Latest news with #UniversityOfQueensland
Medscape
14-07-2025
- Health
- Medscape
New Clozapine Consensus Guidelines Drop ANC Monitoring
Monitoring absolute neutrophil count (ANC) levels beyond 2 years of clozapine treatment is no longer necessary, new international guidelines stated. While low ANC levels — associated with severe neutropenia — pose a significant risk early in treatment, evidence shows that the risk drops substantially over time. Still, many patients continue to undergo routine blood tests well beyond the high-risk period, lead guideline author Dan Siskind, MD, PhD, professor of psychiatry, The University of Queensland, Brisbane, Australia, told Medscape Medical News. 'What we're saying is that after 2 years of monitoring, you can stop doing blood tests to monitor ANC levels, which is a massive change,' he added. The expert panel also provides detailed suggestions for monitoring other adverse drug reactions (ADRs) related to clozapine, including constipation and sialorrhea. And the group recommends an ANC of 1.0 × 109 cells/L as a threshold at which to consider stopping clozapine. The guidelines were published online on July 2, 2025 in Lancet Psychiatry . An Underutilized Treatment Clozapine is the only FDA-approved drug for treatment-resistant schizophrenia. An estimated 814,000 to 1.2 million Americans have this condition. Although clozapine is widely regarded as a superior antipsychotic, many clinicians remain hesitant to prescribe it due to concerns about ADRs — most notably, severe neutropenia, in which dangerously low neutrophil levels increase the risk for infection and even death. Despite estimates that 25%-30% of Americans with schizophrenia could benefit from clozapine, only about 4% receive it. The concern over severe neutropenia has led to stringent ANC monitoring protocols in some jurisdictions. Until recently, a risk evaluation and mitigation strategies (REMS) program in the US required physicians and pharmacists to provide documentation of a patient's ANC. However, after lobbying by relevant professional organizations including the American Psychiatric Association (APA), which argued the program poses unnecessary barriers to accessing a potentially life-saving medication, the FDA made the decision to discontinue the REMS program. Some experts insist the risk for severe neutropenia is low in patients taking clozapine. As previously reported by Medscape Medical News a study presented at the 2024 APA annual meeting showed the risk for moderate-to-severe neutropenia is low to minimal in patients with treatment-resistant schizophrenia. Siskind agreed. He points to other research showing the rate of severe neutropenia at initiation of clozapine is around 0.9%, but after peaking, the risk then 'drops over time' and after about 18 weeks, 'it's very low, and after about 2 years, it's negligible.' Yet patients who have been on clozapine for 10 years still receive blood tests every 4 weeks. 'We felt that's probably low value healthcare that creates impediments to people on clozapine,' said Siskind. No Current Consensus The guideline authors noted there's currently no international consensus on ANC thresholds for considering clozapine cessation. In some jurisdictions, an ANC of fewer than about 2.0 × 109 cells/L is the threshold but in other areas, the threshold is 1.5 × 109 cells/L. And when the REMS program was initiated, it set a lower ANC threshold (1.0 × 109 cells/L), which is in-line with that commonly used in hematology. 'What we're calling for is a global consensus; there should be one threshold,' said Siskind. Aside from neutropenia, there is a host of other clozapine-related ADRs, many of which are under-reported and some can be lethal. The consensus guidelines were developed using a global Delphi process. A steering committee — including a hematologist with expertise in clozapine-associated severe neutropenia — designed a questionnaire focused on ANC and ADR monitoring. The questionnaire was distributed to an international expert panel comprising psychiatrists and pharmacists. Recommendations were formulated based on their responses, with consensus defined as at least 75% agreement. The experts developed a clozapine monitoring algorithm that includes: Weekly ANC monitoring for the first 18 weeks after initiation Monthly monitoring from week 19 through year 2 Annual complete blood counts thereafter to screen for hematologic malignancies The algorithm includes a recommended ANC cessation threshold of 1.0 × 109 cells/L — or 0.5 × 109 cells/L for individuals with benign ethnic neutropenia who are Duffy antigen receptor for chemokines-null. In addition to clozapine, the new guidance advises clinicians to consider other potential causes of a low ANC, said Siskind. 