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Stamp duty is holding us back from moving homes – we’ve worked out how much

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/nick-garvin-1453835">Nick Garvin</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> If just one state of Australia, New South Wales, scrapped its stamp duty on real-estate transactions, about 100,000 more Australians would move homes each year, according to our <a href="https://e61.in/wp-content/uploads/2024/02/Stamp-duty-effects-on-purchases-and-moves.pdf">best estimates</a>. Stamp duty is an unquestioned part of buying a home in Australia – you put your details in an online mortgage calculator, and stamp duty is automatically deducted from the amount you have to contribute. It’s easy to overlook how much more affordable a home would be without it. That means it’s also easy to overlook how much more Australians would buy and move if stamp duty wasn’t there. The 2010 Henry Tax Review found stamp duty was <a href="https://treasury.gov.au/sites/default/files/2019-10/afts_final_report_part_2_vol_1_consolidated.pdf">inequitable</a>. It taxes most the people who most need to or want to move. The review reported: "Ideally, there would be no role for any stamp duties, including conveyancing stamp duties, in a modern Australian tax system. Recognising the revenue needs of the States, the removal of stamp duty should be achieved through a switch to more efficient taxes, such as those levied on broad consumption or land bases." But does stamp duty actually stop anyone moving? It’s a claim more often made than assessed, which is what our team at the <a href="https://e61.in/wp-content/uploads/2024/02/Stamp-duty-effects-on-purchases-and-moves.pdf">e61 Institute</a> set out to do. We used real-estate transaction data and a natural experiment. <h2>What happened when Queensland hiked stamp duty</h2> In 2011, Queensland hiked stamp duty for most buyers by removing some concessions for owner-occupiers at short notice. For owner-occupiers it increased stamp duty by about one percentage point, lifting the average rate from 1.26% of the purchase price to 2.27%. What we found gives us the best estimate to date of what stamp duty does to home purchases. A one percentage point increase in stamp duty causes the number of home purchases to decline by 7.2%. The number of moves (changes of address) falls by about as much. The effect appears to be indiscriminate. Purchases of houses fell about as much as purchases of apartments, and purchases in cities fell about as much as purchases in regions. Moves between suburbs and moves interstate dropped by similar rates. With NSW stamp duty currently averaging about <a href="https://conveyancing.com.au/need-to-know/stamp-duty-nsw">3.5%</a> of the purchase price, our estimates suggest there would be about 25% more purchases and moves by home owners if it were scrapped completely. That’s 100,000 moves. Victoria’s higher rate of stamp duty, about <a href="https://www.sro.vic.gov.au/rates-taxes-duties-and-levies/general-land-transfer-duty-property-current-rates">4.2%</a>, means if it was scrapped there would be about 30% more purchases. That’s another 90,000 moves. <h2>Even low headline rates have big effects</h2> The big effect from small-looking headline rates ought not to be surprising. When someone buys a home, they typically front up much less cash than the purchase price. While stamp duty seems low as a percentage of the purchase price, it is high as a percentage of the cash the buyer needs to find. Here’s an example. If stamp duty is 4% of the purchase price, and a purchaser pays $800,000 for a property with a mortgage deposit of $160,000, the $32,000 stamp duty adds 20%, not 4%, to what’s needed. If the deposit takes five years to save, stamp duty makes it six. A similar thing happens when an owner-occupier changes address. If the buyer sells a fully owned home for $700,000 and buys a new home for $800,000, the upgrade ought to cost them $100,000. A 4% stamp duty lifts that to $132,000. Averaged across all Australian cities, stamp duty costs about <a href="https://e61.in/wp-content/uploads/2024/02/Stepped-on-by-Stamp-Duty.pdf">five months</a> of after-tax earnings. In Sydney and Melbourne, it’s six. <h2>Stamp duty has bracket creep</h2> This cost has steadily climbed from around <a href="https://e61.in/wp-content/uploads/2024/02/Stepped-on-by-Stamp-Duty.pdf">six weeks</a> of total earnings in the 1990s. It has happened because home prices have climbed faster than incomes and because stamp duty has brackets, meaning more buyers have been pushed into higher ones. Replacing the stamp duty revenue that states have come to rely on would not be easy, but a switch would almost certainly help the economy function better. The more that people are able to move, the more they will move to jobs to which they are better suited, boosting productivity. The more that people downsize when they want to, the more housing will be made available for others. Our findings suggest the costs are far from trivial, making a switch away from stamp duty worthwhile, even if it is disruptive and takes time.<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/225773/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/nick-garvin-1453835">Nick Garvin</a>, Adjunct Fellow, Department of Economics, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</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/stamp-duty-is-holding-us-back-from-moving-homes-weve-worked-out-how-much-225773">original article</a>. </div>

Money & Banking

How to fall asleep without sleeping pills: 7 natural sleep aids that actually work

It’s 3am and you’re suddenly wide awake. Try these seven science-backed strategies to fall back to sleep fast. Give meditation a try As a mindfulness coach, I’m very aware of the day-to-day anxieties and worries that can interfere with a good night’s sleep. One of the most effective natural sleep aids is a quick meditation session to ease yourself out of those stresses. If you’ve never meditated before, you’ll likely find the meditation interrupted by thoughts flashing through your mind. It’s important for you to know that this isn’t a failure on your part, and that you aren’t doing anything wrong. Thinking is just what the brain does, as naturally as lungs take in air. The point is to be non-judgmental yet aware of your thoughts, bodily experiences and breath, moment by moment. Sleep better, feel better! <a href="https://gaiam.innovations.com.au/p/gaiam-wellness/rollers-resistance/27-72435-gaiam-strengthen-stretch-kit?affiliate=GAIAM6O" target="_blank" rel="noopener">This Blackout Sleep Mask from Gaiam</a> will help you feel well rested and renewed. Stop wanting to fall asleep It’s counterintuitive, isn’t it? Sometimes trying too hard to do something is the very thing that prevents us from achieving it – and that’s never more true than when it comes to falling asleep. Desperately wanting to sleep will only stoke anxieties that will further stress your brain, essentially feeding it the message that it’s not safe to sleep. Throw in those worries about your to-do list at work the following day, and the whole thing can snowball into a panic attack. Try letting go of that feeling that you absolutely must sleep now, and observe your own anxieties for what they are without judgment. When you stop looking at sleep as a goal, you’ll find it easier to fall asleep. Before you climb into bed, set aside 10-15 minutes to help relax your body and mind, with <a href="https://gaiam.innovations.com.au/p/gaiam-wellness/restore-massage/27-73353-gaiam-wellness-acupressure-neck-back-pillow?affiliate=GAIAM60" target="_blank" rel="noopener">this wellness acupressure neck and back pillow from Gaiam</a>. Start a journal If you find yourself struggling to fall asleep, pick up a pen and paper (not your phone!), and start writing: simply scribble down an account of what’s going on inside your head. Although there’s no “right” way to journal, you might start by listing the events of your day, and from there, how those events and encounters made you feel. Building this structured picture of your thoughts may help you see that the problem that’s keeping you up at night, and is likely less overwhelming than you thought. Why my insistence on a pen and paper? First off, studies show the simple motor action that’s involved in the act of handwriting has a calming effect. Secondly, the light emitted by laptops and phones isn’t conducive to falling asleep. Find yourself a "3am friend" Some of us are lucky to have a ‘3am friend’, that close confidant you can call up in the wee hours knowing that they won’t hold it against you in the morning. Although it’s great to have someone to talk to when you want to fall asleep, it’s important that the conversation doesn’t just rehash the anxieties that are preventing you from catching shut-eye in the first place. Rather than using the call to seek solutions for those issues, talk about things that calm your nerves, or even have them assist you in deep breathing. It may sound silly, but doing a series of deep, relaxing breaths can help you let go of the troubles that are keeping you wide awake. Take a warm shower Taking a warm shower not only relaxes your muscles and soothes minor aches and pains, but it also raises your core body temperature. As soon as you step out of the shower, your body starts working at lowering that temperature, which is something that normally happens when you’re falling asleep naturally. (That’s why we always feel the need for a blanket when we sleep, no matter how warm it is!) By kick-starting that temperature-lowering process, you’re tricking your body into falling asleep fast. Stretch yourself to sleep Anxiety keeping you up? Research suggests mild stretching can help take the edge off and relax muscles that have become stiff and sore after a long day. We’re not talking intricate yoga poses or acrobatics here, either: Simple stretches like an overhead arm stretch and bending over to touch your toes should do the trick. Ramp up the relaxation potential with a soundtrack of ambient noise at a volume that’s just barely audible. There are plenty of white noise apps that are free to download, but soft music can work as well (so long as there are no lyrics). Just remember, if you’re using an electronic device to play these sleep-promoting sounds, make sure it’s placed screen-down so you’re not distracted by the light it emits. Stretching is healing, and this <a href="https://gaiam.innovations.com.au/p/gaiam-wellness/rollers-resistance/27-72435-gaiam-strengthen-stretch-kit?affiliate=GAIAM60" target="_blank" rel="noopener">Strengthen and Stretch Kit from Gaiam</a> is a great way to start. An on-line workout is also included to get you started. Read (or listen!) to something new When you’re struggling with insomnia, it might be tempting to pull an old favourite off the bookshelf. In reality, it’s better to read or listen to an audio book that covers a topic on which you know absolutely nothing. New information, while taking attention away from the stressors that are keeping you up at night, gives your brain enough of a workout to make it tire more quickly than when it’s engaged with familiar subjects and concepts. Again, if it’s an audio book or podcast you’re listening to, make sure the light-emitting side of the device is face down to keep the room as dark as possible. Darkness and warmth play an essential part in the production and maintenance of melatonin, the hormone that plays the central role falling asleep. Image credits: Getty Images This article by Deepak Kashyap originally appeared on <a href="https://www.readersdigest.com.au/healthsmart/conditions/sleep/how-to-fall-asleep-without-sleeping-pills-7-natural-sleep-aids-that-actually-work" target="_blank" rel="noopener">Reader's Digest</a>.

