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These 12 things can reduce your dementia risk – but many Australians don’t know them all

<p><em><a href="https://theconversation.com/profiles/joyce-siette-1377445">Joyce Siette</a>, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a> and <a href="https://theconversation.com/profiles/laura-dodds-1378067">Laura Dodds</a>, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a></em></p> <p>Dementia is a <a href="https://www.abs.gov.au/statistics/health/causes-death/provisional-mortality-statistics/jan-may-2022">leading</a> cause of death in Australia.</p> <p>Although dementia mainly affects older people, it is an avoidable part of ageing. In fact, we all have the power to reduce our risk of developing dementia, no matter your age.</p> <p>Research shows your risk of developing dementia could be <a href="https://www.thelancet.com/article/S0140-6736(20)30367-6/fulltext">reduced by up to 40%</a> (and even higher if you live in a <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30074-9/fulltext">low or middle-income country</a>) by addressing lifestyle factors such as healthy diet, exercise and alcohol consumption.</p> <p>But the first step to reducing population-wide dementia risk is to understand how well people understand the risk factors and the barriers they may face to making lifestyle changes.</p> <p>Our new <a href="https://www.mdpi.com/2673-9259/2/4/21/htm">paper</a>, published this week in the <a href="https://www.mdpi.com/2673-9259/2/4/21/htm">Journal of Ageing and Longevity</a>, found most older people are aware that dementia is a modifiable condition and that they have the power to change their dementia risk.</p> <p>We also found the key barrier to making brain healthy lifestyle choices was a lack of knowledge, which suggests a public awareness campaign is urgently needed.</p> <h2>What we did</h2> <p>We began by <a href="https://www.mdpi.com/2673-9259/2/4/21/htm">reviewing</a> the published research to identify 12 factors shown to reduce dementia risk. We surveyed 834 older Australians about their awareness of the 12 factors, which were:</p> <ol> <li>having a mentally active lifestyle</li> <li>doing physical activity</li> <li>having a healthy diet</li> <li>having strong mental health</li> <li>not smoking</li> <li>not consuming alcohol</li> <li>controlling high blood pressure</li> <li>maintaining a healthy weight</li> <li>managing high cholesterol</li> <li>preventing heart disease</li> <li>not having kidney disease</li> <li>not having diabetes</li> </ol> <p><a href="https://www.thelancet.com/article/S0140-6736(20)30367-6/fulltext">The Lancet</a> subsequently published its own list of factors that help reduce dementia risk, which covered much the same territory (but included a few others, such as reducing air pollution, treating hearing impairment and being socially engaged).</p> <p>Of course, there is no way to cut your dementia risk to zero. Some people do all the “right” things and still get dementia. But there is <a href="https://www.thelancet.com/article/S0140-6736(20)30367-6/fulltext">good evidence</a> managing lifestyle factors help make it <em>less likely</em> you will get dementia over your lifetime.</p> <p>Our study shows many older Australians are quite aware, with over 75% able to correctly identify more than four of the factors in our list of 12.</p> <p>However, few were able to name the less well-known risk factors, such as preventing heart disease and health conditions like kidney disease.</p> <p>The good news is that close to half of the sample correctly identified more than six of the 12 protective factors, with mentally active lifestyle, physical activity and healthy diet in the top three spots.</p> <h2>Two key issues</h2> <p>Two things stood out as strongly linked with the ability to identify factors influencing dementia risk.</p> <p>Education was key. People who received more than 12 years of formal schooling were more likely to agree that dementia was a modifiable condition. We are first exposed to health management in our school years and thus more likely to form healthier habits.</p> <p>Age was the other key factor. Younger respondents (less than 75 years old) were able to accurately identify more protective factors compared to older respondents. This is why health promotion initiatives and public education efforts about dementia are vital (such as Dementia Awareness Month and <a href="https://www.memorywalk.com.au/">Memory, Walk and Jog initiatives</a>).</p> <h2>How can these findings be used in practice?</h2> <p>Our findings suggest we need to target education across the different age groups, from children to older Australians.</p> <p>This could involve a <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/ajag.13049">whole system approach</a>, from programs targeted at <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858574/#:%7E:text=Family%20Coaching%20has%20specific%20goals,to%20problem%20solve%20challenging%20situations.">families</a>, to educational sessions for school-aged children, to involving GPs in awareness promotion.</p> <p>We also need to tackle barriers that hinder dementia risk reduction. This means doing activities that motivate you, finding programs that suit your needs and schedule, and are accessible.</p> <h2>What does this mean for you?</h2> <p>Reducing your dementia risk means recognising change starts with you.</p> <p>We are all familiar with the everyday challenges that stop us from starting an exercise program or sticking to a meal plan.</p> <p>There are simple and easy changes we can begin with. Our team has developed a program that can help. We are offering limited <a href="https://www.brainbootcamp.com.au/">free brain health boxes</a>, which include information resources and physical items such as a pedometer. These boxes aim to help rural Australians aged 55 years and over to adopt lifestyle changes that support healthy brain ageing. If you’re interested in signing up, visit our <a href="https://www.brainbootcamp.com.au">website</a>.</p> <p>Now is the time to think about your brain health. Let’s start now.<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/191504/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/joyce-siette-1377445">Joyce Siette</a>, Research Theme Fellow, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a> and <a href="https://theconversation.com/profiles/laura-dodds-1378067">Laura Dodds</a>, PhD Candidate, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>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/these-12-things-can-reduce-your-dementia-risk-but-many-australians-dont-know-them-all-191504">original article</a>.</em></p>

Mind

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Your friend has been diagnosed with cancer. Here are 6 things you can do to support them

