at the effect of bushfire smoke on pregnancy outcomes. The authors analysed data on air quality, fire incidence and pregnancy and birth records from 2007-2015, during which time Colorado was regularly affected by smoke from fires burning in California and the Pacific Northwest.

The study found PM2.5 due to bushfire smoke was linked to spikes in premature birth, especially in women exposed during the second trimester.

In women exposed to smoke during the first trimester, birth weight was lower than average. Further, exposure during any trimester increased the chance of gestational diabetes and high blood pressure.

The effects were detectable even with low exposure to smoke and small increases in PM2.5. For every 1 microgram/m³ increase in average daily exposure to PM2.5 during the second trimester of pregnancy, the risk of premature birth increased by 13%.

To put this into context, in Canberra in the first week of January, PM2.5 levels averaged more than 200 micrograms/m³, compared with the typical background concentration of 5 micrograms/m³. EPA Victoria classifies PM2.5 levels above 25 micrograms/m³ as unsafe for vulnerable people.




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In another large study, a 24% increase in premature birth was seen after 10 micrograms/m³ increase in PM2.5.

As well as PM2.5, bushfire smoke contains larger PM10 particles, nitric oxides, carbon monoxide and other gases and toxic chemicals. These all have potential to impair lung and heart function in the mother, activate inflammation, and directly affect fetal and placental development.

Smoke threatens fertility, too

Air quality is also a factor for couples attempting to conceive or dealing with infertility.

Population studies suggest air pollution compromises human fertility by reducing ovarian reserve (the number of eggs in the ovary) and affecting sperm number and movement.

Direct exposure to fire, burns and fire retardant chemicals can also negatively impact fertility.




Read more:
How to monitor the bushfires raging across Australia


Precautions to take if you’re pregnant

The best strategy is to reduce smoke exposure as much as possible. Recommendations from NSW Health include staying inside on high-risk days, sealing the house to prevent smoke infiltration and using air conditioning to keep cool.

Avoid creating smoke by cigarette smoking, burning candles, or frying and grilling. Use PM2 (N95) masks and air-filtering devices if possible, and avoid exposure to ash, which contains particulate material you can inhale.

Studies have shown when women are exposed to bushfire smoke during pregnancy, the rates of premature birth increase.
From shutterstock.com

Pregnant women in a fire region should carefully follow emergency services’ direction. It’s better to evacuate early, with an emergency supply kit containing clothes, medications, water and food you don’t need to cook.

Make sure your medication and prenatal vitamins are accessible, continue to take them, and stay well hydrated. Inform authorities and shelters you are pregnant and need to maintain your antenatal care.

Be aware of the signs of premature labour including abdominal cramps or contractions, a heavy vaginal discharge, loss of fluid or vaginal bleeding, pelvic pressure and low backache. Seek help if you think you may be going into labour.

Given what we know about the consequences of poor air quality on pregnancy outcomes, it’s critical pregnant women are given top priority when it comes to bushfire relief and health care support.




Read more:
From face masks to air purifiers: what actually works to protect us from bushfire smoke?


The Conversation


Sarah Robertson, Professor and Director, Robinson Research Institute, University of Adelaide and Louise Hull, Associate Professor and Fertility and Conception Theme Leader, The Robinson Research Institute, University of Adelaide

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

A hot and dry Australian summer means heatwaves and fire risk ahead


Catherine Ganter, Australian Bureau of Meteorology and Andrew B. Watkins, Australian Bureau of Meteorology

Summer is likely to start off hot and dry, according to the Bureau of Meteorology’s summer outlook, released today.

Much of eastern Australia is likely to be hotter and drier than average, driven by the same climate influences that gave us a warmer and drier than average spring.




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But these patterns will break down over summer, meaning these conditions may ease for some areas in the second half of the season. Despite this, we’re still likely to see more fires, heatwaves, and dust across eastern Australia in the coming months.

Rainfall outlook for December 2019.
BOM

What drove the climate in 2019

Our current weather comes in the context of a changing climate, which is driving a drying trend across southern Australia and general warming across the country.

In southern Australia, rain during the April to October “cool season” is crucial to fill dams and grow crops and pasture. However, like 17 of the previous 20 cool seasons, 2019 was well below average, meaning a dry landscape leading into the summer months.

The frequency of high temperatures has also increased at all times of year, with the greatest increase in spring.

But summer, like spring, will also be influenced by two other significant climate drivers: a change in ocean temperatures in the Indian Ocean, and warm winds above Antarctica pushing our weather systems north.

Indian Ocean

The first driver is a near-record strong positive Indian Ocean Dipole (IOD). A positive IOD occurs when warmer than average water develops near the Horn of Africa, and cooler waters emerge off Indonesia.

This pattern draws moisture towards Africa – where in recent weeks they have seen flooding and landslides – and produces higher pressures over central and southern Australia. This means less rain for Australia in winter and spring.

