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Are you over 75? Here’s what you need to know about vitamin D

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/elina-hypponen-108811">Elina Hypponen</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/joshua-sutherland-1646406">Joshua Sutherland</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> Vitamin D is essential for bone health, immune function and overall wellbeing. And it becomes even <a href="https://pubmed.ncbi.nlm.nih.gov/38337682/">more crucial</a> as we age. New guidelines from the international Endocrine Society <a href="https://pubmed.ncbi.nlm.nih.gov/38828931/">recommend</a> people aged 75 and over should consider taking vitamin D supplements. But why is vitamin D so important for older adults? And how much should they take? <h2>Young people get most vitamin D from the sun</h2> In Australia, it is possible for most people under 75 to get enough vitamin D from the sun <a href="https://healthybonesaustralia.org.au/your-bone-health/vitamin-d-bone-health">throughout the year</a>. For those who live in the top half of Australia – and for all of us during summer – we <a href="https://healthybonesaustralia.org.au/your-bone-health/vitamin-d-bone-health">only need</a> to have skin exposed to the sun for a few minutes on most days. The body can only produce a certain amount of vitamin D at a time. So staying in the sun any longer than needed is not going to help increase your vitamin D levels, while it will increase your risk of skin cancer. But it’s difficult for people aged over 75 to get enough vitamin D from a few minutes of sunshine, so the Endocrine Society <a href="https://pubmed.ncbi.nlm.nih.gov/38828931/">recommends</a> people get 800 IU (international units) of vitamin D a day from food or supplements. <h2>Why you need more as you age</h2> This is higher than the recommendation for younger adults, reflecting the increased needs and reduced ability of older bodies to produce and absorb vitamin D. Overall, older adults also tend to have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356951/">less exposure</a> to sunlight, which is the primary source of natural vitamin D production. Older adults may spend more time indoors and wear more clothing when outdoors. As we age, our skin also becomes <a href="https://pubmed.ncbi.nlm.nih.gov/18290718/">less efficient</a> at synthesising vitamin D from sunlight. The kidneys and the liver, which help convert vitamin D into its active form, also lose some of their efficiency with age. This makes it <a href="https://www.sciencedirect.com/science/article/abs/pii/S0889852913000145">harder for the body to maintain</a> adequate levels of the vitamin. All of this combined means older adults need more vitamin D. <h2>Deficiency is common in older adults</h2> Despite their higher needs for vitamin D, people over 75 may not get enough of it. Studies <a href="https://www.abs.gov.au/articles/vitamin-d">have shown</a> one in five older adults in Australia have vitamin D deficiency. In higher-latitude parts of the world, such as the United Kingdom, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6627050/">almost half</a> don’t reach sufficient levels. This increased risk of deficiency is partly due to <a href="https://pubmed.ncbi.nlm.nih.gov/33309415/">lifestyle factors</a>, such as spending less time outdoors and insufficient dietary intakes of vitamin D. It’s difficult to get enough vitamin D from food alone. <a href="https://dietitiansaustralia.org.au/health-advice/vitamin-d">Oily fish, eggs and some mushrooms</a> are good sources of vitamin D, but few other foods contain much of the vitamin. While foods can be fortified with the vitamin D (margarine, some milk and cereals), these may not be readily available or be consumed in sufficient amounts to make a difference. In some countries such as the <a href="https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/">United States</a>, most of the dietary vitamin D comes from fortified products. However, in <a href="https://pubmed.ncbi.nlm.nih.gov/35253289">Australia</a>, dietary intakes of vitamin D are typically very low because only a few foods are fortified with it. <h2>Why vitamin D is so important as we age</h2> Vitamin D <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367643/">helps the body absorb calcium</a>, which is essential for maintaining bone density and strength. As we age, our bones become more fragile, increasing the risk of fractures and conditions like osteoporosis. Keeping bones healthy is crucial. Studies <a href="https://pubmed.ncbi.nlm.nih.gov/28726112/">have shown</a> older people hospitalised with hip fractures are 3.5 times more likely to die in the next 12 months compared to people who aren’t injured. Vitamin D may also help <a href="https://pubmed.ncbi.nlm.nih.gov/28202713/">lower the risk</a> of respiratory infections, which can be more serious in this age group. There is also emerging evidence for other potential benefits, including <a href="https://pubmed.ncbi.nlm.nih.gov/29233204/">better brain health</a>. However, this requires more research. According to the society’s systematic review, which summarises evidence from randomised controlled trials of vitamin D supplementation in humans, there is <a href="https://pubmed.ncbi.nlm.nih.gov/38828931/">moderate evidence</a> to suggest vitamin D supplementation can lower the risk of premature death. The society estimates supplements can prevent six deaths per 1,000 people. When considering the uncertainty in the available evidence, the actual number could range from as many as 11 fewer deaths to no benefit at all. <h2>Should we get our vitamin D levels tested?</h2> The Endocrine Society’s guidelines <a href="https://pubmed.ncbi.nlm.nih.gov/38828931/">suggest</a> routine blood tests to measure vitamin D levels are not necessary for most healthy people over 75. There is no clear evidence that regular testing provides significant benefits, unless the person has a specific medical condition that affects vitamin D metabolism, such as kidney disease or certain bone disorders. Routine <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10498906">testing</a> can also be expensive and inconvenient. In most cases, the <a href="https://pubmed.ncbi.nlm.nih.gov/38828931/">recommended approach</a> to over-75s is to consider a daily supplement, without the need for testing. You can also try to boost your vitamin D by adding fortified foods to your diet, which might lower the dose you need from supplementation. Even if you’re getting a few minutes of sunlight a day, a daily vitamin D is still recommended.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/231820/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/elina-hypponen-108811">Elina Hypponen</a>, Professor of Nutritional and Genetic Epidemiology, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/joshua-sutherland-1646406">Joshua Sutherland</a>, PhD Candidate - Nutrition and Genetic Epidemiology, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/are-you-over-75-heres-what-you-need-to-know-about-vitamin-d-231820">original article</a>. </div>

Body

How do I know when it’s time to replace my running shoes?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/john-arnold-178470">John Arnold</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/joel-fuller-2210202">Joel Fuller</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> Any runner will tell you there’s nothing better than slipping on a brand new pair of shoes. But how regularly should runners fork out hundreds of dollars on their next pair? Conventional wisdom tells us the average lifespan of a running shoe is around 500 to 800 kilometres. But where did this advice come from, and is it based on science? Some evidence comes from <a href="https://doi.org/10.1177/0363546585013004">impact testing</a> with machines designed to simulate the shoe repeatedly contacting the ground during running. Other evidence comes from <a href="https://doi.org/10.1080/19424280.2010.519348">monitoring runners who have used shoes in the real world</a> for long periods. This research is often focused on shoe materials and structure. But we think more compelling markers for the runner are shoe comfort, performance benefit and injury risk. Rather than seeking a “one-size-fits-all” answer to how many kilometres your shoes should be limited to, it’s also better to consider individual signs based on your shoe type and its purpose. <h2>The three signs to watch for</h2> Runners tend to replace their shoes for three main reasons: <ol> <li>they believe their performance is being negatively impacted</li> <li>their shoes are leading to some bodily discomfort which may cause (or has already caused) an injury</li> <li>the shoes are no longer comfortable or “feel” as good as they used to.</li> </ol> So what does the evidence say about these factors? <h2>Performance</h2> Some shoe material properties do contribute to enhanced running efficiency. Degrading these materials by racking up the kilometres may hinder peak performance on race day. This is most clearly seen in carbon fibre plate shoes used by modern elite runners to achieve <a href="https://doi.org/10.1007/s40279-020-01420-7">rapid road race times</a>. The design features <a href="https://doi.org/10.1007/s40279-018-1024-z">thought to drive this</a> are the combination of highly compliant and resilient midsole foam and a stiff embedded carbon fibre plate, which support energy storage and return. Runners will typically “save” these shoes for race day and replace them after fewer kilometres, compared to conventional running shoes. The available research does support the <a href="https://doi.org/10.1007/s40279-017-0811-2">performance benefits of these shoes</a>. However, it’s not known how long the benefits last relative to kilometres of wear. To our best knowledge, there’s only one study on running performance and shoe wear, but unfortunately it did not involve carbon fibre plate shoes. A University of Connecticut 2020 <a href="http://hdl.handle.net/11134/20002:860659513">master’s thesis</a> investigated eight college-level runners over 400 miles (643km) of Nike Pegasus shoe use. Large reductions in running economy were reported at 240km, and this was statistically significant at 320km. No reduction was observed at 160km. So, if you’re chasing personal best times, the evidence above suggests that for peak performance, shoes should be replaced somewhere between 160 and 240km (although this is not directly based on carbon fibre plate shoe research). It appears that minimising training kilometres for your favourite racing shoes – keeping them “fresh” – could contribute to peak performance on race day, compared to racing in a pair of old shoes. <h2>Injury or discomfort</h2> The link between shoe wear and injury is unclear, and based on <a href="https://bjsm.bmj.com/content/37/3/239">minimal and often conflicting evidence</a>. One study did find that <a href="https://doi.org/10.1111/sms.12154">runners who alternate their running shoes</a> have a lower risk of injury than runners who run only in the same pair of shoes over a 22-week period. Runners who alternated shoes throughout the study period would have accumulated less wear in each shoe. This provides some support for the notion that accumulating too many kilometres in your shoes may increase risk of injury. Unfortunately, the exact age of running shoes was not reported in this study. However, based on the running characteristics reported, the single-shoe pair users completed an average of 320km in their shoes (after adjusting for a small fraction who had to replace shoes during the study). This was compared to the multi-shoe pair users who used an average of 3.6 pairs of shoes, ran more total kilometres, but accumulated an average of only 200km per shoe pair. <h2>Comfort</h2> Comfort and fit are the <a href="https://www.tandfonline.com/doi/full/10.1080/19424280.2024.2353597#abstract">two most important factors</a> to runners when selecting running shoes. Evidence linking improved shoe comfort to <a href="https://journals.lww.com/acsm-msse/fulltext/2001/11000/relationship_between_footwear_comfort_of_shoe.21.aspx">reduced injury rates</a> or <a href="https://www.tandfonline.com/doi/full/10.1080/17461391.2019.1640288">improved running economy</a> is mixed, but reducing harms from poorly fitting and uncomfortable shoes is clearly a priority for runners. Most <a href="https://commons.nmu.edu/isbs/vol35/iss1/293/">runners land on their heel</a>. The repeated compression of the midsole causes the material to harden, possibly after as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5534152/pdf/ijspt-12-616.pdf">little as 160km</a>, according to one study from 2017. However, there was virtually no change in the amount of cushioning runners perceived under their heel after 160km. Even after using the shoes for 640km, they felt little difference – about 3%. While at first this might seem like runners are not very good at judging when shoes lose their cushioning, it also tells us changes in perceived shoe cushioning are very gradual and may not be important for runners until they reach a certain threshold. This amount will differ from person to person, and from shoe to shoe, but research suggests it’s not until perceived cushioning reaches about a <a href="https://www.tandfonline.com/doi/full/10.1080/02640414.2020.1773613?casa_token=P87vatZhOlgAAAAA%3ACu11TZmGjKc1xYsaUlEVfWvZDvcSnx3qgKL1E2DsRYwf6hMvBiyVAm-M_-4Iauq4lwHna0QMu1IRmw">10% change</a> that runners consider it meaningful. We must be careful when applying these findings to the latest running shoes which use newer materials. But you can use it as a rule of thumb – once you notice a drop in comfort, it’s time to get a new pair. <h2>When to choose new shoes</h2> Ultimately, there’s no one simple answer for when you should get new running shoes. You may also not keep close track of how many kilometres your favourite pair has racked up. Overall, we believe the most practical advice is to keep your racing shoes “fresh” (under 240km), alternate a couple of other pairs during regular training, and replace them when you detect a notable drop in comfort.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/238997/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/john-arnold-178470">John Arnold</a>, Senior lecturer, Sport & Exercise Biomechanics, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/joel-fuller-2210202">Joel Fuller</a>, Senior Lecturer, Department of Health Sciences, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-do-i-know-when-its-time-to-replace-my-running-shoes-238997">original article</a>. </div>

Beauty & Style

How to know when it’s time to start therapy

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/simon-sherry-557487">Simon Sherry</a>, <a href="https://theconversation.com/institutions/dalhousie-university-1329">Dalhousie University</a> People go to therapy for many reasons. A challenging life event, trauma, volatile emotions, relationship problems, poor mental health: all can prompt someone to seek it out. Whatever the reason, it can be difficult to decide when and if therapy is right for you. If you’re reading this, now’s probably the right time. If you’re considering therapy, something is likely bothering you and you want help. Consider this your sign to reach out. If you’re still unsure, keep reading. <h2>Why therapy?</h2> Sometimes, our minds work against us. Therapy can help you understand why you think, feel, or act how you do and give you the skills you need to think, feel, or act in healthier ways. This includes helping you: <ul> <li> identify, understand, and overcome internal obstacles </li> <li> identify and challenge thought patterns and beliefs that are holding you back </li> <li> improve your mental health </li> <li> cope with mental illness </li> <li> and create lasting changes to your thoughts and behaviour that can improve all areas of your life. </li> </ul> <h2>When your mental health is suffering</h2> Everyone experiences negative emotions in difficult situations — like sadness after a breakup or anxiety before a big life event. But when do these feelings become problematic? When you have <a href="https://www.canada.ca/en/public-health/services/about-mental-health.html">poor mental health</a>. Mental health and mental illness <a href="https://cmha.ca/news/mental-health-what-is-it-really/">are distinct</a>, but related, concepts. <a href="https://dictionary.apa.org/mental-health">Mental health</a> refers to the inner resources you have to handle life’s ups and downs. You have good mental health if you enjoy life; feel connected to others; cope well with stress; and have a sense of purpose, a sense of self and strong relationships. If you have poor mental health, it can be hard to adapt to changes like a breakup, move, loss or parenthood. Therapy can help you improve your mental health, develop resilience and maintain a state of well-being. <a href="https://www.canada.ca/en/public-health/services/about-mental-illness.html">Mental illness</a> refers to distressing disturbances in thoughts, feelings and perceptions that interfere with daily life. There are <a href="https://cmha.ca/brochure/mental-illnesses/">different kinds</a> of mental illness, each characterized by different thoughts, feelings and behaviours. Mental illness may feel like: <ul> <li> Hopelessness — feeling stuck, unmotivated or helpless. </li> <li> Apathy — feeling uninterested in things that used to give you satisfaction or pleasure. </li> <li> Anger — feeling rage or resentment, especially frequently or disproportionately. </li> <li> Stress — feeling overwhelmed, unable to cope, unwilling to rest or like everything is hard (even if you know it shouldn’t be). </li> <li> Guilt — feeling ashamed, undeserving of good things or deserving of bad things. </li> <li> Anxiety — worrying about what has or might happen or having disturbing intrusive thoughts. </li> <li> Exhaustion — sleeping more than usual, having difficulty getting out of bed or lacking energy during the day. </li> <li> <a href="https://doi.org/10.1016/S2215-0366(20)30136-X">Insomnia</a> — having difficulty falling or staying asleep. </li> </ul> Both poor mental health and mental illness are equally good reasons to seek therapy. Ask yourself: Am I having trouble dealing with life challenges? If the answer is yes, therapy might be for you. People often cope with the feelings listed above in different ways. <a href="https://www.nami.org/wp-content/uploads/2023/11/NAMI-Warning-Signs-FINAL.pdf">Some gain or lose a lot of weight</a>. Others might seek out or do things that are unhealthy for them, like entering a toxic relationship, engaging in dangerous activities, developing an unhealthy habit or procrastinating. Others might isolate themselves from friends and family, or catastrophize and <a href="https://pubmed.ncbi.nlm.nih.gov/22468242">ruminate on negative experiences</a>. However it manifests, <a href="https://namica.org/what-is-mental-illness/">mental illness often gets worse if left untreated</a>. It can have very real impacts on your life, potentially leading to unemployment, broken relationships, poor physical health, substance abuse, homelessness, incarceration or even suicide. Ask yourself: Is mental illness negatively affecting my functioning or well-being? If the answer is yes, therapy might be for you. <h2>What if therapy didn’t work before?</h2> Many people put off going to therapy because they don’t think their problems are serious enough, but you don’t need a big, deep reason to start therapy. Some people go to therapy to learn more about themselves. Some, to improve their skills, relationships or productivity. Others go for help reaching their goals or because they aren’t happy and don’t know why. Any of these are good reasons to start therapy, even if they don’t seem like “problems” in a traditional sense. You can go to therapy just because there’s something about yourself or your life you’d like to explore. Therapy is a process. Whether psychotherapy works for you depends on many factors, such as time, effort and your psychologist. There’s no quick fix for mental health. Symptoms can take weeks, months or even years to improve. Although this can be frustrating or disheartening, for therapy to work, you have to give it time. Sometimes people go to therapy, but are skeptical or resistant. Therapy won’t work if you aren’t invested in it. For therapy to work, you have to put in the work. Therapy is a vulnerable process, so finding a psychologist you trust and relate well with is crucial. Psychologists also have different specialities and approaches. For therapy to work, you have to find the right therapist for you. <h2>What if I’m not ready?</h2> There are several reasons why now might not be the right time for you to start therapy. Maybe therapy isn’t in the budget. Maybe you have other priorities. Maybe you’re scared to relive trauma. That’s okay. Therapy can be expensive and difficult, but also rewarding. Just because now isn’t a good time, doesn’t mean there will never be a good time. If you don’t want to start therapy, don’t. However, it can be helpful to determine why you don’t want to. Maybe you don’t want to go to therapy because you’re worried what others might think. If so, remember that people are often <a href="https://www.camh.ca/en/driving-change/the-crisis-is-real/mental-health-statistics">more understanding</a> than we anticipate, and there is nothing wrong with investing in your health or happiness. If you’re struggling with your mental health, know that you’re not alone. Mental health issues are common. Having them or attending therapy does not mean there is something “wrong” with you. Mental illness affects <a href="https://www.who.int/news-room/fact-sheets/detail/mental-disorders">970 million people</a> and is the leading cause of disability worldwide. <a href="https://www.camh.ca/en/driving-change/the-crisis-is-real/mental-health-statistics">One in five</a> <a href="https://www.nami.org/about-mental-illness/mental-health-by-the-numbers/">adults</a> and more than <a href="https://doi.org/10.1001/jamapsychiatry.2023.5051">one in 10 children and youths</a> have mental illness. About <a href="https://health-infobase.canada.ca/datalab/mental-illness-blog.html">15 per cent of Canadians</a> use mental health services each year. Don’t let stigma keep you from bettering your life and well-being. Everyone deserves to live a healthy, fulfilling life. Therapy can help you get there.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/234078/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/simon-sherry-557487">Simon Sherry</a>, Clinical Psychologist and Professor in the Department of Psychology and Neuroscience, <a href="https://theconversation.com/institutions/dalhousie-university-1329">Dalhousie University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-to-know-when-its-time-to-start-therapy-234078">original article</a>. </div>

