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Everything you need to know about tipping in the US

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

International Travel

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

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

Body

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

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

Body

To tackle gendered violence, we also need to look at drugs, trauma and mental health

<a href="https://theconversation.com/profiles/siobhan-odean-1356613">Siobhan O'Dean</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/lucinda-grummitt-1531503">Lucinda Grummitt</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/steph-kershaw-1466426">Steph Kershaw</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> After several highly publicised alleged murders of women in Australia, the Albanese government this week pledged <a href="https://ministers.pmc.gov.au/gallagher/2024/helping-women-leave-violent-partner-payment">more than A$925 million</a> over five years to address men’s violence towards women. This includes up to $5,000 to support those escaping violent relationships. However, to reduce and prevent gender-based and intimate partner violence we also need to address the root causes and contributors. These include alcohol and other drugs, trauma and mental health issues. <h2>Why is this crucial?</h2> The World Health Organization estimates <a href="https://iris.who.int/bitstream/handle/10665/341604/WHO-SRH-21.6-eng.pdf?sequence=1">30% of women</a> globally have experienced intimate partner violence, gender-based violence or both. In Australia, <a href="https://www.abs.gov.au/statistics/people/crime-and-justice/partner-violence/latest-release#key-statistics">27% of women</a> have experienced intimate partner violence by a co-habiting partner; <a href="https://pubmed.ncbi.nlm.nih.gov/37004184/">almost 40%</a> of Australian children are exposed to domestic violence. By gender-based violence we mean violence or intentionally harmful behaviour directed at someone due to their gender. But intimate partner violence specifically refers to violence and abuse occurring between current (or former) romantic partners. Domestic violence can extend beyond intimate partners, to include other family members. These statistics highlight the urgent need to address not just the aftermath of such violence, but also its roots, including the experiences and behaviours of perpetrators. <h2>What’s the link with mental health, trauma and drugs?</h2> The relationships between mental illness, drug use, traumatic experiences and violence are complex. When we look specifically at the link between mental illness and violence, most people with mental illness will not become violent. But there <a href="https://theconversation.com/bondi-attacker-had-mental-health-issues-but-most-people-with-mental-illness-arent-violent-227868">is evidence</a> people with serious mental illness can be more likely to become violent. The use of alcohol and other drugs also <a href="https://theconversation.com/alcohol-and-drug-use-exacerbate-family-violence-and-can-be-dealt-with-69986">increases the risk</a> of domestic violence, including intimate partner violence. About <a href="https://www.aihw.gov.au/family-domestic-and-sexual-violence/understanding-fdsv/factors-associated-with-fdsv">one in three</a> intimate partner violence incidents involve alcohol. These are more likely to result in physical injury and hospitalisation. The risk of perpetrating violence is even higher for people with mental ill health who are also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525086/">using alcohol or other drugs</a>. It’s also important to consider traumatic experiences. Most people who experience trauma do not commit violent acts, but there are <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(23)00075-0/fulltext">high rates</a> of trauma among people who become violent. For example, experiences of childhood trauma (such as witnessing physical abuse) <a href="https://www.sciencedirect.com/science/article/pii/S1359178915000828?via%3Dihub">can increase the risk</a> of perpetrating domestic violence as an adult. Early traumatic experiences can affect the brain and body’s <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0895-4">stress response</a>, leading to heightened fear and perception of threat, and difficulty regulating emotions. This can result in aggressive responses when faced with conflict or stress. This response to stress increases the risk of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9675346/">alcohol and drug problems</a>, developing <a href="https://pubmed.ncbi.nlm.nih.gov/30798897/">PTSD</a> (post-traumatic stress disorder), and <a href="https://psycnet.apa.org/record/2015-17349-001">increases the risk</a> of perpetrating intimate partner violence. <h2>How can we address these overlapping issues?</h2> We can reduce intimate partner violence by addressing these overlapping issues and tackling the root causes and contributors. The early intervention and treatment of <a href="https://doi.org/10.1186/s12905-019-0728-z">mental illness</a>, <a href="https://doi.org/10.1177/1541204020939645">trauma</a> (including PTSD), and <a href="https://doi.org/10.1016/j.avb.2015.06.001">alcohol and other drug use</a>, could help reduce violence. So extra investment for these are needed. We also need more investment to <a href="https://www.sciencedirect.com/science/article/pii/S2212657023000508">prevent mental health issues</a>, and preventing alcohol and drug use disorders from developing in the first place. <a href="https://www.sciencedirect.com/science/article/pii/S074937972200023X?via%3Dihub">Preventing trauma</a> from occuring and supporting those exposed is crucial to end what can often become a vicious cycle of intergenerational trauma and violence. <a href="https://journals.sagepub.com/doi/10.1177/070674371105600505">Safe and supportive</a> environments and relationships can protect children against mental health problems or further violence as they grow up and engage in their own intimate relationships. We also need to acknowledge the widespread <a href="https://store.samhsa.gov/product/practical-guide-implementing-trauma-informed-approach/pep23-06-05-005">impact of trauma</a> and its effects on mental health, drug use and violence. This needs to be integrated into policies and practices to reduce re-traumatising individuals. <h2>How about programs for perpetrators?</h2> Most existing standard intervention programs for perpetrators <a href="https://journals.sagepub.com/doi/10.1177/1524838018791268">do not consider</a> the links between trauma, mental health and perpetrating intimate partner violence. Such programs tend to have <a href="https://psycnet.apa.org/doi/10.1037/a0012718">little</a> or <a href="https://doi.org/10.1016/j.cpr.2021.101974">mixed effects</a> on the behaviour of perpetrators. But we could improve these programs with a <a href="http://rcfv.archive.royalcommission.vic.gov.au/MediaLibraries/RCFamilyViolence/Reports/RCFV_Full_Report_Interactive.pdf">coordinated approach</a> including treating mental illness, drug use and trauma at the same time. Such “<a href="https://www.sciencedirect.com/science/article/pii/S014976341930449X?via%3Dihub">multicomponent</a>” programs show promise in meaningfully reducing violent behaviour. However, we need more rigorous and large-scale evaluations of how well they work. <h2>What needs to happen next?</h2> Supporting victim-survivors and improving interventions for perpetrators are both needed. However, intervening once violence has occurred is arguably too late. We need to direct our efforts towards broader, holistic approaches to prevent and reduce intimate partner violence, including addressing the underlying contributors to violence we’ve outlined. We also need to look more widely at preventing intimate partner violence and gendered violence. We need developmentally appropriate <a href="https://theconversation.com/4-things-our-schools-should-do-now-to-help-prevent-gender-based-violence-228993">education and skills-based programs</a> for adolescents to prevent the emergence of unhealthy relationship patterns before they become established. We also need to address the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7278040/">social determinants of health</a> that contribute to violence. This includes improving access to affordable housing, employment opportunities and accessible health-care support and treatment options. All these will be critical if we are to break the cycle of intimate partner violence and improve outcomes for victim-survivors. <hr /> The National Sexual Assault, Family and Domestic Violence Counselling Line – 1800 RESPECT (1800 737 732) – is available 24 hours a day, seven days a week for any Australian who has experienced, or is at risk of, family and domestic violence and/or sexual assault. If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14. In an emergency, call 000.<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/229182/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/siobhan-odean-1356613">Siobhan O'Dean</a>, Postdoctoral Research Associate, The Matilda Centre for Research in Mental Health and Substance Use, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/lucinda-grummitt-1531503">Lucinda Grummitt</a>, Postdoctoral Research Fellow, The Matilda Centre for Research in Mental Health and Substance Use, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/steph-kershaw-1466426">Steph Kershaw</a>, Research Fellow, The Matilda Centre for Research in Mental Health and Substance Use, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</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/to-tackle-gendered-violence-we-also-need-to-look-at-drugs-trauma-and-mental-health-229182">original article</a>.

Caring

7 things you need to know about fear

Fear is an emotion that can be debilitating and unsettling. But it is a natural part of life and we are hardwired to experience it. 1. Fear can protect you Experiencing fear elicits responses from your brain to your limbs. It is the body’s natural way of protecting itself. For our ancestors the fear was often more physical – such as being chased by a lion. Modern fear can range from physical danger (such as a spider or an intruder) or even from perceived danger (such as the worry that something will happen to our partner or child). Feeling fear doesn’t make you a weak person. In fact, not feeling any fear could mean that there are neurological issues present. 2. There are many levels of fear Not everything that we fear is intense and paralysing. It can range from low levels of fear (such as worry about being robbed), to medium levels of fear (say if a loved one is in hospital) to high levels of fear (you are being chased by an attacker). Fear can also become stronger when we hear about events such as a terrorist attack or a natural disaster. It all relates back to how much the scary event will impact our lives. 3. Fear is not just instinctive We become fearful due to three main factors: instinct, learning, and teaching. An example of instinctual fear is pain – we learn to be fearful of things that hurt us. Learned fear comes from being exposed to unpleasant or uncomfortable things and wanting to avoid them in the future. For instance, having a relative die in a car crash could make you fearful of driving in the future. Other fears are taught to us by our family, friends and even society. For example, some religions teach us to be fearful of other religions or customs. 4. Fear can arise without a real threat of danger Fear can also be imagined, so it can be felt even when there is no danger present. If we feel this all the time it can lead to anxiety and depression. It’s important to think about whether the thing you are fearful of is real or likely to happen before you give it too much airtime. 5. Fear produces fear If you are already in a state of fear, your response to more fear is heightened. For instance if you are watching a scary movie, a small noise from the next room could make you jump and scream. Your senses are on red alert, primed to act if the need arises. 6. Fear leads to action Depending on the individual and the level of fear they are experiencing, there tend to be four main types of action as a result of fear: freeze, fight, flight, or fright. When you freeze it means you don’t move while you decide what to do (for instance you see a snake in your garden). From there you choose either fight (grab a shovel) or flight mode (walk away). If the fear is too much you might experience fright, where you do nothing and take no action (stand there screaming or worrying). 7. Real threats can lead to heroic actions Imagined threats can cause us to live in a permanent state of fear and stress. But often we will do nothing about it (for instance being worried about sharks attacking us in the ocean). Compare this to the threat from a real and identifiable source, which will make you spring into action almost immediately. Often we don’t even make the decision to act, it just happens automatically (such as moving a child out of the way of an approaching car). Image credits: Getty Images

Mind

Everything you need to know before you travel to Vietnam

So you’ve booked your flight to Vietnam to experience the best of south-east Asia. When travelling to Vietnam, and other Asian countries, there are a handful of tips and tricks to be aware of to ensure you have a smooth sailing travel experience. In comparison to travelling around Western countries, exploring Vietnam comes with a unique set of circumstances, and being prepared for every situation will make sure your trip is one to remember. Cash is king When it comes to planning your trip to Vietnam, other than booking your flights, hotels and travel insurance, one of your first priorities should be getting your hands on cash. The Vietnamese Dong is a unique currency to get used to, given that $5 AUD is equal to approximately $82,000 VND. Most of the restaurants, cafes and tourist attractions you’ll be heading to will only accept cash, so make sure you seek out an ATM (most ATMs will let you translate to English) and always have a decent amount of cash on hand. Go off the beaten track Vietnam has so much more to offer than the major cities. While Hanoi and Ho Chi Minh City have a lot of interesting history, tourist attractions and unique cultural experiences, staying in these cities for the entirety of your Vietnam trip is limiting. Make sure you explore coastal towns such as Hoi An, Hue and Phu Quoc, explore the rolling rice fields of Sapa, and don’t forget to book your cruise around the picturesque Ha Long Bay. Don't be afraid of the food While Vietnamese food is maybe not what you’re used to eating everyday, part of experiencing a different culture is immersing yourself in the food scene. One of the best things you can do when you arrive at your destination is to book a food tour with a local guide (there are many available through TripAdvisor), to take you around and show you a variety of dishes to become accustomed to. Your food tour guide will also help ease your anxiety over ordering food in different places. Another top tip: Restaurants will often be called the name of the dishes they serve. For example, places that sell the delicious Bahn Mi bread rolls will have “Bahn Mi” in their name. Google Translate is your friend While your hotel staff will often speak good English, other vendors at restaurants or markets may not be as fluent. Downloading the Google Translate app on your phone will allow you to communicate with locals quickly and easily, by typing in what you want to say in English, and letting the app read out the sentence in Vietnamese. Also, the app’s camera feature lets you hover your smartphone camera over something written in Vietnamese, before translating it into English in seconds. Beware of scams One of the most common scams in Vietnam is taxi scams. Some people will claim to be a taxi and then jack up the prices once they take you to your destination. To avoid this, only get in registered taxis (that actually look like taxis and not just a random car), and download Grab, which is the Vietnamese version of Uber and is just as easy to use. Another common scam is for market vendors to hike up prices for food and souvenirs, so be ready to barter for a better price. Make friends with the locals The Vietnamese people are some of the loveliest, kindest and most accommodating in the world. People on the street, hotel staff and restaurant workers are always happy to help you with queries or concerns, so make the most of their local knowledge and don’t be afraid to approach people with a smile. Image credits: Getty Images