'If it's 2 weeks after starting clozapine and there's a sudden, precipitous drop, it's likely related to the medication,' he explained. 'But if it's 18 months after initiation and you see a drop in neutrophil count, it's probably due to something else — and worth investigating.' Other causes of transient neutropenia could be chemotherapy treatment or a concomitant infection, he added. Side Effect Checklist Panel members developed a detailed checklist for regular and comprehensive ADR monitoring. The checklist includes pharmacological and nonpharmacological recommendations for each ADR where present. For example, in the category of constipation, which Siskind said is 'the number one cause of mortality' in patients taking clozapine, the experts suggest asking patients about bowel movement frequency and presence of blood and pain, and using the Bristol Stool Chart to determine if there's a health issue. Given the high prevalence of gastrointestinal hypomotility, prophylactic laxatives are recommended, the panel said. Sialorrhea occurs in up to 92% of patients taking clozapine and this can cause pneumonia, which is the second highest cause of death in people on clozapine, said Siskind. Here, the panel noted pharmacological strategies could include adding amisulpride or ipratropium sublingual spray while chewing sugar-free gum or placing a towel over the pillow when sleeping. Panel members also provided management guidelines for weight gain and metabolic syndrome, gastro-esophageal reflux, sedation, sleep apnea, nocturnal enuresis and urinary incontinence, and tachycardia. The panel stressed ADR monitoring should occur in partnership with primary care physicians. Annual ECGs did not reach consensus for routine use, so the expert panel does not recommend them. They concluded that cardiomyopathy in clozapine patients is more likely related to comorbidities such as obesity, diabetes, and tachycardia. Removing Barriers to an Optimal Treatment Commenting on the new guidance for Medscape Medical News , Frederick Nucifora Jr, PhD, DO, associate professor, Department of Psychiatry, Johns Hopkins School of Medicine, and director of the clozapine clinic at Johns Hopkins Bayview Medical Center, Baltimore, said it is sensible, reasonable, and could help remove 'troubling' barriers to accessing clozapine. He welcomed the ADR monitoring suggestions as clozapine-related side effects can be life-threatening and are the reason patients don't stay on the drug. 'There's so much confusion around using clozapine and the side effects and how to address them that people don't use the medicine, so it's very useful to have something to help guide us,' he said. He said it's deeply unfortunate that clozapine remains underused, particularly given its status as the most effective treatment available. In his experience, the drug has had a transformative impact on his patients. To increase physician comfort in prescribing clozapine, Nucifora suggests creating centers of excellence that could offer consultations on using the drug. Also commenting for Medscape Medical News , Mahavir Agarwal, MD, PhD, associate professor, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada who heads a clozapine clinic at the Centre for Addiction at Mental Health (CAMH), said the paper's 'mini flow chart' to manage side effects is a valuable tool for physicians to review with patients. He noted that the guideline authors are recognized leaders in the field and fully agrees that lifetime monitoring of ANC levels is likely unnecessary. Clozapine has had a huge impact on patients at the CAMH clinic, said Agarwal. 'Among our clientele are people who work full–time in very, very high-capacity roles; we have scientists, teachers, all manner of professions, who are able to lead meaningful lives after they found clozapine.' 'Other antipsychotics may do that, but the beauty of clozapine is that it can completely turn life around for somebody who has not responded to other antipsychotics.'
