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Deep vein thromboembolism occurs when a blood clot forms deep in the vein, usually in the lower leg, thigh, or pelvis. Occasionally, the arm is affected. Just about anything that hinders blood flow can trigger a blood clot, but a common risk factor is trauma to the limb. A recent meta-analysis published in Medscape has unearthed a new cause.

Thromboembolism often results from a fracture, severe muscle injury or muscle injury, but a recent meta-analysis suggests liver disease may also substantially increase the risk.

In the study, it emerged that patients with chronic liver disease had a substantially higher likelihood of venous thromboembolism (VTE).

Venous thromboembolism can be broken down into two conditions; deep vein thrombosis (DVT) and pulmonary embolism.

The Centres for Disease Control and Prevention (CDC) explains: “VTE, a term referring to blood clots in the veins, is an underdiagnosed and serious condition that can cause disability and death.”

READ MORE: Cancer symptoms: The ‘feeling’ that strikes first thing in the morning – it’s a red flag

The meta-analysis of 29 studies, suggested patients hospitalised with chronic liver disease may have a twofold risk of the condition.

Summarising the findings, the health platform Medscape wrote: “Hospitalised patients with versus without chronic liver disease had a twofold increased risk of VTE.

“Hospitalised patients with chronic liver disease who did not receive VTE treatment were 2.78 times more likely to develop VTE during their hospital stay compared with those who received VTE prophylaxis.”

Researchers suggest these findings could have potentially life-saving implications for patients with liver disease.And this is particularly important in light of the condition’s rising prevalence.

In fact, the prevalence of liver disease has seen a staggering rise of 400 percent since 1970, killing roughly 40 people in the UK every day.

According to the British Liver Trust, these numbers are stark compared to other major killer diseases like heart disease and cancer.

Fortunately, 90 percent of cases are thought to be preventable with healthy lifestyle changes and interventions.

Interestingly, nine out of 10 cases in the UK are due to alcohol, obesity and hepatitis A – all preventable risk factors.

The new findings suggest clinicians should be aware of the risk of venous thrombosis when treating patients in hospital, as blood clots can occur during surgery.

The CDC adds: “The most serious complication […] happens when a part of the clot breaks off and travels through the bloodstream to the lungs, causing a blockage called pulmonary embolism.

“If the clot is small, people usually recover from pulmonary embolism with appropriate treatment, explains the body.

It adds: “However, there could be some damage to the lungs. If the clot is large, it can stop blood from reaching the lungs and is fatal.

“What’s more, a great number of patients diagnosed with DVT endure years of hardship after recovery, because of the damage caused to the valves in the vein.

This is known as post-thrombotic syndrome, and typically causes swelling, pain, discolouration and in severe cases, scaling and ulcers at the site of the blood clot.

Severe cases can lead to disability, warns the CDC.

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A June 15 article in the New England Journal of Medicine reviews current research to take a sweeping inventory of how air pollution and climate change interact to adversely affect people’s health, especially that of kids. It examined the link between fossil fuel emissions and a variety of consequences of climate change — including extreme weather events; wildfires; vector-borne illnesses such as malaria, Zika, and Lyme disease; and heat waves, a topic at the forefront of many people’s minds.

This month, for example, record-high temperatures have been reported across the United States, affecting more than 100 million people and touching locations from the Gulf Coast to the Great Lakes, the Southwest, the mid-Atlantic, and the Midwest.

In Texas, Austin has already experienced an eight-day streak of temperatures above the 100-degree mark in June, according to the Austin American-Statesman.

These patterns are an important reality to note, said Frederica Perera, the article’s lead author. “My concern is that the threats are rising as temperature is rising,” Perera, a professor at Columbia University’s Mailman School of Public Health, told KHN. “Temperatures are rising because greenhouse gas emissions are rising, and that’s a great concern for everyone’s health — but especially the most vulnerable.”

Children fit into this category, wrote Perera and her co-author, Dr. Kari Nadeau, because their ability to regulate temperature, known as thermoregulation, is not fully developed.

They are also more susceptible to heat-related stress because they’re smaller and need to drink and eat more frequently to stay healthy, said Perera. But because “young children are dependent on parents to provide, sometimes their needs go ignored,” she said.

The authors noted that heat-related illness is “a leading and increasing cause of death and illness among student athletes” in the U.S. In addition, they cited studies suggesting that “the heat associated with climate change” takes a toll on the mental health of children and adolescents, as well as their ability to learn.

