What time of day should I take my medicine?



Does it matter if you take your medicine morning, noon or night? That depends on a number of factors.
from Kat Ka/www.shutterstock.com

Nial Wheate, University of Sydney and Andrew Bartlett, University of Sydney

Whether you need to take a drug at a specific time of day depends on the medication and the condition you are treating. For some medicines, it doesn’t matter what time you take it. And for others, the pharmacist may recommend you take it at the same time each day.

But we estimate that for around 30% of all medicines, the time of day you take it does matter. And a recent study shows blood pressure medications are more effective if you take them at night.

So, how do you know if the timing of your medication is critical?




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When timing doesn’t matter

In most cases, it’s not important when you take your medicine. For instance, you can take non-drowsy antihistamines for hay fever, or analgesics for pain when you need them. It doesn’t matter if it is morning, noon or night.

What is more important is the time interval between each dose. For instance, paracetamol needs to be taken at least four hours apart, any closer and you run the risk of taking a toxic dose.




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Even when a medication doesn’t need to be taken at a particular time, the pharmacist may still recommend you take it at the same time every day anyway.

This daily pattern helps remind you to take it. An example is taking the oral contraceptive at the same time each day, simply out of habit.

For the mini pill, taking it at the same time is actually necessary. But the actual time of day can be whatever works best for you.

When does it matter?

It may seem fairly obvious to take some medicines at particular times. For example, it makes sense to taking sleeping medications, such as temazepam, at night before you go to bed.

Some antidepressants, such as amitryptyline or mirtazapine, have drowsy side effects. So it also makes sense to take them at night.

For other medicines, taking them in the morning is more logical. This is true for diuretics, such as furosemide, which helps you get rid of excess fluid via your urine; you don’t want to be getting up in the night for this.

When a medicine needs to be taken at a specific time, this will be indicated on the box.
Author provided

For other medications, it’s not obvious why they have to be taken at a particular time of day. To understand why, we have to understand our circadian rhythm, our own internal body clock. Some systems in our body work at different times of day within that rhythm.

For instance, the enzymes controlling cholesterol production in your liver are most active at night. So there may be some benefit to taking lipid (cholesterol) lowering drugs, such as simvastatin, at night.

Finally, sometimes it’s important to take medications only on particular days. Methotrexate is a medicine used for rheumatoid arthritis and severe psoriasis, and the timing of this medication is critical.




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You should only take it on the same day once a week, and when taken this way it is quite safe. But if you mistakenly take it daily, as happened recently with a patient in Victoria, then it can cause serious illness or even death.

What about blood pressure medicines?

One of the ways the body regulates blood pressure is through a pathway of hormones known as the renin, angiotensin and aldosterone system.

This system responds to various signals, like low blood pressure or stressful events, and controls blood volume and the constriction of blood vessels to regulate your blood pressure.

Importantly, this system is more active while you’re asleep at night. And a recent study, which found blood pressure medication is more effective at night,
may change the way we use medicines to treat high blood pressure.




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Two types of drugs typically prescribed to lower blood pressure are angiotensin converting enzyme (ACE) inhibitors, such as perindopril, and angiotensin receptor blockers (known as ARBs), such as irbesartan. These drugs dilate blood vessels (make them wider) to reduce your blood pressure.

Until now, doctors and pharmacists have often advised patients to take these medications in the morning, assuming it’s good to have a hit of the drugs when you’re up and about.

But this study found taking blood pressure medications at night produced a significant reduction (45%) in heart disease, including fewer strokes, heart attacks and heart failure compared to taking them in the morning.

Taking them at night also meant people’s blood pressure was better controlled and their kidneys were healthier.

So if you take one of these drugs to control your blood pressure and aren’t sure what you should do, talk to your pharmacist or doctor. While evidence is building to support taking them at night, this might not be appropriate for you.