Mind

Sorting a loved one’s finances after their death – what you need to know

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/kate-reed-1548385">Kate Reed</a>, <a href="https://theconversation.com/institutions/university-of-sheffield-1147">University of Sheffield</a> Financial anxiety is often talked about, but rarely in the context of bereavement. Following the death of a loved one, relatives usually have to complete a range of financial “death administration” tasks. These can be anything from closing bank accounts and settling utility bills to managing probate (things like property sales, asset management and inheritance distribution). The <a href="https://bereavementcommission.org.uk/media/xube5elb/ukbc_summary_report_low-res.pdf">UK Commission on Bereavement</a> has estimated that 61% of adults struggle to deal with such time consuming and time sensitive administrative responsibilities. While research has begun to shed light on some of the financial difficulties bereaved people can face after the death of a <a href="https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-015-0194-1">spouse</a> or a <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/1468-4446.12190">family member</a>, the emotional toll of navigating financial admin after bereavement remains <a href="https://www.bereavementjournal.org/index.php/bcj/article/view/1114">largely invisible</a>. But the good news is there are several resources that can help bereaved people to navigate these processes, including the UK government’s own <a href="https://www.gov.uk/when-someone-dies">step-by-step guide</a>. We conducted <a href="https://thenbs.org/partnerships/death-admin-research-report">research</a> on death admin in collaboration with the <a href="https://thenbs.org/">National Bereavement Service</a>, an organisation that provides free practical and emotional support for anyone who has lost a loved-one. The study showed how government services provide a gateway to sorting out a range of financial issues. Financial organisations require proof of the death through a death certificate. This is provided when you <a href="https://www.gov.uk/when-someone-dies">register</a> a death with the local registrar of births, marriages and deaths. Where there is an inquest, an interim death certificate will be issued. Often, multiple copies of the death certificate are needed. And, at £12.50 for <a href="https://www.gov.uk/order-copy-birth-death-marriage-certificate">each copy</a> (£12 in <a href="https://www.mygov.scot/birth-death-marriage-certificate#:%7E:text=You%20can%20order%20a%20certificate,orders%20made%20in%20another%20way.">Scotland</a>), the financial burden falling on bereaved people can quickly grow. In terms of tax, pensions and benefits, the registrar provides a unique reference number that bereaved people can use to inform the government through a service called <a href="https://www.gov.uk/after-a-death/organisations-you-need-to-contact-and-tell-us-once">Tell Us Once</a>. This is an initiative that notifies national and local government bodies including HM Revenue and Customs (to deal with personal tax and to cancel certain benefits and tax credits) and the Department for Work and Pensions (to cancel benefits and entitlements like universal credit or the state pension). The <a href="https://www.gov.uk/valuing-estate-of-someone-who-died?step-by-step-nav=4f1fe77d-f43b-4581-baf9-e2600e2a2b7a">government website</a> also provides help on how to value the person’s estate and work out inheritance tax. <h2>Avoiding family fall-outs</h2> But other financial aspects of death administration can be more challenging to navigate. Probate, for example, is the legal right to deal with someone’s property, money and possessions (their “estate”) when they die. You can <a href="https://www.gov.uk/applying-for-probate?step-by-step-nav=4f1fe77d-f43b-4581-baf9-e2600e2a2b7a">check</a> on the UK government website whether you require probate. It remains one of the most challenging aspects of death administration. Our <a href="https://thenbs.org/partnerships/death-admin-research-report">research</a> shows that people often seek legal advice to manage probate because they are scared to get things wrong, or because they want to avoid future disputes with family members. The process of closing bank accounts and managing assets can be straightforward when the deceased person had made clear arrangements and had few bank accounts. But financial concerns often arise in situations where there are multiple or complicated banking systems. As one of the participants in our research stated: “It’s been a real mess … my dad had quite a few properties, and it’s been quite difficult winding those down.” Worse still, bereaved people can face threatening letters from companies like utilities providers in relation to bills and closing accounts. We found organisations often lack compassion in this context. We encountered cases of companies continuing to write directly to the deceased person, causing further distress to their loved-ones. One of our participants told us that their stepmother was “still getting the bill with my father’s name on, which distresses her”. It is also worth noting that certain types of death present particular administrative and financial challenges. For example, in 2022 17% of deaths in England and Wales were subject to a <a href="https://www.gov.uk/government/statistics/coroners-statistics-2022/coroners-statistics-2022-england-and-wales#inquests-opened">coroner’s inquest</a>. These deaths can be more difficult to administer on the Tell Us Once initiative due to the time-lag and extra bureaucracy involved. In addition, many people die without a will, which usually makes navigating financial issues much harder. The location of the death can also have financial implications. For example, our <a href="https://www.bereavementjournal.org/index.php/bcj/article/view/1114">research</a> shows how financing a care home stay is usually interconnected with inheritance or selling the person’s house, which places extra pressure on those trying to release the funds. Many organisations could make their administrative processes clearer and train their staff to be more compassionate towards people who have recently been bereaved. There are, however, glimmers of hope that things are improving. My own father died last year and while my experiences of helping my mum deal with the financial aspects of death administration have been mixed, we did experience many acts of kindness and compassion along the way. There is also excellent practical guidance out there from organisations like the <a href="https://thenbs.org/">National Bereavement Service</a>, which along with emotional support from charities like <a href="https://www.cruse.org.uk/">Cruse Bereavement Support</a> are vital to helping people navigate complex administrative systems. The COVID pandemic and death of the queen in 2022 have likely meant that, as a society, we are talking more about death and grief both publicly and privately. Death and bereavement happen to us all, and it is crucial that we talk more openly, not just about our emotional concerns, but about the practical and financial implications too.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/231967/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/kate-reed-1548385">Kate Reed</a>, Professor of Sociology and Director of the Sheffield Methods Institute, <a href="https://theconversation.com/institutions/university-of-sheffield-1147">University of Sheffield</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/sorting-a-loved-ones-finances-after-their-death-what-you-need-to-know-231967">original article</a>. </div>

Money & Banking

Castor oil is all the rage among health influencers – what you need to know about this alternative remedy

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/veronique-seidel-1542416">Veronique Seidel</a>, <a href="https://theconversation.com/institutions/university-of-strathclyde-1287">University of Strathclyde </a> Castor oil, which was once used by fascists in Italy as <a href="https://www.rcpe.ac.uk/remoteandruralremedies/activities/exhibitions/medicines.html#:%7E:text=Due%20to%20its%20use%20as,the%20bludgeon%20and%20castor%20oil'.">punishment</a> because of its quick-acting laxative effect, is now a weight-loss trend on TikTok. Not drinking it, but rubbing it on your belly. Influencers are also pouring it in their belly buttons and wrapping towels soaked in it around their midriff. They claim it can <a href="https://www.tiktok.com/@karinawaldron/video/7333667470756072709?lang=en">melt belly fat</a> and <a href="https://www.tiktok.com/@sarahjmce/video/7322670147473362207?lang=en&q=castor%20oil&t=1716463274921">help with bloating</a>. Castor oil – made from the beans of the castor plant – is an ancient medicine. References to it appear in an ancient Egyptian medical text called the <a href="https://www.nationalgeographic.com/premium/article/castor-oil-real-health-benefits">Ebers Papyrus</a> (1550BC). It was used as a laxative and to treat various skin conditions. Cleopatra is said to have <a href="https://www.washingtonpost.com/lifestyle/wellness/cleopatra-used-it-as-a-beauty-aid-now-castor-oil-is-staging-a-cosmetics-comeback/2019/07/05/2d457584-92c5-11e9-aadb-74e6b2b46f6a_story.html?itid=sr_1_4c3daa8b-2b15-41d9-9b45-f1b2af1d7cf7">used it</a> in her hair and to brighten the whites of her eyes. The odourless oil is rich in a fatty substance called ricinoleic acid that strongly stimulates bowel movements. Today, it is an approved <a href="https://dps.fda.gov/omuf/monographsearch/monograph_m007">over-the-counter remedy</a> in some countries for short-term constipation and is used for cleansing the bowel before medical examinations. However, there’s not much scientific evidence to indicate that this laxative effect is better than other commonly used laxatives, such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3862068/">senna</a> – which has also been used for centuries. Other reported traditional uses for the oil include as a cure for sore and itchy eyes, to relieve joint and period pain, and as a means to induce labour. But, again, the evidence for these things is scant. Castor oil isn’t just imbibed, it is also widely used in skin creams, hair conditioners and other cosmetic products, such as lipsticks. It is used to moisturise, soothe irritated skin and reduce the appearance of wrinkles. Its moisturising properties have been attributed to ricinoleic acid. As part of haircare products, it is said to help with hair loss and dandruff. But taking castor oil as a standalone product is not risk free. The main side-effects of imbibing the oil are abdominal cramps, vomiting, bloating and dizziness. Vulnerable people, such as the elderly, babies, pregnant or breastfeeding women, and those with liver or kidney failure should avoid taking castor oil. As should anyone with inflammatory bowel disease, appendicitis or gastrointestinal obstruction or perforation. The side-effects of castor oil can also be exacerbated in people with <a href="https://www.degruyter.com/document/doi/10.1515/jom-1988-880520/html">eating disorders</a> who may choose to use the oil to lose weight by speeding up the passage of food through the gut. However, if you want to apply the oil to your skin or scalp, proceed with caution. In some people, it can trigger an allergic reaction. It is always advised to apply a small amount of pure castor oil or a castor oil-containing cosmetic product onto a small patch of skin. If there is no allergic reaction after 24 hours, then it can be assumed that the product can be applied safely to a larger area of the body. Ultimately, though, there are generally safer and better remedies out there. And rubbing it on your belly – sadly – won’t melt the fat.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/232782/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/veronique-seidel-1542416">Veronique Seidel</a>, Senior Lecturer, Pharmacy and Biomedical Sciences, <a href="https://theconversation.com/institutions/university-of-strathclyde-1287">University of Strathclyde</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/castor-oil-is-all-the-rage-among-health-influencers-what-you-need-to-know-about-this-alternative-remedy-232782">original article</a>. </div>