The review article pointed to previous research that associated in utero exposure to heat waves with “increased risks of preterm birth or low birth weight; hyperthermia and death among infants; and heat stress, kidney disease, and other illnesses” among kids.

“Being pregnant is very physiologically demanding in itself, and then heat places additional stress on a pregnant woman,” said Dr. Robert Dubrow, a professor of epidemiology at Yale’s School of Public Health who was not associated with either study. “And the fetus can experience heat stress as well, which could result in adverse birth outcomes.”

And these heat-related risks are across-the-board greater for “low-income communities and communities of color,” wrote the authors of the new article.

Carbon dioxide emissions from burning fossil fuels have risen sharply in the past 70 years, according to the article. “Modeling indicates that some heat waves would be extraordinarily unlikely to occur in the absence of climate change,” it says.

The authors briefly outline solutions that they describe as “climate and environmental strategies” that “should also be seen as essential public health policy.” Beyond big-picture efforts to mitigate fossil fuel and greenhouse gas emissions, they offered various ways to protect children — steps they term “adaptation measures” — which included providing clean water to children and families facing drought or water contamination and creating shaded areas where children play, live, and go to school.

Separately, Austin-based research highlighted why this step could be meaningful.

Researchers tracked the physical activity levels and location of students ages 8 to 10 during recess at three elementary schools in 2019. They compared children’s activity at recess during two weeks in September, the hottest full month during the school year, to a cooler week in November. “We wanted to understand the impact of outdoor temperatures on children’s play in schoolyard environments,” said Kevin Lanza, the study’s lead investigator, to inform the design of “future school-based interventions for physical activity in the face of climate change.”

During the hotter periods, he said, “children engaged in less physical activity and sought shade.”

As temperatures continue to rise, he said, schools must be flexible in making sure students are getting the daily exercise they need. “Schools should consider adding shade, either by planting trees or installing artificial structures, that cover spaces intended for physical activity,” said Lanza, an assistant professor at UTHealth’s School of Public Health. He also noted that school policies could be updated so that recesses are scheduled during cooler times of the day and moved inside during periods of extreme heat.

But the overall need to protect kids from scorching weather patterns requires action beyond such steps, Perera said, and more climate and clean air policies must be enacted.

“Governments have the responsibility to protect the population and especially those most vulnerable, which especially includes children,” Perera said. “Action must be done immediately because we’re absolutely heading in the wrong direction.”

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The post It’s Hot Outside — and That’s Bad News for Children’s Health appeared first on medicine world council.

• Concerns are being raised about a deadly flu season this winter in Britain and US
• Australia suffered 65,000 flu cases in May, more than double previous record
• Diagnoses are up almost 300 times now compared to 2021 in parts of country

Concerns are being raised about a major flu outbreak this winter in Britain and the US as the virus wreaks havoc in Australia.

Experts have been warning about the potential of an influenza surge throughout the pandemic, with lockdown thought to have weakened people’s immune systems.

So far those fears have not materialised in the northern hemisphere, but Australia is currently in the midst of its worst flu season in years.

Southern hemisphere countries like Australia are seen as the ‘canary in the coalmine’ because they have their winters earlier in the year.

Australia suffered a record 65,000 flu cases in May, more than double the previous May record of 30,000 in 2019, with diagnoses up almost 300 times than last year in parts of the country.

Children’s hospitals have also seen spikes in paediatric admissions that have forced some to take the unprecedented action of diverting ‘less urgent cases’ to other healthcare providers.

Professor Lawrence Young, a virologist at Warwick University, told MailOnline ‘there is a real concern the UK could be faced with a “perfect storm” of respiratory virus infections this coming winter’.

‘Australia really is the “canary in the coalmine” and we should sit up and take notice.’

This graph, from Australia’s National Notifiable Disease Surveillance System shows the number of laboratory confirmed flu cases over the past five years. This year’s outbreak (the solid red line) shows an extraordinary surge in cases far earlier than previous years and well above the five-year average

Cases of the ‘super-flu’ were reported in March but began spreading rapidly in late May with 47,860 cases recorded between May 23 and June 5

It might also be the case that Australians are particularly susceptible to flu this year because the Government went with a zero-Covid approach for most of the pandemic, locking down entire cities at the first sign of a rise in cases.