Body

10 million animals die on our roads each year. Here’s what works (and what doesn’t) to cut the toll

<a href="https://theconversation.com/profiles/graeme-coulson-1378778">Graeme Coulson</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> and <a href="https://theconversation.com/profiles/helena-bender-98800">Helena Bender</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> There’s almost no warning. A dark shape appears on the side of the road, then you feel a jolt as something goes under the car. Or worse, the shape rears up, hits the front of your vehicle, then slams into the windscreen. You have just experienced a wildlife-vehicle collision. This gruesome scene plays out <a href="https://www.bbcearth.com/news/australias-road-kill-map">every night across Australia</a>. When these collisions happen, many animals become instant roadkill. An <a href="https://ses.library.usyd.edu.au/bitstream/handle/2123/23121/Thesis%20updated%20for%20library%20submission.pdf?sequence=1">estimated 10 million</a> native mammals, reptiles, birds and other species are killed each year. Others are injured and die away from the road. Some survive with <a href="https://theconversation.com/10-million-animals-are-hit-on-our-roads-each-year-heres-how-you-can-help-them-and-steer-clear-of-them-these-holidays-149733">terrible injuries and have to be euthanised</a>. The lucky ones might <a href="https://kb.rspca.org.au/knowledge-base/who-should-i-contact-about-injured-wildlife/">be rescued</a> by groups such as <a href="https://wildliferescue.net.au/">Wildlife Rescue</a>, <a href="https://www.wildlifevictoria.org.au/">Wildlife Victoria</a> and <a href="https://www.wires.org.au/">WIRES</a>. Wildlife-vehicle collisions also increase the risk to whole populations of some threatened species, such as <a href="https://doi.org/10.1071/WR17143">Lumholtz’s tree-kangaroo</a> on the Atherton Tablelands in Queensland. People are affected, too. Human <a href="https://doi.org/10.1111/1742-6723.13361">deaths and injuries</a> from these collisions are rising, with motorcyclists at greatest risk. Vehicle repairs are <a href="https://www.mynrma.com.au/-/media/wildlife-road-safety-report--final.pdf">inconvenient and costly</a>. Added to this is the distress for people when dealing with a dead or dying animal on the roadside. How can we reduce the wildlife toll on our roads? Many measures have been tried and proven largely ineffective. However, other evidence-based approaches can help avoid collisions. <h2>Evidence for what works is limited</h2> Many communities are worried about the growing impacts of wildlife-vehicle collisions and are desperate for solutions. Recent reports from <a href="https://www.diva-portal.org/smash/get/diva2:1822182/FULLTEXT01.pdf">Europe</a> and <a href="https://westerntransportationinstitute.org/wp-content/uploads/2021/12/4w7576_Huijser_etal_WVC_ConnectivityLiteratureReview_PooledFundStudyFinalReport_2021.pdf">North America</a> review the many methods to reduce such collisions. Do these findings apply to Australia’s unique fauna? Unfortunately, we don’t have a detailed analysis of options for our wildlife, but here’s what we know now. Well-designed fences keep wildlife off our highways but also fragment the landscape. Happily, animals will use crossing structures – overpasses and <a href="https://theconversation.com/good-news-highway-underpasses-for-wildlife-actually-work-187434">underpasses</a> – to get to food and mates on the other side of the road. Fences and crossings do work, but are regarded as too costly over Australia’s vast road network. As for standard wildlife warning signs, drivers <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4494358/">ignore most of them</a> after a while, making them ineffective. Signs with graphic images and variable messages get <a href="https://doi.org/10.3390/ani3041142">more attention</a>, but we need road trials to assess their effect on drivers and collision rates. <h2>Whistling in the dark</h2> Some drivers install cheap, wind-driven, high-pitched wildlife whistles on their vehicles. Tests in the United States 20 years ago found humans and deer <a href="https://doi.org/10.1121/1.1582071">could not hear any whistling sound</a> above the road noise of the test vehicle. Yet these devices are still sold in Australia as kangaroo deterrents. The Shu-Roo, an Australian invention, is an active wildlife whistle. It is fitted to the bumper bar, producing a high-pitched electronic sound, which is claimed to scare wildlife away from the road. Sadly, <a href="https://rest.neptune-prod.its.unimelb.edu.au/server/api/core/bitstreams/3c3154e0-2f48-5b73-a6cd-a7423c2a75ee/content">our tests</a> show the Shu-Roo signal can’t be heard above road noise 50 metres away and has no effect on captive kangaroo behaviour. We also recruited fleets of trucks, buses, vans, utes and cars to field test the Shu-Roo. Nearly 100 vehicles covered more than 4 million kilometres across Australia over 15,500 days. The drivers reported just over one wildlife-vehicle collision per 100,000km travelled, but <a href="https://doi.org/10.7882/AZ.2021.042">there was no difference in the rate</a> for vehicles fitted with a Shu-Roo versus those without one. The virtual fence is the latest attempt to reduce wildlife-vehicle collisions. It uses a line of posts spaced along the roadside, each with a unit producing loud sounds and flashing lights aimed away from the road. Vehicle headlights activate the units, which are claimed to alert animals and reduce the risk of collision. Early results from Tasmania were encouraging. A 50% drop in possum and wallaby deaths was reported, but <a href="https://doi.org/10.1071/AM19009">this trial had many design flaws</a>. Recent trials in <a href="https://www.mdpi.com/2076-2615/9/10/752">Tasmania</a>, <a href="https://www.mdpi.com/2076-2615/12/10/1323">New South Wales</a> and <a href="https://www.redland.qld.gov.au/downloads/download/292/virtual_fence_to_reduce_vehicle_collisions_with_wallabies_on_heinemann_rd_-_final_report_2020">Queensland</a> show no effect of virtual fencing on collisions with possums, wallabies or wombats. Our concern is that this system is being <a href="https://www.abc.net.au/news/2020-06-02/wildlife-fence-trial-underway-in-queensland-and-phillip-island/12268110">rolled out</a> in <a href="https://www.townsville.qld.gov.au/about-council/news-and-publications/media-releases/2023/june/councils-innovative-trial-helping-keep-local-wildlife-safe">many</a> <a href="https://www.abc.net.au/news/2022-10-26/nsw-south-coast-council-first-virtual-fence-to-protect-wildlife/101571600">parts</a> of <a href="https://www.theage.com.au/politics/victoria/the-stealth-tech-aiming-to-stop-roos-from-becoming-roadkill-20231222-p5etda.html">Australia</a>. It gives the impression of action to reduce collisions with wildlife, but without an evidence base, solid study design or adequate monitoring. <h2>A very messy problem</h2> The problem has many dimensions. We need to consider all of them to achieve safe travel for people and animals on our roads. At a landscape level, collision hotspots occur where wildlife frequently cross roads, which can help us predict the collision risk for species such as <a href="https://doi.org/10.1111/aec.13465">koalas</a>. But the risk differs between species. For example, <a href="https://doi.org/10.1016/j.gecco.2021.e01530">on Phillip Island</a> most wallaby collisions happen on rural roads, while most involving possums and birds are in urban streets. Traffic volume and speed are key factors for many species, including <a href="https://doi.org/10.1002/ece3.2306">kangaroos</a>. Driver training and experience are also important. In the Royal National Park in New South Wales, <a href="https://www.mdpi.com/2076-2615/6/6/40">half the drivers surveyed</a> had struck animals, including wallabies and deer. Yet most still <a href="https://theconversation.com/10-million-animals-are-hit-on-our-roads-each-year-heres-how-you-can-help-them-and-steer-clear-of-them-these-holidays-149733">weren’t keen</a> to slow down or avoid driving at dawn and dusk. Road design has a major influence on wildlife-vehicle collions too, but the planning process too often <a href="https://www.frontiersin.org/articles/10.3389/fenvs.2022.959918">neglects wildlife studies</a>. Smarter cars are <a href="https://www.diva-portal.org/smash/get/diva2:1822182/FULLTEXT01.pdf">being developed</a>. One day these will use AI to spot animal hazards, apply automatic emergency braking and alert other drivers of real-time risk. To explore potential technological solutions, Transport for NSW is running a <a href="https://www.eianz.org/events/event/symposium-using-technology-to-reduce-wildlife-vehicle-collisions">symposium</a> at the University of Technology Sydney on May 21. The symposium will cover wildlife ecology and the evidence base for options to reduce wildlife-vehicle collisions in Australia. <hr /> If you see an injured animal on the road, call <a href="https://www.wildliferescue.net.au/">Wildlife Rescue Australia</a> on 1300 596 457. for specific state and territory numbers, go to the <a href="https://kb.rspca.org.au/knowledge-base/who-should-i-contact-about-injured-wildlife/">RSPCA injured wildlife site</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/222367/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/graeme-coulson-1378778">Graeme Coulson</a>, Honorary Principal Fellow, School of BioSciences, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> and <a href="https://theconversation.com/profiles/helena-bender-98800">Helena Bender</a>, Senior Lecturer, Environmental Social Sciences, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</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/10-million-animals-die-on-our-roads-each-year-heres-what-works-and-what-doesnt-to-cut-the-toll-222367">original article</a>.

Domestic Travel

Who will look after us in our final years? A pay rise alone won’t solve aged-care workforce shortages