International Travel

Silent cancers: here’s what you need to know when there are no obvious symptoms

<a href="https://theconversation.com/profiles/justin-stebbing-1405462">Justin Stebbing</a>, <a href="https://theconversation.com/institutions/anglia-ruskin-university-1887">Anglia Ruskin University</a> The recent revelations about the Princess of Wales’s <a href="https://www.bbc.com/news/uk-68640917">cancer diagnosis</a> highlight a crucial aspect of cancer detection – the disease’s sometimes silent nature. Silent cancers are those without noticeable symptoms. They pose a unique challenge in early detection and treatment. Contrary to common perception, cancer does not always announce its presence through overt symptoms or obvious signs. Many people receive a <a href="https://academic.oup.com/clinchem/article-abstract/70/1/179/7283928">cancer diagnosis incidentally</a>, when it’s found during routine medical examinations or investigations for unrelated health concerns – as seems to be the case for both <a href="https://www.wsj.com/health/kate-middleton-catherine-cancer-what-is-preventative-chemotherapy-9625370d">the princess</a> and <a href="https://www.bbc.co.uk/news/health-68171163">King Charles III</a>. While even silent cancers can sometimes be <a href="https://pubmed.ncbi.nlm.nih.gov/22584215/">aggressive and advance rapidly</a>, they can also remain <a href="https://pubmed.ncbi.nlm.nih.gov/20363069/">dormant</a> for years or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8819710/">even decades</a>. Some <a href="https://ascopubs.org/doi/10.14694/EdBook_AM.2012.32.98">prostate</a>, <a href="https://ascopubs.org/doi/10.14694/EdBook_AM.2012.32.301">breast</a> and <a href="https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2020.571421/full">thyroid</a> cancers, for example, <a href="https://www.tmlep.com/clinical-learning/2023-01-23-when-did-this-tumour-start-the-need-for-a-gompertzian-understanding-of-tumour-growth-kinetics">often evolve slowly</a> without obvious symptoms or spreading beyond the original area. Research suggests that some of these cancers are <a href="https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2020.571421/full">overtreated</a>. Sometimes patients are best left alone or treated much more gently, perhaps even without medical intervention, using a <a href="https://www.nejm.org/doi/full/10.1056/nejmoa1311593">“watch and wait”</a> strategy. This approach may be taken with prostate cancer in the elderly, for example. <h2>The importance of early diagnosis</h2> Whatever the cancer, it’s always important to get an early diagnosis though – and for silent cancers, this is obviously a challenge. Some cancer symptoms <a href="https://pubmed.ncbi.nlm.nih.gov/36702593/">can be vague</a> and easily mistaken for benign ailments. Fatigue, unexplained weight loss and persistent pain are among the nonspecific symptoms that may signal an underlying malignancy. But such symptoms can be misinterpreted or easily dismissed, which contributes to delayed diagnosis and treatment. <figure><iframe src="https://www.youtube.com/embed/MGMy6BzBvp0?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> Fortunately, in many countries including the UK, we have <a href="https://www.england.nhs.uk/cancer/early-diagnosis/screening-and-earlier-diagnosis/">screening</a> tests for diseases like breast or colon cancer, to increase early diagnoses. Early diagnosis is a <a href="https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.32887">key factor</a> for successful cancer treatment. Detecting cancer in its silent phase offers a window of opportunity for early intervention and improved outcomes. The discovery of asymptomatic cancers through diagnostic imaging or screening tests underscores the importance of these proactive healthcare measures. Identifying cancer at an early stage means the disease is confined to its site of origin, smaller and potentially easier to cure. Diagnosing a smaller cancer often means that if an operation is needed, it may be a less invasive surgery. There may also be a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6825992/">lower chance</a> of needing post-operative preventative chemotherapy, to mop up any residual cells. Colorectal cancer (CRC) is a good example to show the critical importance of screening. Studies show that patients who participate in CRC <a href="https://www.nice.org.uk/guidance/dg56/chapter/1-Recommendations">screening</a>, such as colonoscopies or tests that look for blood in the stool, are more likely to be diagnosed while asymptomatic and have more positive prognoses after treatment. Those diagnosed with CRC after showing symptoms, such as rectal bleeding or changes in bowel habits, tend to have more <a href="https://bmjopengastro.bmj.com/content/4/1/e000146%20">advanced tumors and poorer outcomes</a>. <figure><iframe src="https://www.youtube.com/embed/nA9_Io3LDpA?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> Public health initiatives aimed at raising awareness about the importance of both cancer screening and symptom recognition play a pivotal role in reducing diagnostic delays. Empowering people to engage in <a href="https://healthcaredelivery.cancer.gov/prevention/#:%7E:text=Cancer%20can%20be%20prevented%20through,they%20are%20more%20easily%20treated.">preventive healthcare measures</a> such as HPV vaccinations and lifestyle changes that decrease risk can facilitate early detection and intervention, potentially altering the trajectory of the disease. <h2>Biomarker discovery</h2> The latest advances in diagnostic technologies, often known as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8012218/#:%7E:text=During%20biomarker%20discovery%2C%20evaluation%20of,design%20of%20future%20validation%20studies.">“biomarker discovery”</a>, hold promise for improving early detection rates and refining treatment strategies for silent cancers. From <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/molecular-profiling">molecular profiling</a> to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9922467/">liquid biopsy techniques</a> (blood tests to diagnose cancer), innovative approaches are reshaping the landscape of cancer diagnosis, offering new avenues for personalised and precision medicine. For example, I worked with a team using blood tests to identify cancers in more than <a href="https://www.nature.com/articles/s41388-023-02591-z">1,000 women recalled after screening for mammography</a>. We looked at the DNA that tumour cells release – so-called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10496721/">cell-free DNA</a> – and also metabolomics (rare markers related to metabolism in the blood). From this information, we found healthy patients, benign disease, pre-cancer and breast cancer. Although there’s increasing awareness and use of this <a href="https://www.sciencedirect.com/science/article/abs/pii/S1769721218307110">approach in Europe</a>, it isn’t standard in the UK. Asymptomatic cancers represent a formidable challenge for patient care. But, by encouraging patients to adopt preventive lifestyles and engage with screenings and tests, asymptomatic cancers don’t have to be a hidden threat to health.<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/226536/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/justin-stebbing-1405462">Justin Stebbing</a>, Professor of Biomedical Sciences, <a href="https://theconversation.com/institutions/anglia-ruskin-university-1887">Anglia Ruskin 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/silent-cancers-heres-what-you-need-to-know-when-there-are-no-obvious-symptoms-226536">original article</a>.

Body

There are new flu vaccines on offer for 2024. Should I get one? What do I need to know?

<a href="https://theconversation.com/profiles/allen-cheng-94997">Allen Cheng</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Influenza is a common respiratory infection. Although most cases are relatively mild, flu can cause more severe illness in young children and older people. Influenza virtually <a href="https://pubmed.ncbi.nlm.nih.gov/33243355/">disappeared</a> from Australia during the first years of the COVID-19 pandemic when public health restrictions reduced contact between people. Since 2022, it has returned to a seasonal pattern, although the flu season has started and peaked a few months earlier than before 2020. It’s difficult to predict the intensity of the flu season at this point in the year, but we can sometimes get clues from the northern hemisphere. There, the season <a href="https://www.who.int/tools/flunet">started</a> <a href="https://gis.cdc.gov/grasp/fluview/flu_by_age_virus.html">earlier</a> than usual for the third year running (peaking in early January rather than late February/March), with a similar number of reported cases and hospitalisations to the previous year. Influenza vaccines are recommended annually, but there are now an increasing number of different vaccine types. Here’s what to know about this year’s shots, available from <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">this month</a>. <h2>What goes into a flu vaccine?</h2> Like other vaccines, influenza vaccines work by “training” the immune system on a harmless component of the influenza virus (known as an antigen), so it can respond appropriately when the body encounters the real virus. Influenza strains are constantly changing due to genetic mutation, with the pace of genetic change <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10421855">much higher</a> than for SARS-CoV-2 (the virus that causes COVID). The strains that go into the vaccine are <a href="https://www.who.int/teams/global-influenza-programme/vaccines/who-recommendations">reviewed</a> twice each year by the World Health Organization (WHO), which selects vaccine strains to match the next season’s predicted circulating strains. All current influenza vaccines in <a href="https://www.tga.gov.au/resources/publication/meeting-statements/aivc-recommendations-composition-influenza-vaccines-australia-2024">Australia</a> contain four different strains (known as quadrivalent vaccines). One of the strains appeared to <a href="https://www.nejm.org/doi/full/10.1056/NEJMp2314801">disappear</a> during the COVID pandemic, and the WHO has recently <a href="https://cdn.who.int/media/docs/default-source/influenza/who-influenza-recommendations/vcm-southern-hemisphere-recommendation-2024/202309_qanda_recommendation.pdf?sfvrsn=7a6906d1_5">recommended</a> dropping this strain from the vaccine. It’s expected trivalent (three strain) vaccines will become available in the near future. <h2>What’s different about new flu vaccines?</h2> There are eight brands of flu vaccines <a href="https://www.health.gov.au/resources/publications/atagi-statement-on-the-administration-of-seasonal-influenza-vaccines-in-2024?language=en">available</a> in Australia in 2024. These include egg-based vaccines (Vaxigrip Tetra, Fluarix Tetra, Afluria Quad, FluQuadri and Influvac Tetra), cell-based vaccines (Flucelvax Quad), adjuvanted vaccines (Fluad Quad) and high-dose vaccines (Fluzone High-Dose Quad). Until recently, the process of manufacturing flu vaccines has remained similar. Since the development of the influenza vaccine in the <a href="https://www.who.int/news-room/spotlight/history-of-vaccination/history-of-influenza-vaccination">1940s</a>, influenza viruses were grown in chicken eggs, then extracted, inactivated, purified and processed to make up the egg-based vaccines that are still used widely. However, there have been several enhancements to influenza vaccines in recent years. Older people’s immune systems tend not to respond as strongly to vaccines. In some flu vaccines, adjuvants (components that stimulate the immune system) are included with the influenza antigens. For example, an adjuvant is used in the Fluad Quad vaccine, recommended for over 65s. Studies <a href="https://ncirs.org.au/sites/default/files/2021-02/Adjuvanted%20influenza%20vaccine%20vs%20standard%20dose%20influenza%20vaccine%20SoF%20EP%20E2D%20tables_26%20Feb%202021_Final.pdf">suggest</a> adjuvanted influenza vaccines are slightly better than standard egg-based vaccines without adjuvant in older people. An alternative approach to improving the immune response is to use higher doses of the vaccine strains. An example is Fluzone High-Dose Quad – another option for older adults – which contains the equivalent of four doses of a standard influenza vaccine. Studies <a href="https://ncirs.org.au/sites/default/files/2022-05/HD%20vs%20sIV%20SoF%20EP%20E2D_March%202022_Final.pdf">suggest</a> the high dose vaccine is better than the standard dose vaccine (without an adjuvant) in preventing hospitalisation and complications in older people. Other manufacturers have updated the manufacturing process. Cell-based vaccines, such as Flucelvax Quad, use cells instead of eggs in the manufacturing process. Other vaccines that are <a href="https://www.cdc.gov/flu/prevent/advances.htm">not yet available</a> also use different technologies. In the past, <a href="https://pubmed.ncbi.nlm.nih.gov/31151913/">manufacturing issues</a> with egg-based vaccines have reduced their effectiveness. Using an alternative method of production provides some degree of insurance against this in the future. <h2>What should I do this year?</h2> Given indications this year’s flu season may be earlier than usual, it’s probably safest to get your vaccine early. This is particularly <a href="https://www.health.gov.au/resources/publications/atagi-statement-on-the-administration-of-seasonal-influenza-vaccines-in-2024?language=en">important</a> for those at highest risk of severe illness, including older adults (65 years and over), those with chronic medical conditions, young children (six months to five years) and Aboriginal and Torres Strait Islander people. Influenza vaccines are also recommended in pregnancy to protect both the mother and the baby for the first months of life. Influenza vaccines are widely available, including at GP clinics and pharmacies, while many workplaces have occupational programs. For high-risk groups, <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">four of the vaccines</a> are subsidised by the Australian government through the <a href="https://www.health.gov.au/our-work/national-immunisation-program">National Immunisation Program</a>. In older people, a number of vaccines are now recommended: <a href="https://www.health.gov.au/sites/default/files/2024-03/atagi-statement-on-the-administration-of-covid-19-vaccines-in-2024.pdf">COVID</a> and influenza, as well as one-off courses of <a href="https://www.health.gov.au/sites/default/files/documents/2020/06/national-immunisation-program-pneumococcal-vaccination-schedule-from-1-july-2020-clinical-advice-for-vaccination-providers.pdf">pneumococcal</a> and <a href="https://www.health.gov.au/topics/immunisation/vaccines/shingles-herpes-zoster-immunisation-service">shingles</a> vaccines. In general, most vaccines can be given in the same visit, but talk to your doctor about which ones you need. <h2>Are there side effects?</h2> All influenza vaccines can <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">cause</a> a sore arm and sometimes more generalised symptoms such as fever and tiredness. These are expected and reflect the immune system reacting appropriately to the vaccine, and are mostly mild and short-term. These side effects are slightly more common in <a href="https://ncirs.org.au/sites/default/files/2021-02/Adjuvanted%20influenza%20vaccine%20vs%20standard%20dose%20influenza%20vaccine%20SoF%20EP%20E2D%20tables_26%20Feb%202021_Final.pdf">adjuvanted</a> and <a href="https://ncirs.org.au/sites/default/files/2022-05/HD%20vs%20sIV%20SoF%20EP%20E2D_March%202022_Final.pdf">high dose</a> vaccines. As with all medications and vaccines, allergic reactions such as anaphylaxis can occur after the flu vaccine. All vaccine providers are trained to recognise and respond to anaphylaxis. People with egg allergies should discuss this with their doctor, but in general, <a href="https://www.allergy.org.au/patients/food-allergy/egg-allergy-flu-vaccine">studies suggest</a> they can safely receive any (including egg-based) influenza vaccines. Serious side effects from the influenza vaccine, such as Guillain-Barré syndrome, a neurological complication, are very rare (one case per million people vaccinated). They are <a href="https://pubmed.ncbi.nlm.nih.gov/23810252/">thought</a> to be less common after influenza vaccination than after infection with influenza.<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/226623/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/allen-cheng-94997">Allen Cheng</a>, Professor of Infectious Diseases, <a href="https://theconversation.com/institutions/monash-university-1065">Monash 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/there-are-new-flu-vaccines-on-offer-for-2024-should-i-get-one-what-do-i-need-to-know-226623">original article</a>.