Professor Young said the UK needed to ensure both Covid and flu jabs are rolled out to as many people as possible from September onwards to prepare for a possible surge. 

He added that Covid pandemic measures could also make a return.

Flu and pain medicine is flying off the shelves as Australia battles its worst recorded ‘superflu’ outbreak after two years of the Covid pandemic made the illness almost non-existent.

Australia has recorded almost 50,000 flu cases between May 23 and June 5, breaking previous records, with cases up almost 300 times than last year in parts of the country.

Victorian President of the Pharmacy Guild of Australia Anthony Tassone said the dramatic spike in cases has led to a cold and flu medicine shortage.

‘There have been shortages for medications used for pain and fever such as: paracetamol and ibuprofen – in products for children and adults,’ he said.

‘These shortages have happened intermittently throughout the Covid pandemic and may be due to sudden increases in demand which supply cannot keep up with.’

Mr Tassone said he’d seen the shortage first-hand in his Victorian pharmacy where cases are almost 278 times higher than they were this time last year.

‘Pharmacy teams are trying their best to obtain stock as soon as possible and may be able to suggest an alternative,’ he said.

‘The Government should also issue advice on the wearing of face coverings, social distancing and on hand hygiene over the autumn/winter months,’ he said.

‘These are simple but effective measures that will help protect us all and support the NHS through what is likely to be a very challenging period.’

He added: ‘Lower overall immunity due to lockdowns, increased population mixing and the removal of other restrictions (face coverings, hand hygiene) will contribute to increased susceptibility to infection with flu.’ 

Nationally, Australia has reported 87,989 cases of influenza like illnesses this year, but over half of these have been recorded in the last two weeks. 

There have also been 27 deaths linked to flu recorded so far. 

Melbourne’s Royal Children’s Hospital, for example, said flu admissions had risen 500 per cent in a two-week period last month.

Pharmacists have warned that soaring demand has led to shortages of cold and flu medicines.

Flu cases generally rise in the southern hemisphere April to September and in the Northern Hemisphere in October to May.

What has some experts worried is how early and how many flu cases are being seen in Australia.

Some Australian experts have even called for anti-Covid measures like mask wearing and social distancing to be maintained to slow the spread of flu. 

Stocks  of flu medications such as pain and fever such as paracetamol and ibuprofen have also been running low in Australia. 

Scientists have warned flu seasons are going to be unpredictable due to the impact of the Covid pandemic. 

For example US Centers for Disease Control and Prevention statistics show there has been an abnormal surge in flu, starting several weeks ago, long after the Northern Hemisphere flu season is supposed to end.

And last year flu was predicted to bring the NHS to its knees due to it and Covid circulating at the same time. However, this did not come to pass.

The new ‘super-flu’ outbreak in Australia began in March but started spreading rapidly in late May with 47,860 cases recorded between May 23 and June 5.

However actual case numbers are likely to be much higher than recorded as many people do not seek medical attention for the flu.

The fast-spreading outbreak comes after weeks of warning the flu could couple with Covid and create a hybrid ‘flurona’.

A combination outbreak could see even more strain on the public health system as workers call in sick and patients flood in.

Sydney GP Kean Seng Lim called for facemasks to be brought back in late May to prevent another outbreak.

‘I think we have a big problem coming,’ he told the Today Show.

‘You have got the Covid and influenza viruses both coming on together.

‘We do see them happening more during these winter months as people cluster closer together.

‘We also have the problem where we are going to have fewer staff. It isn’t just because staff are off, because they themselves are sick, but also because their kids and grandkids are sick at schools and or schools are reducing because teachers are sick and so forth and so forth because everything interconnects.’

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The post Horror flu in Australia could mean virus havoc in UK this winter appeared first on medicine world council.

That meant the Medicaid benefits of many women expired before they could be referred to other medical providers for help with serious health problems, said Dr. Keila Brown, an OB-GYN in Atlanta. “If they needed other postpartum issues followed up, it was rather difficult to get them in within that finite period of time,” said Brown, who works at the Family Health Centers of Georgia, a group of community health centers.

Georgia lawmakers, recognizing the state’s high rate of pregnancy-related deaths, have taken action. In 2021, Georgia extended the Medicaid coverage window to six months postpartum. And, now, the state plans to broaden that benefits period to a year.

Georgia is one of a dozen states that have opted not to fully expand Medicaid — the federal-state health insurance program for people with low incomes or disabilities — under the Affordable Care Act. But nine of those states, mostly in the South, have sought or plan to seek an extension of postpartum Medicaid coverage, in many cases to a full year after a birth.