<a href="https://theconversation.com/profiles/stephen-duckett-10730">Stephen Duckett</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Aged-care workers will receive a significant pay increase after the Fair Work Commission <a href="https://www.fwc.gov.au/documents/decisionssigned/pdf/2024fwcfb150.pdf">ruled</a> they deserved substantial wage rises of up to 28%. The federal government <a href="https://ministers.dewr.gov.au/burke/fair-work-decision-aged-care">has committed to</a> the increases, but is yet to announce when they will start. <blockquote class="twitter-tweet"> Tens of thousands of aged care workers will receive a major pay rise after the Fair Work Commission recommended the increase. <a href="https://t.co/NeNt1Gvxd9">https://t.co/NeNt1Gvxd9</a> — SBS News (@SBSNews) <a href="https://twitter.com/SBSNews/status/1768557710537068889?ref_src=twsrc%5Etfw">March 15, 2024</a></blockquote> But while wage rises for aged-care workers are welcome, this measure alone will not fix all workforce problems in the sector. The number of people over 80 is expected to <a href="https://treasury.gov.au/sites/default/files/2023-08/p2023-435150.pdf">triple over the next 40 years</a>, driving an increase in the number of aged care workers needed. <h2>How did we get here?</h2> The Royal Commission into Aged Care Quality and Safety, which delivered its <a href="https://www.royalcommission.gov.au/aged-care/final-report">final report</a> in March 2021, identified a litany of tragic failures in the regulation and delivery of aged care. The former Liberal government was dragged reluctantly to accept that a total revamp of the aged-care system was needed. But its <a href="https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/respect-care-and-dignity-aged-care-royal-commission-452-million-immediate-response-as-government-commits-to-historic-reform-to-deliver-respect-and-care-for-senior-australians#:%7E:text=Minister%20for%20Senior%20Australians%20and,%2C%20dementia%2C%20food%20and%20nutrition.">weak response</a> left the heavy lifting to the incoming Labor government. The current government’s response started well, with a <a href="https://theconversation.com/anthony-albanese-offers-2-5-billion-plan-to-fix-crisis-in-aged-care-180419">significant injection of funding</a> and a promising regulatory response. But it too has failed to pursue a visionary response to the problems identified by the Royal Commission. Action was needed on four fronts: <ul> <li>ensuring enough staff to provide care</li> <li>building a functioning regulatory system to encourage good care and weed out bad providers</li> <li>designing and introducing a fair payment system to distribute funds to providers and</li> <li>implementing a financing system to pay for it all and achieve intergenerational equity.</li> </ul> A government taskforce which proposed a <a href="https://theconversation.com/what-will-aged-care-look-like-for-the-next-generation-more-of-the-same-but-higher-out-of-pocket-costs-225551">timid response to the fourth challenge</a> – an equitable financing system – was released at the start of last week. Consultation closed on a <a href="https://media.opan.org.au/uploads/2024/03/240308_Aged-Care-Act-Exposure-Draft-Joint-Submission_FINAL.pdf">very poorly designed new regulatory regime</a> the week before. But the big news came at end of the week when the Fair Work Commission handed down a further <a href="https://www.fwc.gov.au/documents/decisionssigned/pdf/2024fwcfb150.pdf">determination</a> on what aged-care workers should be paid, confirming and going beyond a previous <a href="https://www.fwc.gov.au/documents/sites/work-value-aged-care/decisions-statements/2022fwcfb200.pdf">interim determination</a>. <h2>What did the Fair Work Commission find?</h2> Essentially, the commission determined that work in industries with a high proportion of women workers has been traditionally undervalued in wage-setting. This had consequences for both care workers in the aged-care industry (nurses and <a href="https://training.gov.au/Training/Details/CHC33021">Certificate III-qualified</a> personal-care workers) and indirect care workers (cleaners, food services assistants). Aged-care staff will now get significant pay increases – 18–28% increase for personal care workers employed under the Aged Care Award, inclusive of the increase awarded in the interim decision. <figure class="align-center "><figcaption></figcaption>Indirect care workers were awarded a general increase of 3%. Laundry hands, cleaners and food services assistants will receive a further 3.96% <a href="https://www.fwc.gov.au/documents/decision-summaries/2024fwcfb150-summary.pdf">on the grounds</a> they “interact with residents significantly more regularly than other indirect care employees”.</figure> The final increases for registered and enrolled nurses will be determined in the next few months. <h2>How has the sector responded?</h2> There has been no push-back from employer groups or conservative politicians. This suggests the uplift is accepted as fair by all concerned. The interim increases of up to 15% probably facilitated this acceptance, with the <a href="https://theconversation.com/what-does-the-budget-mean-for-medicare-medicines-aged-care-and-first-nations-health-192842">recognition of the community</a> that care workers should be paid more than fast food workers. There was <a href="https://www.accpa.asn.au/media-releases/accpa-welcomes-further-aged-care-wage-rises">no criticism from aged-care providers</a> either. This is probably because they are facing difficulty in recruiting staff at current wage rates. And because government payments to providers reflect the <a href="https://www.ihacpa.gov.au/">actual cost of aged care</a>, increased payments will automatically flow to providers. When the increases will flow has yet to be determined. The government is due to give its recommendations for staging implementation by mid-April. <h2>Is the workforce problem fixed?</h2> An increase in wages is necessary, but alone is not sufficient to solve workforce shortages. The health- and social-care workforce is <a href="https://www.jobsandskills.gov.au/data/employment-projections">predicted</a> to grow faster than any other sector over the next decade. The “care economy” will <a href="https://theconversation.com/care-economy-to-balloon-in-an-australia-of-40-5-million-intergenerational-report-211876">grow</a> from around 8% to around 15% of GDP over the next 40 years. This means a greater proportion of school-leavers will need to be attracted to the aged-care sector. Aged care will also need to attract and retrain workers displaced from industries in decline and attract suitably skilled migrants and refugees with appropriate language skills. The <a href="https://theconversation.com/demand-driven-funding-for-universities-is-frozen-what-does-this-mean-and-should-the-policy-be-restored-116060">caps on university and college enrolments</a> imposed by the previous government, coupled with weak student demand for places in key professions (such as nursing), has meant workforce shortages will continue for a few more years, despite the allure of increased wages. A significant increase in intakes into university and vocational education college courses preparing students for health and social care is still required. Better pay will help to increase student demand, but funding to expand place numbers will ensure there are enough qualified staff for the aged-care system of the future. <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/225898/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/stephen-duckett-10730">Stephen Duckett</a>, Honorary Enterprise Professor, School of Population and Global Health, and Department of General Practice and Primary Care, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> 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/who-will-look-after-us-in-our-final-years-a-pay-rise-alone-wont-solve-aged-care-workforce-shortages-225898">original article</a>. Image: Getty

Retirement Income

"Cruel twist" in death of policeman at engagement party

The joyous occasion of an engagement party, brimming with excitement and anticipation, turned into a scene of profound sorrow and disbelief for Lilly Watts and her loved ones when, in a devastating turn of events, her fiancé – Senior Constable Liam Trimmer – <a href="https://www.oversixty.com.au/finance/legal/young-wa-cop-dies-at-his-own-engagement-party" target="_blank" rel="noopener">met with a fatal accident</a>, leaving behind shattered dreams and a future that will forever remain incomplete. It has now been revealed that Liam, a dedicated member of the Western Australia Police Force, wasn't just set to embark on a new chapter of his life with Lilly. Their intention, as they celebrated their impending union, was also to announce the impending arrival of their first child. In the wake of this heartbreaking incident, in a gesture of solidarity and support, friends, family and even strangers have rallied around Lilly in her time of need. <a href="https://www.gofundme.com/f/lets-support-lilly-watts-and-baby-trimmer" target="_blank" rel="noopener">A GoFundMe campaign</a> was launched to provide some solace amidst the darkness that has enveloped her life. The outpouring of generosity has been overwhelming, with more than $52,000 raised in just six hours since the campaign's inception. Melinda Kelly, an old friend of Lilly's, wrote: "Tragically, on Saturday night, Lilly’s world was shattered by a freak accident that claimed the life of her beloved fiancé, Senior Constable Liam Trimmer. "The evening was meant to be a joyous celebration of Lilly and Liam’s recent engagement and announcing their pregnancy, a huge milestone in their journey together. Friends and family gathered to share in their happiness. In a cruel twist of events, Liam’s life was cut short leaving behind a void that can never be filled. "Lilly, a dedicated Clinical Registered Nurse at Royal Perth Hospital, now finds herself navigating uncharted waters. Not only has she lost her soulmate, but she also carries the precious gift of new life within her. At almost 14 weeks pregnant, Lilly now faces the prospect of raising a child without her beloved partner, while also grappling with the financial responsibilities that come with homeownership. "This GoFundMe campaign seeks to provide some solace amidst the darkness that has enveloped Lilly’s life. While no amount of money can bring back Liam or erase the pain of his loss, we hope to ease the burden that now weighs heavily on Lilly’s shoulders. The funds raised will enable her to access the support she needs, from counselling to covering the costs of daily living and preparing for the arrival of her baby. "Lilly’s resilience and unwavering spirit have always been her defining qualities, and now, more than ever, she needs our love and support. Let us come together as a community to rally around her in this time of need, offering whatever assistance we can to help her navigate the challenging road ahead. Together, we can help light the path forward for Lilly and honor the memory of the man she loved so dearly." Liam Trimmer's contributions to the police force have not gone unnoticed. Described as "skilful" and possessing a "great sense of humour" and "passion to excel" by his colleagues, Liam was a respected member of the force who approached his duties with dedication and courage. His loss has been deeply felt within the police community, where he was admired for his unwavering commitment to serving and protecting the public. As tributes pour in from across the region, it is evident that Liam's legacy will endure through the lives he touched and the memories he leaves behind. Images: Facebook \ GoFundMe

Caring

Young WA cop dies at his own engagement party

A Western Australian police officer has tragically passed away following a freak accident at his own engagement party. Senior Constable Liam Trimmer, 29, and his fiancee had gathered with family and friends to celebrate their upcoming marriage, when Trimmer fell and cut a carotid artery in his neck, leading him to bleed out. While they did everything they could to save him and provide first aid, Trimmer tragically passed away before paramedics arrived. "Everything was done to try and save him but it wasn't to be and I know everyone that was involved are really, really hurting. I think they wish they could just wake up from this nightmare," Commissioner Col Blanch told 9News. "This extraordinary officer loved helping the community and was a fine example of WA policing and it's just such a tragedy. "(He was) a very, very confident, capable young man with his whole life ahead of him, and that's how sad this is." The senior constable moved to Australia from the UK in 2013 and graduated from Joondalup Police Academy that same year. He then moved to Kalgoorlie in 2017 where he joined the Gang Crime Squad and the tactical response group. The police union have also paid tribute to the senior constable. "Every time a death occurs for a police officer, it doesn't matter how it really does rock the core of the Blue family," WA Police Union President Paul Gale said. The welfare and safety division will provide support to those impacted by this tragedy and police will prepare a report for the coroner. Images: 9News

Legal

Morbid reason why cruise ships throw "free ice cream parties" on board

Dara Starr Tucker, a former cruise ship employee has shared the morbid reason why they throw “free ice cream parties” on board. Tucker, a singer who spent six months living on a cruise ship in the Mediterranean and the Caribbean 10 years ago, shared what life was like at sea. In one of her latest videos, she answered one of her follower's question asking whether it was true that if cruise staff started giving away ice cream, it meant that they needed more freezer space for a body. “This is unfortunately often true,” she said. “If the crew suddenly makes a bunch of ice cream available to passengers, ‘Free ice cream party’, it is often because more people have died on the ship than they have room for in the morgue.” She said that most large ships are legally required to maintain a morgue and carry body bags in the event a passenger dies mid-journey and added that she “thankfully” didn't have to deal with the "morbid stuff". “But we were friends with some crew members who did deal with it and they said maybe four to 10 people die every cruise,” she claimed. “There are a lot of older people on ships, and often (out of) a ship that carried maybe 2500 to 3000 passengers on a typical cruise, four to 10 people would die. “So the morgue, I believe they said held about seven people, and if more than seven people died on that particular ship, they would have to start moving bodies to the freezer.” She claimed that if employees would have to "make room for the extra bodies" in the freezer, they would have to take out everything including ice cream. Her video has been viewed over 2.3 million times, with many other cruise ship employees confirming her claims. “Cruise ship medic here. Can confirm the morgue and ice cream correlation,” one said. “Former sailor here — yes, it is accurate. Sometimes space needs to be made in the freezer," another added. Image: TikTok

Travel Trouble

Inside Jackie O's lavish birthday party

Jackie O Henderson has celebrated her 49th birthday in style with a lavish boat party. The KIIS FM radio host shared the details of her big birthday bash on the Kyle and Jackie O show on Monday morning. Henderson revealed that she had a tarot reader on board who gave readings to her friends, a variety of drinks and all-around good vibes. The party didn't stop there as the group of friends made their way through a series of bars, before heading to a friend's house for an after party. "I had fun," Henderson told co-host Kyle Sandilands and Brooklyn Ross, who also attended the party. "We went to Opera Bar and then Shellhouse... and then a private residence," she said. "We survived Jackie's boat party!" Sandilands quipped. "Your friends are surprisingly good people," he added. "You know, so many people came up to me and were like, you've got great friends, like they were surprised!" Henderson added. Pip Edwards, Kyle Sandilands, John Ibrahim and Cheyenne Tozzi were some of the local stars who attended her birthday party. "I love my friends 😌 best b’day 💛💛" Henderson captioned the series of photos. Henderson flaunted her slim figure in two separate outfits, the first being a casual two-piece set, and the second outfit a colourful one-shoulder dress. Henderson's friend, Edwards who is the co-founder of sportswear label P.E Nation, also shared a few photos from their big day out. "Happiest of birthdays to my dream girl and dream friend. You are soooooo loved," she captioned the photos. "Most perfect day with exceptional friends for the most perfect woman I know ❤️❤️❤️❤️ What a birthday celebration 🎉 🎉🎉🎉🎉 Thank you for the best day!!!" Images: Instagram