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The Conversation


Nial Wheate, Associate Professor | Program Director, Undergraduate Pharmacy, University of Sydney and Andrew Bartlett, Associate Lecturer Pharmacy Practice, University of Sydney

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

Go home on time! Working long hours increases your chance of having a stroke



Is it time to cut back on overtime?
Annie Spratt

Libby Sander, Bond University

Australia is in the bottom third of OECD countries when it comes to working long hours, with 13% of us clocking up 50 hours or more a week in paid work.

These long hours are bad for our health. A new study from France has found that regularly working long days of ten hours or more increases our risk of having a stroke.

Other research has found that employees who work long work hours are likely to have poorer mental health and lower-quality sleep.

Long working hours have also been shown to increase likelihood of smoking, excessive drinking, and weight gain.




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Long hours are bad for our health

The effects of regular long work hours on our health are wide-ranging.

The new French study of more than 143 ,000 participants found those who worked ten or more hours a day for at least 50 days per year had a 29% greater risk of stroke.

The association showed no difference between men and women, but was stronger in white-collar workers under 50 years of age.

Another meta-analysis of more than 600,000 people, published in the British medical journal The Lancet, found similar effects. Employees working long hours (40-55 hours per week) have a higher risk of stroke compared with those working standard working hours (35-40 hours per week).

The association between long working hours and stroke was stronger among white-collar workers.
Bonneval Sebastien

Irregular work hours, or shift work, has also been associated with a range of negative health and well-being outcomes, including the disruption of our circadian rhythm, sleep, accident rates, mental health, and the risk of having a heart attack.




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And it’s not just the physical effects. Regularly working long hours results in poor work-life balance, leading to lower job satisfaction and performance, as well as lower satisfaction with life and relationships.

Why are we working more?

Although many countries have imposed statutory limits on the work week, worldwide around 22% of workers are working more than 48 hours a week. In Japan, long work hours are such a significant issue that karoshi – translated as “death by overwork” – is a legally recognised cause of death.

Concerns around automation, slow wage growth, and increasing underemployment are some of the reasons Australians are working longer. A 2018 study showed Australians worked around 3.2 billion hours in unpaid overtime.




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And work doesn’t end for many people when they leave the office. If they aren’t doing extra work at home, taking calls, or attending after-hours meetings online, working second jobs is increasingly becoming the norm. Many Australians now work additional jobs through the gig economy.

The influence of job control

Autonomy and “decision latitude” at work – that is, the level of control over how and when you perform your duties – is a contributing factor to the increased risk of health problems.

Low levels of decision latitude, as well as shift work, are associated with a greater risk of heart attacks and strokes. Individual control plays a significant role in human behaviour; the extent to which we believe we can control our environment considerably impacts our perceptions of and reactions to that environment.

Early psychology research, for example, showed that reactions to the administration of an electric shock were very much influenced by the perception of control the person had over the stimulus (even if they did not actually have control).

Workers who have little autonomy or control are more likely to experience health problems than those who have a high level of control.
NeONBRAND



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These findings were echoed in data from the Australian Institute of Health and Welfare. It found that a lack of alignment between an individual’s preferences and their actual working hours resulted in lower reported levels of satisfaction and mental health. The results applied both to workers who worked long hours and to those who wanted more hours.

What can employers do?

Effective communication with employees is important. Employees may be unable to complete their work in standard hours, for example, as a result of having to spend excessive amounts of time in meetings.

Employers can take steps to implement policies to ensure that long work isn’t occurring regularly. The Australia Institute holds an annual Go Home on Time Day to encourage employees to achieve work-life balance. While this initiative raises awareness of work hours, going home on time should be the norm rather than the exception.




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Increasing employees’ input into their work schedule and hours can have positive effects on performance and well-being.

The design of the workplace to promote well-being is an important factor. Research on shift work has shown that enhancing the workplace by providing food, child care, health care, accessible transport, and recreational facilities can reduce the effects of shift work.

By improving conditions and benefits, employers can help ameliorate the negative health impact of shift work.
Asael Peña

Finally, implementing flexible work practices, where employees have some control over their schedule, to encourage work-life balance has been shown to have positive effects on well-being.