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I feel sick. How do I know if I have the flu, COVID, RSV or something else?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> You wake with a sore throat and realise you are sick. Is this going to be a two-day or a two-week illness? Should you go to a doctor or just go to bed? Most respiratory illnesses have very similar symptoms at the start: sore throat, congested or runny nose, headache, fatigue and fever. This may progress to a dry cough. Best case scenario is that you have “<a href="https://lungfoundation.com.au/wp-content/uploads/2018/09/Factsheet-Common-Cold-Mar2016.pdf">a cold</a>” (which can be any one of hundreds of viruses, most commonly rhinovirus), which is short-lived and self-limiting. But some respiratory illnesses can be much more serious. Here is a brief guide to some important bugs to know about that are circulating this winter, and how to work out which one you have. <h2>Respiratory syncytial virus (RSV)</h2> For most people an RSV infection will feel like “a cold” – annoying, but only lasting a few days. However, for babies, older adults and people with immune issues, it can lead to <a href="https://www.rch.org.au/kidsinfo/fact_sheets/bronchiolitis/">bronchiolitis</a> or pneumonia, and even become life-threatening. RSV isn’t seasonal, which means you are just as likely to get it in summer as in winter. However, it is highly contagious so we noticed it <a href="https://pubmed.ncbi.nlm.nih.gov/32986804">disappearing almost completely</a> during COVID lockdowns. There is now a <a href="https://www.tga.gov.au/sites/default/files/2024-02/covid-19-rapid-antigen-self-tests-are-approved-australia-ifu-406813.PDF">rapid-antigen test (RAT) for RSV</a> which also checks for influenza and COVID, and is the best way of finding out if RSV is what is causing symptoms. Recently, a preventative immune therapy has become available for high risk babies (<a href="https://www.schn.health.nsw.gov.au/respiratory-syncytial-virus-rsv-monoclonal-antibody-factsheet">nirsevimab</a>) and there are also <a href="https://ncirs.org.au/ncirs-fact-sheets-faqs-and-other-resources/respiratory-syncytial-virus-rsv-frequently-asked">vaccines for higher risk adults</a>. Nirsevimab is also available to all babies for free in <a href="https://www.health.wa.gov.au/Articles/N_R/Respiratory-syncytial-virus-RSV-immunisation">Western Australia</a> and <a href="https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/diseases-infection/immunisation/paediatric-rsv-prevention-program">Queensland</a>. But there are no specific treatments. Adults who get it simply have to ride it out (using whatever you need to <a href="https://www.mayoclinic.org/diseases-conditions/common-cold/diagnosis-treatment/drc-20351611">manage symptoms</a>). Babies and higher risk patients need to present to an emergency department if they test positive for RSV and are also looking or feeling very unwell (this might mean rapid shallow breathing, fevers not coming down with paracetamol or ibuprofen, a baby not feeding, mottled-looking skin, or going blue around the mouth). If a patient has developed a bronchiolitis or pneumonia, they may need to be hospitalised. <h2>Influenza</h2> Once you have had the “true flu” (influenza), you will find it frustrating when people call their sniffly cold-like symptoms a “flu”. Influenza infections generally start with a sore throat and headache which quickly turns into high fevers, generalised aches and excessive fatigue. You feel like you have been hit by a truck and may struggle to get out of bed. This can last a week or more, even in people who are generally fit and healthy. Influenza is a major public health issue internationally, with 3–5 million cases of severe illness and <a href="https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal)">290,000 to 650,000 respiratory deaths annually</a>. People who are at <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/influenza-flu">greater risk of complications</a> from influenza include pregnant women, children under five, adults aged 65 and over, First Nations peoples, and people with chronic or immunosuppressive medical conditions. For this reason, annual vaccination is <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">recommended and funded</a> for vulnerable people. Vaccination is also readily available for <a href="https://www.health.gov.au/topics/immunisation/immunisation-contacts">all Australians who want it</a>, through pharmacies as well as medical clinics, usually at a cost of less than A$30. In <a href="https://www.vaccinate.initiatives.qld.gov.au/what-to-vaccinate-against/influenza#:%7E:text=The%20flu%20vaccine%20is%20free,.qld.gov.au">some states</a>, it’s free for all residents. Influenza is seasonal, with definite peaks in the winter months. This is why vaccines are offered from early autumn. If you think you may have influenza, there are now home-testing RATs: all current influenza RATs are in combination with COVID RATs, as the symptoms overlap. Treatment for most people is to manage symptoms and try to avoid spreading it around. Doctors can also <a href="https://theconversation.com/i-think-i-have-the-flu-should-i-ask-my-gp-for-antivirals-210457">prescribe antivirals</a> to vulnerable patients; these work best if started within 48 hours of symptoms. <h2>COVID</h2> It has been less than five years since COVID-19, caused by SARS-CoV-2, started to spread around the world in pandemic proportions. Although COVID is no longer a <a href="https://www.health.gov.au/news/ahppc-statement-end-of-covid-19-emergency-response">public health emergency</a>, it still causes <a href="https://www.abs.gov.au/articles/deaths-due-covid-19-influenza-and-rsv-australia-2022-may-2024">more deaths than influenza and RSV combined</a>. Unlike RSV and influenza, only those <a href="https://www.health.gov.au/topics/covid-19/protect-yourself-and-others/high-risk-groups">aged over 70</a> are in a high-risk age group for COVID. Other <a href="https://www.cdc.gov/covid/risk-factors/?CDC_AAref_Val=https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html">factors besides age</a> may put you at higher risk of becoming very unwell when infected by this virus. This includes having other respiratory diseases (such as asthma or chronic obstructive pulmonary disease, also known as COPD), diabetes, cancer, kidney disease, obesity or heart disease. Unlike most respiratory viruses, SARS-CoV-2 tends to set off inflammation beyond the respiratory system. This can involve a range of other organs including the heart, kidneys and blood vessels. Although most people are back to their usual work or study after a week or two, a significant proportion go on to experience extended symptoms such as fatigue, breathlessness, brain fog and mood changes. When these last <a href="https://aci.health.nsw.gov.au/statewide-programs/critical-intelligence-unit/post-acute-sequelae">more than 12 weeks</a>, without any other explanation for symptoms, it’s called <a href="https://www.healthdirect.gov.au/covid-19/post-covid-symptoms-long-covid">long COVID</a>. COVID vaccines can prevent serious illness and have been <a href="https://pubmed.ncbi.nlm.nih.gov/38282394/">monitored</a> for several years now for their safety and effectiveness. Current vaccination recommendations are <a href="https://www.health.gov.au/resources/publications/atagi-statement-on-the-administration-of-covid-19-vaccines-in-2024?language=en">based on age and immune status</a>. It’s worth discussing them with your doctor if you are unsure whether you would benefit or not. <a href="https://www.health.gov.au/topics/covid-19/oral-treatments">Antivirals</a> can treat COVID in higher-risk people who contract it, whether vaccinated or not. Specific advice about what to do if you test positive on a RAT will vary according to your current state guidelines and workplace, however the <a href="https://www.health.gov.au/topics/covid-19/testing-positive">general principles</a> are always: avoid spreading the virus to others, and give yourself time to rest and recover. <hr /> <iframe id="ConNR" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/ConNR/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> <hr /> <h2>What if it’s not one of those?</h2> So you’ve done your combined RSV/flu/COVID RAT and the result is negative. But you still have symptoms. What else could it be? More than 200 different viruses can cause cold and flu symptoms, including rhinovirus (mentioned above), adenovirus and sometimes even <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2130424/">undefined pathogens</a>. If an illness progresses to a cough which will not go away, and/or you start coughing up sputum, this could be a bacterial infection, such as pertussis (whooping cough), streptococcus pneumoniae, haemophilus influenzae or moraxella catarrhalis. So it’s worth <a href="https://www.racgp.org.au/getattachment/0a637812-c8f0-45a2-af9c-fa215b64f8e4/attachment.aspx">getting assessed by a GP</a> who may do a chest Xray and/or <a href="https://www.rcpa.edu.au/Manuals/RCPA-Manual/Pathology-Tests/M/MCS-sputum">test your sputum</a>, particularly if they suspect pneumonia. You also may also start out with what is clearly a viral infection but then get a secondary bacterial infection later. So if you are getting more unwell over time, it’s worth getting tested, in case antibiotics will help. However, taking antibiotics for a purely viral illness will not only be useless, it can contribute to harmful <a href="https://www.nps.org.au/consumers/antibiotic-resistance-the-facts">antibiotic resistance</a> and give you unwanted side effects.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/234266/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, General Practitioner, PhD Candidate, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/i-feel-sick-how-do-i-know-if-i-have-the-flu-covid-rsv-or-something-else-234266">original article</a>. </div>

Body

Second marriage asset protection: What you need to know

Of paramount importance for many people in a second marriage is how to protect their assets if their relationship breaks down, or in the event of their death. Although second marriages bring a level of complexity, there are a number of strategies that you can implement to ensure that your assets are protected. Let’s explore some of the options available to you and what you need to know to protect your assets. Binding Financial Agreement A Binding Financial Agreement, often referred to as a pre-nup, allows you and your spouse to put in place a legal agreement which outlines how your assets will be dealt with in the event that your relationship breaks down. Should you wish, it can also extend to the provision of financial support for either party. The intention is for each party to protect their own assets, and such agreements can be put in place prior to a marriage or during a marriage if both parties consent. Like any legal document, a Binding Financial Agreement needs to be well drafted to ensure that it encompasses all relevant information, and it is important that you seek the advice of a family lawyer to assist you with putting this important document in place. Joint Assets v Individual Assets The manner in which you hold your assets is of paramount importance. All joint assets pass to the surviving party. If you and your spouse own a property as joint proprietors upon your death this property will automatically pass to your spouse. By changing the manner in which you hold the property from joint proprietors to tenants in common allows you and your spouse to deal with your individual interest in the property in your respective Wills. Additionally, you need to be mindful of any bank accounts or other investments that you hold jointly with your spouse as these are not individual assets that you can make provision for and will pass to your spouse upon your death. Your Will It is imperative that you put a Will in place that is reflective of your current circumstances and adequately provides for both your spouse and your children from a previous relationship in the manner that you desire. For many parents in second marriages with children from a previous relationship, protecting their children’s inheritance is of paramount importance. Discretionary Testamentary Trusts which are created in accordance with the provisions of your Will, can make provision for your spouse during their lifetime, whilst also ensuring that most of your assets go to your children. If you are the sole registered proprietor of your residence in which you and your spouse reside you may make provision in your Will providing a life interest in your residence to your spouse subject to some conditions being adhered to. This will allow your spouse to reside in your residence for the duration of their life then subsequent to their death the property may then pass to your children. Dying without a valid Will in place deems that you died intestate, and your assets will be distributed in accordance with a government formula and may not end up with the people who you would like to receive them. Your spouse would be entitled to a share of your assets, however this may not have been your intention, or the share that they would receive may be significantly more than you would like them to receive. It is therefore crucial that you take the time to put a well drafted Will in place so that your assets pass to those who you would like to receive them upon your death. Mutual Wills Agreement A Mutual Wills Agreement is a separate document to your Will and essentially is an agreement between you and your spouse that both of you will not change your Will without the consent of the your spouse or their legal personal representative upon their death. This document is intended to prevent the remaining spouse from altering their Will and disinheriting step-children or making other adverse changes to their Will. The Right People in Key Roles The roles of executor of your Will and your attorney in respect to your Power of Attorney documents are important roles and it is paramount that you appoint trusted people to undertake these roles as essentially you are handing control of your assets to those who assume these roles. Your attorney is entrusted to look after your finances and provide the best care for you in the event that you become incapacitated so you need to choose wisely. Communication is Crucial It is important that there is transparency for you and your family. By having important conversations with your spouse and children you can openly discuss your intentions and expectations so that all parties are relevantly informed and fully understand what your wishes are and what you have put in place. In order to evaluate the best options for you it is important that you obtain the appropriate professional advice to determine which is the best strategy for your own individual circumstances so that the relevant documents are put in place which offer you the best asset protection possible. Melisa Sloan is principal of Madison Sloan Lawyers and author of Big Moments: Expert Advice for Conquering those moments that define us. www.melisasloan.com.au Image credits: Shutterstock

Money & Banking

Heading to Bali or somewhere tropical these holidays? Here’s what you need to know about dengue fever

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/cameron-webb-6736">Cameron Webb</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> If you’re looking to escape the Australian winter for your next holiday, don’t forget where there’s warmth, there will also be mosquitoes. In turn, tropical destinations can be hot spots of mosquito-borne diseases such as dengue. In fact, Australian health authorities have warned travellers to Bali <a href="https://www.health.wa.gov.au/Media-releases/2024/May/Dengue-fever-warning-for-Western-Australian-travellers">to be aware</a> of the risk of dengue, with cases surging in the region. So here’s how to protect yourself and your family on holidays. <h2>What is dengue?</h2> <a href="https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue">Dengue virus infection</a> (commonly known as dengue fever, or just dengue) is caused by viruses spread by the bite of a mosquito. The mosquito species that typically transmit dengue are Aedes aegypti and Aedes albopictus. There are four strains of dengue virus. Each has the potential to cause illness that can range from <a href="https://www.cdc.gov/dengue/signs-symptoms/index.html">mild to severe and potentially life threatening</a>. Symptoms <a href="https://www.health.nsw.gov.au/Infectious/factsheets/Pages/dengue.aspx">typically include</a> rash, fever, chills, headache, muscle and joint pain, and fatigue. People also often report abdominal pain, nausea and vomiting. While infection with just one of these viruses can make you sick, subsequent exposure to other strains can have more <a href="https://theconversation.com/explainer-what-are-antibodies-and-why-are-viruses-like-dengue-worse-the-second-time-68227">serious health implications</a>. In these cases, symptoms can also include the presence of blood in vomit, bleeding gums and breathing difficulties. Dengue infection must be confirmed via a blood test, but there are <a href="https://www.healthdirect.gov.au/dengue-fever">no specific treatments</a>. Most people will recover on their own however <a href="https://www.cdc.gov/dengue/treatment/index.html">staying hydrated is crucial</a> and pain relief can help with symptoms. If more severe illness occurs, seek urgent medical care. <h2>Are travellers at risk?</h2> The disease is now endemic in around 100 countries and <a href="https://www.cdc.gov/dengue/areas-with-risk/index.html">an estimated 4 billion people</a> are considered at risk. Asian countries represent <a href="https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue">around 70%</a> of the global disease burden. Even <a href="https://theconversation.com/how-the-paris-olympics-could-become-a-super-spreader-event-for-dengue-231853">Europe is at risk</a>. <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON498">One of the worst years</a> on record was 2023, but the burden of dengue continues to grow. In the first four months of 2024, Indonesia reported <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON518">three times as many cases</a> of dengue compared to the same period in 2023. Dengue is not a new risk to Australian travellers. Before COVID disrupted international travel, the number of Australians returning from tropical destinations with dengue <a href="https://europepmc.org/article/med/23692160">was steadily increasing</a>. For example, between 2010 and 2016, there was an average <a href="https://www.mdpi.com/2414-6366/3/1/9">annual increase of 22%</a> of travellers returning to Victoria with dengue. Almost half of these people contracted the illness in Indonesia. Bali is well documented as posing <a href="https://academic.oup.com/jtm/article/25/1/tay061/5065180?login=false">a risk of dengue</a> to travellers. International travel restrictions due to COVID <a href="https://academic.oup.com/jtm/article/31/2/taae014/7577676">abruptly stopped this trend</a>. But now Australians are again embracing international travel, <a href="https://www.dailymail.co.uk/news/article-13303747/Worrying-reason-Aussie-travellers-Bali-coming-sick.html">cases are rising once more</a>. Bali isn’t the only destination with <a href="https://www.washingtonpost.com/health/2024/06/30/dengue-puerto-rico-mosquito-climate-change/">a surge in dengue</a>, but we know it’s a popular holiday destination for Australian travellers. There’s little doubt plenty of families will be heading to Bali these school holidays. <h2>How about the risk in Australia?</h2> Not all mosquitoes can spread dengue viruses. This is why the risk is different in Bali and other tropical regions compared to Australia. Although there are more than 40 Australian mosquito species known or suspected to be transmitting local pathogens, such as <a href="https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1005070">Ross River virus</a>, Australia is generally free of local dengue risk due to the limited spread of Aedes aegypti and Aedes albopictus. While Aedes aegypti is found in <a href="https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/diseases-infection/diseases/mosquito-borne/dengue/virus-fever">parts of Queensland</a>, thanks to interventions by the <a href="https://www.worldmosquitoprogram.org/en/global-progress/australia/cairns-and-surrounds">World Mosquito Program</a> and local authorities dengue risk is low. These interventions include the release of laboratory-bred mosquitoes that prevent mosquitoes in the environment <a href="https://www.worldmosquitoprogram.org/en/work/wolbachia-method">spreading viruses</a>, as well as <a href="https://www.sciencedirect.com/science/article/pii/S2221169115309096">community education</a>. But <a href="https://theconversation.com/after-decades-away-dengue-returns-to-central-queensland-117821">local cases</a> occasionally occur. Aedes albopictus is not currently found <a href="https://theconversation.com/how-we-kept-disease-spreading-asian-tiger-mozzies-away-from-the-australian-mainland-72873">on the Australian mainland</a> but is present in the islands of the Torres Strait. A dengue outbreak <a href="https://www.torres-cape.health.qld.gov.au/about-us/news/further-cases-of-dengue-fever-on-mer">has occurred</a> there this year. <h2>Keep mozzies away during the day, not just at night</h2> While there is a vaccine available, it’s not recommended for <a href="https://onlinelibrary.wiley.com/doi/full/10.5694/mja2.50471">short-term travellers</a>. There are <a href="https://www.health.gov.au/resources/publications/atagi-advice-on-the-use-of-dengvaxiar-for-australians">strict eligibility criteria</a> for its use, so speak to a health professional for advice. For the majority of travellers, preventing mosquito bites is the only way to prevent disease. But there are differences in the behaviour of dengue mosquitoes that mean the normal measures to avoid mosquito bites may not be as effective. During the Australian summer, mosquitoes found in local wetlands can be <a href="https://theconversation.com/the-worst-year-for-mosquitoes-ever-heres-how-we-find-out-68433">incredibly abundant</a>. We tend to need to reach for the repellent and cover up to stop bites as soon as the sun starts going down. Aedes aegypti and Aedes albopictus <a href="https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0010818">can aggressively bite people</a> but they’re not as abundant as the swarms of summer mosquitoes back home. They also bite during the day, not just at night. So for those travelling to Bali or other areas at risk of dengue, putting insect repellent on <a href="https://www.smartraveller.gov.au/news-and-updates/global-dengue-fever-outbreaks">throughout the day</a> is recommended. <h2>What to pack for protection</h2> If you’re staying in a major resort, there’s likely to be a mosquito control program in place. This may include minimising available water for mosquito breeding in combination with insecticide use. Mosquitoes are also less likely to be an issue in air-conditioned accommodation. But if you’re planning to spend time out and about visiting local villages, markets, or in nature, it’s best to protect against bites. Light coloured and <a href="https://www.health.wa.gov.au/Media-releases/2024/May/Dengue-fever-warning-for-Western-Australian-travellers">loose fitting clothing</a> will help stop mosquito bites (and help keep you cool). Covered shoes can help too – dengue mosquitoes <a href="https://www.npr.org/sections/goatsandsoda/2016/02/22/465594861/why-zika-spreading-mosquitoes-love-ankles">love smelly feet</a>. Finally, it’s best to take some insect repellent with you. There may not be any available at your destination, and formulations on sale might not have been through the same thorough testing as products <a href="https://www.apvma.gov.au/">approved in Australia</a>.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/233670/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/cameron-webb-6736">Cameron Webb</a>, Clinical Associate Professor and Principal Hospital Scientist, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/heading-to-bali-or-somewhere-tropical-these-holidays-heres-what-you-need-to-know-about-dengue-fever-233670">original article</a>. </div>