Family & Pets

Boss slammed for demanding an employee complete work during annual leave

A boss has been dubbed an “abysmal manager” for demanding his employee join a video call for work, despite being on annual leave. Businessman Ben Askins, who has dedicated his TikTok account to calling out unacceptable workplace behaviour, read out the text exchange between the man and his boss, who quickly became unreasonable in his demands. The first message came from the man’s boss, who asked “Where are you? Haven’t seen you at your desk today? I need to run something by you.” The employee responded, reminding his boss that he was off on pre-approved annual leave, and was enjoying a holiday abroad in Spain. Despite his holiday, the employee still offered to help, saying he could “probably jump on a quick call when I am on the bus from the airport if it is really urgent.” <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-permalink="https://www.instagram.com/reel/C2QFCsgtSoS/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/reel/C2QFCsgtSoS/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Ben Askins (@benaskins.official)</a> </div> </blockquote> Unhappy with the compromise, the demanding boss then asked if the employee would “jump on a Zoom call when you get to the hotel” as he would “prefer to do this in person”. “Sorry, not really possible, we have a really packed schedule,” the worker replied to his boss, to which the manager hit back with, “Damn, wish you had told me that you were on annual leave.” The man reminded his boss he had signed off his leave two months prior and it was “in the system” but he came back saying, “Lol as if I would remember that. It is poor form for you to not remind me.” As Ben continued to read the text exchange, he added his own commentary on the situation, saying, “It's your job to remember that, it's not his fault you're just being unbelievably shocking at yours.” “This is so bad, this poor employee has done everything right; he's got it signed off two months in advance, he's done all the handover, he's done everything he could have done,' Ben ranted. “Because the manager is shocking, it's now impacting the employee's holiday. I just hate it when that happens.” Ben, a self-described “champion of younger gens in the workplace” said the heated chat showed the boss's “really poor” form and “abysmal management”. “What are you doing being so unorganised? Because the problem when an unorganised manager happens it hits down to the team below him - what the hell he's playing at? I have no idea,” he said. Ben's clip was viewed more than 2.3million and had users fired up, with thousands of comments flooding in in support of the burnt out employee trying to enjoy his holiday. Image credits: Instagram

Legal

What is micellar water and how does it work?

<a href="https://theconversation.com/profiles/daniel-eldridge-1494633">Daniel Eldridge</a>, <a href="https://theconversation.com/institutions/swinburne-university-of-technology-767">Swinburne University of Technology</a> Micellar water, a product found in supermarkets, chemists and bathroom cabinets around the world, is commonly used to remove make-up. It’s a very effective cleanser and many people swear by it as part of their skincare routine. So, what is micellar water and why is it so good at getting makeup and sunscreen off? Here’s the science. <h2>What are micelles?</h2> Oil and water generally don’t mix, which is why you’ll struggle to remove makeup and sunscreen (which both contain oils) with just plain water. But micellar water products contain something called micelles – clusters of molecules that are very effective at removing oily substances. To understand why, you need to first know two chemistry terms: hydrophilic and hydrophobic. A hydrophilic substance “loves” water and mixes easily with it. Salt and sugar are examples. A hydrophobic substance “hates” water and generally refuses to mix with it. Examples include oil and wax. Hydrophilic materials will happily mix with other hydrophilic materials. The same goes for hydrophobic substances. But if you try to combine hydrophilic and hydrophobic materials, they won’t mix. <h2>How are micelles formed? It’s all about surfactants</h2> The micelles in micellar water are formed by special molecules known as surfactants. Surfactant stands for surface active agent. These molecules looked at their hydrophilic and hydrophobic brethren and said, why not both? They are typically comprised of two ends: a head group that is hydrophilic and a tail that is hydrophobic. When a small amount of surfactant is added to water, the two ends of the molecule have competing interests. The hydrophilic head wants to be in the water, but the hydrophobic tail can’t stand water. Add enough surfactant and, eventually, we will pass a critical micelle concentration and the surfactants will self-assemble into clusters of approximately 20 to 100 surfactant molecules. All the hydrophilic heads will be pointing outwards, while the hydrophobic tails remain “hidden” at the centre. These clusters are micelles. These micelles have a hydrophilic exterior, meaning that they are very happy to remain mixed throughout water. However, in the centre remains a hydrophobic pocket that’s very good at attracting oils. This is very handy, and helps explain why adding some detergent (a surfactant) to water will allow you to wash an oily saucepan. The surfactant first helps lift of the oil, and then the oil can remained mixed into the water, finding a new home in the hydrophobic centre of the micelle. <figure><iframe src="https://www.youtube.com/embed/fnRBCn8fm2o?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <h2>Micellar water in action</h2> Surfactants are in your dishwashing detergent, your body wash, your shampoo, your toothpaste and even many foods. In all of these cases, they are there to help the water interact with the dirt and oils, and micellar water is no different. When you apply some micellar water to a cotton pad, another convenient interaction occurs. The wet cotton is hydrophilic (loves water). Consequently, some of the micelles will unravel, with the hydrophilic heads being attracted to the wet cotton pad. Now, sticking out from the surface will be a layer of hydrophobic tail groups. These hydrophobic tails cannot wait to attract themselves to makeup, sunscreen, oils, dirt, grease and other contaminants on your face. As you sweep the cotton pad across your skin, these contaminants bind to the hydrophobic tails and are removed from the skin. Some contaminants will also find themselves encapsulated in the hydrophobic centres of the micelle. Either way, a cleaner surface is left behind. Look at how a cotton wipe soaked in micellar water cleans up a small oil spill, in comparison to water alone. <figure><iframe src="https://www.youtube.com/embed/5Nge5FEiuYE?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <h2>So why shouldn’t I just use dishwashing detergent to wash my face?</h2> Technically, that would work as detergent does indeed contain lots of micelle-forming surfactants. But these particular surfactants would probably cause a lot of skin and eye irritation, while also damaging and drying out your skin. Not nice. The surfactants in micellar water are chosen to be mild and well tolerated by most people’s skin. But micellar water isn’t the only skincare product to contain micelles. There are many other face-cleaning products that also make great use of surfactant molecules and work very well too. Now, it’s not perfect. While it is effective at removing a wide range of contaminants, thick or heavy makeup might not come off easily with micellar water (you might need to do a more vigorous clean). Some products say there is “zero residue”, although the fine print clearly states this refers to visible residue. Many products also state there is no rinse off required. Surfactants will remain on your skin after product use, but for many people they don’t cause irritation. If your skin is feeling irritated after using a micellar water product, you can try rinsing afterwards or discontinuing use. And as is the case with many cosmetic products, you should test it first on a small patch of skin before using it all over your face.<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/219492/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/daniel-eldridge-1494633">Daniel Eldridge</a>, Senior Lecturer in Chemistry, <a href="https://theconversation.com/institutions/swinburne-university-of-technology-767">Swinburne University of Technology</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/what-is-micellar-water-and-how-does-it-work-219492">original article</a>.

Beauty & Style

What are the new COVID booster vaccines? Can I get one? Do they work? Are they safe?