Such initiatives require ongoing support. Japan instituted Premium Friday, encouraging employees to go home at 3pm once a month. Initial results, however, showed that only 3.7% of employees took up the initiative. The low take-up can be attributed to a cultural norm of lengthy work days, and a collectivist mindset where employees worry about inconveniencing peers when they take time off.

Given the rise in concerns about future work, and workplace cultures where long hours are the norm, change may be slow in coming about, despite the negative health effects of long work hours.The Conversation

Libby Sander, Assistant Professor of Organisational Behaviour, Bond Business School, Bond University

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

When’s the best time to get your flu shot?



File 20190412 76831 1xcigq.jpg?ixlib=rb 1.1
What goes up must come down, and that includes the protection the flu vaccine offers against influenza.
Irina Bg/Shutterstock

Ian Barr, WHO Collaborating Centre for Reference and Research on Influenza

When most of us get the flu, we spend three or four days on the couch feeling miserable, then we bounce back pretty quickly. But others have more severe symptoms and need to be hospitalised because they’re at risk of life-threatening complications. Some people even die from the flu.

The size and impact of influenza seasons varies from year to year. In 2017, Australia had its worst flu season for 20 years, with at least 1,255 lives lost. The 2018 season was relatively mild, but it doesn’t seem to have ever ended – cases have been reported throughout summer and into autumn 2019.

The best way to protect against influenza is to get a flu vaccine each year. It’s not as effective as some other vaccines, but it reduces your risk of getting the flu by around 60%.




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Protection often will have begun to wane four or five months later, so getting vaccinated in mid to late May, or even early June, will give you better protection at the height of the flu season. But there are number of factors to consider before deciding when to get your flu shot.

Remind me, why get a flu shot each year?

Influenza viruses change each year and the vaccine is updated to keep up with these changes. This year, for example, the vaccine protects against two different strains than the 2018 vaccine.

Our body’s immune response to the vaccine also wanes over time. So even if you were vaccinated last winter, you may no longer be fully protected 18 months later, depending on your age and your response to the last vaccination.

When does the flu vax become available?

Influenza vaccines are usually available in early April, or even in March; though you’ll generally have to pay full price for early access, even if you’re eligible for a free flu vaccine later.

In mid-April, stock starts arriving at GP clinics and pharmacies for the government’s immunisation program, which offers free flu vaccines for those most at risk of complications from influenza. This includes:

  • all Aboriginal and Torres Strait Islander people aged six months and over
  • pregnant women (during any stage of pregnancy)
  • all people aged 65 years and over
  • people aged six months and over with medical conditions which increase the risk of complications following influenza infections.



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In addition, most states in Australia offer free vaccination to all other children from six months of age to five years of age.

For those not eligible for the free vaccine, influenza vaccines are available through pharmacies and GPs for between A$10 and A$25 (plus the cost of a consultation if your GP doesn’t bulk bill), or via workplace programs.

The 2018 flu season was mild but there have been more cases of influenza over summer than usual.
kurhan/Shuttestock

Is it good to get in early?

Getting a vaccine immediately after it becomes available will ensure you don’t miss out if there’s a vaccine shortage. And it will protect against the “summer flus” we’ve been seeing over the last few months, which are circulating earlier than normal.

But there is a potential downside. Protection against influenza peaks one to two months after you have your vaccine, and then declines. This rate of decline varies from person to person, by age, and by influenza strain.

The flu season usually reaches its peak in August or sometimes even September. So if you’re vaccinated in early April, four to five months will have passed by the time you reach the peak virus months, and you will have lower levels of protection.




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There are few good quality studies across all ages to measure this rate of decline accurately, although a study from 2015 showed that the measurable antibody responses to the influenza vaccine components reduced slowly.

Another study from 2014 showed the vaccine was less effective in people vaccinated three or more months earlier, adding to the evidence that protection wanes over time.

When is too late for the flu shot?

If you delay your decision to be vaccinated until July or August, when the flu season is well underway, your chance of becoming infected will significantly increase.