Body

Does British tourism really need the royal family?

<a href="https://theconversation.com/profiles/ross-bennett-cook-1301368">Ross Bennett-Cook</a>, <a href="https://theconversation.com/institutions/university-of-westminster-916">University of Westminster</a> Love them or loathe them, the royal family are up there with red telephone boxes and scones when it comes to images of Britishness. Souvenir shops are full of their faces, newspapers across the world discuss them, and <a href="https://www.euronews.com/culture/2022/09/13/netflixs-the-crown-skyrockets-in-popularity-following-the-queens-death">television dramas</a> based on their lives have never been more popular. Whenever people are critical of the royal family, the oft-repeated retort is “but think of the tourism!”. This has been particularly common rhetoric recently, as <a href="https://www.independent.co.uk/life-style/royal-family/who-paid-for-coronation-b2334669.html">many people question</a> how a country facing mass strikes and a crippling cost of living crisis can afford the estimated <a href="https://www.lbc.co.uk/news/explained/how-much-king-charles-iii-coronation-cost-who-pays-for-it/">£100 million</a> cost of King Charles III’s coronation. In a recent <a href="https://yougov.co.uk/topics/arts/survey-results/daily/2023/04/18/25178/3">YouGov poll</a>, 51% did not believe the coronation should be paid for by taxpayers. For young people, this figure was even higher, at 62%. But supporters will often use <a href="https://www.independent.co.uk/news/charles-iii-ap-coronation-buckingham-palace-elizabeth-ii-b2326220.html">tourism</a> as justification for lavish expenses. The royal family does bring tourism to the UK. The economic consultancy Centre for Economics and Business Research <a href="https://cebr.com/reports/uk-economy-raises-a-glass-to-337-million-coronation-boost-from-tourism-and-pub-activity/">estimated</a> that the coronation weekend would lead to a £337 million boost from tourism and pub spending. But if the royal family were to disappear, would the UK’s tourism industry suddenly implode? 2011 research by <a href="https://webarchive.nationalarchives.gov.uk/ukgwa/20140722183820/http://www.visitbritain.org/mediaroom/archive/2011/vbrwwedding.aspx">Visit Britain</a> found that around 60% of tourists to the UK are likely to visit places associated with the royal family. While there is no more recent specifically royal data, in 2022 Visit Britain found that history and heritage was the biggest <a href="https://www.visitbritain.org/MIDAS-research-project">pull factor to tourists</a>. And while the <a href="https://journals.sagepub.com/doi/10.1177/1468797606071477">international perception</a> of Britain is certainly intertwined with the royal family, this does not tell us whether a reigning royal family is necessary for tourism. After all, the history surrounding the monarchy and places associated with them would still be here even if the royal family was not. Ottoman palaces of Istanbul remain <a href="https://edition.cnn.com/travel/article/most-visited-castles-palaces/index.html">wildly popular</a> attractions 100 years since the collapse of the caliphate, as are the royal châteaus of France or imperial palaces of China. Lack of royalty does not seem to have affected these countries’ appeal, each of which attract <a href="https://www.e-unwto.org/doi/epdf/10.18111/wtobarometereng.2020.18.1.7">more tourists</a> annually than the UK. <h2>A special relationship</h2> The USA is the UK’s <a href="https://www.visitbritain.org/inbound-tourism-trends-old">largest tourist market</a>, and <a href="https://www.telegraph.co.uk/royal-family/2023/05/05/coronation-american-tourists-britain-boom-royal-family-usa/">American tourists</a> do seem to be very fond of things associated with British royalty. But this may change with the new monarch. In a <a href="https://today.yougov.com/topics/entertainment/articles-reports/2021/02/17/british-royals-popular-america-poll">poll taken in February 2021</a>, before the death of Queen Elizabeth II, a whopping 68% of Americans viewed her favourably. The same poll found only 34% had a favourable opinion of Charles – but this has changed in his favour following his accession to the throne, according to a <a href="https://today.yougov.com/topics/international/articles-reports/2023/05/05/americans-think-british-royal-family-charles">poll taken before the coronation</a> which gave him a 50% approval rating in the US. That said, 62% of people in the US said they did not care about the coronation very much or at all. Outside America, the UK’s next largest tourist groups have significantly less interest in the royal family. The holiday firm <a href="https://www.traveldailymedia.com/study-reveals-importance-of-royal-family-to-uk-tourism-industry/">Travelzoo</a> found in 2016 that just 19% of German, 15% of French and only 10% of Spanish travellers want to come to the UK because of the British monarchy. <h2>Where do tourists go?</h2> Typically, when commentators discuss the royal contributions to tourism, they talk about significant events such as weddings, jubilees, coronations and funerals. Even though these events attract huge crowds, they happen rarely and are unrepresentative of the tourism industry as a whole. Research <a href="https://journals.sagepub.com/doi/10.1177/13548166211004361">has found</a> that royal weddings massively improve a country’s image and brand awareness, but are not comparable to major mega events such as the Fifa World Cup, the Super Bowl or the Olympics. Even though royal places are popular, they are far from our most popular attractions. Of Britain’s <a href="https://www.visitbritain.org/annual-survey-visits-visitor-attractions-latest-results">ten most visited</a> free and paid-for attractions in 2021, none were royal attractions. The <a href="https://www.visitbritain.org/sites/default/files/vb-corporate/top_20_listings.pdf">highest ranking</a> royal attraction was the Tower of London, making only 17th on the list. Typically, Chester Zoo attracts more visitors than Windsor Castle or Buckingham Palace, although these statistics do not differentiate between domestic and international tourists. In the most recent <a href="https://www.windsor.gov.uk/dbimgs/Windsor%202017%20Visitor%20Survey%20final%20report%2028_11_17.pdf">Windsor visitor survey</a>, the majority of its tourists came from overseas. Anti-monarchy group <a href="https://www.republic.org.uk/tourism">Republic</a> has disputed the widely cited figure that the monarchy generates £500 million in tourism income for the UK annually – which itself would be only a small fraction of Britain’s £127 billion tourism economy. The group also questions why royalty <a href="https://www.youtube.com/watch?v=9hL9yDOK48A">barely feature</a> on British tourism campaigns or advertisements, if they are so vital to the tourism economy. It is impossible to deny that royalty adds to the UK’s appeal as a tourist destination – the history and associated heritage is famous worldwide. However, what is questionable is whether a reigning monarchy is necessary for this attractiveness to continue.<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/205158/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/ross-bennett-cook-1301368">Ross Bennett-Cook</a>, Visiting Lecturer, School of Architecture + Cities, <a href="https://theconversation.com/institutions/university-of-westminster-916">University of Westminster</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/does-british-tourism-really-need-the-royal-family-205158">original article</a>.

International Travel

Why do I need to get up during the night to wee? Is this normal?