Travel Tips

We know what to eat to stay healthy. So why is it so hard to make the right choices?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/nina-van-dyke-822557">Nina Van Dyke</a>, <a href="https://theconversation.com/institutions/victoria-university-1175">Victoria University</a> A healthy diet <a href="https://www.who.int/initiatives/behealthy/healthy-diet">protects us</a> against a number of chronic diseases, including heart disease, diabetes and cancer. From early childhood, we receive an abundance of <a href="https://cdn.who.int/media/docs/default-source/healthy-diet/healthy-diet-fact-sheet-394.pdf?sfvrsn=69f1f9a1_2&download=true">information</a> about how we <a href="https://www.eatforhealth.gov.au/guidelines/australian-guide-healthy-eating">should eat</a> to be healthy and reduce our risk of disease. And most people have a <a href="https://link.springer.com/content/pdf/10.1186/1479-5868-11-63.pdf">broad understanding</a> of what healthy eating looks like. But this knowledge <a href="https://www.sciencedirect.com/science/article/pii/S0001209216310584?casa_token=6CZgCmT1RMgAAAAA:sSRsj2o6swVfvoBxMIVrMTxqdczSAiFwfTCYzYQ8U3z4ey_WLQ6knpmk8WRH77zugAS3wEAQrA">doesn’t always result</a> in healthier eating. In our new research, we set out to <a href="https://link.springer.com/content/pdf/10.1186/s12889-024-18432-x.pdf">learn more</a> about why people eat the way they do – and what prevents them from eating better. Lack of time was a major <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/obr.12472?casa_token=1D1mi-l0TR0AAAAA:dgebTQx-wgw7jbREfdawxZ5AZSDRztvrt8t1tuKyDy1x2mmXlyLDY8z9NbUf0v4hnh80HY_RbAk08Q">barrier</a> to cooking and eating healthier foods. <h2>How do you decide what to eat?</h2> We spoke with <a href="https://link.springer.com/content/pdf/10.1186/s12889-024-18432-x.pdf">17 adults</a> in a regional centre of Victoria. We chose a regional location because less research <a href="https://link.springer.com/content/pdf/10.1186/s40900-020-0179-6.pdf">has been done</a> with people living outside of metropolitan areas and because rates of obesity and other diet-related health issues are <a href="https://www.aihw.gov.au/reports/rural-remote-australians/rural-and-remote-health">higher</a> in such areas in Australia. Participants included a mix of people, including some who said they were over their “most healthy weight” and some who had previously dieted to lose weight. But all participants were either: <ul> <li>young women aged 18–24 with no children</li> <li>women aged 35–45 with primary school aged children</li> <li>men aged 35–50 living with a partner and with pre- or primary-school aged children.</li> </ul> We selected these groups to target <a href="https://www.sciencedirect.com/science/article/pii/S0022318212803669">ages and life-stages</a> in which shifts in eating behaviours may occur. Previous research has found younger women <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1470-6431.2007.00642.x?casa_token=33QKWwhc2ogAAAAA:ZvJ6wfXiRC_6eoqvoxD121JOSKSPmIRHcrdiGl2uHzkq5pY6VVPL6WI2DhmxQ2q9i6bBGvLiFl8afQ">tend to</a> be particularly concerned about appearance rather than healthy eating, while women with children often shift their focus to providing for their family. Men <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/obr.12472?casa_token=KakMB6hAOQ0AAAAA:fLnpoxZQiiJIdEkg_TOcCq8hBwZef1iZETZKTiG5W6zW2x_PYzK0oLeOg5F9arKThq9RzMWEi4x4Xw">tend to be less interested</a> in what they eat. We asked participants about how they decided what food to eat, when, and how much, and what prevented them from making healthier choices. <h2>It’s not just about taste and healthiness</h2> We found that, although such decisions were determined in part by taste preferences and health considerations, they were heavily influenced by a host of other factors, many of which are outside the person’s control. These included other household members’ food preferences, family activities, workplace and time constraints, convenience and price. <a href="https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2767106">Healthy eating</a> means consuming a balanced diet rich in nutrients, including a variety of fruits, vegetables, whole grains, lean proteins and healthy fats, while limiting processed foods, added sugars and excessive salt. Healthy eating also includes how we eat and <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244292">how we think about</a> food and eating, such as having a positive relationship with food. One 35- to 45-year-old woman, for example, said that time constraints and family preferences made it difficult to prepare healthier food: <blockquote> I love the chance when I can actually get a recipe and get all of the ingredients and make it properly, but that doesn’t happen very often. It’s usually what’s there and what’s quick. And what everyone will eat. </blockquote> One of the 35- to 50-year-old men also noted the extent to which family activities and children’s food preferences dictated meal choices: <blockquote> Well, we have our set days where, like Wednesday nights, we have to have mackie cheese and nuggets, because that’s what the boys want after their swimming lesson. </blockquote> <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/joss.12649?casa_token=gsnU9O_G2GQAAAAA:mV2vtHlnEd0jqBGJPFkfml_ecLIDqwSlH5xksSwt4eQb_FP_UShyAKm9sLNnKy6Mkf2q9aKAlDEixA">Research shows</a> that children are often more receptive to new foods than their parents think. However, introducing new dishes takes additional time and planning. An 18- to 24-year-old woman discussed the role of time constraints, her partner’s activities, and price in influencing what and when she eats: <blockquote> My partner plays pool on a Monday and Wednesday night, so we always have tea a lot earlier then and cook the simple things that don’t take as long, so he can have dinner before he goes rather than buying pub meals which cost more money. </blockquote> Despite popular perceptions, healthy diets are not more expensive than unhealthy diets. A <a href="https://preventioncentre.org.au/wp-content/uploads/2017/03/1702_FB_LEE_4p_final_lr.pdf">study</a> comparing current (unhealthy) diets with what the <a href="https://www.health.gov.au/resources/publications/the-australian-dietary-guidelines">Australian Dietary Guidelines</a> recommend people should eat found that the healthy diet was 12–15% cheaper than unhealthy diets for a family of two adults and two children. However, learning and planning to prepare new types of meals <a href="https://www.mdpi.com/2072-6643/12/3/877">takes effort and time</a>. Simply educating people about what they should eat won’t necessarily result in healthier eating. People want to eat healthier, or at least know they should eat healthier, but other things <a href="https://link.springer.com/content/pdf/10.1007/s00394-017-1458-3.pdf">get in the way</a>. A key to improving people’s eating behaviours is to make it easy to eat more healthily. Policy changes to make healthy eating easier could include subsidising healthier foods such as fresh produce, providing incentives for retailers to offer healthy options, and ensuring access to nutritious meals in schools and workplaces. <h2>So how can you make healthier food choices easier?</h2> Here are five tips for making healthy choices easier in your household: <ol> <li> If certain days of the week are particularly busy, with little time to prepare fresh food, plan to cook in bulk on days when you have more time. Store the extra food in the fridge or freezer for quick preparation. </li> <li> If you’re often pressed for time during the day and just grab whatever food is handy, have healthy snacks readily available and accessible. This could mean a fruit bowl in the middle of the kitchen counter, or wholegrain crackers and unsalted nuts within easy reach. </li> <li> Discuss food preferences with your family and come up with some healthy meals everyone likes. For younger children, <a href="https://healthykids.nsw.gov.au/downloads/file/campaignsprograms/NewFoodsFussyEaters.pdf">try serving</a> only a small amount of the new food, and serve new foods alongside foods they already like eating and are familiar with. </li> <li> If you rely a lot on take-away meals or meal delivery services, try making a list ahead of time of restaurants and meals you like that are also healthier. You might consider choosing lean meat, chicken, or fish that has been grilled, baked or poached (rather than fried), and looking for meals with plenty of vegetables or salad. </li> <li> Remember, fruit and vegetables taste better and are often cheaper when they are in season. Frozen or canned vegetables are a <a href="https://www.sbs.com.au/news/article/the-cost-of-fresh-fruit-and-veggies-is-rising-is-canned-or-frozen-produce-just-as-healthy/tzuhnfrnr">healthy and quick alternative</a>.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/231489/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> </li> </ol> <a href="https://theconversation.com/profiles/nina-van-dyke-822557">Nina Van Dyke</a>, Associate Professor and Associate Director, Mitchell Institute, <a href="https://theconversation.com/institutions/victoria-university-1175">Victoria University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/we-know-what-to-eat-to-stay-healthy-so-why-is-it-so-hard-to-make-the-right-choices-231489">original article</a>. </div>

Food & Wine

How much do you need to know about how your spouse spends money? Maybe less than you think

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/scott-rick-1534612">Scott Rick</a>, <a href="https://theconversation.com/institutions/university-of-michigan-1290">University of Michigan</a> Love is in the air, and wedding season is upon us. Like many elder millennials, I grew up watching sitcoms in the 1980s and ‘90s. Whenever those series needed a ratings boost, they would feature a wedding. Those special episodes taught me that weddings usually involve young lovebirds: think Elvin and Sondra from “The Cosby Show,” Cory and Topanga from “Boy Meets World,” or David and Darlene from “Roseanne.” But those were different times. People are getting married later in life than they used to: In the United States, <a href="https://www.census.gov/content/dam/Census/library/visualizations/time-series/demo/families-and-households/ms-2.pdf">the median age of newlyweds</a> has grown to 28 for women and 30 for men. This trend means that many Americans now enter marriage after being self-reliant for several years, including managing their own money. Will they be eager to change that once they get married? Don’t count on it. A 2017 <a href="https://bettermoneyhabits.bankofamerica.com/content/dam/bmh/pdf/ar6vnln9-boa-bmh-millennial-report-winter-2018-final2.pdf">Bank of America survey</a> suggests that millennial married couples are around 15 percentage points more likely than their predecessors to keep their finances separate. This is not necessarily a good development. As a behavioral scientist <a href="https://michiganross.umich.edu/faculty-research/faculty/scott-rick">who studies money and relationships</a>, I find that joint accounts <a href="https://doi.org/10.1093/jcr/ucad020">can bring partners closer</a>. There are some risks, however. Joint accounts create transparency, and intuitively, transparency feels like a good thing in relationships. But I argue that some privacy is important even for highly committed couples – <a href="https://us.macmillan.com/books/9781250280077/tightwadsandspendthrifts">and money is no exception</a>. <h2>The newlywed game</h2> Behavioral scientists <a href="https://kelley.iu.edu/faculty-research/faculty-directory/profile.html?id=jgolson">Jenny Olson</a>, <a href="https://som.yale.edu/faculty-research/faculty-directory/deborah-small">Deb Small</a>, <a href="https://www.kellogg.northwestern.edu/faculty/directory/finkel_eli.aspx">Eli Finkel</a> and I recently conducted <a href="https://academic.oup.com/jcr/article-abstract/50/4/704/7077142">an experiment with engaged and newlywed couples</a>. Each of the pairs had entirely separate accounts, but they were undecided about how they wanted to manage their money moving forward. We randomly assigned each of the 230 couples to one of three groups. One group kept their money in separate accounts; one merged their cash into a joint account and stopped using separate accounts; and one managed their money however they liked. We followed couples for two years, periodically asking them to complete surveys assessing their relationship dynamics and satisfaction. Our relationship quality measure included items such as “I cannot imagine another person making me as happy as my partner does” and “Within the last three months, I shouted or yelled at my partner.” Among the couples who could do whatever they wanted, most kept things separate. They and the couples assigned to keep separate accounts experienced a steady decline in relationship quality over time. This is a fairly typical pattern. For instance, in <a href="https://academic.oup.com/sf/article-abstract/79/4/1313/2234046">a large study that tracked U.S. couples’ marital happiness for 17 years</a>, <a href="https://www.unk.edu/academics/social-work/faculty_staff/van_laningham.php">sociologist Jody Van Laningham</a> and colleagues found that “marital happiness either declines continuously or flattens after a long period of decline.” Declines during the first two years of marriage are particularly important. Social scientist <a href="https://liberalarts.utexas.edu/prc/faculty/hustontl">Ted Huston</a> and colleagues call those first two years <a href="https://doi.org/10.1037/0022-3514.80.2.237">the “connubial crucible</a>.” They find that relationship dynamics that develop during that crucial period can foreshadow relationship quality for many years to come. Couples in our study who were prompted to take the plunge into a joint account, however, maintained their initial level of relationship satisfaction over the course of the two-year experiment. <h2>Tit-for-tat</h2> Our survey results suggest that, by turning “my money” and “your money” into “our money,” a joint account can help to reduce scorekeeping within a relationship. For example, we found that couples with joint accounts were more likely to agree with statements such as “When one person does something for the other, the other should not owe the giver anything.” Relationships usually don’t start with a scorekeeping orientation. In the 1980s and ‘90s, psychologist <a href="https://psychology.yale.edu/people/margaret-clark">Margaret Clark</a> and colleagues conducted experiments where partners had the option of keeping track of each other’s contributions to a shared task. <a href="https://clarkrelationshiplab.yale.edu/sites/default/files/files/Resource%20allocation%20in%20intimate%20relationships.pdf">They observed</a> that intimate relationships often begin with a “communal” orientation, where partners help one another without keeping careful track of who’s doing what. Eventually, however, they take on more of an “exchange” orientation – where inputs are tracked and timely reciprocity is expected. Couples that manage to stave off a tit-for-tat mindset <a href="https://doi.org/10.1177/0956797610373882">tend to be happier</a>. <h2>Too much of a good thing?</h2> The data from our experiment with young couples clearly suggests that using only a joint account is better than using only separate accounts. However, I argue in my new book, “<a href="https://us.macmillan.com/books/9781250280077/">Tightwads and Spendthrifts</a>,” that just a joint account is probably not optimal. When partners use only a joint account, they get an up-close-and-personal view of how the other person is spending money. This kind of transparency is <a href="https://www.businessinsider.com/money-habits-successful-married-couples-avoid-2016-11">normally viewed</a> as a good thing. Some commentators argue that a healthy marriage should have no secrets whatsoever. For example, Willard Harley, Jr., a clinical psychologist who primarily writes for Christian audiences, argues that you should “reveal to your spouse <a href="https://www.marriagebuilders.com/the-policy-of-radical-honesty.htm">as much information about yourself as you know</a>: your thoughts, feelings, habits, likes, dislikes, personal history, daily activities, and plans for the future.” In addition, if your goal is to minimize optional spending, <a href="https://doi.org/10.1002/jcpy.1083">research suggests</a> that the transparency that comes with a joint account can be helpful. We spend less when someone is looking over our shoulder. Still, there are reasons to believe that <a href="https://doi.org/10.1177/0265407500172005">complete transparency can be harmful for couples</a>. Many people have become convinced that if they could just stop buying lattes and avocado toast, they could invest that money and become rich. Unfortunately, the underlying math is highly dubious, as journalist Helaine Olen points out in <a href="https://www.penguinrandomhouse.com/books/308568/pound-foolish-by-helaine-olen/">her book “Pound Foolish</a>.” Still, many people view small indulgences as their primary obstacle to wealth. Complete transparency around these financially inconsequential “treats” <a href="https://slate.com/business/2021/09/partner-hates-retail-therapy-money-advice.html">can lead to unnecessary arguments</a>. Also, spouses may have different passions that their partner does not fully understand. Expenses that seem perfectly reasonable to another hobbyist may seem outrageous <a href="https://academic.oup.com/jcr/article-abstract/19/2/256/1929895">to someone without the proper context</a> – another source of <a href="https://www.sciencedirect.com/science/article/abs/pii/S2352250X21000750">avoidable disagreements</a>. <h2>'Translucent,’ not transparent</h2> I propose that many couples may benefit from a combination of joint and separate accounts. A joint account is essential for ensuring that both partners have immediate and equal access to “our money.” Ideally, all income would be direct-deposited into the joint account, which would help to blur the gap between partners’ earnings. Conspicuous income differences <a href="https://doi.org/10.1086/432228">can jeopardize relationship quality</a>. Separate accounts attached to the joint account can allow some privacy for individual purchases and help partners maintain a sense of autonomy and individuality. Each person gets to spend some of “our money” without their partner looking over their shoulder. Spouses would have a high-level understanding of how much their partner is spending per week or per month, but avoid the occasionally irritating details. This kind of partial financial transparency – <a href="https://us.macmillan.com/books/9781250280077/tightwadsandspendthrifts">what I call “financial translucency</a>” – could help couples strike the right balance between financial and psychological well-being. Of course, this approach requires a lot of trust. If the relationship is already on thin ice, complete financial transparency may be necessary. However, if the relationship is generally in the “good, but could be even better” category, I would argue that financial translucency is worth considering.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/230070/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/scott-rick-1534612">Scott Rick</a>, Associate Professor of Marketing, <a href="https://theconversation.com/institutions/university-of-michigan-1290">University of Michigan</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-much-do-you-need-to-know-about-how-your-spouse-spends-money-maybe-less-than-you-think-230070">original article</a>. </div>