<p><em><a href="https://theconversation.com/profiles/stephanie-cowdery-2217734">Stephanie Cowdery</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a>; <a href="https://theconversation.com/profiles/anna-ugalde-2232654">Anna Ugalde</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a>; <a href="https://theconversation.com/profiles/trish-livingston-163686">Trish Livingston</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a>, and <a href="https://theconversation.com/profiles/victoria-white-1888110">Victoria White</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a></em></p> <p>Across the world, <a href="https://www.who.int/news/item/01-02-2024-global-cancer-burden-growing--amidst-mounting-need-for-services">one in five</a> people are diagnosed with cancer during their lifetime. By age 85, almost <a href="https://www.cancer.org.au/cancer-information/what-is-cancer/facts-and-figures">one in two</a> Australians will be diagnosed with cancer.</p> <p>When it happens to someone you care about, it can be hard to know what to say or how to help them. But providing the right support to a friend can make all the difference as they face the emotional and physical challenges of a new diagnosis and treatment.</p> <p>Here are six ways to offer meaningful support to a friend who has been diagnosed with cancer.</p> <h2>1. Recognise and respond to emotions</h2> <p>When facing a cancer diagnosis and treatment, it’s normal to experience a range of <a href="https://www.canceraustralia.gov.au/impacted-by-cancer/emotions#:%7E:text=It's%20likely%20that%20feelings%20will,these%20feelings%20ease%20with%20time">emotions</a> including fear, anger, grief and sadness. Your friend’s moods may fluctuate. It is also common for feelings to <a href="https://link.springer.com/article/10.1007/s00520-014-2492-9">change over time</a>, for example your friend’s anxiety may decrease, but they may feel more depressed.</p> <p>Some friends may want to share details while others will prefer privacy. Always ask permission to raise sensitive topics (such as changes in physical appearance or their thoughts regarding fears and anxiety) and don’t make assumptions. It’s OK to tell them you feel awkward, as this acknowledges the challenging situation they are facing.</p> <p>When they feel comfortable to talk, follow their lead. Your support and willingness <a href="https://www.cancervic.org.au/get-support/stories/what-to-say-and-not-say.html">to listen without judgement</a> can provide great comfort. You don’t have to have the answers. Simply acknowledging what has been said, providing your full attention and being present for them will be a great help.</p> <h2>2. Understand their diagnosis and treatment</h2> <p><a href="https://onlinelibrary.wiley.com/doi/full/10.1002/pon.4722">Understanding</a> your friend’s diagnosis and what they’ll go through when being <a href="https://www.cancer.org/cancer/caregivers/what-a-caregiver-does/treatment-timeline.html">treated</a> may be helpful.</p> <p>Being informed can reduce your own worry. It may also help you to listen better and reduce the amount of explaining your friend has to do, especially when they’re tired or overwhelmed.</p> <p>Explore reputable sources such as the <a href="https://www.cancer.org.au/">Cancer Council website</a> for accurate information, so you can have meaningful conversations. But keep in mind your friend has a trusted medical team to offer personalised and accurate advice.</p> <h2>3. Check in regularly</h2> <p>Cancer treatment can be isolating, so regular check-ins, texts, calls or visits can help your friend feel less alone.</p> <p>Having a normal conversation and sharing a joke can be very welcome. But everyone copes with cancer differently. Be patient and flexible in your support – some days will be harder for them than others.</p> <p>Remembering key dates – such as the next round of chemotherapy – can help your friend feel supported. Celebrating milestones, including the end of treatment or anniversary dates, may boost morale and remind your friend of positive moments in their cancer journey.</p> <p>Always ask if it’s a good time to visit, as your friend’s immune system <a href="https://www.cancerresearchuk.org/about-cancer/what-is-cancer/body-systems-and-cancer/the-immune-system-and-cancer#:%7E:text=to%20fight%20cancer-,Cancer%20and%20treatments%20may%20weaken%20immunity,high%20dose%20of%20steroids">may be compromised</a> by their cancer or treatments such as chemotherapy or radiotherapy. If you’re feeling unwell, it’s best to postpone visits – but they may still appreciate a call or text.