<a href="https://theconversation.com/profiles/paul-griffin-1129798">Paul Griffin</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> As the COVID virus continues to <a href="https://pubmed.ncbi.nlm.nih.gov/36680207/">evolve</a>, so does our vaccine response. From <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/new-covid-19-vaccines-available-to-target-current-variants?language=en">December 11</a>, Australians will have access to <a href="https://www.health.gov.au/news/atagi-recommendations-on-use-of-the-moderna-and-pfizer-monovalent-omicron-xbb15-covid-19-vaccines?language=en">new vaccines</a> that offer better protection. These “monovalent” booster vaccines are expected to be a <a href="https://theconversation.com/cdc-greenlights-two-updated-covid-19-vaccines-but-how-will-they-fare-against-the-latest-variants-5-questions-answered-213341">better match</a> for currently circulating strains of SARS-CoV-2, the virus that causes COVID. Pfizer’s monovalent vaccine will be <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/new-covid-19-vaccines-available-to-target-current-variants?language=en">available</a> to eligible people aged five years and older. The Moderna monovalent vaccine can be used for those aged 12 years and older. Who is eligible for these new boosters? How do they differ from earlier ones? Do they work? Are they safe? <h2>Who’s eligible for the new boosters?</h2> The federal government has accepted the Australian Technical Advisory Group (ATAGI) recommendation to use the new vaccines, after Australia’s regulator <a href="https://www.tga.gov.au/products/covid-19/covid-19-vaccines/covid-19-vaccines-regulatory-status">approved their use last month</a>. However, vaccine eligibility has remained the same since September. ATAGI <a href="https://www.health.gov.au/news/atagi-recommendations-on-use-of-the-moderna-and-pfizer-monovalent-omicron-xbb15-covid-19-vaccines?language=en">recommends</a> Australians aged over 75 get vaccinated if it has been six months or more since their last dose. People aged 65 to 74 are recommended to have a 2023 booster if they haven’t already had one. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=315&fit=crop&dpr=1 600w, https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=315&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=315&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=396&fit=crop&dpr=1 754w, https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=396&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=396&fit=crop&dpr=3 2262w" alt="" /></a><figcaption>For people without risk factors. <a class="source" href="https://www.health.gov.au/sites/default/files/2023-10/atagi-recommended-covid-19-vaccine-doses.pdf">Health.gov.au</a></figcaption></figure> Adults aged 18 to 64 with underlying risk factors that increase their risk of severe COVID are also recommended to have a 2023 booster if they haven’t had one yet. And if they’ve already had a 2023 booster, they can consider an additional dose. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=311&fit=crop&dpr=1 600w, https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=311&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=311&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=391&fit=crop&dpr=1 754w, https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=391&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=391&fit=crop&dpr=3 2262w" alt="" /></a><figcaption>Advice for people with risk factors. <a class="source" href="https://www.health.gov.au/sites/default/files/2023-10/atagi-recommended-covid-19-vaccine-doses.pdf">Health.gov.au</a></figcaption></figure> For adults aged 18 to 64 without underlying risk factors who have already received a 2023 booster, an additional dose isn’t recommended. But if you’re aged 18 to 64 and haven’t had a booster in 2023, you can consider an additional dose. Additional doses aren’t recommended for children without underlying conditions that increase their risk of severe COVID. A primary course is not recommended for children aged six months to five years without additional risk factors. <h2>Monovalent, bivalent? What’s the difference?</h2> From monovalent The initial COVID vaccines were “monovalent”. They had one target – the original viral strain. But as the virus mutated, we assigned new letters of the Greek alphabet to each variant. This brings us to Omicron. With this significant change, we saw “immune evasion”. The virus had changed so much the original vaccines didn’t provide sufficient immunity. To bivalent So vaccines were updated to target an early Omicron subvariant, BA.1, plus the original ancestral strain. With two targets, these were the first of the “bivalent” vaccines, which were approved in Australia <a href="https://theconversation.com/omicron-specific-vaccines-may-give-slightly-better-covid-protection-but-getting-boosted-promptly-is-the-best-bet-190736">in 2022</a>. Omicron continued to evolve, leading to more “immune escape”, contributing to repeated waves of transmission. The vaccines were updated again in <a href="https://theconversation.com/havent-had-covid-or-a-vaccine-dose-in-the-past-six-months-consider-getting-a-booster-199096">early 2023</a>. These newer bivalent vaccines target two strains – the ancestral strain plus the subvariants BA.4 and BA.5. Back to monovalent Further changes in the virus have meant our boosters needed to be updated again. This takes us to the recent announcement. This time the booster targets another subvariant of Omicron known as XBB.1.5 (sometimes known as <a href="https://theconversation.com/the-kraken-subvariant-xbb-1-5-sounds-scary-but-behind-the-headlines-are-clues-to-where-covids-heading-198158">Kraken</a>). This vaccine is monovalent once more, meaning it has only one target. The target against the original viral strain has been removed. According to advice given to the World Health Organization <a href="https://www.who.int/news/item/18-05-2023-statement-on-the-antigen-composition-of-covid-19-vaccines">in May</a>, this is largely because immunity to this original strain is no longer required (it’s no longer infecting humans). Raising immunity to the original strain may also hamper the immune response to the newer component, but we’re not sure if this is occurring or how important this is. The United States <a href="https://theconversation.com/cdc-greenlights-two-updated-covid-19-vaccines-but-how-will-they-fare-against-the-latest-variants-5-questions-answered-213341">approved</a> XBB.1.5-specific vaccines from Pfizer and Moderna in <a href="https://www.fda.gov/news-events/press-announcements/fda-takes-action-updated-mrna-covid-19-vaccines-better-protect-against-currently-circulating">mid-September</a>. These updated vaccines have also been <a href="https://www.tga.gov.au/sites/default/files/2023-10/auspar-spikevax-xbb.1.5-231012.pdf">approved in</a> places including Europe, Canada, Japan and Singapore. In Australia, the Therapeutic Goods Administration (TGA) approved them <a href="https://www.tga.gov.au/products/covid-19/covid-19-vaccines/covid-19-vaccines-regulatory-status">in October</a>. <h2>Do these newer vaccines work?</h2> Evidence for the efficacy of these new monovalent vaccines comes from the results of research <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent=&id=CP-2023-PI-02409-1&d=20231117172310101">Pfizer</a> and <a href="https://www.tga.gov.au/resources/auspar/auspar-spikevax-xbb15">Moderna</a> submitted to the TGA. Evidence also comes from a <a href="https://www.medrxiv.org/content/10.1101/2023.08.22.23293434v2">preprint</a> (preliminary research available online that has yet to be independently reviewed) and an update Pfizer <a href="https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2023-09-12/10-COVID-Modjarrad-508.pdf">presented</a> to the US Centers for Disease Control. Taken together, the available evidence shows the updated vaccines produce good levels of antibodies in <a href="https://www.tga.gov.au/resources/auspar/auspar-spikevax-xbb15">laboratory studies</a>, <a href="https://www.medrxiv.org/content/10.1101/2023.08.22.23293434v2">in humans</a> and <a href="https://www.tga.gov.au/resources/auspar/auspar-spikevax-xbb15">mice</a> when compared to previous vaccines and when looking at multiple emerging variants, including EG.5 (sometimes known as <a href="https://theconversation.com/the-who-has-declared-eris-a-variant-of-interest-how-is-it-different-from-other-omicron-variants-211276">Eris</a>). This variant is the one causing high numbers of cases around the world currently, including in Australia. It is very similar to the XBB version contained in the updated booster. The updated vaccines should also cover <a href="https://theconversation.com/how-evasive-and-transmissible-is-the-newest-omicron-offshoot-ba-2-86-that-causes-covid-19-4-questions-answered-212453">BA.2.86 or Pirola</a>, according to <a href="https://www.tga.gov.au/sites/default/files/2023-10/auspar-spikevax-xbb.1.5-231012.pdf">early results</a> from clinical trials and the US <a href="https://www.cdc.gov/respiratory-viruses/whats-new/covid-19-variant.html">Centers for Disease Control</a>. This variant is responsible for a rapidly increasing proportion of cases, with case numbers growing <a href="https://twitter.com/BigBadDenis/status/1725310295596560662?s=19">in Australia</a>. It’s clear the virus is going to continue to evolve. So performance of these vaccines against new variants will continue to be closely monitored. <h2>Are they safe?</h2> The <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent=&id=CP-2023-PI-02409-1&d=20231117172310101">safety</a> of the updated vaccines has also been shown to be similar to previous versions. Studies <a href="https://www.medrxiv.org/content/10.1101/2023.08.22.23293434v2">comparing them</a> found no significant difference in terms of the adverse events reported. Given the availability of the updated vaccines, some countries have removed their approval for earlier versions. This is because newer versions are a closer match to currently circulating strains, rather than any safety issue with the older vaccines. <h2>What happens next?</h2> The availability of updated vaccines is a welcome development, however this is not the end of the story. We need to make sure eligible people get vaccinated. We also need to acknowledge that vaccination should form part of a comprehensive strategy to limit the impact of COVID from now on. That includes measures such as mask wearing, social distancing, focusing on ventilation and air quality, and to a lesser degree hand hygiene. Rapidly accessing antivirals if eligible is also still important, as is keeping away from others if you are infected.<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/217804/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/paul-griffin-1129798">Paul Griffin</a>, Professor, Infectious Diseases and Microbiology, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</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/what-are-the-new-covid-booster-vaccines-can-i-get-one-do-they-work-are-they-safe-217804">original article</a>.

Body

How do stimulants actually work to reduce ADHD symptoms?

<a href="https://theconversation.com/profiles/mary-bushell-919262">Mary Bushell</a>, <a href="https://theconversation.com/institutions/university-of-canberra-865">University of Canberra</a> Stimulants are <a href="https://adhdguideline.aadpa.com.au/">first-line drugs</a> for children and adults diagnosed with attention-deficit hyperactivity disorder (ADHD). But how do they actually work? <h2>First, let’s look at the brain</h2> ADHD is a neurodevelopmental condition, which means it affects how the brain functions. Medical imaging indicates people with ADHD may have slight differences in their brain’s <a href="https://jamanetwork.com/journals/jama/article-abstract/195386">structure</a>, the way their brain regions work together to perform tasks, and how their brain’s chemical messengers, called neurotransmitters, pass on information. These brain differences are associated with the symptoms of ADHD, including inattention, impulse control and problems with memory. <h2>What stimulants are prescribed in Australia?</h2> The three main stimulants prescribed for ADHD in Australia are dexamfetamine, methylphenidate (sold under the brand names Ritalin and Concerta) and lisdexamfetamine (sold as Vyvanse). Dexamfetamine and methylphenidate have been around <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3666194/">since</a> the 1930s and 1940s respectively. Lisdexamfetamine is a newer stimulant that has been around <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2873712/">since</a> the late 2000s. Dexamfetamine and lisdexamfetamine are amphetamines. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2873712/">Lisdexamfetamine</a> is inactive when it’s taken and actually changes into active dexamfetamine in the red blood cells. This is what’s known as a “prodrug”. <h2>So how do they work for ADHD?</h2> Stimulant drugs are thought to alter the activity of key neuotransmitters, dopamine and noradrenaline, in the brain. These neurotransmitters help with attention and focus, among other things. Stimulants increase the amount of dopamine and noradrenaline in the tiny gaps between neurons, known as synapses. They do this by predominantly blocking a transporter that then prevents their re-uptake back into the neuron that released them. This means more dopamine and noradrenaline can bind to their respective receptors. This <a href="https://www.tga.gov.au/sites/default/files/auspar-lisdexamfetamine-dimesilate-180515-pi.pdf">helps</a> connected neurons in the brain talk to one another. Amphetamines also increase the amount of dopamine the neuron releases into the synapse (the tiny gaps between neurons). And it stops the enzymes that break down dopamine. This results in an increase of dopamine in the synapse. <h2>What effect do they have on ADHD symptoms?</h2> We still don’t fully understand the underlying brain mechanisms that change behaviour in people with ADHD. But <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6109107/">research shows</a> stimulants that modulate noradrenaline and dopamine can improve brain processes such as: <ul> <li>attention</li> <li>memory</li> <li>decision-making</li> <li>task completion</li> <li>hyperactivity.</li> </ul> They can also improve general behaviour, such as self-control, not talking over the top of others, and concentration. These behaviours are important for social interactions. Stimulants <a href="https://pubmed.ncbi.nlm.nih.gov/15737659/">reduce ADHD symptoms</a> in about 70% to 80% of children and adults who take them. Some people will notice their symptoms improve right away. Other times, these improvements will be more noticeable to parents, carers, teachers, colleagues and partners. <h2>Not everyone gets the same dose</h2> The optimal stimulant dose varies between individuals, with multiple dosage options available. This enables a “start low, go slow” approach, where the stimulant can be gradually increased to the most effective dose for the individual. There are also different delivery options. Dexamfetamine and methylphenidate are available in immediate-release preparations. As these have short half-lives (meaning they act quickly and wear off rapidly), they are often taken multiple times a day – usually in the morning, lunch and afternoon. Methylphenidate is also <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-03175-3&d=20231023172310101">available</a> in long-acting tablets (Concerta) and capsules (Ritalin LA). They are released into the body over the day. Lisdexamfetamine is a long-acting drug and is not available in a short-acting formulation. The long-acting stimulants are generally taken once in the morning. This avoids the need to take tablets during school or work hours (and the need to store a “controlled drug”, which has the potential for abuse, outside the home). <h2>What are the side effects?</h2> The most common side effects are sleep problems and decreased appetite. A <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012069.pub2/full">recent study</a> showed children and young people taking methylphenidate for ADHD were around 2.6 times more likely to have sleep problems and 15 times more likely to have a decreased appetite than those not taking methylphenidate. Headache and abdominal pain are also relatively common. <h2>Can someone without ADHD take a stimulant to improve productivity?</h2> Stimulants are tightly controlled because of their potential for abuse. In Australia, only paediatricians, psychiatrists or neurologists (and GPs in special circumstances) can prescribe them. This follows a long assessment process. As stimulants increase dopamine, they can cause euphoria and a heightened sense of wellbeing. They can also cause <a href="https://www.ncbi.nlm.nih.gov/books/NBK576548/#:%7E:text=The%20immediate%20psychological%20effects%20of,and%20may%20result%20in%20insomnia.">weight loss</a>. A common myth about stimulant medicines is they can improve the concentration and productivity of people without ADHD. A <a href="https://www.science.org/doi/full/10.1126/sciadv.add4165">recent study shows</a> the opposite is true. This study gave a group of 40 people online arithmetic tasks to complete across four sessions. At each of the sessions, participants were given either a placebo or a stimulant before completing the task. The results showed that while stimulants did not impact getting the correct answer, it increased the number of moves and time to solve the problems compared to a placebo. This indicates a reduction in productivity. However, the myth that stimulants improve study prevails. It’s likely that users feel different – after all, they are taking a medicine that speeds up messages between the brain and body. It may make them “feel” more alert and productive, even if they’re not.<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/215801/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/mary-bushell-919262">Mary Bushell</a>, Clinical Assistant Professor in Pharmacy, <a href="https://theconversation.com/institutions/university-of-canberra-865">University of Canberra</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/how-do-stimulants-actually-work-to-reduce-adhd-symptoms-215801">original article</a>.