Money & Banking

Breast cancer screening in Australia may change. Here’s what we know so far

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/brooke-nickel-200747">Brooke Nickel</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/katy-bell-134554">Katy Bell</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> The way women are screened for breast cancer in Australia may <a href="https://www.cancer.org.au/about-us/policy-and-advocacy/early-detection/breast-cancer/rosa/key-findings">change</a>. There’s international debate on the <a href="https://www.bmj.com/content/385/bmj.q1353">age</a> women should be invited for screening. But an even larger change being considered worldwide is whether to screen women at <a href="https://www.nature.com/articles/s41416-021-01550-3">high and low risk</a> of breast cancer differently. But what such a “risk-based” approach to screening might look like in Australia is not yet clear. Here’s why researchers and public health officials are floating a change to breast cancer screening in Australia, and what any changes might mean. <h2>Why breast cancer screening may need to change</h2> Mass screening (known as population-based screening) for breast cancer was introduced in Australia and many other developed countries in the 1980s and 90s. This was based on <a href="https://pubmed.ncbi.nlm.nih.gov/26756588/">robust research</a> that found early detection and treatment of cancers before there were symptoms prevented some women from dying from breast cancer. These programs offer regular breast cancer screening to women within a specific age group. For example, <a href="https://www.aihw.gov.au/reports/cancer-screening/national-cancer-screening-programs-participation/contents/breastscreen-australia">in Australia</a>, women aged 40-74 years can have free mammograms (x-rays of the breasts) every two years. The BreastScreen program sends invitations for screening to those aged 50-74. However, evidence has been mounting that mammography screening could be inadvertently causing <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61611-0/abstract">harm</a> for some women. For some, screening causes a false alarm that may cause anxiety, and unnecessary tests and procedures. Even though these tests rule out cancer, these women may remain anxious and perceive something is wrong <a href="https://bmjopen.bmj.com/content/13/4/e072188">for many years</a>. A more insidious harm is <a href="https://theconversation.com/five-warning-signs-of-overdiagnosis-110895">overdiagnosis</a>, where screening detects a non-growing or slow-growing lesion that looks like “cancer” under the microscope, but would not have progressed or caused harm if it had been left alone. This means some women are having unnecessary surgery, radiotherapy and hormone therapy that will not benefit them, but may harm. Although trials have shown screening reduces the risk of dying from breast cancer, questions are being raised about how much it <a href="https://www.bmj.com/content/352/bmj.h6080.abstract">saves lives overall</a>. That is, it’s uncertain how much the reduced risk of dying from breast cancer translates into improvements in a woman’s overall survival. <h2>How about better targeting women?</h2> One idea is to target screening to those most likely to benefit. Under such a “<a href="https://www.nature.com/articles/s41416-021-01550-3">risk-based</a>” approach, a women’s personal risk of breast cancer is estimated. This may be based on her age and many other factors that may include breast density, family history of breast cancer, body-mass index, genetics, age she started and stopped her periods, and the number of children she’s had. Women who are at higher risk would be recommended to start screening at a younger age and to screen more frequently or to use different, more sensitive, imaging tests. Women at lower risk would be recommended to start later and to screen less often. The idea of this more “precise” approach to screening is to direct efforts and resources towards the smaller number of women most likely to benefit from screening via the early detection of cancer. At the same time, this approach would reduce the risk of harm from false positives (detection of an anomaly but no cancer is present) and overdiagnosis (detection of a non-growing or slow-growing cancer) for the larger number of women who are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6230256/">unlikely to benefit</a>. On face value this sounds like a good idea, and could be a favourable change for breast cancer screening. <h2>But there’s much we don’t know</h2> However, it’s uncertain how this would play out in practice. For one thing, someone’s future risk of a cancer diagnosis includes the risk of detecting both <a href="https://www.acpjournals.org/doi/10.7326/m17-2792">overdiagnosed cancers</a> as well as potentially lethal ones. This is proving to be a problem in risk-based screening for <a href="https://www.nature.com/articles/s41698-022-00266-8">prostate cancer</a>, another cancer prone to overdiagnosis. Ideally, we’d want to predict someone’s risk of <a href="https://www.thelancet.com/journals/landig/article/PIIS2589-7500(23)00113-9/fulltext">potentially lethal cancers</a> as these are the ones we want to catch early. It is also still uncertain how many women found to be at <a href="https://pubmed.ncbi.nlm.nih.gov/31701797/">low risk</a> will accept a recommendation for <a href="https://pubmed.ncbi.nlm.nih.gov/23092125/">less screening</a>. These uncertainties mean we need robust evidence the benefits outweigh the harms for Australian women before we make changes to the breast cancer screening program. There are several international <a href="https://www.nature.com/articles/s41416-021-01550-3">randomised controlled trials</a> (the gold standard for research) under way to evaluate the effectiveness of risk-based screening compared to current practice. So it may be prudent to wait for their findings before making changes to policy or practice. Even if such trials did give us robust evidence, there are still a number of issues to address before implementing a risk-based approach. One key issue is having enough staff to run the program, including people with the skills and time to discuss with women any concerns they have about their calculated risk. <h2>How about breast density?</h2> Women with dense breasts are at <a href="https://www.sciencedirect.com/science/article/pii/S0960977622001618#:%7E:text=Mammographic%20density%20is%20a%20well,increased%20risk%20of%20breast%20cancer.">higher risk of breast cancer</a>. So notifying women about their breast density has been proposed as a “first step” on the pathway to risk-based screening. However, this ignores the many other factors that determine a woman’s risk of breast cancer. Legislation in the <a href="https://www.fda.gov/radiation-emitting-products/mammography-quality-standards-act-and-program">United States</a> and changes in some <a href="https://australianbreastcancer.org.au/news-stories/latest-news/breast-density-reporting-at-all-sa-clinics/">Australian states</a> mean some women are already being notified about their breast density. The idea is to enhance their knowledge about their breast cancer risk so they can make informed decisions about future screening. But this has happened before we know what the best options are for such women. An <a href="https://www.mja.com.au/journal/2023/219/9/psychosocial-outcomes-and-health-service-use-after-notifying-women-participating">ongoing Australian trial</a> is investigating the effects that breast density notification has on individual women and the health system. <h2>What next?</h2> Robust evidence and careful planning are needed before risk-based screening or other changes are made to Australia’s breast cancer screening program. Where changes are made, there needs to be early evaluation of both the <a href="https://www.bmj.com/content/350/bmj.h1566.abstract">benefits and harms</a>. Programs also need <a href="https://www.bmj.com/content/374/bmj.n2049.long">independent, regular re-evaluation</a> in the longer term.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/231917/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/brooke-nickel-200747">Brooke Nickel</a>, NHMRC Emerging Leader Research Fellow, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/katy-bell-134554">Katy Bell</a>, Professor in Clinical Epidemiology, Sydney School of Public Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/breast-cancer-screening-in-australia-may-change-heres-what-we-know-so-far-231917">original article</a>. </div>

Body

"I want her parents to know": Fellow Qantas passenger reveals final moments of young woman

The passenger who was seated next to the woman who tragically <a href="https://oversixty.com.au/travel/travel-trouble/young-woman-dies-on-qantas-flight" target="_blank" rel="noopener">died</a> after boarding a Qantas flight has broken his silence on her last moments. Ravinder Singh was seated next to Manpreet Kaur, who passed away shortly after boarding a flight from Melbourne to Delhi on June 20th. The 24-year-old student, who had dreams of becoming a chef, was travelling to see her parents in India for the first time in four years, but did not make it to her destination. Now, Ravinder Singh has shared details on her final moments in the hopes it will bring her grieving parents some comfort. “I was sitting next to her on the Qantas flight from Melbourne to Delhi and was actually the last person to talk to her,” Ravinder Singh exclusively told <a href="https://www.news.com.au/travel/travel-updates/incidents/passenger-speaks-after-woman-dies-next-to-him-on-qantas-flight/news-story/24e8396d8eb3a1d35aea4a4291b847ba" target="_blank" rel="noopener">news.com.au</a>. “When I boarded the plane, she was already seated in the aisle. I was in the window, so I asked if she could please get up so I could occupy my seat. “I noticed that she began scrolling through photos on her mobile phone and stopped at a photograph of an elderly couple. I asked if they were her parents. She smiled and nodded and kept staring at it.” Mr Singh, who had been in Australia to visit family, said that everything seemed fine and the plane eventually began moving towards the runway, ready for take off. He explained that Ms Kaur had then put her phone down and rested her head on the seat in front, when he realised something was not right. “She was wearing her seatbelt and leaned forward to rest her head on the seat in front. As the plane was preparing for takeoff, I wanted to alert her to sit upright,” he shared. “But the plane jerked and I expected her to wake up. But instead, her head just moved towards me." “I got the attention of a flight attention and told her that this woman does not seem very well. She checked her pulse and after that, the reaction of the cabin crew was very commendable." “They tried their best to revive her. She was then evacuated by medical staff.” The retired army officer said the incident still “haunts him” and he wants her parents to know that she “left the world peacefully”. “The incident has been etched in my memory for life,” he said. “It is very difficult to digest that a young girl with whom you were just interacting with has passed away in front of your eyes." “Her innocent face stills haunts me and I want her parents to know she loved them a lot. She left this world peacefully looking at their photograph." “My heart breaks for her family who would have been looking forward to seeing her after a long time.” It is understood that Ms Kaur had been feeling "unwell" when she arrived at the airport and boarded the plane with no issues, with reports suggesting she died of tuberculosis. Image credits: news.com.au

Caring

What you need to know about protecting your children’s inheritance

For many people, ensuring that their children’s inheritance is protected is of paramount importance to them. There are a number of strategies that you can put in place to achieve this objective, you just need to determine which one bests suits you and your family’s circumstances. Put a Will in place By putting a Will in place, you get to decide who your assets go to, allowing you to make provision in your Will for them to pass to your children upon your death. If you do not have a Will in place then it is up to the government where your assets get paid and this may mean that your assets do not pass to your children, or do not pass to them in the manner that you desire. Play it safe and ensure things go the way you want them by taking the time to put a Will in place. Testamentary trust Let me introduce you to Testamentary Trusts. These amazing vehicles allow you to transfer your wealth to your children in the most asset protective and tax effective way possible. With an increasing number of marriages crumbling and divorce rates soaring, the last thing you want is your hard earned wealth passing to your child’s estranged partner in the event of one of your child’s marriage breakdown. By making provision in your Will leaving your children’s inheritance in a Testamentary Trust it protects their inheritance from any divorce or family law risks if your child’s relationship breaks down. Additionally, you may have a child who works in a high-risk occupation – a doctor, financial advisor or perhaps carrying on the role of a director. Alternatively, your child may be an entrepreneur, taking risks in their own business operations. If something adverse happened to your child whilst they were undertaking these roles and they were sued, they could be personally liable for them for any actions brought upon them by the aggrieved party. Creditors and other associated parties could only seek recourse to moneys owed by your child from them in their own personal capacity. If your child had received their inheritance in their own name, and hence the assets were now individual assets, the creditors and other associated parties would have recourse in recovering funds owed to them by your child. However, if your child’s inheritance was paid to a Testamentary Trust for their benefit at the time of your death then these assets would be held on trust for them and are not personal assets, hence the creditors and other associated parties would not have recourse in respect to these assets. Blended marriages If you have children from a previous marriage, it’s imperative that you obtain the appropriate legal advice in respect to how to protect your assets for your children. There are a number of options that you can put in place including a Binding Financial Agreement and a Mutual Wills Agreement. There are also strategies that you can put in place which ensure that your assets pass to your children upon your death. Options are also available where you may wish for your partner to receive some benefit of some of your assets during your lifetime with all assets passing to your children upon your partner’s death. Choose the right executor If you have young children, it will be your executor who looks after your children’s inheritance until your children reach the age that you have stipulated in your Will that you would like them to receive your assets. It is therefore imperative that you have the best person possible to undertake this role as you are effectively giving them the keys to everything that you own and control. That’s big. You need to appoint someone that you trust implicitly to undertake this role. You need to appoint your most trusted ally. Your executor also needs to be financial savvy or receptive to obtaining the appropriate financial advice to enable them to look after and grow your children’s inheritance. It is important that you seek the appropriate advice so that you can put the best strategies in place that protect your children’s inheritance in the best manner possible. There are a number of ways that you can protect your children’s inheritance, you just need to find the best one that works for you and your children. Melisa Sloan, author of Big Moments, expert advice for conquering those moments that define us, is a lawyer, industry leader, author and board director who loves helping people put in place beautiful legacies. For more information visit www.melisasloan.com.au Image credits: Shutterstock