</p> <h2>4. Offer practical support</h2> <p>Sometimes the best way to show your care is through practical support. There may be different ways to offer help, and what your friend needs might change at the beginning, during and after treatment.</p> <p>For example, you could offer to pick up prescriptions, drive them to appointments so they have transport and company to debrief, or wait with them at appointments.</p> <p>Meals will always be welcome. However it’s important to remember cancer and its treatments may <a href="https://www.cancer.gov/about-cancer/treatment/side-effects/nutrition#effects-of-cancer-treatment-on-nutrition">affect</a> taste, smell and appetite, as well as your friend’s ability to eat enough or absorb nutrients. You may want to check first if there are particular foods they like. <a href="https://www.cancervic.org.au/downloads/resources/booklets/nutrition-cancer.pdf">Good nutrition</a> can help boost their strength while dealing with the side effects of treatment.</p> <p>There may also be family responsibilities you can help with, for example, babysitting kids, grocery shopping or taking care of pets.</p> <h2>5. Explore supports together</h2> <p>Studies <a href="https://pubmed.ncbi.nlm.nih.gov/35834503/">have shown</a> mindfulness practices can be an effective way for people to manage anxiety associated with a cancer diagnosis and its treatment.</p> <p>If this is something your friend is interested in, it may be enjoyable to explore classes (either online or in-person) together.</p> <p>You may also be able to help your friend connect with organisations that provide emotional and practical help, such as the Cancer Council’s <a href="https://www.cancer.org.au/support-and-services/cancer-council-13-11-20">support line</a>, which offers free, confidential information and support for anyone affected by cancer, including family, friends and carers.</p> <p><a href="https://www.researchgate.net/publication/5659099_Systematic_review_of_peer-support_programs_for_people_with_cancer">Peer support groups</a> can also reduce your friend’s feelings of isolation and foster shared understanding and empathy with people who’ve gone through a similar experience. GPs <a href="https://pubmed.ncbi.nlm.nih.gov/34333571/">can help</a> with referrals to support programs.</p> <h2>6. Stick with them</h2> <p>Be committed. Many people feel <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC11120751/">isolated</a> after their treatment. This may be because regular appointments have reduced or stopped – which can feel like losing a safety net – or because their relationships with others have changed.</p> <p>Your friend may also experience emotions such as worry, lack of confidence and uncertainty as they adjust to a <a href="https://www.cancer.gov/about-cancer/coping/survivorship/new-normal">new way of living</a> after their treatment has ended. This will be an important time to support your friend.</p> <p>But don’t forget: looking after <a href="https://www.healthdirect.gov.au/caring-for-someone-with-cancer">yourself</a> is important too. Making sure you eat well, sleep, exercise and have emotional support will help steady you through what may be a challenging time for you, as well as the friend you love.</p> <p><a href="https://www.deakin.edu.au/faculty-of-health/research/cancer-carer-hub">Our research</a> team is developing new programs and resources to support carers of people who live with cancer. While it can be a challenging experience, it can also be immensely rewarding, and your small acts of kindness can make a big difference.<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/239844/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/stephanie-cowdery-2217734">Stephanie Cowdery</a>, Research Fellow, Carer Hub: A Centre of Excellence in Cancer Carer Research, Translation and Impact, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a>; <a href="https://theconversation.com/profiles/anna-ugalde-2232654">Anna Ugalde</a>, Associate Professor &amp; Victorian Cancer Agency Fellow, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a>; <a href="https://theconversation.com/profiles/trish-livingston-163686">Trish Livingston</a>, Distinguished Professor &amp; Director of Special Projects, Faculty of Health, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a>, and <a href="https://theconversation.com/profiles/victoria-white-1888110">Victoria White</a>, Professor of Pyscho-Oncology, School of Psychology, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>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/your-friend-has-been-diagnosed-with-cancer-here-are-6-things-you-can-do-to-support-them-239844">original article</a>.</em></p>