<a href="https://theconversation.com/profiles/christian-moro-121754">Christian Moro</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> and <a href="https://theconversation.com/profiles/charlotte-phelps-1187658">Charlotte Phelps</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> It can be normal to wake up once or even twice during the night to wee, especially as we get older. One in three adults over 30 makes <a href="https://pubmed.ncbi.nlm.nih.gov/30085529">at least two</a> trips to the bathroom every night. Waking up from sleep to urinate on a regular basis is called <a href="https://www.ncbi.nlm.nih.gov/books/NBK518987/">nocturia</a>. It’s one of the most commonly reported <a href="https://pubmed.ncbi.nlm.nih.gov/32249998/">bothersome urinary symptoms</a> (others include urgency and poor stream). So what causes nocturia, and how can it affect wellbeing? <h2>A range of causes</h2> Nocturia can be caused by a variety of <a href="https://www.health.gov.au/sites/default/files/nocturia-going-to-the-toilet-at-night_0.pdf">medical conditions</a>, such as heart or kidney problems, poorly controlled diabetes, bladder infections, an <a href="https://www.nature.com/articles/s41598-023-44916-8">overactive bladder</a>, or gastrointestinal issues. Other causes include pregnancy, <a href="https://onlinelibrary.wiley.com/doi/10.1002/nau.24839">medications</a> and consumption of alcohol or caffeine before bed. While nocturia causes disrupted sleep, the reverse is true as well. Having broken sleep, or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4055528/">insomnia</a>, can also cause nocturia. When we sleep, an antidiuretic hormone is released that slows down the rate at which our <a href="https://theconversation.com/is-urine-sterile-do-urine-therapies-work-experts-debunk-common-pee-myths-191862">kidneys produce urine</a>. If we lie awake at night, less of this hormone <a href="https://journals.physiology.org/doi/full/10.1152/ajprenal.00025.2023">is released</a>, meaning we continue to produce normal rates of urine. This can accelerate the rate at which we fill our bladder and need to get up during the night. Stress, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153377/">anxiety</a> and watching television <a href="https://www.ncbi.nlm.nih.gov/books/NBK518987">late into the night</a> are common causes of insomnia. <h2>Effects of nocturia on daily functioning</h2> The recommended amount of sleep for adults is between <a href="https://www.nhlbi.nih.gov/health/sleep/how-much-sleep">seven and nine hours</a> per night. The more times you have to get up in the night to go to the bathroom, the more this impacts <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3602727/#:%7E:text=Nocturia%20is%2C%20however%2C%20an%20important,(QoL)%20and%20general%20health.">sleep quantity and quality</a>. Decreased sleep can result in increased <a href="https://hqlo.biomedcentral.com/articles/10.1186/s12955-019-1251-5">tiredness</a> during the day, poor concentration, forgetfulness, changes in mood and impaired <a href="https://pubmed.ncbi.nlm.nih.gov/28425062/">work performance</a>. If you’re missing out on quality sleep due to nighttime trips to the bathroom, this can affect your quality of life. In more severe cases, nocturia has been compared to having a similar impact on <a href="https://www.racgp.org.au/getattachment/b43c05ba-e29e-47c3-b816-ec47ceeafe97/Nocturia-a-guide-to-assessment-and-management.aspx">quality of life</a> as diabetes, high blood pressure, chest pain, and some forms of arthritis. Also, frequent disruptions to quality and quantity of sleep can have longer-term health impacts. Nocturia not only upsets sleep, but also increases the risk of <a href="https://www.auajournals.org/doi/10.1097/JU.0000000000000459">falls</a> from moving around in the dark to go to the bathroom. Further, it can affect sleep partners or others in the household who may be disturbed when you get out of bed. <h2>Can you have a ‘small bladder’?</h2> It’s a common misconception that your trips to the bathroom are correlated with the size of your bladder. It’s also unlikely your bladder is <a href="https://youtu.be/blVmyrBPves">smaller</a> relative to your other organs. If you find you are having to wee more than your friends, this could be due to body size. A smaller person drinking the same amount of fluids as someone larger will simply need to go the bathroom more often. <figure><iframe src="https://www.youtube.com/embed/blVmyrBPves?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>Can you have a small bladder?</figcaption></figure> If you find you are going to the bathroom quite a lot during the day and evening (<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5903463/">more than eight times</a> in 24 hours), this could be a symptom of an overactive bladder. This often presents as frequent and sudden urges to urinate. If you are concerned about any lower urinary tract symptoms, it’s worth having a chat with your family GP. There are some medications that can assist in the management of nocturia, and your doctor will also be able to help identify any underlying causes of needing to go to the toilet during the night. <h2>A happy and healthy bladder</h2> Here are some tips to maintain a happy and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3206217/">healthy</a> bladder, and reduce the risk you’ll be up at night: <ul> <li> make your <a href="https://theconversation.com/what-position-should-i-sleep-in-and-is-there-a-right-way-to-sleep-189873">sleep environment comfortable</a>, with a suitable mattress and sheets to suit the temperature </li> <li> get to bed early, and limit <a href="https://www.ncbi.nlm.nih.gov/books/NBK518987/">screens</a>, or activites before bed </li> <li> limit foods and drinks that irritate the bladder, such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9811496/">coffee or alcohol</a>, especially before bedtime </li> <li> sit in a <a href="https://theconversation.com/does-it-matter-if-you-sit-or-stand-to-pee-and-what-about-peeing-in-the-shower-206869">relaxed position</a> when urinating, and allow time for the bladder to completely empty </li> <li> practice <a href="https://www.continence.org.au/about-continence/continence-health/pelvic-floor">pelvic floor muscle exercises</a> </li> <li> drink an adequate amount of fluids during the day, and avoid becoming <a href="https://www.health.gov.au/sites/default/files/nocturia-going-to-the-toilet-at-night_0.pdf">dehydrated</a> </li> <li> maintain a healthy lifestyle, eat <a href="https://journals.physiology.org/doi/full/10.1152/advan.00052.2023">nutritious foods</a> and do not do anything harmful to the body such as smoking or using illicit drugs </li> <li> review your medications, as the time you take some <a href="https://www.health.gov.au/sites/default/files/nocturia-going-to-the-toilet-at-night_0.pdf">pharmaceuticals</a> may affect urine production or sleep </li> <li> if you have <a href="https://pubmed.ncbi.nlm.nih.gov/28675633/">swollen legs</a>, raise them a few hours before bedtime to let the <a href="https://www.racgp.org.au/afp/2012/june/nocturia-a-guide-to-assessment-and-management">fluid drain</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/224160/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> </li> </ul> <a href="https://theconversation.com/profiles/christian-moro-121754">Christian Moro</a>, Associate Professor of Science & Medicine, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> and <a href="https://theconversation.com/profiles/charlotte-phelps-1187658">Charlotte Phelps</a>, Senior Teaching Fellow, Medical Program, <a href="https://theconversation.com/institutions/bond-university-863">Bond 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/why-do-i-need-to-get-up-during-the-night-to-wee-is-this-normal-224160">original article</a>.

Body

Why and how often do I need to wash makeup brushes and sponges?

<a href="https://theconversation.com/profiles/enzo-palombo-249510">Enzo Palombo</a>, <a href="https://theconversation.com/institutions/swinburne-university-of-technology-767">Swinburne University of Technology</a> and <a href="https://theconversation.com/profiles/rosalie-hocking-1428271">Rosalie Hocking</a>, <a href="https://theconversation.com/institutions/swinburne-university-of-technology-767">Swinburne University of Technology</a> From the bristles of brushes to the porous surfaces of sponges, your makeup kit can harbour a host of bacteria and fungi. These potentially hazardous contaminants can originate not only from the cosmetics themselves, but also from the very surface of our skin. So, how can we keep things hygienic and avoid microbial growth on makeup brushes and sponges? Here’s what you need to know. <h2>How do germs and fungi get in my brushes and sponges?</h2> Germs and fungi can make their way into your makeup kit in lots of ways. Ever flushed a toilet with the lid open with your makeup brushes nearby? There’s a good chance <a href="https://theconversation.com/mobile-phones-are-covered-in-germs-disinfecting-them-daily-could-help-stop-diseases-spreading-135318">faecal particles</a> have landed on them. Perhaps a family member or housemate has used your eyeshadow brush when you weren’t looking, and transferred some microbes across in the process. Bacteria that trigger a pimple outbreak can be easily transferred from the surface of your skin to a makeup brush or sponge. And tiny little mites called Demodex mites, which have been linked to certain rashes and acne, live on your skin, as well, and so may end up in your sponge or brushes. Bacterial contamination of <a href="https://pubmed.ncbi.nlm.nih.gov/38020232/">lip cosmetics</a>, in particular, can pose a risk of skin and eye infections (so keep that in mind if you use lip brushes). Lipsticks are frequently contaminated with bacteria such as Staphylococcus aureus, E. coli, and Streptococcus pneumoniae. Low-quality cosmetics are more likely to have higher and more diverse microbial growth compared to <a href="https://www.sciencedirect.com/science/article/pii/S1319562X23002978?pes=vor">high-quality cosmetics</a>. Brushes exposed to sensitive areas like the eyes, mouth and nose are particularly susceptible to being potential sources of infection. The range of conditions caused by these microorganisms includes: <ul> <li> abscesses </li> <li> skin and soft tissue infections </li> <li> skin lesions </li> <li> rashes </li> <li> and dermatitis. </li> </ul> In severe cases, infections can lead to invasion of the bloodstream or deep tissues. Commercially available cosmetics contain varying amounts and types of preservatives aimed at inhibiting the growth of fungi and bacteria. But when you apply makeup, different cosmetics with unique formulations of preservatives can become mixed. When a preservative meant for one product mixes with others, it might not work as well because they have different water amounts or pH levels. So preservatives are not foolproof. We also need to observe good hygiene practices when it comes to brushes and other cosmetics applicators. <h2>Keeping brushes clean</h2> Start with the basics: never <a href="https://www.semanticscholar.org/paper/Isolation-of-Pathogenic-Microbes-from-Beauty-Salons-Hassan-Hamad/0199635290628fe326fcd04a2b8a2422884a8240">share makeup brushes or sponges</a>. Everyone carries different microbes on their skin, so sharing brushes and sponges means you are also sharing germs and fungi. If you need to share makeup, use something disposable to apply it, or make sure any shared brushes are washed and sterilised before the next person uses it. Clean makeup brushes by washing with hot soapy water and rinsing thoroughly. How often? Stick to a cleaning routine you can repeat with consistency (as opposed to a deep clean that is done annually). <a href="https://www.aad.org/public/everyday-care/skin-care-secrets/routine/clean-your-makeup-brushes#:%7E:text=To%20protect%20your%20skin%20and,every%207%20to%2010%20days.">Once a week</a> might be a good goal for some, while others may need to wash more regularly if they are heavy users of makeup. Definitely wash straight away if someone else has used your brushes or sponges. And if you’ve had an eye infection such as conjunctivitis, ensure you clean applicators thoroughly after the infection has resolved. You can use bactericidal soap, 70% ethanol or chlorhexidine solutions to wash. Just make sure you wash very thoroughly with hot water after, as some of these things can irritate your skin. (While some people online say alcohol can degrade brushes and sponges, opinion seems to be mixed; in general, most disinfectants are unlikely to cause significant corrosion.) For some brushes, heating or steaming them and letting them dry may also be an effective sterilisation method once they are washed with detergent. Microwaving sponges isn’t a good idea because while the heat generated by a domestic microwave would kill microbes, it would need temperatures approaching 100°C for a decent period of time (at least several minutes). The heat could melt some parts of the sponge and hot materials could be a scalding hazard. Once clean, ensure brushes and sponges are stored in a dry place away from water sources (and not near an open toilet). If you’re having makeup applied professionally, brushes and applicators should be sterilised or changed from person to person. <h2>Should I wash them with micellar water?</h2> No. Not only is this expensive, it’s unnecessary. The same benefits can be achieved with cheaper detergents or alcohol (just rinse brushes carefully afterwards). Disinfection methods such as using bactericidal soap, 70% ethanol, or chlorhexidine are all very good at reducing the amount of microbes on your brushes and sponges.<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/220280/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/enzo-palombo-249510">Enzo Palombo</a>, Professor of Microbiology, <a href="https://theconversation.com/institutions/swinburne-university-of-technology-767">Swinburne University of Technology</a> and <a href="https://theconversation.com/profiles/rosalie-hocking-1428271">Rosalie Hocking</a>, <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/why-and-how-often-do-i-need-to-wash-makeup-brushes-and-sponges-220280">original article</a>.