Money & Banking

We finally know why some people got COVID while others didn’t

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/marko-nikolic-1543289">Marko Nikolic</a>, <a href="https://theconversation.com/institutions/ucl-1885">UCL</a> and <a href="https://theconversation.com/profiles/kaylee-worlock-1543639">Kaylee Worlock</a>, <a href="https://theconversation.com/institutions/ucl-1885">UCL</a> Throughout the pandemic, one of the key questions on everyone’s mind was why some people avoided getting COVID, while others caught the virus multiple times. Through a collaboration between University College London, the Wellcome Sanger Institute and Imperial College London in the UK, we set out to answer this question using the world’s first controlled <a href="https://www.nature.com/articles/s41591-022-01780-9">“challenge trial” for COVID</a> – where volunteers were deliberately exposed to SARS-CoV-2, the virus that causes COVID, so that it could be studied in great detail. Unvaccinated healthy volunteers with no prior history of COVID were exposed – via a nasal spray – to an extremely low dose of the original strain of SARS-CoV-2. The volunteers were then closely monitored in a quarantine unit, with regular tests and samples taken to study their response to the virus in a highly controlled and safe environment. For our <a href="https://www.nature.com/articles/s41586-024-07575-x">recent study</a>, published in Nature, we collected samples from tissue located midway between the nose and the throat as well as blood samples from 16 volunteers. These samples were taken before the participants were exposed to the virus, to give us a baseline measurement, and afterwards at regular intervals. The samples were then processed and analysed using single-cell sequencing technology, which allowed us to extract and sequence the genetic material of individual cells. Using this cutting-edge technology, we could track the evolution of the disease in unprecedented detail, from pre-infection to recovery. To our surprise, we found that, despite all the volunteers being carefully exposed to the exact same dose of the virus in the same manner, not everyone ended up testing positive for COVID. In fact, we were able to divide the volunteers into three distinct infection groups (see illustration). Six out of the 16 volunteers developed typical mild COVID, testing positive for several days with cold-like symptoms. We referred to this group as the “sustained infection group”. Out of the ten volunteers who did not develop a sustained infection, suggesting that they were able to fight off the virus early on, three went on to develop an “intermediate” infection with intermittent single positive viral tests and limited symptoms. We called them the “transient infection group”. The final seven volunteers remained negative on testing and did not develop any symptoms. This was the “abortive infection group”. This is the first confirmation of abortive infections, which were previously <a href="https://www.nature.com/articles/s41586-021-04186-8">unproven</a>. Despite differences in infection outcomes, participants in all groups shared some specific novel immune responses, including in those whose immune systems prevented the infection. When we compared the timings of the cellular response between the three infection groups, we saw distinct patterns. For example, in the transiently infected volunteers where the virus was only briefly detected, we saw a strong and immediate accumulation of immune cells in the nose one day after infection. This contrasted with the sustained infection group, where a more delayed response was seen, starting five days after infection and potentially enabling the virus to take hold in these volunteers. In these people, we were able to identify cells stimulated by a key antiviral defence response in both the nose and the blood. This response, called the “interferon” response, is one of the ways our bodies signal to our immune system to help fight off viruses and other infections. We were surprised to find that this response was detected in the blood before it was detected in the nose, suggesting that the immune response spreads from the nose very quickly. <h2>Protective gene</h2> Lastly, we identified a specific gene called HLA-DQA2, which was expressed (activated to produce a protein) at a much higher level in the volunteers who did not go on to develop a sustained infection and could hence be used as a marker of protection. Therefore, we might be able to use this information and identify those who are probably going to be protected from severe COVID. These findings help us fill in some gaps in our knowledge, painting a much more detailed picture regarding how our bodies react to a new virus, particularly in the first couple of days of an infection, which is crucial. We can use this information to compare our data to other data we are currently generating, specifically where we are “challenging” volunteers to other viruses and more recent strains of COVID. In contrast to our current study, these will mostly include volunteers who have been vaccinated or naturally infected – that is, people who already have immunity. Our study has significant implications for future treatments and vaccine development. By comparing our data to volunteers who have never been exposed to the virus with those who already have immunity, we may be able to identify new ways of inducing protection, while also helping the development of more effective vaccines for future pandemics. In essence, our research is a step towards better preparedness for the next pandemic.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/233063/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/marko-nikolic-1543289">Marko Nikolic</a>, Principal Research Fellow/Honorary consultant Respiratory Medicine, <a href="https://theconversation.com/institutions/ucl-1885">UCL</a> and <a href="https://theconversation.com/profiles/kaylee-worlock-1543639">Kaylee Worlock</a>, Postdoc Research Fellow, Molecular and Cellular Biology, <a href="https://theconversation.com/institutions/ucl-1885">UCL</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/we-finally-know-why-some-people-got-covid-while-others-didnt-233063">original article</a>. </div>

Body

I’ve been given opioids after surgery to take at home. What do I need to know?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/katelyn-jauregui-1527878">Katelyn Jauregui</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/asad-patanwala-1529611">Asad Patanwala</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/jonathan-penm-404921">Jonathan Penm</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/shania-liu-1433659">Shania Liu</a>, <a href="https://theconversation.com/institutions/university-of-alberta-1232">University of Alberta</a> Opioids are commonly prescribed when you’re discharged from hospital after surgery to help manage pain at home. These strong painkillers may have unwanted side effects or harms, such as constipation, drowsiness or the risk of dependence. However, there are steps you can take to minimise those harms and use opioids more safely as you recover from surgery. <h2>Which types of opioids are most common?</h2> The <a href="https://journals.sagepub.com/doi/full/10.1177/0310057X231163890">most commonly prescribed</a> opioids after surgery in Australia are oxycodone (brand names include Endone, OxyNorm) and tapentadol (Palexia). In fact, <a href="https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/bcp.16063">about half</a> of new oxycodone prescriptions in Australia occur after a recent hospital visit. <a href="https://journals.sagepub.com/doi/full/10.1177/0310057X231163890">Most commonly</a>, people will be given immediate-release opioids for their pain. These are quick-acting and are used to manage short-term pain. Because they work quickly, their dose can be easily adjusted to manage current pain levels. Your doctor will provide instructions on how to adjust the dosage based on your pain levels. Then there are slow-release opioids, which are specially formulated to slowly release the dose over about half to a full day. These may have “sustained-release”, “controlled-release” or “extended-release” on the box. Slow-release formulations are primarily used for chronic or long-term pain. The slow-release form means the medicine does not have to be taken as often. However, it takes longer to have an effect compared with immediate-release, so it is not commonly used after surgery. Controlling your pain after surgery is <a href="https://www.nps.org.au/assets/4811a27845042173-00a4ff09097b-postoperative-pain-management_36-202.pdf">important</a>. This allows you get up and start moving sooner, and recover faster. Moving around sooner after surgery prevents muscle wasting and harms associated with immobility, such as bed sores and blood clots. Everyone’s pain levels and needs for pain medicines are different. Pain levels also decrease as your surgical wound heals, so you may need to take less of your medicine as you recover. <h2>But there are also risks</h2> As mentioned above, side effects of opioids include constipation and feeling drowsy or nauseous. The drowsiness can also make you more likely to fall over. Opioids prescribed to manage pain at home after surgery are usually prescribed for short-term use. But up to <a href="https://pubmed.ncbi.nlm.nih.gov/35545810/">one in ten</a> Australians still take them up to four months after surgery. <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/msc.1837">One study</a> found people didn’t know how to safely stop taking opioids. Such long-term opioid use may lead to dependence and overdose. It can also reduce the medicine’s effectiveness. That’s because your body becomes used to the opioid and needs more of it to have the same effect. Dependency and side effects are also more common with <a href="https://www.anzca.edu.au/getattachment/535097e6-9f50-4d09-bd7f-ffa8faf02cdd/Prescribing-slow-release-opioids-4-april-2018#:%7E:text=%E2%80%9CSlow%2Drelease%20opioids%20are%20not,its%20Faculty%20of%20Pain%20Medicine.">slow-release opioids</a> than immediate-release opioids. This is because people are usually on slow-release opioids for longer. Then there are concerns about “leftover” opioids. One study found 40% of participants were prescribed <a href="https://journals.sagepub.com/doi/full/10.1177/0310057X231163890">more than twice</a> the amount they needed. This results in unused opioids at home, which <a href="https://www.anzca.edu.au/getattachment/558316c5-ea93-457c-b51f-d57556b0ffa7/PS41-Guideline-on-acute-pain-management">can be dangerous</a> to the person and their family. Storing leftover opioids at home increases the risk of taking too much, sharing with others inappropriately, and using without doctor supervision. <h2>How to mimimise the risks</h2> Before using opioids, speak to your doctor or pharmacist about using over-the-counter pain medicines such as paracetamol or anti-inflammatories such as ibuprofen (for example, Nurofen, Brufen) or diclofenac (for example, Voltaren, Fenac). These can be quite effective at controlling pain and will lessen your need for opioids. They can often be used instead of opioids, but in some cases a combination of both is needed. Other techniques to manage pain include physiotherapy, exercise, <a href="https://theconversation.com/hot-pack-or-cold-pack-which-one-to-reach-for-when-youre-injured-or-in-pain-161086">heat packs or ice packs</a>. Speak to your doctor or pharmacist to discuss which techniques would benefit you the most. However, if you do need opioids, there are some ways to make sure you use them <a href="https://www.safetyandquality.gov.au/sites/default/files/2022-04/opioid-analgesic-stewardship-in-acute-pain-clinical-care-standard.pdf">safely and effectively</a>: <ul> <li> ask for <a href="https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/full/10.1111/anae.16085">immediate-release</a> rather than slow-release opioids to lower your risk of side effects </li> <li> do not drink alcohol or take sleeping tablets while on opioids. This can increase any drowsiness, and lead to reduced alertness and slower breathing </li> <li> as you may be at higher risk of falls, remove trip hazards from your home and make sure you can safely get up off the sofa or bed and to the bathroom or kitchen </li> <li> before starting opioids, have a plan in place with your doctor or pharmacist about how and when to stop taking them. Opioids after surgery are ideally taken at the lowest possible dose for the shortest length of time. </li> </ul> <h2>If you’re concerned about side effects</h2> If you are concerned about side effects while taking opioids, speak to your pharmacist or doctor. Side effects include: <ul> <li> <a href="https://theconversation.com/health-check-what-causes-constipation-114290">constipation</a> – your pharmacist will be able to give you lifestyle advice and recommend laxatives </li> <li> drowsiness – do not drive or operate heavy machinery. If you’re trying to stay awake during the day, but keep falling asleep, your dose may be too high and you should contact your doctor </li> <li> weakness and slowed breathing – this may be a sign of a more serious side effect such as respiratory depression which requires medical attention. Contact your doctor immediately. </li> </ul> <h2>If you’re having trouble stopping opioids</h2> Talk to your doctor or pharmacist if you’re having trouble stopping opioids. They can give you alternatives to manage the pain and provide advice on gradually lowering your dose. You may experience withdrawal effects, such as agitation, anxiety and insomnia, but your doctor and pharmacist can help you manage these. <h2>How about leftover opioids?</h2> After you have finished using opioids, take any leftovers to your local pharmacy to <a href="https://theconversation.com/health-check-what-should-you-do-with-your-unused-medicine-81406">dispose of them safely</a>, free of charge. Do not share opioids with others and keep them away from others in the house who do not need them, as opioids can cause unintended harms if not used under the supervision of a medical professional. This could include accidental ingestion by children. <hr /> For more information, speak to your pharmacist or doctor. Choosing Wisely Australia also has <a href="https://www.choosingwisely.org.au/resources/consumers-and-carers/patient-guide-to-managing-pain-and-opioid-medicines">free online information</a> about managing pain and opioid medicines.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/228615/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/katelyn-jauregui-1527878">Katelyn Jauregui</a>, PhD Candidate and Clinical Pharmacist, School of Pharmacy, Faculty of Medicine and Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/asad-patanwala-1529611">Asad Patanwala</a>, Professor, Sydney School of Pharmacy, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/jonathan-penm-404921">Jonathan Penm</a>, Senior lecturer, School of Pharmacy, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/shania-liu-1433659">Shania Liu</a>, Postdoctoral Research Fellow, Faculty of Medicine and Dentistry, <a href="https://theconversation.com/institutions/university-of-alberta-1232">University of Alberta</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/ive-been-given-opioids-after-surgery-to-take-at-home-what-do-i-need-to-know-228615">original article</a>. </div>

Body

What you should know before you start chasing bargains at the EOFY sales

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/park-thaichon-175182">Park Thaichon</a>, <a href="https://theconversation.com/institutions/university-of-southern-queensland-1069">University of Southern Queensland</a> What cost-of-living crisis? Millions of Australians are expected to spend <a href="https://www.roymorgan.com/findings/9592-ara-roy-morgan-media-release-eofy-mid-year-sales-2024">A$10.1 billion</a> during the end of financial year (EOFY) sales. Many products, from cars and holiday packages to clothing and white goods will be available at marked down prices over the next few weeks. Clothing and accessories will attract the biggest spend, followed by electronics and technology, household items and decorations and then appliances and white goods. To put the estimated $10.1 billion EOFY spend in perspective, in 2023 Australians spent <a href="https://ecommerce-report.auspost.com.au/">$361 billion on retail goods</a>, with $63.6 billion of that spent online. With such high spending, consumers need to make informed decisions to maximise their savings and avoid pitfalls. <h2>Buyer beware</h2> It is important to understand the return and exchange policies of the different retail stores. Most retailers allow shoppers who change their mind up to 30 days to return and receive a refund or exchange the product. Some may have shorter return periods or may not accept returns on sale items. These items are sometimes referred to as final sales, non-refundable purchases, last-chance deals, no-return sales and clearance items. This means if a customer bought something on sale and later doesn’t want it, they can’t return or exchange it. Some retailers have specific conditions about where items can be returned. For example, in Melbourne <a href="https://www.davidjones.com/return-options">David Jones</a> requires boutique brands to be returned to specific branch locations. For example, items purchased instore from Chanel can only be returned at Elizabeth Street and Bourke Street Mall branches. Other conditions might include <a href="https://www.myer.com.au/content/returns-exchanges">no refunds/no exchanges</a> on large electrical items, furniture or mattresses unless faulty or damaged. Or retailers may only offer instore credit or charge a <a href="https://www.davidjones.com/return-options">25% restocking fee</a> when a customer cancels an order for a large or bulky item. Many retailers, such as streetwear brand <a href="https://www.culturekings.com.au/pages/shipping-returns">Culture Kings</a>, also require a payment if the return process involves shipping. As well as these conditions, retailers require any returned items to be in their original condition and sometimes, their original packaging. Being aware of these policies can help customers make more informed decisions and avoid being stuck with items they don’t want. <h2>What to buy and where to get it</h2> Certain items, such as off-season clothing, electronics and furniture are often discounted during EOFY sales, making it a good time to get them at reduced cost. However, some items, like the latest Playstation or newest smart phone, may not be as heavily discounted and might be better bought at other times of the year. Shoppers should also avoid buying items they are unlikely to use or consume before they expire including perishable goods like food, cosmetics and vitamins. <hr /> <iframe id="dnC1Y" class="tc-infographic-datawrapper" style="border: none;" src="https://datawrapper.dwcdn.net/dnC1Y/" width="100%" height="400px" frameborder="0"></iframe> <hr /> It’s also important to consider the value of the item and whether the discount offered during sales justifies the purchase, especially for big-ticket items that may require significant storage space or maintenance. Customers should also consider where to buy their items. Online retailers often have competitive prices and a wide selection, but some customers may prefer to see the item before they purchase instore. <a href="https://journals.sagepub.com/doi/full/10.1177/14413582231167664">Multi-channel shopping</a> is a combination of both instore and online shopping. It gives customers the flexibility to choose how and where they want to browse and purchase. For example, some customers prefer to touch, feel and try a product instore but then make the purchase online for convenience, taking advantage of any free shipping offers and online discount. <h2>Pressure tactics</h2> It is important to be wary any deceptive tactics to persuade you to buy unwanted products. For example, some stores might use misleading advertising or pressure tactics to convince customers to make purchases with the feeling of fear of missing out (FOMO). <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/ijcs.12649?casa_token=271MN72XdP8AAAAA%3AfhYF_2yUJtM7KGv5jvFdXn5UsXQLkMcIM_F6hffYa30QaSdRivjf2mhFX-cr5C7ttCuLl1-e2OFYXBA">Our research found</a> FOMO played a role in panic buying. During the EOFY sales, businesses may try to create a sense of urgency by claiming that items are selling out quickly or prices will increase soon. For example, online sites might state a product is “low in stock”, “151 items have been sold today” or “25 people are watching this item”. By being aware these tactics are intended to lock them into buying, customers can take their time to consider purchases carefully and avoid being swayed into buying things they do not really want or need. Ultimately, the best approach for customers is to plan ahead, research prices and shop around to find the best deals for their needs. <h2>Why we have EOFY sales</h2> The original purpose of the EOFY is to mark the end of a 12-month accounting period for businesses and individuals. EOFY sales help businesses clear out last year’s stock and make way for new. Moving stock also helps to improve the bottom line by converting unsold goods into revenue. If consumers are savvy, they can find ways to make savings while also putting money back into the economy.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/232568/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/park-thaichon-175182">Park Thaichon</a>, Associate Professor of Marketing, <a href="https://theconversation.com/institutions/university-of-southern-queensland-1069">University of Southern Queensland</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-you-should-know-before-you-start-chasing-bargains-at-the-eofy-sales-232568">original article</a>. </div>