Mind

"You've restored my faith": Community shows up for lonely birthday boy

One dad's desperate plea has "restored" his faith after his local community showed up for his son's third birthday party. Pre-schooler William Buck and his dad Steven sat patiently on a beach in Wellington, waiting for his friends to arrive and begin the celebrations for his third birthday party. As time passed, William and his dad grew more hopeless, and they worried about the fate of the celebrations. "He kept asking where everyone was, and we were like 'they’re coming soon'," Steven Buck told <a href="https://www.stuff.co.nz/life-style/wellbeing/parenting/133203054/familys-plea-after-nobody-shows-at-3yearolds-birthday-brings-community-to-beach" target="_blank" rel="nofollow noopener" data-i13n="cpos:2;pos:1" data-ylk="slk:Stuff;cpos:2;pos:1;elm:context_link;itc:0" data-rapid_p="9" data-v9y="1">Stuff</a>. Steven felt "guilty" that none of his son's mates had come to the party, especially given how excited his son had been for this birthday, as he had been talking about the celebration for weeks. In a last ditch effort to make William's day special, Steven turned to social media for help. Steven posted an image of the pair online and invited any locals wanting "some sun and sand" to join them. "William would love some friends to play with. He has Hot Wheels, sand toys, dinos, and we have some snacks and drinks. Any and all welcome," he wrote. Amazingly, locals responded in their thousands, wishing William a 'Happy Birthday' while many others joined the three-year-old and his parents. "Going there. See you soon," one local wrote, before arriving with her family. The partygoers arrived with bubbles and inflatables, parking themselves down on beach chairs ready to celebrate the sunny day with William. "Thank you so much everyone for the birthday wishes and support," Steven wrote online after the day. "Wellington you always restore my faith in humanity!" Image credits: Facebook

Family & Pets

How can I get some sleep? Which treatments actually work?

<a href="https://theconversation.com/profiles/alexander-sweetman-1331085">Alexander Sweetman</a>, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a>; <a href="https://theconversation.com/profiles/jen-walsh-1468594">Jen Walsh</a>, <a href="https://theconversation.com/institutions/the-university-of-western-australia-1067">The University of Western Australia</a>, and <a href="https://theconversation.com/profiles/nicole-grivell-1468590">Nicole Grivell</a>, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a> Do you have difficulty falling asleep? Do you stay awake for a long time at night? Do these sleep problems make you feel fatigued, strung-out, or exhausted during the day? Has this been happening for months? If so, you’re not alone. About <a href="https://www.sleephealthfoundation.org.au/special-sleep-reports/chronic-insomnia-disorder-in-australia">12-15%</a> of Australian adults have chronic insomnia. You might have tried breathing exercises, calming music, white noise, going to bed in a dark and quiet bedroom, eating different foods in the evening, maintaining a regular sleep pattern, or reducing caffeine. But after three to four weeks of what seems like progress, your insomnia returns. What next? <h2>What not to do</h2> These probably won’t help: <ul> <li> spending more time in bed often results in more time spent awake in bed, which can make <a href="https://theconversation.com/how-do-i-stop-my-mind-racing-and-get-some-sleep-207904">insomnia patterns worse</a> </li> <li> drinking coffee and taking naps might help get you through the day. But <a href="https://theconversation.com/nope-coffee-wont-give-you-extra-energy-itll-just-borrow-a-bit-that-youll-pay-for-later-197897">caffeine</a> stays in the system for many hours, and can disrupt our sleep if you drink too much of it, especially after about 2pm. If naps last for more than 30 minutes, or occur after about 4pm, this can reduce your “sleep debt”, and can make it <a href="https://theconversation.com/why-do-i-fall-asleep-on-the-sofa-but-am-wide-awake-when-i-get-to-bed-208371">more difficult</a> to fall asleep in the evening </li> <li> drinking alcohol might help you fall asleep quicker, but <a href="https://journals.sagepub.com/doi/10.1300/J465v26n01_01">can cause</a> more frequent awakenings, change how long you sleep, change the time spent in different “stages” of sleep, and reduce the overall quality of sleep. Therefore, it is not recommended as a sleep aid. </li> </ul> <h2>What to do next?</h2> If your symptoms have lasted more than one or two months, it is likely your insomnia requires targeted treatments that focus on sleep patterns and behaviours. So, the next stage is a type of non-drug therapy known as cognitive behavioural therapy for insomnia (or <a href="https://www.sleepprimarycareresources.org.au/insomnia/cbti">CBTi</a> for short). This is a four to eight week treatment that’s been shown to be <a href="https://doi.org/10.1016/j.smrv.2022.101687">more effective</a> than sleeping pills. It involves education about sleep, and offers psychological and behavioural treatments that address the underlying causes of long-term insomnia. You can do this one-on-one, in a small group with health professionals trained in CBTi, or via self-guided <a href="https://www.sleepprimarycareresources.org.au/insomnia/cbti/referral-to-digital-cbti-programs">online programs</a>. Some GPs are trained to offer CBTi, but it’s more usual for specialist <a href="https://psychology.org.au/find-a-psychologist">sleep psychologists</a> to offer it. Your GP can refer you to one. There are some Medicare rebates to subsidise the cost of treatment. But many psychologists will also charge a gap fee above the Medicare subsidy, making access to CBTi a challenge for some. <a href="https://doi.org/10.12703%2Fr%2F11-4">About 70-80%</a> of people with insomnia sleep better after CBTi, with improvements lasting <a href="https://doi.org/10.1016/j.smrv.2019.08.002">at least a year</a>. <h2>What if that doesn’t work?</h2> If CBTi doesn’t work for you, your GP might be able to refer you to a specialist sleep doctor to see if other sleep disorders, such as <a href="https://doi.org/10.1016/j.smrv.2016.04.004">obstructive sleep apnoea</a>, are contributing to your insomnia. It can also be important to manage any mental health problems such as <a href="https://doi.org/10.5694/mja2.51200">depression and anxiety</a>, as well as physical symptoms such as pain that can also disrupt sleep. Some lifestyle and work factors, such as shift-work, might also require management by a specialist sleep doctor. <h2>What about sleeping pills?</h2> Sleeping pills are <a href="https://www.sleepprimarycareresources.org.au/insomnia/pharmacological-therapy">not the recommended</a> first-line way to manage insomnia. However, they do have a role in providing short-term, rapid relief from insomnia symptoms or when CBTi is not accessible or successful. Traditionally, medications such as benzodiazepines (for example, temazepam) and benzodiazepine receptor agonists (for example, zolpidem) have been used to help people sleep. However, these can have <a href="https://doi.org/10.1136/bmj.38623.768588.47">side-effects</a> including a risk of falls, being impaired the next day, as well as tolerance and dependence. Melatonin – either prescribed or available from pharmacies for people aged 55 and over – is also often used to manage insomnia. But the <a href="https://doi.org/10.1016/j.smrv.2022.101692">evidence suggests</a> it has limited benefits. <h2>Are there new treatments? How about medicinal cannabis?</h2> Two newer drugs, known as “orexin receptor antagonists”, are available in Australia (suvorexant and lemborexant). These block the wake-promoting pathways in the brain. <a href="https://doi.org/10.4088/PCC.22nr03385">Early data suggests</a> they are effective in improving sleep, and have lower risk of potential side-effects, tolerance and dependence compared with earlier medicines. However, we don’t know if they work or are safe over the long term. <a href="https://doi.org/10.1093/sleep/zsab149">Medicinal cannabis</a> <a href="https://doi.org/10.1111/jsr.13793">has only in recent years</a> <a href="https://doi.org/10.1093/sleepadvances/zpac029.048">been studied</a> as a treatment for <a href="https://doi.org/10.1093/sleepadvances/zpac029.005">insomnia</a>. In an Australian survey, <a href="https://doi.org/10.2147/nss.s390583">more than half</a> of people using medicinal cannabis said they used it to treat insomnia. There are reports of <a href="https://doi.org/10.1371/journal.pone.0272241">significant benefit</a>. But of the four most robust studies so far, <a href="https://doi.org/10.1093/sleep/zsab149">only one</a> (led by one of us, Jen Walsh) has demonstrated an improvement in insomnia after two weeks of treatment. So we need to learn more about which cannabinoids – for example, delta-9-tetrahydrocannabinol, cannabidiol or cannabinol – and which doses may be beneficial. We also need to learn who can benefit most, and whether these are safe and effective over the long term. <h2>What now?</h2> If you’ve had trouble sleeping for a short time (under about a month) and nothing you try is working, there may be underlying reasons for your insomnia, which when treated, can provide some relief. Your GP can help identify and manage these. Your GP can also help you access other treatments if your insomnia is more long term. This may involve non-drug therapies and/or referral to other services or doctors. <hr /> For more information about insomnia and how it’s treated, see the Sleep Health Foundation’s <a href="https://www.sleephealthfoundation.org.au/sleep-disorders/insomnia-2">online resource</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/212964/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/alexander-sweetman-1331085">Alexander Sweetman</a>, Research Fellow, College of Medicine and Public Health, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a>; <a href="https://theconversation.com/profiles/jen-walsh-1468594">Jen Walsh</a>, Director of the Centre for Sleep Science, <a href="https://theconversation.com/institutions/the-university-of-western-australia-1067">The University of Western Australia</a>, and <a href="https://theconversation.com/profiles/nicole-grivell-1468590">Nicole Grivell</a>, Research Coordinator and final year PhD Candidate at FHMRI Sleep Health, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders 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-can-i-get-some-sleep-which-treatments-actually-work-212964">original article</a>.