Yahoo
10-07-2025
- Health
- Yahoo
Exercising throughout adulthood lowers risk of early death by up to 40%
Exercising throughout adulthood slashes the risk of early death by 30% to 40% – but any activity is better than none, a study has found. While long-term good habits reap the most benefits, switching to a more active lifestyle at any point in adulthood extends life, suggesting it is never too late to get healthy, researchers said. Overall, physically active people are less likely to die from a range of conditions, including heart disease, stroke and cancer. Experts reviewed 85 existing studies on millions of people for their research, published online in the British Journal of Sports Medicine. They found that people who were consistently physically active had around a 30%-40% lower risk of dying from any cause, while those who increased their levels of exercise (from below recommended amounts) had a 20%-25% lower risk. Notably, people who switched from being physically inactive to being active were 22% less likely to die from any cause than those who remained inactive. The team, including experts from the University of Queensland in Australia, wrote: 'Several mechanisms may explain the reduced mortality risk with high physical activity, such as physical function improvement and anti-inflammatory effects.' They said their results 'emphasised the importance of physical activity across adulthood, indicating that initiating physical activity at any point in adulthood may provide survival benefits'. Currently, the World Health Organisation (WHO) recommends adults aim for 150 to 300 minutes per week of moderate-intensity physical activity, or 75 to 150min per week of vigorous-intensity activity, or a combination of the two. Examples of moderate activity include very brisk walking (4mph or faster), heavy cleaning such as washing windows or mopping, cycling at 10mph-12mph, or badminton. Vigorous activity includes hiking, jogging at 6mph or faster, shovelling, fast cycling, a football game, basketball or tennis. Cancer Research UK health information manager, Amy Hirst, said: 'Being active has many benefits, and by helping you keep a healthy weight it can reduce the risk of 13 different types of cancer. 'Any exercise is better than none, and the more you do, the better. You don't need to run a marathon or join a gym – anything that gets you warmer, slightly out of breath, and your heart beating faster counts. 'So, whether you go for a brisk walk, a cycle with a friend, or even get the housework done, these all count as ways to be active. Think about making small changes to your daily routine – it all adds up and helps you get moving more.' June Davison, senior cardiac nurse at the British Heart Foundation, said: 'This review suggests that being consistently active is associated with a reduction in deaths from any cause. 'It suggests it is never too late to get active, as switching to a more active lifestyle at any point in adulthood has health benefits, such as reducing the risk of death from cardiovascular disease. 'To keep your heart healthy, adults should aim to be active every day, building up to a total of 150 minutes of moderate-intensity activity every week. 'Simple everyday activities, like a brisk 10-minute walk during your lunch break, all count.' Sport England chief executive Tim Hollingsworth said: 'Doing something will always be better than doing nothing, and – as is rightly stated – it is also never too late to start. 'The report reaffirms that being physically active should be championed at every turn by decision-makers for the good of our health, communities, economy and country.' Huw Edwards, chief executive of ukactive, said: 'This study provides clear evidence that switching to an active lifestyle, at any life stage, has a drastic impact on prolonging life.
ABC News
10-07-2025
- Health
- ABC News
Disability-led research project exploring when safety becomes a restriction for adults with intellectual disability
Like most young adults, Ruth Faragher is navigating independence. The 29-year-old, who has Down syndrome, has lived in a share house, managed her money, gone on holidays with friends and secured work across different universities. Ms Faragher said she had always been supported by her family to try new things. "Sometimes I make mistakes, but everyone does," she said. In her latest role at the University of Queensland (UQ), Ms Faragher is part of a team researching when protection becomes restrictive for adults who live with an intellectual disability. "Support workers need to know how to decide what to do," she said. "[In] some situations they should take over. The study is one of 15 disability-led research projects focused on improving safety for people with disability which have received funding from the National Disability Research Partnership (NDRP). The projects aim to address critical safety gaps identified by the disability royal commission, which was handed down in 2023 and contained more than 200 recommendations for change. Leading the research is UQ's Professor Rhonda Faragher, who is also Ruth's mum. The inclusive education and diversity professor said she believes sometimes people with intellectual disabilities are wrapped in cotton wool by those who are supporting them. "The more you protect people, the less they have [the] opportunity to learn and grow and to develop their own autonomy," Professor Faragher said. The first phase of the study involved hiring and training people with intellectual disabilities as research assistants to help co-design the study's proposal. She said its end game would be to provide "helpful guardrails" for National Disability Support Scheme (NDIS) workers, as well as parents and carers, so they could best support people with intellectual disability. "We at no point want to suggest that we should remove support or we should make everybody pretend to be