Mid to late May or early in June is the sweet spot between trying to maximise your protective levels of antibodies generated by vaccination and getting vaccinated before there are significant levels of influenza virus circulating.

It’s better to be vaccinated early than not at all.
DonyaHHI/Shutterstock

Remember, it takes seven to ten days from the time of your flu shot for the vaccine to begin to be fully effective.

Getting vaccinated in late May or early June should provide good levels of protection during the peak of the influenza season and may even last through to November, by which time the influenza season has usually finished.

Vaccinate kids a month earlier

Vaccination timing is a little different for children. Those aged six months to nine years who haven’t been vaccinated against influenza before need two doses of vaccine, four weeks apart. So they will need to start their vaccination program a month earlier than adults and the elderly.




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So if you want to get vaccinated in 2019, there’s no need to rush, and in fact May or even early June might be a better time to be vaccinated. But it’s better to be vaccinated early than not at all.

Your GP or pharmacist will advise you on the most appropriate vaccine and the best timing for you.The Conversation

Ian Barr, Deputy Director, WHO Collaborating Centre for Reference and Research on Influenza

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

Time doesn’t heal all wounds: how DNA damage as we age causes cancer


File 20181004 52678 1kfc9sn.jpg?ixlib=rb 1.1
Our risk of cancer is determined by a complex mix of genes, environment and lifestyle factors.
Claudia van Zyl

Ian Majewski, Walter and Eliza Hall Institute and Edward Chew, Walter and Eliza Hall Institute

As we age, our bodies inevitably deteriorate. Some changes, like grey hair and wrinkles, are easily visible. Others, like high blood pressure, often go unnoticed, but can be deadly.

Just as our body shows signs of ageing, so does our genome. Damage comes from chemical reactions that alter our DNA, and from errors introduced when it is copied. Our cells protect against these ravages, but these mechanisms are not foolproof and cells gradually accumulate DNA damage over a lifetime.

As a consequence of this damage, your genome is not the same in every cell; you are a patchwork of cells with subtle differences in their DNA. When a cell divides it will pass on these changes, and as they accumulate there is more and more likelihood that there will be consequences.

If these changes – we call them mutations – chip away at the systems that govern cell proliferation and survival, this can lead to cancer.

Our latest research, published today in the journal Blood, provides new clues about how our cells protect their genome and guard against cancer.

Guarding the genome

Nearly 10% of cancers have a familial component. Genes like BRCA1 and TP53 are among the best known cancer susceptibility genes, and both are involved in coordinating the cell’s response to DNA damage.

BRCA1 helps to repair a specific type of DNA damage, in which both strands of DNA are broken. Inheriting a defective BRCA1 gene elevates the lifetime risk of both breast and ovarian cancer.




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When DNA repair mechanisms break down, cells can accumulate staggering numbers of mutations, and cancer becomes almost inevitable.

Beyond genetics, a complex mix of environmental and lifestyle factors modify cancer risk.

When we read the genome of a cancer it is possible to attribute mutations to certain types of stress. UV radiation, for example, will fuse certain DNA bases. The UV damage signature is writ large in melanoma, a cancer linked to sun exposure.

Lung cancers from smokers and non-smokers have different mutation patterns because of the action of chemicals in cigarette smoke that attack the DNA.

We can also use this approach to diagnose defective DNA repair, as each defect triggers a characteristic pattern of mutations. In this way, mutation signatures can help us understand why a cancer has developed.

A ticking genetic clock

Smoking, UV radiation and X-rays all damage your DNA, but damage also comes from reactive molecules present within the cell. These molecules are fundamental to the chemistry of life – take water, for example.




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Water is a very reactive molecule and can do damage to our DNA. One of the most common mutations, either in cancer or in normal cells, results from water molecules reacting with methylated DNA.

DNA methylation is a small chemical modification that acts as a signpost on top of our genetic code. It helps to control which genes are switched on or off. This fine-tuning is essential for normal development, but methylation also makes DNA more susceptible to damage. Most of these events are quickly repaired, but the damage is unrelenting and some sneak through.