Caring

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What are house dust mites and how do I know if I’m allergic to them?

<p><em><a href="https://theconversation.com/profiles/deryn-lee-thompson-1449312">Deryn Lee Thompson</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a></em></p> <p>People often believe they are allergic to <a href="https://ahd.csiro.au/everything-in-our-homes-gathers-dust-but-what-exactly-is-it-where-does-it-come-from-and-why-does-it-keep-coming-back-is-it-from-outside-is-it-fibres-from-our-clothes-and-cells-from-our-skin/">house dust</a>. But of the <a href="https://www.allergy.org.au/patients/allergy-treatments/allergen-minimisation">20% of Australians</a> suffereing with allergies, a number are are actually allergic to microscopic <a href="https://www.healthdirect.gov.au/dust-mites">house dust mites</a>.</p> <p>House dust mites belong to the same family as spiders and ticks. They measure just 0.2-0.3 mm, with 50 fitting on a single pinhead. They <a href="https://www.intechopen.com/chapters/71977">live</a> for 65–100 days, and females lay 60–100 eggs in their life.</p> <p>House dust mites love temperate climates and humidity. They feed off the skin cells we and animals shed, as well as mould, which they digest using special enzymes. These enzymes are excreted in their poo about <a href="https://www.intechopen.com/chapters/71977">20 times a day</a>. They also shed fragments of their exoskeletons.</p> <p>All these fragments trigger allergies in people with this type of allergic rhinitis (which is also known as hay fever)</p> <h2>What are the symptoms?</h2> <p>When people with house dust mite allergy inhale the allergens, they penetrate the mucous membranes of the airways and eyes. Their body recognises the allergens as a threat, releasing chemicals including one called histamine.</p> <p>This causes symptoms including a runny nose, an itchy nose, eyes and throat, sneezing, coughing and a feeling of mucus at the back of your throat (known as a post-nasal drip).</p> <p>People with this type of allergy usually mouth breath, snore, rub their nose constantly (creating a nasal crease called the “dust mite salute”) and have dark shadows under their eyes.</p> <p>House dust mite allergy <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328274/">can also cause</a> poor sleep, constant tiredness, reduced concentration at work or school and lower quality of life.</p> <p>For people with eczema, their damaged skin barrier can allow house dust mite proteins in. This prompts immune cells in the skin to <a href="https://academic.oup.com/bjd/article/190/1/e5/7485663">release chemicals</a> which make already flared skin become redder, sorer and itchier, especially in children.</p> <p>Symptoms of house dust mite allergy occur year round, and are often worse after going to bed and when waking in the morning. But people with house dust mite allergy <em>and</em> pollen allergies find their year-round symptoms worsen in spring.</p> <h2>How is it diagnosed?</h2> <p>House dust mite allergy symptoms often build up over months, or even years before people seek help. But an accurate diagnosis means you can not only access the right treatment – it’s also vital for minimising exposure.</p> <p>Doctor and nurse practitioners can order a <a href="https://www.allergy.org.au/patients/allergy-treatments/allergen-minimisation">blood test</a> to check for house dust mite allergy.</p> <p>Alternatively, health care providers with <a href="https://www.allergy.org.au/hp/a-career-in-clinical-immunology-and-allergy">specialised allergy training</a> can perform skin prick tests. This involves placing drops of the allergens on the arm, along with a positive and negative “control”. After 15 minutes, those who test positive will have developed a mosquito bite-like mark.</p> <h2>How is it treated?</h2> <p>Medication options include one or a combination of:</p> <ul> <li>daily non-sedating antihistamines</li> <li>a steroid nasal spray</li> <li>allergy eye drops.</li> </ul> <p>Your health care professional will work with you to develop a <a href="https://www.allergy.org.au/images/stories/pospapers/ar/ASCIA_HP_Allergic_Rhinitis_2022.pdf">rhinitis (hay fever) medical management plan</a> to reduce your symptoms. If you’re using a nasal spray, your health provider will <a href="https://www.youtube.com/watch?v=_ytYj1TLojM">show you how to use it</a>, as people often use it incorrectly.</p> <p>If you also have <a href="https://www.nationalasthma.org.au/understanding-asthma/how-is-asthma-managed">asthma</a> or eczema which is worsened by dust mites, your health provider will adapt your <a href="https://www.nationalasthma.org.au/health-professionals/asthma-action-plans">asthma action plan</a> or <a href="https://medcast.com.au/qhub/eczema/resources">eczema care plan</a> accordingly.</p> <p>If you experience severe symptoms, a longer-term option is <a href="https://www.allergy.org.au/images/pc/ASCIA_PC_Allergen_Immunotherapy_FAQ_2024.pdf">immunotherapy</a>. This aims to gradually turn off your immune system’s ability to recognise house dust mites as a harmful allergen.</p> <p>Immunotherapy involves taking either a daily sublingual tablet, under the tongue, or a series of injections. Injections require monthly attendances over three years, after the initial weekly build-up phase.</p> <p>These are <a href="https://theconversation.com/im-considering-allergen-immunotherapy-for-my-hay-fever-what-do-i-need-to-know-190408">effective</a>, but are costly (as well as time-consuming). So it’s important to weigh up the potential benefits and downsides with your health-care provider.</p> <h2>How can you minimise house dust mites?</h2> <p>There are also important allergy minimisation measures you can take to reduce allergens in your home.</p> <p>Each week, <a href="https://www.allergy.org.au/component/finder/search?q=minimisation&amp;Itemid=100001">wash</a> your bedding and pyjamas in hot water (over 60°C). This <a href="https://www.nationalasthma.org.au/living-with-asthma/resources/patients-carers/factsheets/dust-mites-trigger-my-asthma">removes</a> house dust mite eggs and debris.</p> <p>Opt for doonas, covers or quilts that can be washed in hot water above 60°C. Alternatively, low-cost waterproof or leak proof covers can keep house dust mites out.</p> <p>If you can, favour blinds and wood floors over curtains and carpet. Dust blinds and surfaces with a damp cloth each week and vacuum while wearing a mask, or have someone else do it, as house dust mites can become airborne during cleaning.</p> <p>But beware of costly products with big marketing budgets and little evidence to support their use. A new mattress, for example, will always be house dust mite-free. But once slept on, the house dust mite life cycle can start.</p> <p>Mattress protectors and toppers commonly claim to be “hypoallergenic”, “anti-allergy” or “allergy free”. But their pore sizes are not small enough to keep house dust mites and their poo out, or shed skin going through.</p> <p>Sprays claiming to kill mites require so much spray to penetrate the product that it’s likely to become wet, may smell like the spray and, unless dried properly, may grow mould.</p> <p>Finally, claims that expensive vacuum cleaners can extract all the house dust mites are unsubstantiated.</p> <p><em>For more information, visit <a href="https://www.healthdirect.gov.au/dust-mites">healthdirect.gov.au</a> or the <a href="https://www.allergy.org.au/patients/allergy-treatments/allergen-minimisation">Australian Society of Clinical Immunology and Allergy</a>.</em><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/240918/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/deryn-lee-thompson-1449312">Deryn Lee Thompson</a>, Eczema and Allergy Nurse; Lecturer, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-are-house-dust-mites-and-how-do-i-know-if-im-allergic-to-them-240918">original article</a>.</em></p>

Body

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Grave cleaning videos are going viral on TikTok. Are they honouring the dead, or exploiting them?