Some took advantage of a provision of the American Rescue Plan Act that allows states to extend coverage using a Medicaid state plan amendment, an easier path than applying for a federal waiver. The option is currently available to states only until March 31, 2027.

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The extensions have political overtones. Some maternal health advocates say the new postpartum benefits could open the door to Medicaid expansion in some states. But other advocates say the extensions provide cover to lawmakers who don’t want to fully expand Medicaid, which would give longer-lasting insurance coverage to these low-income women and others.

Lawmakers, physicians, and patient advocates point to high rates of maternal mortality as a reason to extend maternity coverage — as well as the positive impacts it could have on women’s health generally.

Maternal health is on the mind of policy analysts, doctors, and advocates because the U.S. Supreme Court seems poised to upend abortion policy nationwide. States across the country, many of them in the South, have plans to restrict access to abortion if the court overturns its 1973 Roe v. Wade decision, which established the right to an abortion. New limits on abortion access could mean an increase in the number of women who continue their pregnancies and need postpartum care.

Nearly 2 in 3 pregnancy-related deaths are preventable, and 1 in 3 happen one week to one year after delivery, according to the Centers for Disease Control and Prevention. Many of these deaths are associated with chronic health conditions, and Black and Indigenous women are more likely to die than white women.

Medicaid pays for an estimated 42% of U.S. births, so health advocates suggest that expanding the insurance program to reach more mothers for longer would improve maternal health and save more lives.

A recent report on maternal mortality from Tennessee’s health department linked many maternal deaths to substance use disorder, mental health conditions, and heart disease. A year of continuous Medicaid coverage could help mothers address those problems, said Dr. Nikki Zite, an OB-GYN in Knoxville.

The state’s extension of coverage from 60 days to one year officially started April 1.

“You can’t solve all problems in a year, but I think you can get a much better grasp of control on some of these problems in a year than you could in six to eight weeks — especially when that six to eight weeks was pretty much dominated by new infant care,” Zite said.

Policy experts say the move to a year of postpartum Medicaid coverage, while important, solves only one part of the maternal health puzzle.

“A lot of these are conditions — for example, hypertension, cardiovascular conditions — which need to be addressed before a woman gets pregnant,” said Joan Alker, a research professor at the Georgetown University McCourt School of Public Policy.

And women, whether they’re pregnant or new mothers, can more easily get treatment for those conditions in Medicaid expansion states, Alker said. A 2020 study found that mothers in the states that had expanded Medicaid coverage had better health outcomes than those in non-expansion states.

Dr. Bonzo Reddick, a family practice doctor in Savannah, Georgia, said Medicaid expansion also reduces demand for abortion. “How you can prevent a lot of abortions is by having contraception available to people,” he said.

For now, states must continue Medicaid coverage until the covid-related public health emergency ends, so women currently enrolled aren’t falling through the cracks.

In a 2021 issue brief, federal health researchers said about 20% of people with pregnancy-related Medicaid become uninsured within six months of giving birth, including in states that have fully expanded Medicaid. The percentage is nearly double in non-expansion states.

That drop-off in coverage is why states as politically diverse as California, Oregon, Kentucky, Ohio, and Louisiana — all states that have expanded Medicaid — have instituted the 12-month maternal coverage extension. As many as 720,000 women across the country would qualify if all states adopted the longer coverage, according to a federal estimate.

There’s some talk that the postpartum extensions might lead non-expansion states to take the next step. “In states that have taken up the extension, you’re building the political will and the momentum to get to a Medicaid expansion point,” said Taylor Platt, a health policy researcher with the American College of Obstetricians and Gynecologists.

But some health care officials are wary of reading too much into the popularity of the benefits extension.

“Postpartum moms are a group that politicians of any stripe are going to have an interest in supporting,” said Christian Soura, executive vice president of the South Carolina Hospital Association. Extending postpartum coverage might complicate efforts to get South Carolina lawmakers to fully expand Medicaid, Soura said. Peeling away a small, uncontroversial group for a coverage extension leaves what he called the “least politically sympathetic” groups uncovered.

Republican state lawmakers who pushed for the postpartum extension in other states say they encountered considerable resistance from some members of their party.