Cells accumulate mutations when DNA repair mechanisms break down.
K.D.P/Shutterstock

Methylation damage is the most prominent feature of an ageing genome. It’s so pervasive and reliable it has been proposed as a molecular clock that marks ageing. But our new research shows this process occurs more rapidly in some people.

We found and studied three people whose pathways to repair methylation damage had broken down. They all lacked a DNA repair protein called MBD4, which led to a marked accumulation of methylation damage – as though their cells were ageing prematurely.

All three developed an aggressive form of leukaemia in their early 30s, a cancer which usually wouldn’t be seen until the person is in their 60s or 70s.

Methylation damage plays a role in most cancers, but in these cases it was the primary driver of the disease.

While complete inactivation of MDB4 – as occurred in the three participants – is extremely rare, our findings raise the question of how more subtle differences in DNA repair shape cancer risk, particularly in the context of ageing.

Turning back the clock

Ageing contributes to cancer risk in myriad ways. While we’ve focused here on the buildup of DNA damage, our immune system also plays an important role and tends to fade as we get older.

Lifestyle factors – such as obesity, stress and diet – also provide a cumulative risk that builds over a lifetime.




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Understanding the interplay between these factors is key to finding strategies that will effectively diffuse the health consequences associated with ageing.

Our research is helping to tease apart the contribution of DNA damage in different disease processes. Our findings suggest that some people accumulate more DNA damage than others – their clocks are ticking a little faster – and measuring these differences may help to spot people at risk of developing cancer, or help match them with more effective treatments.The Conversation

Ian Majewski, Laboratory Head & Victorian Cancer Agency Fellow, Cancer & Haematology Division, Walter and Eliza Hall Institute and Edward Chew, PhD candidate, Cancer and Haematology Division, Walter and Eliza Hall Institute

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

Article: Japanese Women Wear Diapers to Save Time


In Japan women are increasingly turning to diapers to save time. Time is saved by not having to go to the bathroom. I sure hope this isn’t something that catches on in Australia.

For more visit:
http://www.odditycentral.com/news/ultimate-slobs-japanese-women-wear-diapers-to-avoid-going-to-the-toilet.html

Plinky Prompt: Name One of the Best Decisions You’ve Ever Made


resignation

One of the best decisions I have made, if not the best, was to resign from my job after 20 years of work there. I moved on and now work in a lesser paid job – however, my health has improved across the board as a result and I am far happier now than I was back then. I no longer work the excessive hours and have more time to do my own thing. What’s not to like.

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Harold Camping: Fall Out from False Prediction of the End Continues


The latest in End Times predictions by a PreMillenialist has ended in falsehood yet again. This should come as no surprise, given that no-one on earth serves in any role on the Lord’s ‘returning to earth committee (not that there is such a committee I should make clear).’ The day is not known to anybody, whether saved or unsaved and will not be made known until such time as it actually happens. Of all the difficuties surrounding the interpretations of End Times Eschatology, surely that is one of the clearer areas that most Christians should be able to agree upon.

Sadly there are too many who are willing to presume a role in deciding the time of the Lord’s return and yet again we have another example of such a delusion causing the name of the Lord and His followers to be mocked on the earth. This is all that can happen from such flights of deluded fancy, excepting the destruction wrought in the faith of some believers that are caught up in such delusive predictions.

For more on the fall out of Harold Camping’s falsehood see:
http://www.christianpost.com/news/harold-camping-bashed-as-false-prophet-on-family-radio-airwaves-50713/

 

Persecution News: What was Missed While on My Break – Part 1


The following are articles from Compass Direct News from the period I was on my break:

 

Back from a Break: Much Needed


Well, I’m back from a rather large break which I have to say was much needed. Now that I’m back it is time to probably reflect a little on just what this Blog is about – or rather, where it will be going into the future. This is something I’ll be thinking over a little in coming weeks and I guess what the Blog looks into the future like will be the result of these reflections. So I guess this is really something of a nothing post now that I think about it – except to say that I am back.