<p><em><a href="https://theconversation.com/profiles/edith-jennifer-hill-1018412">Edith Jennifer Hill</a>, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a> and <a href="https://theconversation.com/profiles/marina-deller-947925">Marina Deller</a>, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a></em></p> <p>Cleaning the graves of strangers is the latest content trend taking over TikTok. But as millions tune in to watch the videos, it’s becoming clear not all of them are created equal. Two grave-cleaning creators in particular seem to reside at opposite ends of the trend.</p> <p>One of the first accounts to gain popularity for grave cleaning was <a href="https://www.tiktok.com/@ladytaphos">@ladytaphos</a>. This account is run by Alicia Williams, a Virginia resident who treats the graves with great dignity. Williams will often share the story of the person residing within, and acts with grace and kindness as she restores beauty to the <a href="https://www.tiktok.com/@ladytaphos/video/7197894295641148714">graves</a>.</p> <p>On the other end of the spectrum is Kaeli Mae McEwen, or <a href="https://www.tiktok.com/@_the_clean_girl">@the_clean_girl</a>, who leans into more clickbait-y tactics. McEwen is known for throwing a pink spiky ball through a graveyard and cleaning the grave it lands on. She also uses her videos to promote her own pink foamy cleaner (which at one point could be purchased via a link in her bio).</p> <h2>Cleaning and death</h2> <p>While Williams’ and McEwen’s videos may seem novel to some, death and cleaning have a long and varied relationship that spans time and cultures.</p> <p>Washing a loved one’s body before burial or cremation isn’t just practical – it’s a significant <a href="https://www.theage.com.au/national/victoria/washing-and-dressing-our-dead-the-movement-challenging-how-we-grieve-20230510-p5d794.html">ritual</a> that provides meaning during a period of grief. In certain cultures and religions it’s also a process of purification, or preparation for the afterlife.</p> <p>Much has been written about cleaning and clearing out the homes of deceased people. Family members often won’t agree on how to approach such a task. In his <a href="https://theconversation.com/friday-essay-grief-and-things-of-stone-wood-and-wool-136721">essay on death and objects</a>, author Tony Birch writes about his mother clearing out his grandmother’s house.</p> <p>“My mother decided that our first task after her death was to empty out her Housing Commission flat and scrub it clean,” Birch writes.</p> <p>He first laments the move, but later recognises the value of cleaning together before sorting – and treasuring – the items his grandmother left behind.</p> <p>Margaretta Magnuson’s 2017 book, <a href="https://www.google.com.au/books/edition/The_Gentle_Art_of_Swedish_Death_Cleaning/uW00DwAAQBAJ?hl=en&amp;gbpv=1&amp;pg=PT7&amp;printsec=frontcover">The Gentle Art of Swedish Death Cleaning</a>, is a humorous and thoughtful introduction to the Swedish movement of <em>döstädning</em>. The book (and subsequent <a href="https://www.sbs.com.au/ondemand/tv-series/the-gentle-art-of-swedish-death-cleaning">reality TV series</a>) has sparked various conversations on death and cleaning, and especially on cleaning before you yourself pass away so you don’t leave a mess for your loved ones.</p> <p>Grave cleaning can be seen as another continuation of caring for the deceased. People who decide to clean the graves of strangers may do so out of <a href="https://www.theguardian.com/society/2022/sep/04/how-gravetok-videos-of-cleaning-headstones-went-viral">respect</a>, or in an attempt to <a href="https://www.buzzfeed.com/alexalisitza/tiktok-woman-cleans-old-gravestones">give them “their name back”</a> (as names on graves become visible following the removal of debris).</p> <h2>Two very different approaches</h2> <p>Williams and McEwen are received quite differently by viewers. Anecdotally, viewers respond more positively to the calmer and more respectful cleaning videos by Williams, who takes time to explain the process while ensuring the correct products are used.</p> <p>Meanwhile, many find McEwen’s videos problematic and criticise her for not adhering to proper graveyard decorum. McEwen makes a spectacle of sites of mourning, such as by pretending to vacuum graves, replacing flowers placed by others and making jokes. Viewers also speculate the products she uses may cause damage to the graves.</p> <p>Perceived intent plays a role in how each creator’s content is received. While Williams focuses on respectfully restoring graves to their former glory, McEwen positions herself as the focus and merely uses the graves for content.</p> <h2>A complex emotional object</h2> <p>Similar to other funerary objects such as coffins and urns, graves are associated with both the person who died and the fact of their death. As such, they are emotionally complex objects that bring both strength and sadness to those left behind.</p> <p>But graves are unique also in that they are private objects of grief exposed in a public context. Anyone visiting the graveyard can view and interact with them. Does that make them “fair game” for content creators?</p> <p>Graves don’t just represent deceased loved ones. They can also act as stand-ins in their absence, becoming stone bodies of sorts. As sociologist Margaret Gibson describes in her book <a href="https://www.mup.com.au/books/objects-of-the-dead-paperback-softback">Objects of the Dead: Mourning and Memory in Everyday Life</a>, “death reconstructs our experience of objects”.</p> <p>“There is the strangeness of realising that things have outlived persons, and, in this regard, the materiality of things is shown to be more permanent than the materiality of the body,” she says.</p> <p>Caring for and cleaning graves can therefore be interpreted as caring for the deceased, by extending their existence through the materiality of their resting place.</p> <p>Psychological researcher <a href="https://www.tandfonline.com/doi/abs/10.1080/1600910X.2018.1521339">Svend Brinkmann asserts</a> artefacts such as graves are “culturally sanctioned”, gaining “significance from a collective system of meaning”.</p> <p>In other words, we as a community create and uphold reverence for such items. This is partly why the desecration of graves is viewed as abhorrent. It is societally understood to be a desecration of the person themselves. It’s also why content creators must tread lightly.</p> <h2>A reason for haunting?</h2> <p>There are ways to interact with gravestones (and even create content) which acknowledge their complexity and connection to their owners.</p> <p>TikTok creator Rosie Grant (<a href="https://www.tiktok.com/@ghostlyarchive?lang=en">@ghostlyarchive</a>) bakes recipes found on headstones and records the process. She has even met with the families of the deceased <a href="https://www.independent.co.uk/life-style/food-and-drink/defining-dishes-ghostly-archive-tiktok-b2414122.html">to make the recipes together</a> and learn more about the people behind the engraving-worthy food.</p> <p>However, randomly cleaning the graves of strangers is fraught territory – and rife with potential privacy issues. It isn’t clear whether McEwen seeks permission from loved ones before cleaning graves, but contextually this seems unlikely.</p> <p><a href="https://www.youtube.com/watch?v=nKkOS2GjCxk">Recent discussions</a> have also uncovered questionable editing in her videos. Some graves in her before-and-after videos have been edited to appear cleaner and to have their structure altered. McEwen’s pink foaming cleaner also appears to be a blue cleaner edited to appear pink, raising even more questions about intent and responsibility.</p> <p>While McEwen claims to be “honouring” lives by cleaning “final resting places”, the consensus from viewers is her actions are dishonourable. As one host <a href="https://www.youtube.com/watch?v=nKkOS2GjCxk">commented on a in podcast</a> discussing McEwen cleaning a baby’s grave while speaking in a kiddish voice: “F**k you, you’re going to get haunted.”<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/240553/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/edith-jennifer-hill-1018412">Edith Jennifer Hill</a>, Associate Lecturer, Learning &amp; Teaching Innovation, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a> and <a href="https://theconversation.com/profiles/marina-deller-947925">Marina Deller</a>, Casual Academic, Creative Writing and English Literature, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>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/grave-cleaning-videos-are-going-viral-on-tiktok-are-they-honouring-the-dead-or-exploiting-them-240553">original article</a>.</em></p>

Caring

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What causes food cravings? And what can we do about them?