Money & Banking

The hidden risks of buy now, pay later: What shoppers need to know

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/vivek-astvansh-1318943">Vivek Astvansh</a>, <a href="https://theconversation.com/institutions/mcgill-university-827">McGill University</a> and <a href="https://theconversation.com/profiles/chandan-kumar-behera-1479139">Chandan Kumar Behera</a>, <a href="https://theconversation.com/institutions/indian-institute-of-management-lucknow-6023">Indian Institute of Management Lucknow</a> <iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" src="https://narrations.ad-auris.com/widget/the-conversation-canada/the-hidden-risks-of-buy-now-pay-later-what-shoppers-need-to-know" width="100%" height="400"></iframe> <a href="https://www.canada.ca/en/financial-consumer-agency/services/loans/buy-now-pay-later.html">Buy now, pay later</a> is a relatively new form of financial technology that allows consumers to purchase an item immediately and repay the balance at a later time in instalments. Unlike applying for a credit card, buy now, pay later <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4591446">doesn’t require a credit check</a>. Instead, <a href="https://doi.org/10.1108/EJM-11-2021-0923">these programs use algorithms</a> to perform <a href="https://www.investopedia.com/terms/s/soft-inquiry.asp">“soft” credit checks</a> to determine <a href="https://theconversation.com/if-it-looks-like-debt-lets-treat-it-like-debt-buy-now-pay-later-schemes-need-firmer-regulation-in-nz-211820">a shopper’s eligibility</a>. This means buy now, pay later loans target <a href="https://www.theguardian.com/money/2022/jan/27/buy-now-pay-later-schemes-entice-consumers-spend-more">low-income, tech-savvy</a> <a href="https://www.cnbc.com/2022/10/27/gen-z-and-millennials-prefer-buy-now-pay-later-services.html">millennials and Gen Z shoppers</a> in an effort to <a href="https://libertystreeteconomics.newyorkfed.org/2023/09/who-uses-buy-now-pay-later/">supposedly improve financial inclusion</a> for these groups. However, the newness of buy now, pay later programs means existing <a href="https://doi.org/10.1111/acfi.13100">consumer credit laws don’t cover it</a>. This lack of regulation puts shoppers at financial risk of accumulating higher levels of debt. <h2>Credit cards versus buy now, pay later</h2> There are three key differences between credit cards and buy now, pay later loans. First, while buy now, pay later loans are a line of credit like credit cards are, <a href="https://www.cnbc.com/2022/05/04/klarna-to-report-buy-now-pay-later-data-to-uk-credit-bureaus.html">they don’t impact credit reports</a>. Because of this, shoppers might be less cautious when using buy now, pay later services. Credit cards typically have annual interest rates ranging from <a href="https://www.bankrate.com/finance/credit-cards/what-is-credit-card-apr/#credit-card-apr-vs-credit-card-interest">15 to 26 per cent</a>. While most buy now, pay later loans have no interest, longer term loans have <a href="https://www.cbsnews.com/news/buy-now-pay-later-loans-interest-rate-fees-tips-what-to-know/">annual interest rates of about 37 per cent</a>. Shoppers are <a href="https://hbswk.hbs.edu/item/buy-now-pay-later-how-retails-hot-feature-hurts-lower-income-shoppers">at risk of overusing buy now, pay later programs</a> and accumulating more debt than they can manage. In addition, formal lenders, such as banks, currently have no way of knowing what buy now, pay later debt a person is carrying. The lender, therefore, likely incurs more risk than they are aware of. Second, credit cards typically provide <a href="https://doi.org/10.1080/1369118X.2022.2161830">an interest-free period</a>, after which <a href="https://doi.org/10.1177/03128962211032448">borrowers must pay interest</a>. In contrast, buy now, pay later users typically don’t have interest fees, but can incur <a href="https://doi.org/10.1108/IJBM-07-2022-0324">late fees for missed or late payments</a>. Falling behind on payment terms <a href="https://www.forbes.com/sites/andriacheng/2020/12/16/why-retailers-are-embracing-buy-now-pay-later-service-this-holiday-season/">can result in charges</a> that exceed <a href="https://stateline.org/2022/02/02/regulators-scrutinize-buy-now-pay-later-plans/">typical credit card interest rates</a>, causing more harm than interest payments. Low-income buy now, pay later users are <a href="https://hbswk.hbs.edu/item/buy-now-pay-later-how-retails-hot-feature-hurts-lower-income-shoppers">particularly vulnerable</a> to <a href="https://www.consumerfinance.gov/data-research/research-reports/consumer-use-of-buy-now-pay-later-insights-from-the-cfpb-making-ends-meet-survey/">using overdrafts to cover their buy now, pay later payments</a>. Third, people typically have just a few credit cards, making it easier to keep track of payments. Buy now, pay later users, on the other hand, usually engage with multiple buy now, pay later lenders through retailers. As a result, it’s difficult for them to keep track of all the buy now, pay later lenders and retailers they made purchases from. <h2>What are the Canadian governments doing?</h2> Canada classifies buy now, pay later as an unsecured instalment loan, which means lenders are subject to laws at the federal and provincial levels. Under federal law, there is an <a href="https://www.sec.gov/Archives/edgar/data/1711291/000171129122000011/curo-20211231.htm">annual interest rate cap of 60 per cent</a>. Provincial laws require buy now, pay later lenders to disclose the cost of credit and extend consumer protection rights to buy now, pay later shoppers. At the provincial level, <a href="https://www.canada.ca/en/financial-consumer-agency/services/loans/buy-now-pay-later.html">specific laws come into play</a>. Manitoba, Alberta, Québec, and Ontario have passed laws that require lenders to be licensed before they offer these products and be subject to regulatory oversight. These laws regulate high-cost credit products that have annual rates of 32 per cent or higher. This means buy now, pay later services should fall under this category. However, I found no evidence of buy now, pay later lenders being licensed in Canada. This means either lenders are not aware they fall under these laws, or no one is enforcing them. This ambiguity over whether or not buy now, pay later lenders are subject to regulatory oversight could be a hindrance for banks like the <a href="https://financialpost.com/fp-finance/fintech/why-higher-interest-rates-threaten-the-buy-now-pay-later-bubble">Bank of Nova Scotia and the Canadian Imperial Bank of Commerce</a>, as it deters them from entering the buy now, pay later market despite its profitability. <h2>Questions to ask before using buy now, pay later</h2> Before signing up for a buy now, pay later loan, shoppers should consider the following six questions. 1. Payment structure. How much of the invoice amount needs to be paid upfront? The norm is typically 25 per cent. What is the number of remaining instalments? The answer to this is usually four. Lastly, what is the frequency of instalments? The norm is biweekly. 2. Sensitive information. Does the lender require you to provide information about your chequing account? This is sensitive information to give away and puts you at risk of data breaches. Most buy now, pay later lenders withdraw instalment amounts from chequing accounts or debit cards, potentially exposing shoppers to greater risks than credit cards. 3. Interest charges Does the buy now, pay later lender charge interest on instalment payments? The norm is no. 4. Late fees How much is the late fee, when does it apply and what is the maximum amount of the late fee? Typically, late fees don’t exceed $8 or one-quarter of the invoice amount. Late fees usually kick in if your scheduled payment remains unpaid after 10 days. 5. Data responsibility. Who is responsible for your data? Whether it’s the retailer, the buy now, pay later lender or a company whose cloud storage the provider may be using, you should know. In general, the buy now, pay later lender holds this responsibility. 6. Licensing. Is the buy now, pay later lender licensed to sell the loan? Usually, the <a href="https://dfpi.ca.gov/wp-content/uploads/sites/337/2020/03/afterpay-settlement.pdf">answer to this question is no</a>. <h2>Buy now, pay later regulation</h2> Two sets of laws and regulations should be implemented to address some of these issues. The first set of regulations focuses on how buy now, pay later lenders interact with consumers. These lenders should clearly communicate <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4359956">all terms and conditions of their loans</a>, including late charges, interest charges and payment schedules, on their platforms to ensure shoppers are fully informed of their financial obligations. The Financial Conduct Authority in the United Kingdom recently issued guidelines allowing buy now, pay later lenders to <a href="https://www.ft.com/content/ca428bc8-65c3-49ed-8ba6-0d6f206098aa">terminate, suspend or restrict access to shopper accounts</a> for any reason without notice. Effective September 2024, New Zealand will require buy now, pay later lenders to <a href="https://theconversation.com/if-it-looks-like-debt-lets-treat-it-like-debt-buy-now-pay-later-schemes-need-firmer-regulation-in-nz-211820">check a shopper’s credit</a> before providing them a buy now, pay later loan. The second set of regulations defines the scope and boundaries of buy now, pay later lenders. On Dec. 9, 2022, California became the first American state to <a href="https://dfpi.ca.gov/2022/12/09/buy-now-pay-later-protect-yourself-before-you-check-out/">classify buy now, pay later as a loan</a>. Such classifications allowed California regulators to <a href="https://stateline.org/2022/02/02/regulators-scrutinize-buy-now-pay-later-plans/">question lenders about their transparency in disclosing the terms of their offerings</a>. The hope is that these laws and regulations will facilitate microlending and not impede the existence of buy now, pay later services, but rather make it safer and more secure for both lenders and users.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/215421/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/vivek-astvansh-1318943">Vivek Astvansh</a>, Associate Professor of Quantitative Marketing and Analytics, <a href="https://theconversation.com/institutions/mcgill-university-827">McGill University</a> and <a href="https://theconversation.com/profiles/chandan-kumar-behera-1479139">Chandan Kumar Behera</a>, PhD Student in Marketing, <a href="https://theconversation.com/institutions/indian-institute-of-management-lucknow-6023">Indian Institute of Management Lucknow</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/the-hidden-risks-of-buy-now-pay-later-what-shoppers-need-to-know-215421">original article</a>. </div>

Money & Banking

Everything you need to know about tipping in the US

There are few social customs in the US more confusing to travellers than tipping. To most Americans, gratuities are normal, like adding sales tax at the register. To foreign visitors, though, the very idea can induce anxiety or panic. We're notoriously poor tippers. Partly this is accidental ignorance, but partly it is self-righteous rejection of an institution many of us see as unfair. I once had a meal in New York with a woman from Brisbane who refused to tip "on principle." I nodded in agreement ... and then tipped for both of us. The truth is, federal minimum wage for adults in the US is just US$7.25 an hour. In industries where tipping is routine, employers are legally allowed to pay wages as low as US$2.13 an hour. So while travellers may stage a quiet rebellion, refusing to tip, the bereaved party is never going to be the restaurant owners (who earns their profit through the itemised bill), but the poor waiters. Until the US government raises minimum wages to Australian levels (something that will probably never happen), tipping is here to stay. Which means travellers need to accept it, then learn the rules. First rule: After clearing immigration get your hands on a stack of "singles" (US$1 bills). You're going to need them. Getting around In theory, tips should only go to people who are helpful; the more helpful, the more bountiful their reward. In reality, tips are par for the course, and to "stiff" somebody is tantamount to slapping them in the face. If a airport porter helps you with your bags, give them US$1-2 per bag. If they meet you at the gate with a wheelchair, give them US$3-5. For most travellers, the first real test comes with transports away from the airport. If you're lucky enough to have a hotel worker collect you from Arrivals, give them US$10-15 for the effort. If you take a taxi, a little more thought will be required. Many taxis now have seat-back displays that offer "default tipping" amounts at the end of a journey: in New York, 20, 25, and 30 per cent. You should only really tip 30 per cent if the taxi turns out to be the Batmobile, getting you to your destination in record time. Even 20 per cent can sometimes feels a little high. Tipping is subjective: I often manually override the default, leaving 15-20 per cent, or a few extra dollars if I'm paying in cash. If you hire a car and take advantage of valet (all but mandatory in Los Angeles), be prepared to tip the worker US$3-5 upon pick-up, depending on how ritzy the establishment is. A quick rule of thumb: more ritz equals more tip. Hotels If you arrive at the hotel and somebody opens the door for you, that's on the house. If they carry your bags, that is not on the house. Give them US$2-3 a bag. If the hotel has a concierge, their friendliness isn't contingent on your generosity. But if they perform a service for you - book a trip, hire a car, charter a private jet to the Bahamas - acknowledge this effort with US$10-20 at the end of your stay, presented with a handshake. One case where tipping can have a direct impact on the quality of service you receive is housekeeping. Each morning, leave US$2-5 on your pillow with a thank you note. This ensures different cleaners get their due, and it also means cleaners will be extra diligent for the rest of your stay. If you think this is a little rich, keep in mind that these people are picking up your dirty towels, so spare change for a cup of coffee is the least you can do. One point of confusion with hotel tipping is the in-room dining. Some hotels include a default tip on their dining bills; some include a "service charge," which goes to the hotel, and should not be treated as a tip. If there's no obvious tip included on the bill, slip the server 15-20 per cent when they knock on your door. Dining and drinking Nobody can force you to tip in a restaurant, though they can try to counteract your miserliness by stating on the menu that tips are automatically added to the final charge. This is increasingly common in areas catering to large numbers of foreign travellers; it's also pretty standard when your table has more than six people. If tips have been added by the time you come to hand over your card, no further gratuity is needed. If no tip has been included, you might need to leave some money on the table. How much exactly depends on what kind of table it is. If it is a fast food table, no tip. If it is a table at a restaurant ranging from modest diner to upmarket eatery, 15-20 per cent for the waiter is standard (err on the high side in major cities like New York and San Francisco). If you leave less than 15 per cent, staff will assume you weren't happy with their service. If you leave two pennies on top of the bill - a code - they will know you were very unhappy, and feel bad even as they silently loathe you for being a Scrooge. It is almost never okay to withhold a tip; if you're considering doing that, you should also be considering complaining to the manager. If it is a very fancy restaurant, perhaps one with Michelin stars, prepare to hand over 25 per cent of the bill (before tax) to the waiter, who will divide it up among his or her support staff. You should also tip the sommelier if they suggest wine, and perhaps the maitre'd, if they gave you a fabulous table. Always, without exception, tip a bartender a dollar for every drink; bigger tips can mean stronger second cocktails in my experience. As for coffee shops, despite the increasing prevalence of tip jars, and "suggested tips" when paying with a card, this is cheekiness and should only be taken seriously if the barista goes out of their way, like the man who once drew Darth Vader in my cappuccino crema. Everything else This guide covers the most common situations a traveller will have to contend when in the US, though the list is not exhaustive. For example, do you tip a massage therapist? Yes, 10-20 per cent. A hairdresser? Same. Tour guide or hiking leader? 15-20 per cent of the total charge, depending on their performance. That Elvis impersonator who officiated your wedding in a Las Vegas chapel? Same. Tip anyone, in fact, that provides you with a service: 15 per cent is a good default to keep in mind. Just remember, nobody is affronted by the offer of a gratuity, so you shouldn't feel bashful about giving one. Written by Lance Richardson. First appeared on <a href="http://Stuff.co.nz" target="_blank" rel="noopener">Stuff.co.nz</a>. Image credits: Shutterstock