“There are those that absolutely do not want to expand Medicaid in any form or fashion in the state,” said Republican state Rep. Debbie Wood of Alabama. Wood said she supported legislation that would have permanently extended postpartum coverage in Alabama from 60 days to a full year. The bill didn’t pass, but lawmakers ended up putting $4 million in the state budget for a pilot program instead.

In Georgia, extending postpartum coverage took years of work and behind-the-scenes lobbying of fellow Republicans, said state Rep. Sharon Cooper, who pushed for the change. “In a perfect world, everybody would have some form of health insurance one way or the other. But this is not a perfect world,” said Cooper, who chairs a House health care committee. “And if a year is what I’ve got, I’ll take a year.”

Some states that haven’t expanded Medicaid — such as Wyoming, South Dakota, and Mississippi — don’t have the political will to extend postpartum care. “We’ve been very clear we’re just not for Medicaid expansion,” Mississippi House Speaker Philip Gunn recently told Mississippi Public Broadcasting. “This is arguably Medicaid expansion, certainly expanding coverage.”

More work needs to be done to buttress coverage during the postpartum period, maternal health advocates said. They would like to see the fast-track extension option made available beyond 2027 and one year of coverage for new moms become a permanent requirement for all states.

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Benoit Coffin, MD, PhD, and Henri Duboc, MD, PhD, from Hôpital Louis Mourier, Colombes, France, conducted a literature review to identify rare and less well-known causes of persistent abdominal pain, identifying almost 50 across several categories.

“Some causes of persistent abdominal pain can be effectively treated using established approaches after a definitive diagnosis has been reached,” they write.

“Other causes are more complex and may benefit from a multidisciplinary approach involving gastroenterologists, pain specialists, allergists, immunologists, rheumatologists, psychologists, physiotherapists, dieticians, and primary care clinicians,” they write.

The research was published online in Alimentary Pharmacology and Therapeutics.

Frequent and  Frustrating Symptoms

Although there is “no commonly accepted definition” for persistent abdominal pain, the authors say it may be defined as “continuous or intermittent abdominal discomfort that persists for at least 6 months and fails to respond to conventional therapeutic approaches.”

They highlight that it is “frequently encountered” by physicians and has a prevalence of 22.9 per 1000 person-years, regardless of age group, ethnicity, or geographical region, with many patients experiencing pain for more than five years.

The cause of persistent abdominal pain can be organic with a clear cause or functional, making diagnosis and management “challenging and frustrating for patients and physicians.”

“Clinicians not only need to recognize somatic abnormalities, but they must also perceive the patient’s cognitions and emotions related to the pain,” they add, suggesting that clinicians take time to “listen to the patient and perceive psychological factors.”

Coffin and Duboc highlight that the most common conditions associated with persistent abdominal pain are irritable bowel syndrome and functional dyspepsia, as well as inflammatory bowel disease, chronic pancreatitis, and gallstones.

To examine the diagnosis and management of its less well-known causes, the authors conducted a literature review, beginning with the diagnosis of persistent abdominal pain.

Diagnostic Workup

“Given its chronicity, many patients will have already undergone extensive and redundant medical testing,” they write, emphasizing that clinicians should be on the lookout for any change in the description of persistent abdominal pain or new symptoms.

“Other ‘red flag’ symptoms include fever, vomiting, diarrhea, acute change in bowel habit, obstipation, syncope, tachycardia, hypotension, concomitant chest or back pain, unintentional weight loss, night sweats, and acute gastrointestinal bleeding,” the authors say.

They stress the need to determine whether the origin of the pain is organic or functional, as well as the importance of identifying a “triggering event, such as an adverse life event, infection, initiating a new medication, or surgical procedure.” They also recommend discussing the patient’s diet.

There are currently no specific algorithms for diagnostic workup of persistent abdominal pain, the authors say. Patients will have undergone repeated laboratory tests, “upper and lower endoscopic examinations, abdominal ultrasounds, and computed tomography scans of the abdominal/pelvic area.”

Consequently, “in the absence of alarm features, any additional tests should be ordered in a conservative and cost-effective manner,” they advise.

They suggest that, at a tertiary center, patients should be assessed in three steps:

• In-depth questioning of the symptoms and medical history

• Summary of all previous investigations and treatments and their effectiveness

• Determination of the complementary explorations to be performed

The authors go on to list 49 rare or less well-known potential causes of persistent abdominal pain, some linked to digestive disorders, such as eosinophilic gastroenteritis, mesenteric panniculitis, and chronic mesenteric ischemia, as well as endometriosis, chronic abdominal wall pain, and referred osteoarticular pain.