Body

If you’re 65 or over and want to work, you’re far better off in New Zealand than Australia

<a href="https://theconversation.com/profiles/peter-martin-682709">Peter Martin</a>, <a href="https://theconversation.com/institutions/crawford-school-of-public-policy-australian-national-university-3292">Crawford School of Public Policy, Australian National University</a> Want to keep working after you’ve reached pension age? The Australian government has just made it a <a href="https://ministers.treasury.gov.au/ministers/jim-chalmers-2022/media-releases/getting-more-australians-back-work">little bit</a> easier, increasing the amount you can earn per year from work before losing some of your pension by A$4,000 on an ongoing basis. Late last year, it temporarily upped the so-called <a href="https://www.dss.gov.au/seniors/programmes-services/work-bonus">work bonus</a> from $7,800 per year to $11,800 to “<a href="https://images.theconversation.com/files/555212/original/file-20231023-17-xduxan.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip">incentivise pensioners into the workforce</a>”. It was part of the government’s response to its September jobs and skills summit. It meant pensioners could earn an underwhelming $227 per week from work without harming their pension, up from the previous $150. The rules for older workers are very different in New Zealand. In fact, if Australia adopted New Zealand’s approach, we could have an extra 500,000 willing workers – a fair chunk of them paying tax. <h2>What’s NZ doing differently for older workers?</h2> Last month, as part of his <a href="https://treasury.gov.au/employment-whitepaper/final-report">employment white paper</a>, Australian Treasurer Jim Chalmers made the increase to $227 per week permanent. Chalmers headlined the announcement: <a href="https://ministers.treasury.gov.au/ministers/jim-chalmers-2022/media-releases/getting-more-australians-back-work">Getting more Australians back into work</a>. But it’s doing an underwhelming job. In Australia, <a href="https://www.abs.gov.au/statistics/labour/employment-and-unemployment/labour-force-australia-detailed/aug-2023">15.1%</a> of the population aged 65 and older are in some kind of paid work, up from 14.7% a year earlier. In contrast, in New Zealand the proportion has just hit <a href="https://www.stats.govt.nz/information-releases/labour-market-statistics-june-2023-quarter/">26%</a>. That’s right: more than one-quarter of New Zealanders aged 65 and older are employed. It’s a similar story if we look at how Australia and New Zealand compared to others internationally on labour force participation (which covers those in paid work plus people actively looking for it). <hr /> <iframe id="qjojO" class="tc-infographic-datawrapper" style="border: none;" src="https://datawrapper.dwcdn.net/qjojO/5/" width="100%" height="400px" frameborder="0"></iframe> <hr /> New Zealand wants to see that number rise further. It has been talking about <a href="https://www.msd.govt.nz/documents/what-we-can-do/seniorcitizens/older-workers-employment-action-plan/the-ageing-workforce-briefing-paper-future-of-work-governance-group-meeting-4-may-.pdf">33.1%</a> of its population aged 65 or more in paid work, which is what Iceland has. What is New Zealand doing for over-65s that Australia is not? You won’t find it mentioned in either treasury’s employment <a href="https://treasury.gov.au/employment-whitepaper/final-report">white paper</a> (released in September) or <a href="https://treasury.gov.au/publication/2023-intergenerational-report">intergenerational report</a> (released in August) – even though National Seniors Australia <a href="https://nationalseniors.com.au/uploads/NSA-Employment-White-Paper-Submission-Final-Web.pdf">pointed it out</a> in submissions. One crucial thing New Zealand is not doing is annoying pensioners who work. Australian pensioners in paid work get called in for discussions with Centrelink, if it looks as if they are at risk of doing too many hours and going over the $227 per week limit. <h2>The more you work, the more your pension is cut</h2> Pensioners who do go over the $227 per week limit lose half of every extra dollar they earn in a cut to their pension. Plus tax, this means they lose a total of <a href="https://ipa.org.au/publications-ipa/media-releases/employment-white-paper-cop-out">69%</a> of what they earn over the limit where their tax rate is 19%, and 82.5% on the portion of earnings taxed at 32.5%. And this is after the boost designed to “<a href="https://images.theconversation.com/files/555212/original/file-20231023-17-xduxan.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip">incentivise pensioners into the workforce</a>”. Last year’s jobs summit also set up a <a href="https://www.pmc.gov.au/sites/default/files/resource/download/womens-economic-equality-taskforce-final-report.pdf">Women’s Economic Equality Taskforce</a>. It reported this week, drawing attention to the “disincentive rates” facing second earners (usually women) who return to work after caring for children. It said that taking the loss of benefits, tax and childcare costs together, the penalty for returning to work was more than half of what was earned on the first three days of the week, and up to 110% of what was earned on the fourth and fifth days. My point here is that the losses facing age pensioners who attempt to work are of a similar order – in Australia but not in New Zealand. Australia’s rules aren’t just stopping pensioners from taking on extra hours. They seem to stop them taking up paid work at all. There were 2.6 million Australians on the age pension in June this year. Only <a href="https://data.gov.au/data/dataset/dss-payment-demographic-data/resource/7a6457a8-44a3-406c-b552-62eb0fef9d66">83,925</a> reported income from working. That’s just 3.2%. <h2>NZ pensioners keep their pensions</h2> What’s different about New Zealand is that New Zealand’s pensioners don’t face a penalty if they work. They simply face income tax. In New Zealand, the age pension (which is called <a href="https://www.workandincome.govt.nz/eligibility/seniors/superannuation/who-can-get-it.html">superannuation</a>, making it confusing for Australians) is paid to everyone of pension age. There’s no income test or assets test. You get it because you are a citizen or permanent resident. Australia wouldn’t need to go as far as New Zealand to get the same benefit. We would simply need to ditch the pension income test in cases where that income came from paid work, leaving the assets test in place. Then there would be no concern about working. <h2>Half a million reasons for change</h2> If we made that change – and if the same proportion of older Australians chose to work as New Zealanders – we would soon have an extra half a million older Australians able to step into fields such as teaching, where there are <a href="https://www.abs.gov.au/statistics/labour/jobs/job-vacancies-australia/latest-release">15,500 vacancies</a>, and health care and social assistance, where there are 68,100 vacancies. It would cost the federal government money because it’d put more Australians of pension age on the pension. But it’d cost less if we abolished the special tax concession for seniors and pensioners, known as the <a href="https://www.ato.gov.au/individuals/income-deductions-offsets-and-records/tax-offsets/seniors-and-pensioners-tax-offset/">seniors and pensioners tax offset</a>. In New Zealand, senior citizens face the same tax rates as everyone else. And it would cost less as more pensioners earned wages and paid income tax. Calculations prepared for <a href="https://nationalseniors.com.au/uploads/NSA-Employment-White-Paper-Submission-Final-Web.pdf">National Seniors Australia</a> by Deloitte suggest that beyond a certain point, the change would become revenue-positive – actually boosting federal coffers – as the extra income tax revenue outweighed the cost of the extra pensions. National Seniors is calling its campaign <a href="https://nationalseniors.com.au/advocacy/fairer-retirement-income-system/let-pensioners-work">“let pensioners work”</a>. <h2>Tapping into the cash economy</h2> Importantly – and here’s where we get to a fact National Seniors might not like me mentioning – that would happen not only because more senior Australians were employed, but also because more senior Australians were employed legitimately. It’s hard to get a handle on how many senior Australians are working and being paid in cash, which they store rather than bank to avoid tripping the income test. But we do know this. At the end of March, there were <a href="https://www.rba.gov.au/statistics/tables/xls/a06hist.xls?v=2021-04-05-19-23-58">18</a> Australian $100 notes in circulation for each Australian resident, an astonishingly high proportion given the use of cash for transactions is <a href="https://theconversation.com/cash-could-be-almost-gone-in-australia-in-a-decade-but-like-cheques-wholl-miss-it-208020">collapsing</a>. In New Zealand at the end of March, there were just <a href="https://www.rbnz.govt.nz/statistics/series/reserve-bank/bank-notes-in-the-hands-of-the-public">five</a> New Zealand $100 notes in circulation for each New Zealand resident. That may be just a coincidence. But New Zealand is certainly making it easier for retirees to work legitimately, rather than stay at home or accept cash in hand.<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/216260/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/peter-martin-682709">Peter Martin</a>, Visiting Fellow, <a href="https://theconversation.com/institutions/crawford-school-of-public-policy-australian-national-university-3292">Crawford School of Public Policy, Australian National University</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/if-youre-65-or-over-and-want-to-work-youre-far-better-off-in-new-zealand-than-australia-216260">original article</a>.

International Travel

Hunt for Cinderella! Mystery shoe left at Prince Christian's party sparks search

A mystery shoe left at Prince Christian's <a href="https://oversixty.com.au/lifestyle/family-pets/unseen-pics-of-prince-christian-mark-his-18th-birthday" target="_blank" rel="noopener">18th birthday party</a> inside Christianborg Palace has sparked a search for a real life Cinderella. In the hours after the ball, which saw royalty from around the world attend, the Danish royal household posted a photo of the gold stiletto that was left behind from one of the high profile party guests. The post read, "Is it Cinderella who forgot her shoe last night?" The caption continued, "When the guests at Her Majesty the Queen's gala dinner yesterday had gone home, this lonely stiletto shoe was left at Christiansborg Castle." "The owner is welcome to contact you to get it back." <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-permalink="https://www.instagram.com/p/CydeENrNum2/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/CydeENrNum2/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by DET DANSKE KONGEHUS 🇩🇰 (@detdanskekongehus)</a> </div> </blockquote> The ball was attended by Crown Princess Mary and Crown Prince Frederik, along with Christian's younger siblings Princess Isabella, 16, Prince Vincent and Princess Josephine, both 12. His uncle Prince Joachim, who relocated to America in August, was also there with his wife Princess Marie and their three youngest children Count Felix, 21, Count Henrik, 14, and Countess Athena, 12. A number of future monarchs were also present including royals from Sweden, Norway, the Netherlands and Belgium. Thankfully, the owner of the shoe was found, with Anne-Sofie Tørnsø Olesen, from Denmark's Egedal region, coming forward to claim the golden stiletto. And it turns out, she left it at the palace on purpose after being inspired by the story of Cinderella who marries her prince after long search. "I thought it was a bit funny myself, and I talked to my family and friends about it before, and they agreed that I should do it," Tørnsø Olesen, 18, told local Danish publication Se & Hør. "It's such a chance you won't get again." She said she was keen to get the shoe back because it was "a memory from a great evening". The lost shoe, by Danish brand Deichmann's Catwalk collection, sparked an immediate flurry of comments on the royal family's Instagram page. The shoe brand said, "If the princess comes from a long way, we will gladly give her a new pair". Image credits: Getty Images / Instagram