Usually the IOD events break down by early summer, when the monsoon arrives in the southern hemisphere. However, this year the monsoon has been very sluggish moving south – in fact it was the latest retreat on record from India – and international climate models suggests the positive IOD may not end until January.

Rainfall outlook for summer 2019-20.
BOM

Southern Ocean

The other unusually persistent climate driver is a negative Southern Annular Mode (SAM), which means weather systems over the Southern Ocean – the fronts and lows and wild winds – are further north than usual. This means more days of westerly winds for Australia.

In western Tasmania, where those winds are coming off the ocean, it means cooler and wetter weather. In contrast, in southeast Queensland and New South Wales, where westerlies blow across long fetches of land, this air is dry and hot.

This persistent period of negative SAM in 2019 was triggered by a sudden warming of the stratosphere above Antarctica – a rare event identified in early September.




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Models suggest the negative SAM will decay in December. This means the second half of summer is less likely to be influenced by as many periods of these strong westerlies.

But while both these dry climate drivers are expected to be gone by midsummer, their legacy will take some time to fade.

The positive IOD and the dry conditions we have seen in winter and spring are associated with severe fire seasons for southeast Australia in the following summer.

And while the drying influences are likely to ease, the temperature outlook indicates that days are very likely to remain warmer than average.

We also know that any delay in the monsoon will keep air drier for longer across Australia, and potentially aid in heating up the continent.

Maximum temperature outlook for summer 2019-20.
BOM

What about the wet season?

For areas of southern Queensland and northeastern NSW, the wet season will eventually bring seasonal rains, although heatwaves are likely to continue through summer.

So, while the outlook for below average rainfall may ease over summer months for some areas, the lead-up to summer means Australia’s landscape is already very dry. Even a normal summer in the south will mean little easing of the dry until at least autumn.

With dry and hot conditions looking likely this summer, it’s important to stay safe, have an emergency plan in place, look after your friends and neighbours in the hot times, and always listen to advice from your local emergency services.




Read more:
Climate change will make fire storms more likely in southeastern Australia


You can visit the Bureau of Meteorology website to view the latest outlook, or subscribe to receive climate outlooks via email.The Conversation

Catherine Ganter, Senior Climatologist, Australian Bureau of Meteorology and Andrew B. Watkins, Head of Long-range Forecasts, Australian Bureau of Meteorology

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

Call for clearer risk information for tourists following Whakaari/White Island tragedy



The Royal New Zealand Navy during a recovery operation on Whakaari/White Island, on December 13. Rescue and recovery efforts have been hampered by hazardous conditions on the island, and the danger of another eruption.
EPA/Royal NZ Navy, CC BY-ND

Freya Higgins-Desbiolles, University of South Australia and James Higham, University of Otago

In the aftermath of the tragedy at Whakaari/White Island on December 9, many are analysing the risks of adventure tourism, particularly volcano tourism, and asking pointed questions.

It is a sensitive time, with 15 people now confirmed dead, many hospitalised in critical condition, and two bodies yet to be retrieved from the disaster zone.

We question whether the tourists caught up in the events actually knew the risks they faced, and whether other tourist groups may be unaware of the potential risks that their travel decisions may carry.

Although geologists are monitoring Whakaari/White Island, some volcanic activity cannot be predicted.



Read more:
Why were tourists allowed on White Island?


Risk assessment and visitor safety

The websites for White Island Tours and the promotion pages on the Bay of Plenty website are currently not viewable. But the Trip Advisor site for Whakaari calls it “New Zealand’s most active volcano”. It mentions the need for gas masks and hard hats and describes conditions of a still active volcano, including steam vents and sulphurous fumes.

But it is doubtful that cruise ship passengers, such as those from the Ovation of the Seas, would have done such research. Cruises offer a variety of shore excursions when in port, ranging from passive sightseeing to adventure activities.

Many tourists will assume endorsed excursions have been properly vetted by their cruise company and assume there is negligible risk to personal safety. But this may not be the case.

Major cruise lines such as Royal Caribbean visit multiple destinations with very different regulatory environments. The assumption that shore excursions will be safe may be misplaced, both by the cruise line and the visitors they book on such excursions. This is now clear from the events at Whakaari but also in previous incidents, such as last year’s fatal bus crash in Mexico.

Local supporters gather on the quayside as a boat that carried families for a morning blessing at White Island returns during a recovery operation to retrieve the remaining bodies.
AAP/David Rowland, CC BY-ND

Adventure capital

New Zealand is known as an adventure tourism destination, but its regulatory systems have undergone recent change. After 37 deaths over four years, then prime minister John Key ordered an urgent safety audit in 2009.