Systemic causes of persistent abdominal pain may include adrenal insufficiency and mast cell activation syndrome, while acute hepatic porphyrias and Ehlers–Danlos syndrome may be genetic causes.

There are also centrally mediated disorders that lead to persistent abdominal pain, the authors note, including postural orthostatic tachycardia syndrome and narcotic bowel syndrome due to opioid therapy, among others.

Writing support for the manuscript was funded by Alnylam Switzerland GmbH. Coffin has served as a speaker for Kyowa Kyrin and Mayoly Spindler and as an advisory board member for Sanofi and Alnylam. Duboc  reports no relevant financial relationships. 

Alimentary Pharmacology & Therapeutics. Published online June 2, 2022. Full text

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The number of programs and prescribers offering safer supply to reduce risk of overdose increased dramatically in the early days of the COVID-19 pandemic, according to a new study looking at services across Canada.

The findings, published this month in the International Journal of Drug Policy, suggest capacity for further rapid scale-up of flexible safer supply prescribing to address the increasing toxic drug supply.

“Many public health experts anticipated that the early response to COVID-19 in March 2020 could lead to an increase in overdose and substance use-related harms,” says the study’s lead author Dr. Stephanie Glegg, a postdoctoral fellow at UBC’s department of medicine and the BC Center on Substance Use (BCCSU). “Safer supply was identified as an option to reduce those risks and with new clinical guidance and policy changes introduced to support prescribing we witnessed a dramatic increase in both access and availability.”

As part of a national environmental scan, the researchers documented that 60 new sites were prescribing safer supply in May 2020, a 285-per-cent increase from the 21 sites available just two months earlier in March 2020. Through interviews with healthcare providers, the study authors found that the COVID-19 pandemic was a driving force behind this rapid scale-up in prescribing services.

Measures to limit COVID-19 spread have been cited as contributing to an increase in fatal drug poisonings and substance use related hospitalizations in regions across Canada, which led to disruptions to the global illicit drug supply chain, a reduction in the availability of harm reduction services, and more isolation to reduce risk of infection.

More access to safer supply but barriers still exist

Safer supply refers to providing prescribed medications as an alternative to the toxic illegal drug supply to people who are at high risk of overdose. During COVID-19 the illicit drug supply has become increasingly toxic as fentanyl concentrations increase, and unpredictable with the emergence of contaminants such as benzodiazepines.

British Columbia saw the most dramatic expansion of sites and prescribers offering safer supply, with the number rising from two in March 2020 to 56 in May 2022.

“This expansion in B.C. was partially driven by interim provincial risk mitigation guidance published by the BCCSU,” said Dr. Glegg.

Provincial and regional bodies in Ontario and Québec also updated guidance for safer supply and COVID-19 risk mitigation prescribing in the months immediately following the declaration of the COVID-19 pandemic.

The researchers documented that the most common substances prescribed were opioids, made available mostly through addiction treatment programs, community health centers and primary care clinics, outreach and home delivery services, and onsite pharmacies models—relatively flexible program settings able to quickly adapt practices based on community need.

Despite the rapid increase in services, access is still limited and barriers to scaling up prescribed safer supply persist. Access in rural and remote settings remains mostly non-existent and 79 percent of safer supply services were unfunded.

Fears of diversion remain a barrier to prescribing

Concerns related to the risk of diversion have also been cited as barrier to a broader scaling up of safer supply prescribing. Drug diversion is when prescription medications are distributed illicitly for purposes not intended by the prescriber.

A perceived over-prescribing of pharmaceutical opioids in the early 2000s is often cited as a factor in the increase of opioid-related overdoses. However, data from various provincial coroners services indicates that prescription opioids have not been a key contributor to fatal overdose. Additionally, recent research has found that diverted prescription opioids can have a protective effect on community, as people become less reliant on the toxic illicit drug supply.

“As clinicians, we have a duty and an obligation to keep people safe even if it’s not within a treatment framework,” says the study’s senior author Dr. Nadia Fairbairn, an addiction medicine clinician and the Philip Owen Professor in Addiction Medicine at UBC. “It can be complex and challenging, to balance that obligation with the potential for opioid-naïve people to access diverted prescription opioids. The reluctance that many clinicians have about prescribing safer supply speaks to the need for other models of delivery.”