Beauty & Style

How much weight do you actually need to lose? It might be a lot less than you think

<a href="https://theconversation.com/profiles/nick-fuller-219993">Nick Fuller</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> If you’re one of the <a href="https://www.finder.com.au/new-years-resolutions-statistics">one in three</a> Australians whose New Year’s resolution involved losing weight, it’s likely you’re now contemplating what weight-loss goal you should actually be working towards. But type “setting a weight loss goal” into any online search engine and you’ll likely be left with more questions than answers. Sure, the many weight-loss apps and calculators available will make setting this goal seem easy. They’ll typically use a body mass index (BMI) calculator to confirm a “healthy” weight and provide a goal weight based on this range. Your screen will fill with trim-looking influencers touting diets that will help you drop ten kilos in a month, or ads for diets, pills and exercise regimens promising to help you effortlessly and rapidly lose weight. Most sales pitches will suggest you need to lose substantial amounts of weight to be healthy – making weight loss seem an impossible task. But the research shows you don’t need to lose a lot of weight to achieve health benefits. <h2>Using BMI to define our target weight is flawed</h2> We’re a society fixated on numbers. So it’s no surprise we use measurements and equations to score our weight. The most popular is BMI, a measure of our body weight-to-height ratio. BMI classifies bodies as underweight, normal (healthy) weight, overweight or obese and can be a useful tool for weight and health screening. But it shouldn’t be used as the single measure of what it means to be a healthy weight when we set our weight-loss goals. This is <a href="https://theconversation.com/using-bmi-to-measure-your-health-is-nonsense-heres-why-180412">because</a> it: <ul> <li> fails to consider two critical factors related to body weight and health – body fat percentage and distribution </li> <li> does not account for significant differences in body composition based on gender, ethnicity and age. </li> </ul> <h2>How does losing weight benefit our health?</h2> Losing just 5–10% of our body weight – between 6 and 12kg for someone weighing 120kg – can significantly improve our health in four key ways. 1. Reducing cholesterol Obesity increases the chances of having too much low-density lipoprotein (LDL) cholesterol – also known as bad cholesterol – because carrying excess weight changes how our bodies produce and manage lipoproteins and triglycerides, another fat molecule we use for energy. Having too much bad cholesterol and high triglyceride levels is not good, narrowing our arteries and limiting blood flow, which increases the risk of heart disease, heart attack and stroke. But <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4987606/">research</a> shows improvements in total cholesterol, LDL cholesterol and triglyceride levels are evident with just 5% weight loss. 2. Lowering blood pressure Our blood pressure is considered high if it reads more than 140/90 on at least two occasions. Excess weight is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082272/">linked to</a> high blood pressure in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082272/">several ways</a>, including changing how our sympathetic nervous system, blood vessels and hormones regulate our blood pressure. Essentially, high blood pressure makes our heart and blood vessels work harder and less efficiently, damaging our arteries over time and increasing our risk of heart disease, heart attack and stroke. Like the improvements in cholesterol, a 5% weight loss <a href="https://onlinelibrary.wiley.com/doi/10.1002/oby.21358">improves</a> both systolic blood pressure (the first number in the reading) and diastolic blood pressure (the second number). A <a href="https://www.ahajournals.org/doi/10.1161/01.hyp.0000094221.86888.ae">meta-analysis of 25 trials</a> on the influence of weight reduction on blood pressure also found every kilo of weight loss improved blood pressure by one point. 3. Reducing risk for type 2 diabetes Excess body weight is the primary manageable risk factor for type 2 diabetes, particularly for people carrying a lot of visceral fat around the abdomen (belly fat). Carrying this excess weight can cause fat cells to release pro-inflammatory chemicals that disrupt how our bodies regulate and use the insulin produced by our pancreas, leading to high blood sugar levels. Type 2 diabetes can lead to serious medical conditions if it’s not carefully managed, including damaging our heart, blood vessels, major organs, eyes and nervous system. <a href="https://www.nejm.org/doi/full/10.1056/nejmoa012512">Research</a> shows just 7% weight loss reduces risk of developing type 2 diabetes by 58%. 4. Reducing joint pain and the risk of osteoarthritis Carrying excess weight can cause our joints to become inflamed and damaged, making us more prone to osteoarthritis. <a href="https://pubmed.ncbi.nlm.nih.gov/21425246/">Observational studies</a> show being overweight doubles a person’s risk of developing osteoarthritis, while obesity increases the risk fourfold. Small amounts of weight loss alleviate this stress on our joints. <a href="https://pubmed.ncbi.nlm.nih.gov/15986358/">In one study</a> each kilogram of weight loss resulted in a fourfold decrease in the load exerted on the knee in each step taken during daily activities. <h2>Focus on long-term habits</h2> If you’ve ever tried to lose weight but found the kilos return almost as quickly as they left, you’re not alone. An <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/">analysis</a> of 29 long-term weight-loss studies found participants regained more than half of the weight lost within two years. Within five years, they regained more than 80%. When we lose weight, we take our body out of its comfort zone and trigger its survival response. It then counteracts weight loss, triggering several <a href="https://pubmed.ncbi.nlm.nih.gov/25896063/">physiological responses</a> to defend our body weight and “survive” starvation. Just as the problem is evolutionary, the solution is evolutionary too. Successfully losing weight long-term comes down to: <ul> <li> losing weight in small manageable chunks you can sustain, specifically periods of weight loss, followed by periods of weight maintenance, and so on, until you achieve your goal weight </li> <li> making gradual changes to your lifestyle to ensure you form habits that last a lifetime. </li> </ul> Setting a goal to reach a healthy weight can feel daunting. But it doesn’t have to be a pre-defined weight according to a “healthy” BMI range. Losing 5–10% of our body weight will result in immediate health benefits. At the Boden Group, Charles Perkins Centre, we are studying the science of obesity and running clinical trials for weight loss. You can <a href="https://redcap.sydney.edu.au/surveys/?s=RKTXPPPHKY">register here</a> to express your interest.<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/217287/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/nick-fuller-219993">Nick Fuller</a>, Charles Perkins Centre Research Program Leader, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</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-much-weight-do-you-actually-need-to-lose-it-might-be-a-lot-less-than-you-think-217287">original article</a>.

Body

14 personal finance tips you were never taught – but need to know

Take a day to think about large purchases to avoid impulse buys “Delaying your purchases for a day gives you time to think about whether or not you really need the items, and it curbs regrettable impulse buys,” advises Marc Diana, CEO of MoneyTips. “Sale items may be an exception to this rule, but even then, question how badly you need the item compared to saving or investing the money you would use to purchase it. When times are tough, and you’re cutting expenses, would you rather have a rarely worn $300 pair of shoes or $300 cash?” Budgets are freeing, not constricting Says financial educator Tiffany Aliche, “Keeping a budget allows you to say yes to your goals in a strategic way. If you have a budget, you can save for the holiday, house or car you want to get. You can look at it as ‘No dining out,’ but I see it as ‘Yes to a trip to Paris.’ A budget is not a NO plan, but a YES plan with actual steps towards achieving your goals.” Budget with the 50/20/30 rule Lynn Toomey, co-founder of Your Retirement Advisor, suggests following this easy budgeting rule: Use 50 per cent of your income for non-discretionary necessities like food, rent/house payment, utilities, and transportation. Put aside 20 per cent of your income for an emergency fund (three to six months’ salary is a good target), retirement, savings, and to pay off any debts. Use 30 per cent of your income for discretionary (non-essential) spending such as entertainment, holidays and gifts. Penny-pinching is not the road to wealth Spending less doesn’t mean you’ll have more. Saving is a good way to stabilise your finances, but you still need to invest. “Pretend there are two islands,” advises Aliche, who is also known as The Budgetnista: “Financially Stuck Island and Wealthy Island.” She says that your savings can be like a car – you can’t drive off Financially Stuck Island without a bridge. Investing is the bridge to financial success. “To get from one island to another, you need to get in your savings car and drive it over your investment bridge.” It’s OK to put yourself before your kids Many people want their kids to go to university, says Aliche, “but it’s more important for you to save enough for retirement. Because the best gift you can give your child is not a free ride to school, but rather not to be a financial burden on them when it’s time to start their own family. Kids can get student loans; no one is going to lend you money without collateral when you’re retired.” Financial advisors aren’t only for wealthy people Millions of people have trillions invested in stocks, bonds, mutual funds and other stock exchange investments, but just because you can easily make trades yourself doesn’t mean you should. “Why not do what you do best to earn money and let a trained professional invest it for you?” asks Brian Saranovitz, president of Your Retirement Advisor. “A recent Vanguard Investments study indicated that integrating proper retirement strategies can add as much as 3 per cent efficient return to a retirement portfolio.” Adds Aliche, “You need to purposefully seek out knowledge. If you break a leg, you know that you need to go to a doctor. With personal finance, people have got the notion that they could just fix it themselves. When it comes to investing, don’t be afraid to seek professional help.” Get a clear picture of yourself at 80 Barring tragedy, you will live to a ripe, old age. Aliche recommends naming your 80-year-old image of yourself. “Mine is Wanda. I imagine Wanda sitting on the front steps in her yard. People feel disconnected from their older self. The more you can picture her, the better. I don’t want to see her mopping floors at 80. When I’m making a decision, I think, ‘How will this affect Wanda?’ If I dip into my retirement funds to buy an expensive car, that’s going to hurt Wanda.” If it’s easier, pretend you’re living with your grandfather or grandmother. “You’re not going to tell Granny, ‘You have to go to work. We need the money,’” she says. You can never have too much retirement savings Says Lynn Toomey, co-founder of Your Retirement Advisor, “Life is good. Retirement is better, if you are prepared.” She points out that retirement is laden with potential costs, such as healthcare, longevity, market volatility and inflation. “Even if you think you’re saving enough and have assets, it still may not be enough. The earlier you start saving and investing, the longer compound interest can work its magic to help you achieve a successful retirement.” Don’t blow your tax refund “What are you planning on doing with your tax refund?” asks financial advisor Mike Zaino. “If you’re like most people, the world of instant gratification is beckoning. It could be extremely damaging to your retirement account, however, especially given the time value of money and what Albert Einstein called ‘The eighth wonder of the world” – compound interest.” Ask current lenders for a better rate “Banks, credit unions and other lenders are keenly aware of their competition,” says Diana of MoneyTips.com. “If your credit score qualifies you for a better rate from another credit card issuer or lender, ask them to match the rate. There’s no downside to asking; the worst they could do is refuse.” Asking for your credit limit to be raised can improve your credit score Keep your credit utilisation – the amount of credit you use compared to your credit limit – low to boost your all-important credit, advises Diana. “You can borrow less, or you can ask for a raise in your credit limit.” A recent study from CreditCards.com found that only 28 per cent of respondents have never asked for an increase in their credit limit. However, a whopping 89 per cent of those who asked for a credit limit increase received one. Unless they have a high annual fee, don’t close your old credit cards “The longer your stable credit history, the better it reflects on your credit score,” explains Diana. “The age of accounts is averaged over all of your credit accounts, so closing an older account that is infrequently used actually harms your credit score in two ways: it lowers your credit limit, which raises your credit utilisation; and it lowers your average account age. If you have an old card with a decent credit limit, use it at least annually to keep it open. But don’t forget to pay the bill on time!” Don’t ever co-sign a loan “Co-signing a loan isn’t just vouching for someone’s character,” explains Toomey. “Understand that if the borrower doesn’t pay, then you’re responsible for every single missed payment. If they don’t pay, it’s your credit that will be ruined.” Being debt-free should not be your goal Says Aliche, creator of the Live Richer Challenge, “People focus on getting out of debt. If they use that money to grow wealth instead of getting rid of debt, they could be debt-free faster. Do you pay off your student loans to get debt-free, or invest money in your business to grow and secure wealth for yourself? If you focus on being debt-free, that’s all you’ll be. If you focus on building wealth, then you can be wealthy and debt-free.” Image credits: Getty Images This article originally appeared on <a href="https://www.readersdigest.co.nz/food-home-garden/money/14-personal-finance-tips-you-were-never-taught-but-need-to-know?pages=1" target="_blank" rel="noopener">Reader's Digest</a>.

Money & Banking

What does a building need to call itself ‘accessible’ – and is that enough?