This resulted in a shift, from 2013, from a voluntary system under Outdoors New Zealand and the regulatory system under Worksafe NZ to the New Zealand adventure activity certification scheme. Some tour operators have found this audit system too onerous. Striking the right balance between risk management while allowing the adventure tourism sector to thrive has proved difficult.

But the case of Whakaari/White Island is unique in many ways. The island is privately owned. GeoNet monitors volcanic activity and rates the threat level. The tour companies then assess the risk and determine if visits can proceed or should be temporarily suspended.

Three companies have operated tours to Whakaari/White Island, including the Māori-owned White Island Tours (owned by Ngāti Awa). The other two are helicopter companies Kahu and Volcanic Air Safaris. White Island Tours was accredited under AdventureMark, which is a Worksafe NZ approved certification body.

We must await the Worksafe investigation to know whether it was reasonable to allow the tours to go ahead when volcanic risk rating had risen from level 1 to level 2. We also still await the full human toll, knowing that recovery for survivors may take years. It is also clear that the impact on Ngāti Awa and the Whakatāne community has been profound.

Inherent risk in active environments

In laying out these complexities in which small private tour companies and large internationally owned cruise ships took thousands of visitors to Whakaari each year, we underscore how difficult an assessment of risk might be for some visitors.

Adventure tourists typically make an assessment weighing up risks against the thrills they seek to achieve. New Zealand’s reputation for adventure tourism is built in part on well developed policy settings and regulatory regimes, and an expectation among visitors of high adventure safety standards.

Risk – both perceived and actual – is carefully managed to ensure that perceived risk is high but actual risk is as low as humanly possible. The reputation of the sector and, indeed, the interests of the wider New Zealand tourism industry hinge on high safety standards. For example, bungy jumping appears to be very high risk, but its commercial viability comes from the highly controlled operation, which means actual risk is in fact very low.

Set against this are longstanding activities that take visitors into spectacular settings to experience firsthand the wonders of nature. Such environments do present inherent risk even if many decades may pass between natural events.

The Pink and White Terraces – the largest silica sinter deposit on earth – were a spectacular visitor attraction in the mid-19th century, and the centrepiece of Māori tourism development. That was until they were completely destroyed by the eruption of Mount Tarawera in 1886.

New Zealand’s most stunning natural vistas – Aoraki/Mount Cook, the fjords of Te Wahipounamu world heritage area, towering glaciers and raging rivers – are the result of millions of years of seismic activity on the Pacific and Australian tectonic plate boundary. These environments are dynamic and, at times, very destructive.

These settings contrast adventure tourism activities. Risk may be perceived as low or non-existent given that these environments may be largely inactive for years.




Read more:
Why White Island erupted and why there was no warning


Informed consent

In a complex international environment, the ultimate decision to participate in activities in dynamic and potentially destructive environments rests with the visitors.

Ultimately, visitor welfare depends on informed visitor choice. This case highlights the need for consent forms to be signed in many more cases, beyond those already used in adventure tourism and medical tourism.

Such documents should make clear the nature of the possible risks. Elevated risk levels on the day of the visit as well as changing risk levels in the days prior to the scheduled visit should be clearly communicated. Participation should only proceed after informed consent is secured.

Such an approach does not obviate the need for accreditation, audits, regulations and strict oversight by relevant authorities. But it does ensure that tourists play their part in deciding what risks are worth taking on their holidays.

We cannot undo the events that unfolded at Whakaari/ White Island, but we can honour lives lost by making absolutely sure that we learn from this tragedy.The Conversation

Freya Higgins-Desbiolles, Senior Lecturer in Tourism Management, University of South Australia and James Higham, Professor of Tourism, University of Otago

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

Does eating dairy foods increase your risk of prostate cancer?



If you’re a male who enjoys dairy, there’s no reason to stop having it.
From shutterstock.com

Rosemary Stanton, UNSW

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.


Recent headlines have warned a diet high in dairy foods may increase men’s risk of prostate cancer.

The news is based on a recent review published in the Journal of the American Osteopathic Association which claimed to find eating high quantities of plant-based foods may be associated with a decreased risk of prostate cancer, while eating high quantities of dairy products may be associated with an increased risk.

But if you’re a man, before you forego the enjoyment and known nutritional benefits of milk, cheese and yoghurt, let’s take a closer look at the findings.

What the study did

This study was a review, which means the researchers collated the findings of a number of existing studies to reach their conclusions.

They looked at 47 studies which they claim constitute a comprehensive review of all available data from 2006-2017. These studies examined prostate cancer risk and its association with a wide variety of foods including vegetables, fruits, legumes, grains, meat (red, white and processed), milk, cheese, butter, yoghurt, total diary, calcium (in foods and supplements), eggs, fish and fats.




Read more:
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Some studies followed groups of men initially free of prostate cancer over time to see if they developed the disease (these are called cohort studies). Others compared health habits of men with and without prostate cancer (called case-control studies). Some studies recorded the incidence of prostate cancer in the group while others concentrated on the progression of the cancer.