independent," Professor Faragher said. "It's not something that I think is a good goal for people." She said it was important to find a way of "making sure that people can continue to live lives of meaning and purpose" while not being "overly constrained". "We want to explore how to balance that," Professor Faragher said. NDRP CEO Mary Sayers said her organisation chose the theme of safety for the projects because it impacted "all elements of people's lives". "The disability royal commission told us about some of the systemic injustices that are happening for people with disability that are leading to violence, abuse and neglect," she said. The commission heard from almost 10,000 people with disability, their families, and advocates over more than four-and-a-half years. "This first funding round supports co-designed research that was recommended by the royal commission, that people with disability are at the forefront of the solutions that are needed in their life," Ms Sayers said. The NDRP received funding from the federal government to support the research program. The independent non-profit distributed $900,000 across the 15 projects, which will be followed by more funding for larger projects. Some of the other projects will investigate topics including how families of children with disability experience family violence and whether group homes are the safest option for people with intellectual disability. The NDRP has been in development since 2000, but formed as an independent organisation only a year ago. "It was established to strengthen the disability research ecosystem," Ms Sayers said. "Putting people with disability at the forefront of that research ... can really impact on policy and practice." All the projects are expected to run for six to 10 months and will involve university researchers working with people with disability, First Nations people, disabled people's organisations, and culturally and linguistically diverse communities. "This funding round is designed to support relationship building and knowledge sharing, and the grants will help research teams to deeply understand the issue by hearing different perspectives," Ms Sayers said. Down Syndrome Australia CEO Darryl Steff said the projects would all contribute towards the outcomes recommended by the disability royal commission. Mr Steff, who is also involved in the UQ study, said that "disappointingly", since the royal commission's final report was handed down, there had only been "some change".
Free Malaysia Today
23-06-2025
- Health
- Free Malaysia Today
How screen use can create a vicious cycle for some children and teens
Children's screen time and socioemotional problems fuel each other over time, an Australian study finds. (Envato Elements pic) PARIS : It has long been known that screens are harmful to children. Excessive exposure has been linked to cognitive development delays, as well as learning, language and memory disorders. In adolescents, excessive screen use may cause manic symptoms, such as mood disorders and sleep disturbances. But a new Australian meta-analysis highlights a lesser-known problem: excessive screen use can exacerbate socioemotional problems in children, such as anxiety, depression, hyperactivity and aggression – in turn driving them to screens to cope with these issues. This vicious circle mainly affects children aged six to 10 and seems to be more prevalent in boys than in girls. Conducted by researchers at the University of Queensland, the findings, published in the journal Psychological Bulletin, examined around 100 studies involving more than 292,000 children from around the world. Most of the cases included in this study were conducted in the United States (41 studies), Canada (13), Australia (11), Germany, and the Netherlands (7 each). The researchers found that video games are associated with higher risks of developing behavioral disorders compared to other screen-based content, including those intended for educational or recreational purposes. 'As a kid I loved video games – they give you a challenge and powerful feedback when you're doing a good job. For this reason, games are particularly tempting for children having problems and especially hard to get children away from,' said study senior author Michael Noetel, quoted in a news release. While it's true that some video games have an educational dimension – some of them have even been recognised as a vehicle for mental well-being among teenagers – excessive use can be counterproductive. 'Parents and policymakers have long debated whether screens cause problems, or whether children with problems were simply drawn to screens,' the news release notes. 'Our review shows it's both,' Noetel revealed. 'If we only address one side of the equation – cutting down on screen time but overlooking anxiety or aggression that leads kids to screens – we risk leaving children stuck in a cycle.' However, the researcher tempers this by pointing out that the emotional and behavioral disorders mentioned can also be explained by other factors, such as exposure to alcohol and/or drugs. The '3-6-9-12 rule' In France, some health professionals now recommend keeping children under six away from screens entirely, which is three years longer than the current official recommendations. To help parents limit their children's screen time, French pediatrician Serge Tisseron has invented the '3-6-9-12 rule', designed according to children's age and stage of cognitive development. The rules are as follows: no screens before the age of 3; no personal consoles before age 6; no internet before age 9; and no internet without supervision before age 12. Other initiatives have recently emerged to encourage children and teens to 'detox' from digital devices, such as the challenge of spending 10 days without using any screens at all, in favour of activities that promote relaxation and creativity.