<a href="https://theconversation.com/profiles/ilan-wiesel-303040">Ilan Wiesel</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> and <a href="https://theconversation.com/profiles/rebecca-bentley-173502">Rebecca Bentley</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> The <a href="https://www.ndisreview.gov.au/resources/reports/working-together-deliver-ndis">National Disability Insurance Scheme (NDIS) review</a> and the disability royal commission’s <a href="https://disability.royalcommission.gov.au/system/files/2023-09/Final%20Report%20-%20Volume%207%2C%20Inclusive%20education%2C%20employment%20and%20housing%20-%20Part%20C.pdf">final report</a> both highlighted the crucial role of accessible buildings and homes in ensuring the inclusion of people with disabilities. But the experiences of people with disability show Australia is a very long way from achieving this. There are the stories from people with disability who <a href="https://www.abc.net.au/news/2023-06-25/taylor-swift-concert-disability-access-concerns/102520088">can’t enjoy events</a> or <a href="https://www.abc.net.au/news/2023-03-09/harry-styles-concert-disability-tickets-consumer-rights/102060698">venues</a>. And researchers say even <a href="https://www.unsw.edu.au/arts-design-architecture/our-research/research-impact/case-studies/are-our-accessible-bathrooms-inaccessible-to-people-in-wheelchairs">accessible bathrooms are not usable</a> for half the people with disability. What can be called an accessible building or home? And should standards be improved? <h2>What is accessibility?</h2> The <a href="https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-rights-persons-disabilities">Convention on the Rights of Persons with Disability</a> includes the right to accessibility. Australia’s 1992 <a href="https://humanrights.gov.au/our-work/disability-rights/frequently-asked-questions-access-premises">Disability Discrimination Act</a> includes premises standards to ensure people with disability have “dignified, equitable, cost-effective and reasonably achievable access to buildings, facilities and services”. However, a building is exempt if the owners can demonstrate modifying a building would cause them “unjustifiable hardship”. The burden of making a complaint about an inaccessible building falls on people with disability and the act also does not apply to private homes. Although experts follow different definitions of accessibility, they generally include some key principles: <ul> <li> easy entry and exit into a building </li> <li> easy navigation and functionality in and around the building </li> <li> potential for easy adaptation in response to changing needs of occupants. </li> </ul> An accessible building is one where people of all abilities are able move and carry out activities independently, safely, in comfort and with dignity. For people with disabilities <a href="https://disability.unimelb.edu.au/__data/assets/pdf_file/0010/3969109/Accessible-Housing-Research-Report-22-October-2020.pdf">many buildings are inaccessible</a>. In these buildings, basic everyday activities such as taking a shower or preparing breakfast becomes difficult, tiring, uncomfortable and sometimes dangerous. Some people have been <a href="https://disability.unimelb.edu.au/__data/assets/pdf_file/0010/3969109/Accessible-Housing-Research-Report-22-October-2020.pdf">injured</a> repeatedly in inaccessible homes, for example falling down a staircase. Such injuries may compound their disability. Many people with disabilities worry that if they’re injured at home, they will be forced to move permanently into a nursing home. <a href="https://www.sciencedirect.com/science/article/pii/S0016718523001525">Studies</a> have found living in inaccessible homes severely harms the dignity, independence, social inclusion, employment, health and wellbeing of people with disabilities. People become more reliant on family members for support, putting strain on their relationships. Difficulty getting in and out of the house for social activities worsens social isolation. A sense of fatigue also reduces the motivation and capacity to work. <h2>Access through the front door</h2> Dignity is a crucial aspect of accessibility but it is often forgotten. For example, many buildings’ front entry has stairs that make it inaccessible for wheelchair users. There may be an accessible ramp entry in the back of the building. The building is then considered accessible, since wheelchair users can enter and exit. But such a “backdoor treatment” can be experienced as an indignity and discrimination. Accessible toilets are sometimes used for <a href="https://www.sbs.com.au/news/article/most-public-toilets-inaccessible-to-people-with-disabilities/adsx7cnr8">storage, locked or out of order</a>. Again, although the design meets accessibility standards, in practice the building is inaccessible because of poor management. And accessibility is not exclusively about physical disabilities and physical barriers. People with cognitive disabilities, for example, might struggle to find their way in a building if way-finding signs are difficult to understand. <a href="https://theconversation.com/for-people-with-communication-disability-complaining-about-their-treatment-isnt-so-simple-214717">Communication accessibility</a> in building is achieved when the information needed to navigate and use the building is understood by everyone, no matter how they communicate. <h2>Silver, gold and platinum standards</h2> There are different levels of accessibility. In Australia, housing accessibility is most often assessed according to <a href="https://livablehousingaustralia.org.au/wp-content/uploads/2021/02/SLLHA_GuidelinesJuly2017FINAL4.pdf">Livable Housing Australia</a>’s (LHA) three standards of silver, gold and platinum. Silver-level homes have minimal accessibility features, but are designed in a way that enables easy home modifications over time. The silver standard of accessibility requires seven features: • a step-free path of travel from the street or parking area • at least one step-free entrance • internal doors and corridors that allow comfortable movement, including for people using wheelchairs • a toilet on the entry level with easy access • a bathroom with a hobless shower recess, so there isn’t a step-over barrier to entry • reinforced walls around the toilet, shower and bath. These allow installation of grabrails later if needed • stairways designed to reduce the risk of injury and also enable future adaptation. Gold-level homes have additional accessibility features. Platinum homes are designed for people with higher mobility needs and to allow ageing at home. <h2>A patchwork of standards and what the NDIS review says</h2> In 2021 Australian housing ministers <a href="https://www.industry.gov.au/news/building-ministers-meeting-communique-april-2021">agreed for the first time</a> to introduce minimum accessibility standards in the National Construction Code. It followed decades of campaigning by activist groups such as the <a href="https://anuhd.org/">Australian Network for Universal Housing Design</a>, <a href="https://riaustralia.org/">Rights and Inclusion Australia</a> and the <a href="https://www.summerfoundation.org.au/">Summer Foundation</a>. The code requires all new homes be built to silver standards. It does not apply to existing homes and exemptions will apply for some newly built homes because of site restrictions. When the code was introduced, New South Wales and Western Australia announced they would not adopt the new code. Both the NDIS review and the disability royal commission recommended all states and territories <a href="https://disability.royalcommission.gov.au/system/files/2023-09/Final%20Report%20-%20Volume%207%2C%20Inclusive%20education%2C%20employment%20and%20housing%20-%20Part%20C.pdf">immediately adopt</a> the code’s new accessibility standards. A consistent application of the code’s new standards across Australia is a good start. But the code provides only the minimum standard of accessibility. To make buildings and homes truly accessible, we need to improve education on accessibility for designers, operators and consumers. <h2>An urgent national priority</h2> With Australia’s ageing population, most people will experience disability – or have a household member with disability – at some point. Accessible homes and buildings can reduce pressure on the health system and improve quality of life. A consistent national construction code is just the first step urgently needed to improve building accessibility and inclusion so people with disability have autonomy and flourish.<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/217278/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/ilan-wiesel-303040">Ilan Wiesel</a>, Associate Professor in Urban Geography, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> and <a href="https://theconversation.com/profiles/rebecca-bentley-173502">Rebecca Bentley</a>, Professor of Social Epidemiology and Director of the Centre of Research Excellence in Healthy Housing at the Melbourne School of Population and Global Health, <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/what-does-a-building-need-to-call-itself-accessible-and-is-that-enough-217278">original article</a>.

Caring

“I need a future”: New details on boy kidnapped for six years

When concerned motorist Fabien Accidini <a href="https://www.oversixty.co.nz/lifestyle/family-pets/missing-boy-found-alive-after-six-long-years" target="_blank" rel="noopener">happened upon Alex Batty</a> walking along a road in the foothills of the Pyrenees in France, he had no idea of the mysterious and tragic situation he had uncovered. “I said to myself, ‘That’s strange. It’s 3am in the morning, it’s raining, he’s all by himself on the road between two villages,’” Accidini told French news outlet BFMTV. Batty had gone missing from his home in England at the tender age of 11 back in 2017. Now 17, new details have emerged about the extraordinary six-year journey that unfolded since his disappearance. British and French authorities confirmed on Friday that the teenager discovered by Accidini was, indeed, Alex Batty. The initial family holiday to Spain turned into a six-year odyssey across Morocco, Spain and southwest France, as Alex and his family embraced a nomadic, off-the-grid lifestyle. French authorities revealed that Alex and his family moved from house to house, carrying their own solar panels, growing their own food, and living with other families in what the teenager described as a “spiritual community". However, last Wednesday marked a turning point as Alex suddenly appeared on a remote road in rural France, having parted ways with his mother. According to French prosecutor Antoine Leroy, Alex decided to strike out on his own when his mother expressed a desire to move yet again, this time to Finland. Leroy stated at a news conference in Toulouse, “When his mother indicated that she intended to leave for Finland with him, this young man understood that this journey had to stop.” Undeterred by the challenging circumstances, Alex walked for four nights, resting during the days and sustaining himself with whatever he could find in fields or gardens. It was during this solitary journey that Accidini spotted him on the rain-soaked road. Accidini offered assistance, and despite initial suspicion and a false name, Alex eventually opened up during the deliveryman's rounds. “He’d had enough. He said, ‘I am 17. I need a future.’ He didn’t see a future for himself there,” Accidini recounted. In an interview with La Depeche, Accidini shared more details about Alex's arduous journey: “He told me that he had been walking for four days, that he’d left from the mountains. He didn’t really know where.” Showing kindness, Accidini provided the thirsty teenager with water and allowed him to use his mobile phone to send a message to his grandmother. The message read, “Hello grandma, it is me, Alex. I am in France, Toulouse. I really hope that you receive this message. I love you. I want to come home.” Back in the UK, Greater Manchester Police confirmed that Alex had spoken with his grandmother, Susan Caruana, via video call. Assistant Chief Constable Chris Sykes stated, “Whilst she is content that this is indeed Alex, we have further checks to do when he returns to the United Kingdom. “Our main priority now is to see Alex returned home to his family in the UK.” Alex is expected to return to the UK in the coming days, as the investigation into the full circumstances of his disappearance continues. Images: Greater Manchester Police

Family & Pets

Do you really need antibiotics? Curbing our use helps fight drug-resistant bacteria