For every potential risk factor, the reviewers marked studies as showing no effect, or an increased or decreased risk of prostate cancer. The results varied significantly for all the foods examined.

For cohort studies (considered more reliable than case-control studies), three studies for vegan diets and one for legumes recorded decreased risk of prostate cancer. For vegetarian diets and vegetables, some reported decreased risk and some recorded no effect. Fruits, grains, white meat and fish appeared to have no effect either way.

An increased risk was reported for eggs and processed meats (one study each), red meat (one out of six studies), fats (two out of five), total dairy (seven out of 14), milk (six out of 15), cheese (one out of six), butter (one out of three), calcium (three out of four from diet and two out of three from supplements) and fats (two out of five).

Notably, some very large cohort studies included in the review showed no association for milk or other dairy products. And most case-control studies, though admittedly less reliable, showed no association.

The authors also omitted other studies published within the review period which showed no significant association between dairy and prostate cancer.

A person’s weight likely has more influence on their risk of developing prostate cancer than whether or not they eat dairy.
From shutterstock.com

So the inconsistency in results across the studies reviewed – including large cohort studies – amount to very limited evidence dairy products are linked to prostate cancer.

Could it be vitamin D?

In earlier research, a link between milk and prostate cancer has been attributed to a high calcium intake, possibly changing the production of a particular form of vitamin D within the body.

Vitamin D is an important regulator of cell growth and proliferation, so scientists believed it may lead to prostate cancer cells growing unchecked. But the evidence on this is limited, and the review adds little to this hypothesis.




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Perhaps the review’s most surprising omission is mention of the World Cancer Research Fund (WCRF) Continuous Update Project report on prostate cancer. This rigorous global analysis of the scientific literature identified much stronger risk factors that should be considered as possible confounding factors.

For example, the evidence is rated as “strong” that being overweight or obese, and being tall (separate to weight), are associated with increased risk of prostate cancer. The exact reasons for this are not fully understood but could be especially significant in Australia where 74% of men are overweight or obese.

A new Australian study found a higher body mass index was a risk factor for aggressive prostate cancer.

For dairy products and diets high in calcium, according to the WCRF, the evidence remains “limited”.




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It’s about the whole diet

It’s not wise to judge any diet by a single food group or nutrient. A healthy diet overall should be the goal.

That being said, milk, cheese and yoghurt are included in Australia’s Dietary Guidelines because of evidence linking them with a lower risk of heart disease, type 2 diabetes, bowel cancer and excess weight. These dairy products are also sources of protein, calcium, iodine, several of the B complex vitamins, and zinc.

Evidence about dairy products and prostate cancer remains uncertain. So before fussing about whether to skip milk, cheese and yoghurt, men who wish to reduce their risk of prostate cancer would be better advised to lose any excess weight. – Rosemary Stanton


Blind peer review

I agree with the author of this Research Check who highlights there is a high degree of variability in the results of the studies examined in this review.

While the authors searched three journal databases, most comprehensive reviews search up to eight databases. Further, the authors did not undertake any assessment of the methodological quality of the studies they looked at. So the results should be interpreted with caution.

Although the authors concluded higher amounts of plant foods may be protective against prostate cancer, the figure presented within the paper indicates more studies reported no effect compared to a decreased risk, so how they came to that conclusion in unclear. For total dairy they present a figure showing there were as many studies suggesting no effect or lower risk as there were showing higher risk.

Importantly, they did not conduct any meta-analyses, where data are mathematically pooled to generate and overall effect across all studies.

As the reviewer points out, many other important sources of high quality data have not been included and there are a number of recent higher quality systematic reviews that could be consulted on this topic. – Clare CollinsThe Conversation

Rosemary Stanton, Visiting Fellow, School of Medical Sciences, UNSW

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

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:
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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.




Read more:
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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.

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?




Read more:
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:
Interactive body map: what really gives you cancer?


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.




Read more:
INTERACTIVE: We mapped cancer rates across Australia – search for your postcode here


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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The ‘yield curve’ is one of the most accurate predictors of a future recession – and it’s flashing warning signs


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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What is an inverted yield curve? Why is it panicking markets, and why is there talk of recession?


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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Mine are bigger than yours. Labor’s surpluses are the Coalition’s worst nightmare


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.




Read more:
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.




Read more:
India, Pakistan and the changing rules of engagement: here’s what you need to know


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.




Read more:
India Tomorrow part 3: Kashmir


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.




Read more:
How the dangerous evolution of Pakistan’s national security state threatens domestic stability


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.




Read more:
What causes Alzheimer’s disease? What we know, don’t know and suspect


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.




Read more:
Six things you can do to reduce your risk of dementia


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.