<p><em><a href="https://theconversation.com/profiles/gabrielle-weidemann-91497">Gabrielle Weidemann</a>, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a> and <a href="https://theconversation.com/profiles/justin-mahlberg-1634725">Justin Mahlberg</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a></em></p> <p>Many of us try to eat more fruits and vegetables and less ultra-processed food. But why is sticking to your goals so hard?</p> <p>High-fat, sugar-rich and salty foods are simply so enjoyable to eat. And it’s not just you – we’ve evolved that way. These foods <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5928395/">activate</a> the brain’s reward system because in the past they were <a href="https://doi.org/10.1037/a0030684">rare</a>.</p> <p>Now, they’re all around us. In wealthy modern societies we are bombarded by <a href="https://theconversation.com/junk-food-is-promoted-online-to-appeal-to-kids-and-target-young-men-our-study-shows-234285">advertising</a> which intentionally reminds us about the sight, smell and taste of calorie-dense foods. And in response to these powerful cues, our brains respond just as they’re designed to, triggering <a href="https://doi.org/10.1111/obr.12354">an intense urge</a> to eat them.</p> <p>Here’s how food cravings work and what you can do if you find yourself hunting for sweet or salty foods.</p> <h2>What causes cravings?</h2> <p>A food craving is an intense desire or urge to eat something, <a href="https://pubmed.ncbi.nlm.nih.gov/15589112/">often focused on a particular food</a>.</p> <p>We are programmed to learn how good a food tastes and smells and where we can find it again, especially if it’s high in fat, sugar or salt.</p> <p>Something that <a href="https://doi.org/10.1111/obr.12354">reminds us</a> of enjoying a certain food, such as an eye-catching ad or delicious smell, can cause us to <a href="https://doi.org/10.1111/obr.12354">crave it</a>.</p> <p>The cue triggers a physical response, increasing saliva production and gastric activity. These responses are relatively automatic and difficult to control.</p> <h2>What else influences our choices?</h2> <p>While the effect of cues on our physical response is relatively automatic, what we do next is influenced by <a href="https://journals.sagepub.com/doi/pdf/10.1177/1090198107303308">complex</a> factors.<br />Whether or not you eat the food might depend on things like cost, whether it’s easily available, and if eating it would align with your health goals.</p> <p>But it’s usually hard to keep healthy eating in mind. This is because we tend to prioritise a more immediate reward, like the <a href="https://doi.org/10.1016/j.physbeh.2010.04.029">pleasure of eating</a>, over one that’s delayed or abstract – including health goals that will make us feel good in the long term.</p> <p><a href="https://doi.org/10.1016/S0022-3999(00)00076-3">Stress</a> can also make us eat more. When hungry, we <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8656885/">choose larger portions</a>, underestimate calories and find eating more <a href="https://www.sciencedirect.com/science/article/pii/S0195666315000793">rewarding</a>.</p> <h2>Looking for something salty or sweet</h2> <p>So what if a cue prompts us to look for a certain food, but it’s not available?</p> <p><a href="https://doi.org/10.1016/j.appet.2014.04.005">Previous research</a> suggested you would then look for anything that makes you feel good. So if you saw someone eating a doughnut but there were none around, you might eat chips or even drink alcohol.</p> <p>But our <a href="https://doi.org/10.1016/j.appet.2024.107640">new research</a> has confirmed something you probably knew: it’s more specific than that.</p> <p>If an ad for chips makes you look for food, it’s likely a slice of cake won’t cut it – you’ll be looking for something salty. Cues in our environment don’t just make us crave food generally, they prompt us to look for certain food “categories”, such as salty, sweet or creamy.</p> <h2>Food cues and mindless eating</h2> <p>Your <a href="https://core.ac.uk/download/pdf/161283824.pdf">eating history</a> and <a href="https://doi.org/10.1002/eat.24179">genetics</a> can also make it harder to suppress food cravings. But don’t beat yourself up – relying on willpower alone is <a href="https://doi.org/10.1016/j.appet.2015.01.004">hard</a> for almost everyone.</p> <p>Food cues are so powerful they can prompt us to <a href="https://doi.org/10.1177/0956797613484043">seek</a> out a certain food, even if we’re not overcome by a particularly <a href="https://doi.org/10.1177/0956797613484043">strong urge</a> to eat it. The effect is more intense if the food is easily available.</p> <p>This helps explain why we can eat an entire large bag of chips that’s in front of us, even though our pleasure decreases as we <a href="https://doi.org/10.1016/0031-9384(81)90310-3">eat</a>. Sometimes we use finishing the packet as the signal to stop <a href="https://doi.org/10.1016/j.physbeh.2015.03.025">eating</a> rather than hunger or desire.</p> <h2>Is there anything I can do to resist cravings?</h2> <p>We largely don’t have control over cues in our environment and the cravings they trigger. But there are some ways you can try and control the situations you make food choices in.</p> <ul> <li> <p><strong>Acknowledge your craving and think about a healthier way to satisfy it</strong>. For example, if you’re craving chips, could you have lightly-salted nuts instead? If you want something sweet, you could try fruit.</p> </li> <li> <p><strong>Avoid shopping when you’re hungry, and make a list beforehand</strong>. Making the most of supermarket “click and collect” or delivery options can also help avoid ads and impulse buys in the aisle.</p> </li> <li> <p><strong>At home, have fruit and vegetables easily available – and easy to see</strong>. Also have other nutrient dense, fibre-rich and unprocessed foods on hand such as nuts or plain yoghurt. If you can, remove high-fat, sugar-rich and salty foods from your environment.</p> </li> <li> <p><strong>Make sure your goals for eating are <a href="https://www.aafp.org/pubs/fpm/issues/2018/0300/p31.html">SMART</a></strong>. This means they are specific, measurable, achievable, relevant and time-bound.</p> </li> <li> <p><strong>Be kind to yourself</strong>. Don’t beat yourself up if you eat something that doesn’t meet your health goals. Just keep on trying.<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/237035/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> </li> </ul> <p><em><a href="https://theconversation.com/profiles/gabrielle-weidemann-91497">Gabrielle Weidemann</a>, Associate Professor in Psychological Science, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a> and <a href="https://theconversation.com/profiles/justin-mahlberg-1634725">Justin Mahlberg</a>, Research Fellow, Pyschology, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>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-causes-food-cravings-and-what-can-we-do-about-them-237035">original article</a>.</em></p>