Yahoo
19-06-2025
- Business
- Yahoo
Housing solution given major tax boost as Australia faces 'critical problem'
A tax break will be extended 'indefinitely' for owners of new build-to-rent developments as the NSW government tries to boost rental supply in the country's most expensive property market. The change was announced today ahead of the state budget, alongside rules to help fast-track infrastructure. The NSW budget will extend the 50 per cent land tax discount on build-to-rent developments indefinitely. The tax break was due to expire in 2039 under the previous government. University of Queensland Professor of Finance Shaun Bond told Yahoo Finance build-to-rent could have a 'big impact' on the landscape of Australian housing over the coming years and was 'key' to taking some pressure off the market. RELATED Growing property tactic that allowed 25-year-old to buy first Sydney home Centrelink age pension changes coming into effect from July 1 $1,000 ATO school fees tax deduction that Aussies don't realise they can claim 'The key problem we have in Australia is we just haven't been building enough homes. This is a critical problem that was severely exacerbated during Covid when all the supply chains shut down and we've seen a big increase in material costs and a lot of building companies went out of business,' he said. NSW Treasurer Daniel Mookhey said the measures announced would give developers the certainty they needed to build more homes faster. 'We are making sure we build the homes we need, along with the essential infrastructure we need to go with them,' he said. 'Extending the tax incentives for build-to-rent will make it easier for developers to build, and give renters more choice.' Property Council NSW executive director Katie Stevenson welcomed the measures and said there was no time to waste, given we are still falling short of the government's goal of building 1.2 million homes by 2029. 'Making the BTR exemption permanent provides long-term certainty to investors and developers, helping to enable more high-quality rental homes to be delivered across NSW,' she said. To be eligible for the tax concession, a building must be owned by a single owner and manager and include at least 50 rental dwellings. Build-to-rent is an established practice in the UK and USA, but it is still a fairly new concept in Australia. Residential apartments are usually built by developers, with units sold off one by one. With build-to-rent, the units are designed specifically for renters and are held in a single ownership and professionally managed. They usually build a large number of units, with some having 200 or 300 units. They may offer longer-term lease options, better security for tenants and more rental housing choices in areas people want to live. Investors are pouring billions into the sector, with more than 8,900 dedicated build-to-rent apartments under construction in Australia at the end of last year and a further 20,000 units approved for development over the next five years. Other states like Victoria also have a 50 per cent land tax discount in place to encourage build-to-rent properties. Bond said one of the advantages of build-to-rent was that it helped bring supply on more quickly. 'You have maybe a large pension fund or institutional investor who might be able to provide large amounts of capital, because you could need $100 million or more for a big new development, and they can make that decision pretty quickly to go ahead,' he told Yahoo Finance. 'Because they have the resources, they can team up with a big developer and bring that property online. 'Whereas the traditional model in Australia has mainly been a developer will propose a new development, and then they'll have to do pre-sales, so it might take you two years to get the 60 or 70 per cent pre-sales you need to start construction.' Build-to-rent properties can also have a bigger focus on lifestyle factors for tenants. 'They'll really focus on the amenities that they offer to a tenant, because they want the tenants to stay there and be happy,' Bond said.