Beauty & Style

"Cutest thing ever": Bride and groom praised for breaking wedding tradition

A bride and groom have been praised online for deviating from the traditional wedding party to include their siblings in an adorable way. Carla Wehbe took to TikTok to share a video from her cousin Raymond's nuptials to his partner Bella, in which both the bride and groom wanted their siblings standing next to them on their big day. Raymond had his sister wear a black dress, to match his groomsmen in their black tuxedos, and be given the title best woman. In contrast, Bella’s brother was given a pink suit to match the pink dresses of the other bridesmaids and was given the title man of honour. <div class="embed" style="font-size: 16px; box-sizing: inherit; margin: 0px; padding: 0px; border: 0px; vertical-align: baseline; outline: none !important;"><iframe class="embedly-embed" style="box-sizing: inherit; margin: 0px; padding: 0px; border-width: 0px; vertical-align: baseline; width: 600px; max-width: 100%; outline: none !important;" title="tiktok embed" src="https://cdn.embedly.com/widgets/media.html?src=https%3A%2F%2Fwww.tiktok.com%2Fembed%2Fv2%2F7286234571937484034&display_name=tiktok&url=https%3A%2F%2Fwww.tiktok.com%2F%40carlawehbe%2Fvideo%2F7286234571937484034%3Flang%3Den&image=https%3A%2F%2Fp16-sign-sg.tiktokcdn.com%2Fobj%2Ftos-alisg-p-0037%2F153b8be3937b45a99bf0be11c35a53f4_1696458709%3Fx-expires%3D1697590800%26x-signature%3D04xfM01KhIsZZkTHQoqTUi%252BiU70%253D&key=59e3ae3acaa649a5a98672932445e203&type=text%2Fhtml&schema=tiktok" width="340" height="700" frameborder="0" scrolling="no" allowfullscreen="allowfullscreen"></iframe></div> “The reason they did it was because their siblings were their best friends and they wanted them to stand by their side on their special day,” Wehbe said in an interview with <a href="https://www.newsweek.com/bride-groom-best-woman-man-honor-wedding-1833939" target="_blank" rel="noopener">Newsweek</a>. “I loved the idea and thought it made the day really special.” The video has racked up over 65 million views, with thousands of people flocking to the comments to congratulate the newlywed couple, while praising their decision to break with tradition. “This needs to be done more often,” one comment read. However, not all of the commenters were on board with the idea, while many traditionalists slammed the act. Despite the critcs, Wehbe said most of the comments were positive, and that she wanted to use the video to let people know that they can have any kind of wedding they want, whether it breaks tradition or not. “It will definitely inspire people who may have wanted to but were not sure if it was acceptable,” she said. “People should just do what makes them happy on their special day!” Image credits: TikTok

Relationships

“You deserve more”: Company slammed over measly send-off party

A company has been slammed online for their measly attempt to farewell a hard-working employee of 42 years. John Barlett was a dedicated worker for four decades, commuting long distances to work at minimum wage and give his all to his colleagues. After 42 years of hard work, John announced his retirement from the company, prompting a measly farewell party from his place of work. One of John’s longtime co-worker, Sonia, was devastated over the injustice, sharing a short clip to social media of John – now in his 70s – and what she felt was his hard work going unappreciated. “Today is my co-worker’s last day. He worked for this company for 42 years making minimum wage,” Sonia wrote with the video. “The company only threw him a barbecue and gave him a certificate. He takes the bus and Bart (train) to get here every day on time. He’s 70+.” “He loves working here so much he didn’t want to retire. [He got] No bonus, just a barbecue and a certificate. Don’t be a slave to your job. Thank you John for your loyalty.” The video quickly went viral and was flooded with comments of support for John, with one person even suggesting that John start a <a href="https://www.gofundme.com/f/happy-retirement-john" target="_blank" rel="noopener">GoFundMe</a> for people to contribute to his retirement. In the fundraiser, she revealed John could not drive because of a disability, but “rain or shine” would always make it to work. He was “extremely dependable”, Sonia added, revealing it had been difficult to convince him to take a break because he always wanted to work. He was “one of the most talented and hard working” employees at the company and his energy was “unmatched”, she said. “He has no wife or kids, however he does have a nephew whom he loves dearly,” she wrote in the fundraiser. “It would be nice to give him some kind of company or something to do so he knows that he’s special and loved.” In the few days since the GoFundMe was created, it has raised almost $45,000, as many shared their comments of support. One person wrote, “Happy retirement, John. You deserve more than what this company has offered you. Wish you all the best in your life and your future.” Image credits: GoFundMe

Retirement Life

Princess Beatrice reveals the “most terrifying moment” in her life

Princess Beatrice has shared the “most terrifying moment” that she encountered at work. The 35-year-old royal has been open about her struggles with dyslexia, and has opened up on a podcast about a major challenge she faced at work. "I was anecdotally talking about how difficult it was at work," Beatrice, who works for US-based technology firm Afiniti, told podcast host Kate Griggs. "Sometimes you get handed a whiteboard pen and you've got to do the group think again and collaborate and off you go to the whiteboard." "And I was thinking that's the most terrifying moment for me in my life, and please don't ever make me do it. I'll do a speech tomorrow but don't give me a pen and a whiteboard." Beatrice also shared the difficulties she faced as a child, and having to go through school before being formally diagnosed with dyslexia. "The early days of school really, really stand out as to those moments where you just don't fit in and you can't figure out what it is about you," the royal said candidly. "I remember trying to do extra lessons with teachers and just sort of blankly staring up at her face, and she was like, 'why are you looking at me? The words are not on my face' [and] I said 'well, they're not on the page either'." "So the early days, in and around that understanding that my brain worked slightly differently, I remember them being a real challenge." Princess Beatrice became emotional when talking about the teachers who helped her during her schooling career, saying she "probably wouldn't be the person I am today if they hadn't been there in my life". The princess also paid tribute to her mum, Sarah Ferguson, for championing her to find a new way to do things. "My family and I are incredibly close, so I would say that all throughout our lives, we've been able to go through everything with humour and with joy and my mum really instilled that," Beatrice said. Image credits: Getty Images

Mind

Lots of women try herbs like black cohosh for menopausal symptoms like hot flushes – but does it work?

<a href="https://theconversation.com/profiles/sasha-taylor-1461085">Sasha Taylor</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Menopause is the stage of life where the ovaries stop releasing eggs and menstrual periods cease. Most Australian women go through menopause between <a href="https://www.nature.com/articles/nrdp20154">45 and 55</a> years of age, with the average age being 51 years, although some women may be younger. Hot flushes and night sweats are <a href="https://www.nature.com/articles/nrendo.2017.180">typical symptoms</a> of menopause, with vaginal dryness, muscle and joint pains, mood changes and sleep disturbance also commonly reported. Up to <a href="https://pubmed.ncbi.nlm.nih.gov/25706184/">75% of women</a> experience menopausal symptoms, with nearly 30% severely affected. These symptoms can negatively impact day-to-day life and wellbeing. The main therapies available include menopausal hormone therapy (MHT) and non-hormonal prescription therapy. Some women will elect to try complementary and alternative medicines, such as herbal medicines and nutritional supplements. Black cohosh is one of them. <h2>What causes hot flushes</h2> The cause of hormonal hot flushes (also called hot flashes) still isn’t completely understood, but the decline in oestrogen at menopause appears to play a role in a process that involves the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3833827/">area of the brain that regulates temperature</a> (the hypothalamus). Factors linked to a greater likelihood of hot flushes include <a href="https://pubmed.ncbi.nlm.nih.gov/19675142/">being overweight or having obesity</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/25706184/">smoking</a>. MHT, previously known as hormone replacement therapy (HRT), usually includes oestrogen and is the <a href="https://pubmed.ncbi.nlm.nih.gov/26444994/">most effective treatment</a> for menopausal symptoms, such as hot flushes. But women may choose complementary and alternative medicines instead – either because they shouldn’t take hormone therapy, for example because they have breast cancer, or because of personal preference. Close <a href="https://pubmed.ncbi.nlm.nih.gov/26224187/">to 40%</a> of Australian women report using complementary and alternative medicines for menopausal symptoms, and up to 20% using them specifically to treat hot flushes and sweats. <h2>A long history</h2> Complementary and alternative medicines have a long history of use in many cultures. Today, their potential benefits for menopausal symptoms are promoted by the companies that make and sell them. The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419242/">complementary and alternative medicines</a> women often try for menopausal symptoms include phytoestrogens, wild yam, dong quai, ginseng and black cohosh. Black cohosh (plant name Cimicifuga racemosa) was <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599854/">traditionally</a> used by Native Americans to treat a variety of health concerns such as sore throat, kidney trouble, musculoskeletal pain and menstrual problems. It is now a popular herbal choice for hot flushes and night sweats, as well as vaginal dryness and mood changes. There are <a href="https://pubmed.ncbi.nlm.nih.gov/37252752/">many theories</a> for how the active ingredients in black cohosh might work in the body, such as acting like oestrogen, or affecting chemical pathways in the brain. But despite extensive research, the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599854/">evidence to support these theories remains inconclusive</a>. It is also not clear whether black cohosh is effective for hot flushes. Results from individual studies are mixed, with <a href="https://pubmed.ncbi.nlm.nih.gov/17565936/">some</a> finding black cohosh improves hot flushes, while <a href="https://pubmed.ncbi.nlm.nih.gov/18257142/">others</a> have found it doesn’t. A 2012 <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599854/">review</a> combined all the results from studies of menopausal women using black cohosh to that date and found overall there was no proof black cohosh reduces hot flushes more effectively than an inactive treatment (placebo). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599854/">This review</a> also revealed that many studies did not use rigorous research methods, so the findings are hard to interpret. A more recent <a href="https://pubmed.ncbi.nlm.nih.gov/33021111/">review</a> of clinical trials claimed black cohosh may ease menopausal symptoms, but the included studies were mostly small, less than six months long, and included women with mild symptoms. There is also no meaningful evidence black cohosh helps other symptoms of menopause, such as vaginal symptoms, sexual problems, or poor general wellbeing, or that it protects against bone loss. Evidence for how black cohosh is absorbed and metabolised by the body is also lacking, and it is not known what dose or formulation is best to use. More good quality studies are needed to decide whether black cohosh works for hot flushes and other menopausal symptoms. <h2>Is it safe to try?</h2> A <a href="https://pubmed.ncbi.nlm.nih.gov/33021111/">review of studies</a> suggests black cohosh is safe to use, although many of the studies have not reported possible adverse reactions in detail. Side effects such as gastrointestinal upset and rashes may occur. While there have been <a href="https://www.mja.com.au/journal/2008/188/7/liver-failure-associated-use-black-cohosh-menopausal-symptoms#0_i1091948">rare reports of liver damage</a>, there is <a href="https://pubmed.ncbi.nlm.nih.gov/21228727/">no clear evidence</a> black cohosh was the cause. Even so, in Australia, black cohosh manufacturers and suppliers are required to put a warning label for the potential of harm to the liver on their products. It is recommended black cohosh is not used by women with menopausal symptoms <a href="https://www.canceraustralia.gov.au/cancer-types/breast-cancer/impacted-by-breast-cancer/physical-changes/menopause/treatments-menopausal-symptoms">after breast cancer</a>, as its safety after breast cancer is uncertain. All women should consult with their doctor before using black cohosh if they are taking other medications in case of possible drug interactions. Many women like to try herbal therapies for hot flushes and other menopausal symptoms. While black cohosh is generally considered safe and some women may find it helps them, at the moment there is not enough scientific evidence to show its effects are any better than placebo. Women experiencing troublesome menopausal symptoms, such as hot flushes, should talk to their doctor about the best treatment options for them.<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/211272/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/sasha-taylor-1461085">Sasha Taylor</a>, Research fellow, Chronic Disease & Ageing, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, Chair of Women's Health, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</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/lots-of-women-try-herbs-like-black-cohosh-for-menopausal-symptoms-like-hot-flushes-but-does-it-work-211272">original article</a>.

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