<a href="https://theconversation.com/profiles/minyon-avent-1486987">Minyon Avent</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a>; <a href="https://theconversation.com/profiles/fiona-doukas-1157050">Fiona Doukas</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/kristin-xenos-1491653">Kristin Xenos</a>, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Antibiotic resistance occurs when a microorganism changes and no longer responds to an antibiotic that was previously effective. It’s <a href="https://thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00502-2/fulltext">associated with</a> poorer outcomes, a greater chance of death and higher health-care costs. In Australia, antibiotic resistance means some patients are admitted to hospital because oral antibiotics are <a href="https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance">no longer effective</a> and they need to receive intravenous therapy via a drip. Antibiotic resistance is rising to high levels in certain parts of the world. Some hospitals <a href="https://www.reactgroup.org/news-and-views/news-and-opinions/year-2022/the-impact-of-antibiotic-resistance-on-cancer-treatment-especially-in-low-and-middle-income-countries-and-the-way-forward/">have to consider</a> whether it’s even viable to treat cancers or perform surgery due to the risk of antibiotic-resistant infections. Australia is <a href="https://www.safetyandquality.gov.au/our-work/antimicrobial-resistance/antimicrobial-use-and-resistance-australia-aura/aura-2023-fifth-australian-report-antimicrobial-use-and-resistance-human-health">one of the highest users</a> of antibiotics in the developed world. We need to use this precious resource wisely, or we risk a future where a simple infection could kill you because there isn’t an effective antibiotic. <h2>When should antibiotics not be used?</h2> Antibiotics only work for some infections. They work against bacteria but <a href="https://www.safetyandquality.gov.au/publications-and-resources/resource-library/do-i-really-need-antibiotics">don’t treat</a> infections caused by viruses. Most community acquired infections, even those caused by bacteria, are likely to get better without antibiotics. Taking an antibiotic when you don’t need it won’t make you feel better or recover sooner. But it can increase your chance of side effects like nausea and diarrhoea. Some people think green mucus (or snot) is a sign of bacterial infection, requiring antibiotics. But it’s actually <a href="https://www.safetyandquality.gov.au/sites/default/files/2023-11/aura_2023_do_i_really_need_antibiotics.pdf">a sign</a> your immune system is working to fight your infection. <h2>If you wait, you’ll often get better</h2> <a href="https://www.tg.org.au/">Clinical practice guidelines</a> for antibiotic use aim to ensure patients receive antibiotics when appropriate. Yet 40% of GPs say they prescribe antibiotics <a href="https://doi.org/10.1071/HI13019">to meet patient expectations</a>. And <a href="https://pubmed.ncbi.nlm.nih.gov/35973750/">one in five</a> patients expect antibiotics for respiratory infections. It can be difficult for doctors to decide if a patient has a viral respiratory infection or are at an early stage of serious bacterial infection, particularly in children. One option is to “watch and wait” and ask patients to return if there is clinical deterioration. An alternative is to prescribe an antibiotic but advise the patient to not have it dispensed unless specific symptoms occur. This can <a href="https://doi.org/10.1002/14651858.CD004417.pub5">reduce antibiotic use by 50%</a> with no decrease in patient satisfaction, and no increase in complication rates. <h2>Sometimes antibiotics are life-savers</h2> For some people – particularly those with a weakened immune system – a simple infection can become more serious. Patients with life-threatening suspected infections should receive an appropriate antibiotic <a href="https://www.safetyandquality.gov.au/our-work/clinical-care-standards/antimicrobial-stewardship-clinical-care-standard">immediately</a>. This includes serious infections such as <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/bacterial-meningitis#:%7E:text=What%20is%20bacterial%20meningitis%3F,can%20cause%20life%2Dthreatening%20problems.">bacterial meningitis</a> (infection of the membranes surrounding the brain) and <a href="https://clinicalexcellence.qld.gov.au/priority-areas/safety-and-quality/sepsis/adult-sepsis#:%7E:text=Adult%20patients%20with%20sepsis%20also,adult%20emergency%20department%20sepsis%20pathway.">sepsis</a> (which can lead to organ failure and even death). <h2>When else might antibiotics be used?</h2> Antibiotics are sometimes used to prevent infections in patients who are undergoing surgery and are at significant risk of infection, such as those undergoing bowel resection. These patients will <a href="https://www.tg.org.au">generally receive</a> a single dose before the procedure. Antibiotics may also <a href="https://www.tg.org.au">be given</a> to patients undergoing chemotherapy for solid organ cancers (of the breast or prostate, for example), if they are at high risk of infection. While most sore throats are caused by a virus and usually resolve on their own, some high risk patients with a bacterial strep A infection which can cause “scarlet fever” are given antibiotics to prevent a more serious infection like <a href="https://www.rhdaustralia.org.au/">acute rheumatic fever</a>. <h2>How long is a course of antibiotics?</h2> The recommended duration of a course of antibiotics depends on the type of infection, the likely cause, where it is in your body and how effective the antibiotics are at killing the bacteria. In the past, courses were largely arbitrary and based on assumptions that antibiotics should be taken for long enough to eliminate the infecting bacteria. More recent research does not support this and shorter courses are <a href="https://www.acpjournals.org/doi/full/10.7326/M19-1509">nearly always as effective as longer ones</a>, particularly for community acquired respiratory infections. For <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736742/">community acquired pneumonia</a>, for example, research shows a three- to five-day course of antibiotics is at least as effective as a seven- to 14-day course. The “take until all finished” approach is no longer recommended, as the longer the antibiotic exposure, the greater the chance the bacteria will develop resistance. However, for infections where it is more difficult to eradicate the bacteria, such as tuberculosis and bone infections, a combination of antibiotics for many months is usually required. <h2>What if your infection is drug-resistant?</h2> You may have an antibiotic-resistant infection if you don’t get better after treatment with standard antibiotics. Your clinician will collect samples for lab testing if they suspect you have antibiotic-resistant infection, based on your travel history (especially if you’ve been hospitalised in a country with high rates of antibiotic resistance) and if you’ve had a recent course of antibiotics that hasn’t cleared your infection. Antibiotic-resistant infections are managed by prescribing broad-spectrum antibiotics. These are like a sledgehammer, wiping out many different species of bacteria. (Narrow-spectrum antibiotics conversely can be thought of as a scalpel, more targeted and only affecting one or two kinds of bacteria.) Broad-spectrum antibiotics are usually more expensive and come with more severe side effects. <h2>What can patients do?</h2> Decisions about antibiotic prescriptions should be made using <a href="https://www.safetyandquality.gov.au/our-work/partnering-consumers/shared-decision-making/decision-support-tools-specific-conditions">shared decision aids</a>, where patients and prescribers discuss the risks and benefits of antibiotics for conditions like a sore throat, middle ear infection or acute bronchitis. Consider asking your doctor questions such as: <ul> <li>do we need to test the cause of my infection?</li> <li>how long should my recovery take?</li> <li>what are the risks and benefits of me taking antibiotics?</li> <li>will the antibiotic affect my regular medicines?</li> <li>how should I take the antibiotic (how often, for how long)?</li> </ul> Other ways to fight antibiotic resistance include: <ul> <li>returning leftover antibiotics to a pharmacy for safe disposal</li> <li>never consuming leftover antibiotics or giving them to anyone else</li> <li>not keeping prescription repeats for antibiotics “in case” you become sick again</li> <li>asking your doctor or pharmacist what you can do to feel better and ease your symptoms rather than asking for antibiotics.</li> </ul> <a href="https://theconversation.com/profiles/minyon-avent-1486987">Minyon Avent</a>, Antimicrobial Stewardship Pharmacist, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a>; <a href="https://theconversation.com/profiles/fiona-doukas-1157050">Fiona Doukas</a>, PhD candidate, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/kristin-xenos-1491653">Kristin Xenos</a>, Research Assistant, College of Health, Medicine and Wellbeing, School of Biomedical Science and Pharmacy, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</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/do-you-really-need-antibiotics-curbing-our-use-helps-fight-drug-resistant-bacteria-217920">original article</a>.

Body

Readers respond: What is your go-to movie when you need a good cry?

There's an abundance of movies out there, but not many that can bring you to tears. While The Notebook and Beaches are clearly the fan favourites for our readers, here are a few other recommendations that you can watch this holiday season. Get those tissues ready! Carol Wardley - Its a wonderful life Watch the trailer <a href="https://www.youtube.com/watch?v=iLR3gZrU2Xo" target="_blank" rel="noopener">here</a>, and stream the movie on Stan. Denyse Galle - Me Before You and A Walk to Remember Watch the trailer for <a href="https://www.youtube.com/watch?v=Eh993__rOxA" target="_blank" rel="noopener">Me Before you</a> and stream it on YouTube, Apple TV or Amazon Prime Video. Watch the trailer for <a href="https://www.youtube.com/watch?v=k3B2XBcp7vA" target="_blank" rel="noopener">A Walk to Remember</a> and stream it on Apple TV or Amazon Prime Video Kerrie Anne - The Remains of the Day Watch the trailer <a href="https://www.youtube.com/watch?v=jALmEb72beg" target="_blank" rel="noopener">here</a> and stream it on Netflix. Ken Smyth - Dancer in the Dark. That ending... Watch the trailer <a href="https://www.youtube.com/watch?v=53vr9EiOH7g" target="_blank" rel="noopener">here</a> and stream it on Apple TV. Michael Kopp - Bambi Watch the trailer <a href="https://www.youtube.com/watch?v=yDGv4GIR7A4" target="_blank" rel="noopener">here</a> and stream it on Disney+. Anne Connolly Finnegan - The Bridges of Madison county Watch the trailer <a href="https://www.youtube.com/watch?v=Up-oN4NtvbM" target="_blank" rel="noopener">here</a> and stream it on YouTube. Leone Mitchell - Love Story with Ryan O’Neal and Allie MacGraw beautiful Watch the trailer <a href="https://www.youtube.com/watch?v=mYhS8q66L38" target="_blank" rel="noopener">here</a> and stream it on Foxtel Go, Binge or YouTube Julie B - The Colour Purple Watch the trailer <a href="https://www.youtube.com/watch?v=yFMCW5-jdqM" target="_blank" rel="noopener">here</a> and stream it on Netflix. Are there any other movies that make you cry? Let us know. Image: Getty

Movies

Thinking of trying a detox? Here’s what you need to know first

<a href="https://theconversation.com/profiles/clare-collins-7316">Clare Collins</a>, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> What is a “detox”? It’s a process that involves using particular products, diets or other detoxification methods to try and rid the body of so-called “toxins”. Detoxes are <a href="https://www.sciencedirect.com/science/article/abs/pii/S1499404619308127">prevalent on social media</a> and spruiked by brands offering detox products, celebrities and influencers. A documentary airing on Channel 10 this week – Todd Sampson’s <a href="https://tvblackbox.com.au/page/2023/11/06/todd-sampson-returns-with-new-mirror-mirror-testing-wellness-industry/">Mirror Mirror: Are You Well?</a> – explores our fascination with detoxing, and the science (or lack thereof) behind it. So if you’re thinking of trying a detox, here’s what you need to know. <h2>Detoxing is not new</h2> Detoxing has held an attraction since the time of <a href="https://bcmj.org/premise/history-bloodletting">Hippocrates</a>, who believed four bodily fluids or “humors” – blood, phlegm, black bile and yellow bile – had to remain in balance to maintain good health. Being unwell meant the body’s organs and fluids were somehow imbalanced and in need of correction. Throughout the centuries these “imbalances” have been treated with everything from <a href="https://www.smh.com.au/national/nsw/leeches-bloodletting-enemas-and-emetics-the-uncomfortable-history-of-medicine-20220726-p5b4u2.html">enemas and emetics</a> to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3757849/">leech therapy</a> and <a href="https://en.wikipedia.org/wiki/Bloodletting">bloodletting</a>. An enema sees a tube <a href="https://www.healthline.com/health/enema-administration#administration">inserted into the anus</a> to deliver medication or fluids to the rectum or colon. An <a href="https://www.britannica.com/science/emetic">emetic</a> is a compound designed to make you vomit. <a href="https://bcmj.org/premise/history-bloodletting">Bloodletting</a> involved using certain techniques – not for the faint of heart – to remove blood from a patient and supposedly cure disease. Meanwhile, throughout history, the <a href="https://pubmed.ncbi.nlm.nih.gov/26133274/">ritual of fasting</a> as a display of self-discipline, purity and holiness was common, particularly among women. <h2>What are the different types of detox?</h2> Fast forward to today, and detoxes look a bit different. Detox products sold over the counter or online are typically teas or drinks to be consumed instead of food. These approaches sometimes start with a fasting phase or use intermittent fasting throughout the program. The “detox” tag is appearing on a growing range of teas, coffee, infused waters, drinks with added fruit, vegetables, herbal mixes, nutrients or added blends of “natural” ingredients. These products often claim to flush toxins from the body, or to boost immunity. <a href="https://www.fortunebusinessinsights.com/detox-drinks-market-107122">Global predictions</a> indicate the detox drink market, estimated at more than US$5 billion in 2022, will grow in value by another 50% before 2030. A <a href="https://pubmed.ncbi.nlm.nih.gov/22103982/">survey of detoxification therapies</a> used by naturopaths in the United States reported that more than three-quarters recommended dietary measures, including “cleansing foods” (such as beetroot), vitamin, mineral or antioxidant supplements, organic foods, elimination diets and probiotics. While drinks and dietary measures represent typical approaches to a detox, there are also some more unusual detox practices. One-third of patients in that same US study had undergone colonic irrigation, which involves <a href="https://www.healthline.com/health/digestive-health/pros-cons-colon-cleanse#what-is-it?">infusing fluids into the colon</a> to remove digestive waste. More than one-quarter had used <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/homeopathy">homeopathic remedies</a> or laxative herbs. While we don’t have equivalent data for Australia, a survey of <a href="https://pubmed.ncbi.nlm.nih.gov/30470778/">more than 2,000 Australian adults</a> found 63% had either used or consulted someone about complementary therapies in the previous year. A portion of these were likely detox therapies. <h2>Do detoxes work?</h2> The short answer is no. A <a href="https://pubmed.ncbi.nlm.nih.gov/35866077/">review published in 2022</a> found detox diets failed to identify plausible pathways by which toxins could be eliminated, or the specific toxins supposedly removed by a particular diet. This review also pointed out that detoxes defy the general principles of human physiology, in that the liver and kidneys are quite efficient at removing toxins from our bodies. A previous <a href="https://pubmed.ncbi.nlm.nih.gov/25522674/">review from 2015</a> similarly found studies did not provide convincing evidence to support the use of detox diets. Detox products don’t have to prove they’re effective to be on the market. In Australia, complementary medicines sold over the counter are regulated by the <a href="https://www.tga.gov.au/what-tga-regulates">Therapeutic Goods Administration</a>, with ingredients assessed for quality and safety, but not whether the products actually work. You should check any product and marketing claims before purchasing to see what the manufacturers say. Big promises to be sceptical about include eliminating toxins, rapid weight loss, stronger willpower, improved self-esteem, an energy or immunity boost, feeling happier, inner peace, or better skin, hair and nails. <h2>Potential dangers of detoxing</h2> Consuming detox products in place of a regular diet leads to a very low total kilojoule intake, and therefore may lead to <a href="https://pubmed.ncbi.nlm.nih.gov/29124370/">weight loss</a> in the short term. But they’re not a sustainable way to lose weight. Detox diets that severely restrict kilojoules or food groups increase the risk of nutrient deficiencies. Adverse effects <a href="https://www.healthline.com/nutrition/detox-diets-101#safety-and-side-effects">include</a> fatigue, irritability and <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/halitosis-or-bad-breath">bad breath</a>. There’s also a risk detox product ingredient labels <a href="https://pubmed.ncbi.nlm.nih.gov/35866077/">might not be accurate</a>, increasing the risk of side effects, potential overdoses or other adverse events. In Spain, a <a href="https://pubmed.ncbi.nlm.nih.gov/22884574/">50-year-old man</a> died after an incorrect ingredient was added to a liver cleanse detox product he used, leading to manganese poisoning. A 2018-19 <a href="https://www.phrp.com.au/issues/july-2023-volume-33-issue-2/compliance-audit-of-colonic-lavage-businesses/">audit of premises in New South Wales</a> performing colonic irrigation found failures to meet infection control standards. Some people should definitely not try detoxing. This includes people with chronic medical conditions, eating disorders, older adults, children and women who are pregnant or breastfeeding. One positive aspect of detox programs is that they may help raise awareness of your current food, alcohol or lifestyle habits that could be improved. Reflecting on these can potentially provide the motivation to try and eat more healthily.<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/212776/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/clare-collins-7316">Clare Collins</a>, Laureate Professor in Nutrition and Dietetics, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/thinking-of-trying-a-detox-heres-what-you-need-to-know-first-212776">original article</a>.