International Travel

Yes, adults can develop food allergies. Here are 4 types you need to know about

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/clare-collins-7316">Clare Collins</a>, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> If you didn’t have food allergies as a child, is it possible to develop them as an adult? The short answer is yes. But the reasons why are much more complicated. Preschoolers are about <a href="https://pubmed.ncbi.nlm.nih.gov/25316115/">four times more likely to have a food allergy</a> than adults and are more likely to grow out of it as they get older. It’s hard to get accurate figures on adult food allergy prevalence. The Australian National Allergy Council reports <a href="https://nationalallergycouncil.org.au/about-us/our-strategy">one in 50 adults</a> have food allergies. But a US survey suggested as many as <a href="https://pubmed.ncbi.nlm.nih.gov/30646188/">one in ten adults</a> were allergic to at least one food, with some developing allergies in adulthood. <h2>What is a food allergy</h2> <a href="https://pubmed.ncbi.nlm.nih.gov/36509408/">Food allergies</a> are immune reactions involving <a href="https://www.aaaai.org/tools-for-the-public/allergy,-asthma-immunology-glossary/immunoglobulin-e-(ige)-defined">immunoglobulin E (IgE)</a> – an antibody that’s central to triggering allergic responses. These are known as “IgE-mediated food allergies”. Food allergy symptoms that are not mediated by IgE are usually delayed reactions and called <a href="https://pubmed.ncbi.nlm.nih.gov/25316115/">food intolerances or hypersensitivity</a>. Food allergy symptoms can include hives, swelling, difficulty swallowing, vomiting, throat or chest tightening, trouble breathing, chest pain, rapid heart rate, dizziness, low blood pressure or <a href="https://www.allergy.org.au/hp/papers/acute-management-of-anaphylaxis-guidelines?highlight=WyJhbmFwaHlsYXhpcyJd">anaphylaxis</a>. IgE-mediated food allergies can be life threatening, so all adults need an <a href="https://allergyfacts.org.au/allergy-management/newly-diagnosed/action-plan-essentials">action management plan</a> developed in consultation with their medical team. Here are four IgE-mediated food allergies that can occur in adults – from relatively common ones to rare allergies you’ve probably never heard of. <h2>1. Single food allergies</h2> The most <a href="https://pubmed.ncbi.nlm.nih.gov/30646188/">common IgE-mediated food allergies</a> in adults in a US survey were to: <ul> <li>shellfish (2.9%)</li> <li>cow’s milk (1.9%)</li> <li>peanut (1.8%)</li> <li>tree nuts (1.2%)</li> <li>fin fish (0.9%) like barramundi, snapper, salmon, cod and perch.</li> </ul> In these adults, about 45% reported reacting to multiple foods. This compares to <a href="https://pubmed.ncbi.nlm.nih.gov/25316115/">most common childhood food allergies</a>: cow’s milk, egg, peanut and soy. Overall, adult food allergy prevalence appears to be increasing. Compared to <a href="https://pubmed.ncbi.nlm.nih.gov/14657884/">older surveys published in 2003</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/15241360/">2004</a>, peanut allergy prevalence has increased about three-fold (from 0.6%), while tree nuts and fin fish roughly doubled (from 0.5% each), with shellfish similar (2.5%). While new <a href="https://pubmed.ncbi.nlm.nih.gov/38214821/">adult-onset food allergies are increasing</a>, childhood-onset food allergies are also more likely to be retained into adulthood. Possible reasons for both <a href="https://pubmed.ncbi.nlm.nih.gov/38214821/">include</a> low vitamin D status, lack of immune system challenges due to being overly “clean”, heightened sensitisation due to allergen avoidance, and more frequent antibiotic use. <h2>2. Tick-meat allergy</h2> Tick-meat allergy, also called α-Gal syndrome or mammalian meat allergy, is an allergic reaction to galactose-alpha-1,3-galactose, or α-Gal for short. <a href="https://pubmed.ncbi.nlm.nih.gov/33529984/">Australian immunologists first reported</a> links between α-Gal syndrome and tick bites in 2009, with cases also reported in the United States, Japan, Europe and South Africa. The <a href="https://pubmed.ncbi.nlm.nih.gov/38318181/">US Centers for Disease Control estimates</a> about 450,000 Americans <a href="https://www.cdc.gov/mmwr/volumes/72/wr/mm7230a2.htm">could be affected</a>. The α-Gal contains a carbohydrate molecule that is bound to a <a href="https://pubmed.ncbi.nlm.nih.gov/38318181/">protein</a> molecule in <a href="https://alphagalinformation.org/what-is-a-mammal/">mammals</a>. The IgE-mediated allergy is triggered after repeated bites from ticks or <a href="https://www.insectshield.com/pages/chiggers">chigger mites</a> that have bitten those mammals. When tick saliva crosses into your body through the bite, antibodies to α-Gal are produced. When you subsequently eat foods that contain α-Gal, the allergy is triggered. These triggering foods include meat (lamb, beef, pork, rabbit, kangaroo), dairy products (yoghurt, cheese, ice-cream, cream), <a href="https://en.wikipedia.org/wiki/Gelatin">animal-origin gelatin</a> added to gummy foods (jelly, lollies, marshmallow), prescription medications and over-the counter supplements containing gelatin (<a href="https://www.drugs.com/inactive/gelatin-57.html">some antibiotics, vitamins and other supplements</a>). Tick-meat allergy reactions can be hard to recognise because they’re usually delayed, and they can be severe and include anaphylaxis. Allergy <a href="https://www.allergy.org.au/patients/food-allergy/mammalian-meat-tick-faq">organisations produce management guidelines</a>, so always discuss management with your doctor. <h2>3. Fruit-pollen allergy</h2> Fruit-pollen allergy, called pollen food allergy syndrome, is an <a href="https://pubmed.ncbi.nlm.nih.gov/38002141/">IgE-mediated allergic reaction</a>. In susceptible adults, pollen in the air provokes the production of IgE antibodies to antigens in the pollen, but these antigens are similar to ones found in some fruits, vegetables and herbs. The problem is that <a href="https://pubmed.ncbi.nlm.nih.gov/38002141/">eating those plants</a> triggers an allergic reaction. The <a href="https://pubmed.ncbi.nlm.nih.gov/38002141/">most allergenic tree pollens</a> are from birch, cypress, Japanese cedar, <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/latex-allergy">latex</a>, grass, and ragweed. Their pollen can cross-react with <a href="https://pubmed.ncbi.nlm.nih.gov/38002141/">fruit and vegetables</a>, including kiwi, banana, mango, avocado, grapes, celery, carrot and potato, and some herbs such as caraway, coriander, fennel, pepper and paprika. Fruit-pollen allergy is not common. Prevalence <a href="https://pubmed.ncbi.nlm.nih.gov/38002141/">estimates are between 0.03% and 8%</a> depending on the country, but it can be life-threatening. Reactions range from itching or tingling of lips, mouth, tongue and throat, called <a href="https://pubmed.ncbi.nlm.nih.gov/20306812/">oral allergy syndrome</a>, to mild <a href="https://www.allergy.org.au/patients/skin-allergy/urticaria-hives">hives</a>, to anaphylaxis. <h2>4. Food-dependent, exercise-induced food allergy</h2> During heavy exercise, the stomach produces less acid than usual and gut permeability increases, meaning that small molecules in your gut are more likely to escape across the membrane into your blood. These include food molecules that trigger an IgE reaction. If the person already has IgE antibodies to the foods eaten before exercise, then the risk of triggering food allergy reactions is increased. This allergy is called <a href="https://pubmed.ncbi.nlm.nih.gov/37893663/">food-dependent exercise-induced allergy</a>, with symptoms ranging from hives and swelling, to difficulty breathing and anaphylaxis. <a href="https://pubmed.ncbi.nlm.nih.gov/30601082/">Common trigger foods include</a> wheat, seafood, meat, poultry, egg, milk, nuts, grapes, celery and other foods, which could have been eaten many hours before exercising. To complicate things even further, allergic <a href="https://pubmed.ncbi.nlm.nih.gov/33181008/">reactions can</a> occur at lower levels of trigger-food exposure, and be more severe if the person is simultaneously taking non-steroidal inflammatory medications like aspirin, drinking alcohol or is sleep-deprived. Food-dependent exercise-induced allergy is extremely rare. Surveys have estimated prevalence as between <a href="https://www.sciencedirect.com/science/article/pii/S1555415517300259">one to 17 cases per 1,000 people worldwide</a> with the highest prevalence between the teenage years to age 35. Those affected often have other allergic conditions such as hay fever, asthma, allergic conjunctivitis and dermatitis. <h2>Allergies are a growing burden</h2> The <a href="https://pubmed.ncbi.nlm.nih.gov/36509408/">burden on physical health, psychological health</a> and health costs due to food allergy is increasing. In the US, this <a href="https://pubmed.ncbi.nlm.nih.gov/38393624/">financial burden was estimated as $24 billion per year</a>. Adult food allergy needs to be taken seriously and those with severe symptoms should wear a medical information bracelet or chain and carry an <a href="https://www.healthdirect.gov.au/how-to-use-an-adrenaline-autoinjector-epipen-anapen">adrenaline auto-injector pen</a>. Concerningly, surveys suggest only <a href="https://pubmed.ncbi.nlm.nih.gov/30646188/">about one in four adults</a> with food allergy have an adrenaline pen. If you have an IgE-mediated food allergy, discuss your management plan with your doctor. You can also find more information at <a href="https://allergyfacts.org.au/">Allergy and Anaphylaxis Australia</a>.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/223342/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/clare-collins-7316">Clare Collins</a>, Laureate Professor in Nutrition and Dietetics, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/yes-adults-can-develop-food-allergies-here-are-4-types-you-need-to-know-about-223342">original article</a>. </div>

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Vitamins and supplements: what you need to know before taking them

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/neelaveni-padayachee-1018709">Neelaveni Padayachee</a>, <a href="https://theconversation.com/institutions/university-of-the-witwatersrand-894">University of the Witwatersrand</a> and <a href="https://theconversation.com/profiles/varsha-bangalee-1253468">Varsha Bangalee</a>, <a href="https://theconversation.com/institutions/university-of-kwazulu-natal-1941">University of KwaZulu-Natal</a> If you were to open your medicine cabinet right now, there’s a fair chance that you’d find at least one bottle of vitamins alongside the painkillers, plasters and cough syrup. After all, people are definitely buying vitamins: in 2020, the global market for complementary and alternative medicines, which includes multivitamin supplements, had an estimated value of <a href="https://www.grandviewresearch.com/industry-analysis/complementary-alternative-medicine-market">US$82.27 billion</a>. The use of natural health products such as minerals and amino acids has <a href="https://journals.lww.com/nutritiontodayonline/Abstract/2007/03000/Why_People_Use_Vitamin_and_Mineral_Supplements.4.aspx">increased</a> – and continues to rise, partly driven by consumers’ buying habits during the COVID-19 pandemic. People <a href="https://www.businesslive.co.za/bd/companies/healthcare/2021-02-08-native-sales-of-sas-vitamins-and-nutritional-supplements-boom/">sought out</a> vitamins C and D, as well as zinc supplements, as potential preventive measures against the virus – even though the <a href="https://www.health.harvard.edu/blog/do-vitamin-d-zinc-and-other-supplements-help-prevent-covid-19-or-hasten-healing-2021040522310">evidence</a> for their efficacy was, and <a href="https://pubmed.ncbi.nlm.nih.gov/35888660/#:%7E:text=Concluding%2C%20available%20data%20on%20the,trials%20(RCTs)%20are%20inconsistent">remains</a>, inconclusive. Multivitamins and mineral supplements are easily accessible to consumers. They are often marketed for their health claims and benefits – sometimes unsubstantiated. But their potential adverse effects are not always stated on the packaging. Collectively, vitamins and minerals are known as micronutrients. They are essential elements needed for our bodies to function properly. Our bodies can only produce micronutrients in small amounts or not at all. We get the bulk of these nutrients <a href="https://www.iprjb.org/journals/index.php/IJF/article/view/1024">from our diets</a>. People usually buy micronutrients to protect against disease or as dietary “insurance”, in case they are not getting sufficient quantities from their diets. There’s a common perception that these supplements are harmless. But they can be dangerous at incorrect dosages. They provide a false sense of hope, pose a risk of drug interactions – and can delay more effective treatment. <h2>Benefits</h2> Vitamins are beneficial if taken for the correct reasons and as prescribed by your doctor. For example, folic acid supplementation in pregnant women has been shown to prevent neural tube defects. And individuals who reduce their intake of red meat without increasing legume consumption require a vitamin B6 supplement. But a worrying trend is increasing among consumers: intravenous vitamin therapy, which is often punted by celebrities and social media marketing. Intravenous vitamins, nutrients and fluids are administered at pharmacies as well as beauty spas, and more recently “<a href="https://www.health.harvard.edu/blog/drip-bar-should-you-get-an-iv-on-demand-2018092814899">IV bars</a>”. Users believe these treatments can quell a cold, slow the effects of ageing, brighten skin, fix a hangover or just make them feel well. Intravenous vitamin therapy was previously only used in medical settings to help patients who could not swallow, needed fluid replacements or had an electrolyte imbalance. However, the evidence to support other benefits of intravenous vitamin therapy is limited. No matter how you choose to get additional vitamins, there are risks. <h2>Warning bells</h2> Most consumers use multivitamins. But others take large doses of single nutrients, especially vitamin C, iron and calcium. As lecturers in pharmacy practice, we think it’s important to highlight the potential adverse effects of commonly used vitamins and minerals: <ul> <li> <a href="https://www.hsph.harvard.edu/nutritionsource/vitamin-a/">Vitamin A/retinol</a> is beneficial in maintaining good eye health. But it can cause toxicity if more than 300,000IU (units) is ingested. Chronic toxicity (hypervitaminosis) has been <a href="https://www.ncbi.nlm.nih.gov/books/NBK532916/">associated</a> with doses higher than 10,000IU a day. Symptoms include liver impairment, loss of vision and intracranial hypertension. It can cause birth defects in pregnant women. </li> <li> <a href="https://www.hsph.harvard.edu/nutritionsource/niacin-vitamin-b3/">Vitamin B3</a> is beneficial for nervous and digestive system health. At moderate to high doses it can cause peripheral vasodilation (widening or dilating of the blood vessels at the extremities, such as the legs and arms), resulting in skin flushing, burning sensation, pruritis (itchiness of the skin) and hypotension (low blood pressure). </li> <li> <a href="https://www.hsph.harvard.edu/nutritionsource/vitamin-b6/">Vitamin B6</a> is essential for brain development and in ensuring that the immune system remains healthy. But it can result in damage to the peripheral nerves, such as those in the hands and feet (causing a sensation of numbness and often referred to as pins and needles) at doses over 200mg/daily. </li> <li> <a href="https://www.hsph.harvard.edu/nutritionsource/vitamin-c/">Vitamin C</a> is an antioxidant and assists in the repair of body tissue. Taken in high doses it can cause kidney stones and interactions with drugs, such as the oncology drugs doxorubicin, methotrexate, cisplatin and vincristine. </li> <li> <a href="https://www.hsph.harvard.edu/nutritionsource/vitamin-d/">Vitamin D</a> is essential for bone and teeth development. At high doses it can cause hypercalcaemia (calcium level in the blood is above normal) that results in thirst, excessive urination, seizures, coma and death. </li> <li> <a href="https://www.hsph.harvard.edu/nutritionsource/calcium/#:%7E:text=Calcium%20is%20a%20mineral%20most,heart%20rhythms%20and%20nerve%20functions">Calcium</a> is essential for bone health, but can cause constipation and gastric reflux. High doses can cause hypercalciuria (increased calcium in the urine), kidney stones and secondary hypoparathyroidism (underactive parathyroid gland). It can have drug interactions with zinc, magnesium and iron. </li> <li> <a href="https://www.hsph.harvard.edu/nutritionsource/magnesium/">Magnesium</a> is important for muscle and nerve functioning. At high doses it can cause diarrhoea, nausea and abdominal cramping, and can interact with tetracyclines (antibiotics). </li> <li> Zinc <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7781367/">can impair</a> taste and smell, and doses over 80mg daily have been <a href="https://link.springer.com/article/10.1007/s10654-022-00922-0#:%7E:text=Zinc%20supplementation%20of%20more%20than,zinc%20supplements%20among%20adult%20men.">shown</a> to have adverse prostate effects. </li> <li> <a href="https://www.hsph.harvard.edu/nutritionsource/selenium/">Selenium</a> can cause hair and nail loss or brittleness, lesions of the skin and nervous system, skin rashes, fatigue and mood irritability at high doses. </li> <li> <a href="https://www.sciencedirect.com/science/article/pii/S0098299720300364#:%7E:text=Expert%20guidelines%20for%20oral%20iron%20supplementation&text=Traditionally%2C%20the%20recommended%20daily%20dose,iron%20(Brittenham%2C%202018).">Iron</a> at 100-200mg/day can cause constipation, black faeces, black discoloration of teeth and abdominal pain. </li> </ul> <h2>Recommendations</h2> People need to make <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8377299/">informed decisions</a> based on evidence before consuming health products. Regular exercise and a well-balanced diet are more likely to do us good, as well as being lighter on the pocket. Seeking advice from a healthcare professional before consuming supplements can reduce the risk of adverse effects. Be aware of the potential adverse effects of vitamins and seek a healthcare professional’s guidance if you have symptoms.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/198345/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/neelaveni-padayachee-1018709">Neelaveni Padayachee</a>, Senior Lecturer, Department of Pharmacy and Pharmacology, <a href="https://theconversation.com/institutions/university-of-the-witwatersrand-894">University of the Witwatersrand</a> and <a href="https://theconversation.com/profiles/varsha-bangalee-1253468">Varsha Bangalee</a>, Associate Professor, Pharmaceutical Sciences, <a href="https://theconversation.com/institutions/university-of-kwazulu-natal-1941">University of KwaZulu-Natal</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/vitamins-and-supplements-what-you-need-to-know-before-taking-them-198345">original article</a>. </div>

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