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Juneteenth is the oldest nationally celebrated commemoration of the ending of slavery in the United States. The first Juneteenth was celebrated back in 1866. Yet despite its long history, it only just recently became a federal holiday in 2021 — when President Biden signed the bill making it the first holiday to obtain legal observance since Martin Luther King Jr. Day in 1983. The holiday has deep roots in the South and has been celebrated for generations by many, but on the same token, many non-Black Americans had never heard of Juneteenth until it was observed as a federal holiday. And before the federal holiday, before national recognition, and before it became popular in retail, it was a day of remembrance for many. A day that celebrates freedom. 

As a Black mother, it is extremely important to me for my kids to have accurate depictions of history beyond what is taught in schools. My oldest child is only 7, and therefore I have to think outside of the box for age appropriate ways to teach them about pretty much anything. They already learn the public school’s version of history, but teaching goes beyond the classroom. Here are some age appropriate ways I teach my early elementary-aged children about Juneteenth. Whether you do just one of these with your kids or pair several of the activities together, they’re a great way to respectfully observe the holiday … and you can probably learn something new yourself!

YouTube videos

We live in the age of technology and kids consume a little bit of everything on the internet. YouTube has tons of educational content surrounding a wide variety, and I’ve found some pretty good resources for Juneteenth as well. 

• PBS Kids’ Juneteenth video explains about the significance of the holiday in an age appropriate format. And clocking in at just under a minute and a half, it’s perfect for those little attention spans.
  
• “What is Juneteenth and Why Do We Celebrate?” by BrainPOP is a fun and informative animated video. With an almost 8 minute run time it’s a little longer, but it held my 7-year-old’s interest. It’s definitely a conversation starter, so pause, take breaks, and talk it through.
  

Books 

Books centering around Juneteenth (and Black History in general) are another easy way to teach the history and commemorate the day. Some great titles for young readers include:

• Juneteenth: It’s a Celebration by Chastity Collins
• My First Heroes: Black History
  by the Editors of Silver Dolphin Books
• The Juneteenth Story: Celebrating the End of Slavery in the United States by Alliah L. Agostini 
• Opal Lee and What It Means to Be Free: The True Story of the Grandmother of Juneteenth by Alice Faye Duncan
• Juneteenth for Mazie by Floyd Cooper
• Juneteenth Jamboree by Carole Boston Weatherford

Activities 

For most young kids, the most effective way to learn is by doing. Pairing one of these activities with a book or video will help drive the lessons learned home.

• Make a freedom flag. Goose Goose Duck has a free printable to help create a freedom flag for the holiday. You can either do it this way, or craft your own with construction paper, crayons, etc. While you do this activity, discuss what freedom means, and then put on your own freedom parade at home! 
• Make a Juneteenth meal. Red foods are chosen as a symbol of the resilience and ingenuity of enslaved people. Have a red-themed feast is a great way to honor the holiday. Red juice, red velvet cake, and red fruit are just a few ideas. 
• Check out Juneteenth events in your city. With the holiday now being recognized federally, many cities and local children’s museums host activities perfect for families. Check locally to see what is being done in your area (or Googling “Juneteenth activities near me” can yield some great results too!).
• Take a virtual lesson. Outschool is an excellent platform that hosts tons of Juneteenth lessons kids can take virtually. They have Juneteenth content for kids ranging from ages 3 to 17, so there’s really something for every age group!

Educating our children about slavery and other topics are important, not only to understand the history of the United States, but teaching cultural understanding. Hopefully the provided resources are a starting point for starting conversations and possibly developing new traditions with your family.

Celebrate Juneteenth by reading these beautiful books with your kids.

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Many Americans still struggle to get their daily steps in, despite the physical and emotional benefits of walking as part of a healthy lifestyle. Where a person spends their day, however, can influence the likelihood that they will engage in moderate to vigorous exercise, according to a new study co-authored by researchers from North Carolina State University.

The analysis, led by former NC State postdoctoral scholar Oriol Marquet, used wearable sensors and satellite data to link people’s activity levels with the walkability and greenness of where they spent their time. “Walkability” accounts for factors like street intersection density and mix of land uses, while “greenness” is an indicator of the abundance of vegetation in an area. In 2012 or 2013, 354 working female adults from four sites across the United States each wore a GPS unit (which recorded a location every 15 seconds) and an accelerometer (which recorded movement and total number of steps taken) for one week. Researchers then mapped participants’ “activity spaces” and measured walkability and greenness within them.