Body

Separating? 5 commonly overlooked money issues you need to address

Amid the heartache of a relationship ending, it’s easy to overlook money, legal and logistical matters or make poor decisions on the fly. However, that can bring more pain – even years down the track. When a relationship ends, you have the chance to embrace your new-found independence and do things for yourself. Including managing money. Make the most of this freedom by taking charge of your financial affairs, starting with these aspects that commonly get neglected: 1. Split finances and expenses Separating finances is an important first step. Otherwise, your savings could be pilfered or you could be held liable for your ex’s debts and spending. Be thorough – smaller things are especially easy to miss. That includes store cards, utilities, subscriptions, memberships, as well as loans and credit cards. Some could be cancelled; others may need to be retained, in which case they should be changed into just one name. Don’t leave it up to your ex to take your name off anything. Redirect your payments and direct debits to your personal bank account to avoid penalties for missed payments. Update details with your employer for your salary (and superannuation, if necessary) to be paid into. 2. Update estate planning The next step is to look at your estate planning. Failing to do this means your ex could receive an unexpected windfall should you pass away – at the expense of loved ones you actually want to support. Update your will to reflect your new situation as well as the beneficiaries in your superannuation – which is treated separately from your will. The same goes for any trusts, companies, or similar structures you have. 3. Get your best settlement Many people – especially women – settle for less than their fair share in a separation. Why? Some don’t realise their real worth or legal entitlements. Others just want to get it done with quickly. While it makes financial sense not to drag things out due to spite, your future quality of life and retirement depend on how much you walk away with. Among the factors to consider are: <ul> <li>Superannuation: you may be eligible for part of your ex’s super because it forms part of the joint asset pool. This is especially valuable if you earned considerably less or had time out of the workforce to raise children or care for relatives.</li> <li>Custody: supporting children and pets obviously impacts ongoing living costs. Child support isn’t necessarily guaranteed.</li> <li>Your home: is this really worth keeping at all cost if you won’t be able to afford it on your own? </li> <li>Sale time: if you separate on good terms, do you really need to sell assets now? Could you keep them to maximise value jointly or sell later at a better price?</li> </ul> Ensure you get pre-settlement financial advice BEFORE you sign on the bottom line. 4. Live independently You’re now on one income. Economies of scale (most things cost less per person when you’re coupled) no longer work in your favour. Taking time off work may be harder. So, don’t keep spending like you used to. Be proactive in adjusting to your new situation. Make a new spending and investment plan (a nicer and more comprehensive version of a budget). See what you can and cannot afford and make necessary cuts. Update insurances, subscriptions, and utilities to ensure you’re only paying for what you still need. Set up an easily accessible emergency fund, to cover you should you lose your job or face an unexpected crisis. Tailored advice from your financial adviser can help you make the most of what you have – for now and the future. 5. Be wise in love It may be the last thing on your mind amidst a separation, but a new relationship could be in your future. Learn from your current separation and take measures to protect your future self. A pre-nuptial agreement (pre-nup) could be useful to protect your assets. Or a post-nuptial agreement if you already have a new partner. Carefully consider co-habiting arrangements – your place, their place, a new place together? Who contributes what? Even if you don’t ultimately need them (fingers crossed!), the peace of mind from having protections in place will make any new relationship feel that much sweeter. Image credits: Getty Images Helen Baker is a licensed Australian financial adviser and author of the new book, On Your Own Two Feet: The Essential Guide to Financial Independence for all Women (Ventura Press, $32.99). Helen is among the 1% of financial planners who hold a master’s degree in the field. Proceeds from book sales are donated to charities supporting disadvantaged women and children. Find out more at <a href="http://www.onyourowntwofeet.com.au">www.onyourowntwofeet.com.au</a>

Money & Banking

No, antibiotics aren’t always needed. Here’s how GPs can avoid overprescribing

<a href="https://theconversation.com/profiles/mina-bakhit-826292">Mina Bakhit</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> and <a href="https://theconversation.com/profiles/paul-glasziou-13533">Paul Glasziou</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> The growth in antibiotic resistance threatens to return the world to the pre-antibiotic era – with deaths from now-treatable infections, and some elective surgery being restricted because of the risks of infection. Antibiotic resistance is a major problem worldwide and should be the concern of everyone, including you. We need to develop new antibiotics that can fight the resistant bacteria or antibiotics that bacteria would not be quickly resistant to. This is like finding new weapons to help the immune system fight the bacteria. More importantly, we need to use our current antibiotics – our existing weapons against the bacteria – more wisely. <h2>Giving GPs the tools to say no</h2> In 2022, more than <a href="https://www.safetyandquality.gov.au/publications-and-resources/resource-library/aura-2023-fifth-australian-report-antimicrobial-use-and-resistance-human-health">one-third of Australians</a> had least one antibiotic prescription, with <a href="https://www.safetyandquality.gov.au/publications-and-resources/resource-library/analysis-2015-2022-pbs-and-rpbs-antimicrobial-dispensing-data">88%</a> of antibiotics prescribed by GPs. Many people <a href="https://pubmed.ncbi.nlm.nih.gov/28289114/">mistakenly think</a> antibiotics are necessary for treating any infection and that infections won’t improve unless treated with antibiotics. This misconception is found in studies involving patients with various conditions, including respiratory infections and conjunctivitis. In reality, not all infections require antibiotics, and this belief drives patients requesting antibiotics from GPs. Other times, GPs give antibiotics because they think patients want them, even when they might not be necessary. Although, in reality they are <a href="https://pubmed.ncbi.nlm.nih.gov/17148626/">after symptom relief</a>. For GPs, there are ways to target antibiotics for only when they are clearly needed, even with short appointments with patients perceived to want antibiotics. This includes: <ul> <li> using <a href="https://pubmed.ncbi.nlm.nih.gov/32357226/">decision guides</a> or tests to decide if antibiotics are really necessary </li> <li> giving <a href="https://www.safetyandquality.gov.au/our-work/partnering-consumers/shared-decision-making/decision-support-tools-specific-conditions">patients information sheets</a> when antibiotics aren’t needed </li> <li> giving a “<a href="https://pubmed.ncbi.nlm.nih.gov/33910882/">delayed prescription</a>” – only to be used after the patient waits to see if they get better on their own. </li> </ul> All these strategies need some <a href="https://www.nps.org.au/assets/NPS/pdf/NPS-MedicineWise-Economic-evaluation-report-Reducing-Antibiotic-Resistance-2012-17.pdf">training</a> and practice, but they can help GPs prescribe antibiotics more responsibly. GPs can also learn from each other and use tools like <a href="https://pubmed.ncbi.nlm.nih.gov/24474434/">posters</a> as reminders. To help with patients’ expectations, public campaigns have been run periodically to educate people about antibiotics. These campaigns <a href="https://pubmed.ncbi.nlm.nih.gov/35098267/">explain why</a> using antibiotics too much can be harmful and when it’s essential to take them. <h2>Giving doctors feedback on their prescribing</h2> National programs and interventions can help GPs use antibiotics more wisely One successful way they do this is by <a href="https://pubmed.ncbi.nlm.nih.gov/34356788/">giving GPs feedback</a> about how they prescribe antibiotics. This works better when it’s provided by organisations that GPs trust, it happens more than once and clear goals are set for improvement. The NPS (formerly National Prescribing Service) MedicineWise program, for example, had been giving feedback to GPs on how their antibiotic prescriptions compared to others. This reduced the number of antibiotics prescribed. However, <a href="https://australianprescriber.tg.org.au/articles/the-end-of-nps-medicinewise.html">NPS no longer exists</a>. In 2017, the Australian health department did something similar by sending <a href="https://behaviouraleconomics.pmc.gov.au/projects/nudge-vs-superbugs-behavioural-economics-trial-reduce-overprescribing-antibiotics">feedback letters</a>, randomly using different formats, to the GPs who prescribed the most antibiotics, showing them how they were prescribing compared to others. The most effective letter, which used pictures to show this comparison, reduced the number of antibiotics GPs prescribed by <a href="https://behaviouraleconomics.pmc.gov.au/sites/default/files/projects/nudge-vs-superbugs-12-months-on-report.pdf">9% in a year</a>. <h2>Clearer rules and regulations</h2> Rules and regulations are crucial in the fight against antibiotic resistance. Before April 2020, many GPs’ computer systems made it easy to get multiple repeat prescriptions for the same condition, which could encourage their overuse. However, in April 2020, the Pharmaceutical Benefits Scheme (PBS) <a href="https://www.pbs.gov.au/pbs/industry/listing/elements/pbac-meetings/psd/2019-08/antibiotic-repeats-on-the-pharmaceutical-benefits-scheme">changed the rules</a> to ensure GPs had to think more carefully about whether patients actually needed repeat antibiotics. This meant the amount of medicine prescribed better matched the days it was needed for. Other regulations or policy targets could include: <ul> <li> ensuring all GPs have access to antibiotic prescribing guidelines, such as <a href="https://www.tg.org.au/">Therapeutic Guidelines</a>, which is well accepted and widely available in Australia </li> <li> ensuring GPs are only prescribing antibiotics when needed. Many of the conditions antibiotics are currently prescribed for (such as sore throat, cough and middle ear infections) are self-limiting, meaning they will get better without antibiotics </li> <li> encouraging GP working with antibiotics manufacturers to align pack sizes to the recommended treatment duration. The recommended first-line treatments for uncomplicated urinary tract infections in non-pregnant women, for example, are either three days of trimethoprim 300 mg per night or five days of nitrofurantoin 100 mg every six hours. However, the packs contain enough for seven days. This can mean patients take it for longer or use leftovers later. </li> </ul> <h2>Australia lags behind Sweden</h2> Australia has some good strategies for antibiotic prescribing, but we have not had a sustained long-term plan to ensure wise use. Although Australian GPs have been doing well in <a href="https://www.safetyandquality.gov.au/our-work/antimicrobial-resistance/antimicrobial-use-and-resistance-australia-surveillance-system/aura-2021">reducing antibiotic prescribing</a> since 2015, <a href="https://pubmed.ncbi.nlm.nih.gov/35098269/">more</a> could be done. In the 1990s, Sweden’s antibiotic use was similar to Australia’s, but is now less than half. For more than two decades, Sweden has had a national strategy that reduces antibiotic use by about <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5677604/">7% annually</a>. It is vital Australia invests in a similar long-term national strategy – to have a centrally funded program, but with regional groups working on the implementation. This could be funded directly by the Commonwealth Department of Health and Ageing, or with earmarked funds via another body such as the Australian Centre for Disease Control. In the meantime, individual GPs can do their part to prescribe antibiotics better, and patients can join the national effort to combat antibiotic resistance by asking their GP: “what would happen if I don’t take an antibiotic?”. <a href="https://theconversation.com/profiles/mina-bakhit-826292">Mina Bakhit</a>, Assistant Professor of Public Health, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> and <a href="https://theconversation.com/profiles/paul-glasziou-13533">Paul Glasziou</a>, Professor of Medicine, <a href="https://theconversation.com/institutions/bond-university-863">Bond 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/no-antibiotics-arent-always-needed-heres-how-gps-can-avoid-overprescribing-213981">original article</a>.

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