Food & Wine

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I’m iron deficient. Which supplements will work best for me and how should I take them?

<p><em><a href="https://theconversation.com/profiles/alannah-mckay-1548258">Alannah McKay</a>, <a href="https://theconversation.com/institutions/australian-catholic-university-747">Australian Catholic University</a></em></p> <p>Iron deficiency is common and can be debilitating. It mainly affects women. One in three premenopausal women <a href="https://static1.squarespace.com/static/57bfc0498419c24a01318ae2/t/607fc2e06ace2f22d5ca9a43/1618985699483/20210421+-+IDC+-+economic+impact+of+iron+deficiency+-+FINAL.pdf">are low in iron</a> compared to just 5% of Australian men. Iron deficiency particularly affects teenage girls, women who do a lot of exercise and those who are pregnant.</p> <p>The <a href="https://pubmed.ncbi.nlm.nih.gov/11160590/">body needs iron</a> to make new red blood cells, and to support energy production, the immune system and cognitive function. If you’re low, you may experience a range of symptoms including fatigue, weakness, shortness of breath, headache, irregular heartbeat and reduced concentration.</p> <p>If a blood test shows you’re iron deficient, your doctor may recommend you start taking an oral iron supplement. But should you take a tablet or a liquid? With food or not? And when is the best time of day?</p> <p>Here are some tips to help you work out how, when and what iron supplement to take.</p> <h2>How do I pick the right iron supplement?</h2> <p>The iron in your body is called “elemental iron”. Choosing the right oral supplement and dose will depend on how much elemental iron it has – your doctor will advise exactly how much you need.</p> <p>The sweet spot is between <a href="https://www.sciencedirect.com/science/article/pii/S0098299720300364?via%3Dihub">60-120 mg of elemental iron</a>. Any less and the supplement won’t be effective in topping up your iron levels. Any higher and you risk gastrointestinal symptoms such as diarrhoea, cramping and stomach pain.</p> <p>In Australia, iron salts are the most common oral supplements because they are cheap, effective and come in different delivery methods (tablets, capsules, liquid formulas). <a href="https://www.ncbi.nlm.nih.gov/books/NBK557376/">The iron salts</a> you are most likely to find in your local chemist are ferrous sulfate (~20% elemental iron), ferrous gluconate (~12%) and ferrous fumarate (~33%).</p> <p>These formulations <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3867244/">all work similarly</a>, so your choice should come down to dose and cost.</p> <p>Many multivitamins may look like an iron supplement, but it’s important to note they usually have too little iron – usually less than 20 mg – to correct an iron deficiency.</p> <h2>Should I take tablets or liquid formulas?</h2> <p>Iron contained within a tablet is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3867244/">just as well absorbed</a> as iron found in a liquid supplement. Choosing the right one usually comes down to personal preference.</p> <p>The main difference is that liquid formulas tend to contain less iron than tablets. That means you might need to take more of the product to get the right dose, so using a liquid supplement could work out to be more expensive in the long term.</p> <h2>What should I eat with my iron supplement?</h2> <p>Research <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajh.26987">has shown</a> you will absorb more of the iron in your supplement if you take it on an empty stomach. But this can cause more gastrointestinal issues, so might not be practical for everyone.</p> <p>If you do take your supplement with meals, it’s important to think about what types of food will boost – rather than limit – iron absorption. For example, taking the supplement alongside vitamin C improves your body’s ability to absorb it.</p> <p>Some supplements already contain vitamin C. Otherwise you could take the supplement along with a glass of orange juice, or other <a href="https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/">vitamin C-rich foods</a>.</p> <p>On the other hand, tea, coffee and calcium all <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajh.26987">decrease the body’s ability to absorb iron</a>. So you should try to limit these close to the time you take your supplement.</p> <h2>Should I take my supplement in the morning or evening?</h2> <p>The best time of day to take your supplement is in the morning. The body can <a href="https://journals.lww.com/acsm-msse/fulltext/2019/10000/the_impact_of_morning_versus_afternoon_exercise_on.20.aspx">absorb significantly more</a> iron earlier in the day, when concentrations of hepcidin (the main hormone that regulates iron) are at their lowest.</p> <p>Exercise also affects the hormone that regulates iron. That means taking your iron supplement after exercising can <a href="https://journals.humankinetics.com/view/journals/ijsnem/32/5/article-p359.xml">limit your ability to absorb it</a>. Taking your supplement in the hours following exercise will mean significantly poorer absorption, especially if you take it between two and five hours after you stop.</p> <p><a href="https://journals.lww.com/acsm-msse/fulltext/2024/01000/iron_absorption_in_highly_trained_male_runners_.14.aspx">Our research</a> has shown if you exercise every day, the best time to take your supplement is in the morning before training, or immediately after (within 30 minutes).</p> <h2>My supplements are upsetting my stomach. What should I do?</h2> <p>If you experience gastrointestinal side effects such as diarrhoea or cramps when you take iron supplements, you may want to consider taking your supplement every second day, rather than daily.</p> <p>Taking a supplement every day is still the fastest way to restore your iron levels. But a recent study <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00463-7/fulltext#%20">has shown</a> taking the same total dose can be just as effective when it’s taken on alternate days. For example, taking a supplement every day for three months works as well as every second day for six months. This results in fewer side effects.</p> <p>Oral iron supplements can be a cheap and easy way to correct an iron deficiency. But ensuring you are taking the right product, under the right conditions, is crucial for their success.</p> <p>It’s also important to check your iron levels prior to commencing iron supplementation and do so only under medical advice. In large amounts, <a href="https://www.ncbi.nlm.nih.gov/books/NBK430862/">iron can be toxic</a>, so you don’t want to be consuming additional iron if your body doesn’t need it.</p> <p>If you think you may be low on iron, talk to your GP to find out your best options.<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/235315/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/alannah-mckay-1548258">Alannah McKay</a>, Postdoctoral Research Fellow, Sports Nutrition, <a href="https://theconversation.com/institutions/australian-catholic-university-747">Australian Catholic University</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>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/im-iron-deficient-which-supplements-will-work-best-for-me-and-how-should-i-take-them-235315">original article</a>.</em></p>