Study participants who spent their time in places that were both very walkable and very green exhibited the highest levels of moderate to vigorous physical activity.

“To me, the most interesting thing is the interaction between walkability and greenness,” says Aaron Hipp, co-author of the study and Associate Director of Social and Behavioral Science Applications at NC State’s Center for Geospatial Analytics. “It’s intuitive––having places to walk to, with sidewalks that are shaded by trees. But it’s really rare to get both. A lot of places are walkable and urban, with few trees, or places are really green but they lack sidewalks, or nearby destinations like schools, work, parks, places to get coffee, groceries. It’s unfortunately rare to live or work in a neighborhood that has the walking infrastructure like sidewalks, destinations like a spot for lunch, and are green and shaded. This work again supports that the best environments have all three.”

Previous studies had examined the characteristics of residential neighborhoods to draw connections between physical activity and people’s environments, but this new study used wearable sensors (GPS units and accelerometers) to track activity across all of the environments encountered throughout a person’s day. The new findings suggest that having opportunities to walk between home, work and other destinations is likely to boost physical activity, as long as those areas are also very green.

If urban planners, landscape architects, and policy makers are interested in encouraging people to get more exercise during the day, the researchers say, “interventions to plant vegetation should focus on doing so in areas where walkability is high to maximize opportunities for physical activity.”

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Gut health is at the epicentre of human wellbeing, and understanding the microbes that reside in it has helped medicine in immeasurable ways. The gut comprises roughly 100 trillion bacteria, both good and bad, which are collectively referred to as the microbiome. The diversity of these microorganisms holds a significant influence on the risk of various health conditions, such as cancer and heart attack. A new study has suggested one alcoholic drink could bring variety to the microbiome and allow it to flourish.

New scientific findings suggest lager beer can confer some levels of protection against disease by altering the gut’s microbiome.

The new findings, published in the Journal of Agricultural and Food Chemistry, compared the microbiome of men who drank either one alcoholic or non-alcoholic daily.

Their findings revealed that gut microbes reduced the risk for some diseases, suggesting that drinking in moderation could be healthful.

The microbiome is a complex colony of micro-organisms that resides within the lining of the human gastrointestinal tract.

READ MORE: Heart attack: Scientists discover sign in the eyes that may precede symptoms by ‘years’

The implications of microbiome diversity for human health is a growing area of interest for scientists.

Science Daily noted: “Studies have shown that when more types of bacteria are present, people tend to have a low chance of developing chronic diseases, such as heart disease and diabetes.”

Research published in the journal Microbiome has previously stated that the chemical processes related to gut bacteria have been tied to a higher risk of heart failure, and major cardiac events like heart attack and stroke.

Some earlier studies have even shown that lager beer could substantially reduce the risk of suffering a heart attack by altering the structure of blood clots.

These particular findings, published in the British Medical Journal (BMJ), were made by a team of Israeli researchers.

Writing in the BMJ, they said: “Pale lager beer causes structural changes in the blood clotting protein fibrinogen that can significantly reduce the risk of heart attacks.”

Doctor Shela Gorinstein, a senior researcher at the department of medical chemistry, explained at the time that it was the hops in lager beer that were largely responsible for this effect.

Hops are present in the majority of beer, but their grassy, floral and lemony taste is more prevalent in certain kinds.

The latest research highlights that beer also contains polyphenols and other microorganisms derived from the fermentation process.

Both these compounds are known to have a flourishing effect on the variety of microbes that reside in the human gut.

Scientists have previously found that men and women who drink non-alcoholic beer for 30 days have a broader diversity in their microbiome.

These results, however, have been inconsistent when volunteers consumed an alcoholic version of beer.

But the latest study suggests alcoholic versions of beer may be just as beneficial for the gut.

The new research was conducted on 19 healthy men, divided into two groups who drank 11 fluid ounces of either alcoholic or non-alcohol lager with dinner for four weeks.

Body mass index and markers for heart health and metabolism were left unchanged in the study.

At the end of the four-week period, however, both groups had greater bacterial diversity in their microbiome, indicating improvement in intestinal health.

Science Daily noted: “Based on this pilot study, the scientists said that consuming one bottle of beer, regardless of its alcohol content, may benefit the gut microbiome and intestinal health of men.”

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