Body

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Woman “bullied” on plane over budget seating trick

<p dir="ltr">A young woman has recalled a flight from hell when she was “bullied” by a couple who were trying to utilise a seating hack that went viral on TikTok. </p> <p dir="ltr">The solo traveller took to Reddit to recount the story and ask social media users if she was in the wrong for her action. </p> <p dir="ltr">The woman began by saying she usually pays more to select her plane seat ahead of time, but a medical emergency on another plane had her waiting on standby and left with no option other than to sit in a middle seat.</p> <p dir="ltr">When she was finally able to board, she was greeted by a couple who had purchased both the window and aisle seats in a bid to have more space, utilising a travel “trick” that has been popular on TikTok.</p> <p dir="ltr">The method, which has been dubbed the 'poor man's business class', usually leaves travellers with an empty middle seat and more space, and few travellers opt to pick a middle seat. </p> <p dir="ltr">“When I got to my row the man and woman were chatting and sharing a snack... it was obvious they were together. I mentioned to the man that I'm in the middle, and he got up to let me in,” the unsuspecting traveller wrote on Reddit.  </p> <p dir="ltr">“I asked them if they would prefer to sit together, I said I was totally okay with that. The woman reacted rudely to this and said ‘you're not supposed to be sitting here anyway’.”</p> <p dir="ltr">After noticing how the plane was full, she offered to show the pair her new ticket with the correct seat number on it.</p> <p dir="ltr">“She flicked her hand at my ticket and made a disgusted sound. I offered again if they wanted to sit together to which she didn't reply, her partner said it's okay and... made some small talk,” she continued. </p> <p dir="ltr">The man’s girlfriend then interrupted their conversation to ask,”'Did you use one of those third party websites to book your flight? It's so frustrating when people cheap out to inconvenience others.”</p> <p dir="ltr">The American woman explained that she had booked her flight directly and she had been placed on standby like everyone else and didn't choose the middle seat - she was assigned it.</p> <p dir="ltr">She then tried to keep the peace by refusing to engage with the furious woman.  </p> <p dir="ltr">“I was so done with her attitude, I put my headphones on and attempted to do my own thing,” she explained.</p> <p dir="ltr">But the “entitled” girlfriend wasn't letting it go, as the woman explained, “This woman kept reaching over me and tapping her partner and trying to talk to him in a way that was super intrusive.”</p> <p dir="ltr">“I could tell even her partner was trying to engage her less so that she would hopefully stop, but she didn't.”</p> <p dir="ltr">“I think they tried to pull that tactic where they don't sit together on purpose...hoping no one will sit between them. But on full flights it doesn't work. And even so - it's not the other person's fault.”</p> <p dir="ltr">The traveller's post was met with hundreds of comments slamming the girlfriend’s behaviour, as one person wrote, “It's like a toddler having a tantrum.”</p> <p dir="ltr">“She was disappointed and a total a**hole. Gross entitled people,” another added. </p> <p dir="ltr">Another person applauded the traveller’s level-headed behaviour, writing, “Wow! You are my hero for keeping it classy - I’m afraid I would not have been as kind as you.”</p> <p dir="ltr"><em>Image credits: Shutterstock </em></p>

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What’s the difference between ‘strep throat’ and a sore throat? We’re developing a vaccine for one of them

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/kim-davis-1535254">Kim Davis</a>, <a href="https://theconversation.com/institutions/murdoch-childrens-research-institute-1027">Murdoch Children's Research Institute</a>; <a href="https://theconversation.com/profiles/alma-fulurija-1535255">Alma Fulurija</a>, <a href="https://theconversation.com/institutions/telethon-kids-institute-1608">Telethon Kids Institute</a>, and <a href="https://theconversation.com/profiles/myra-hardy-1535253">Myra Hardy</a>, <a href="https://theconversation.com/institutions/murdoch-childrens-research-institute-1027">Murdoch Children's Research Institute</a></em></p> <p>the time of the year for coughs, colds and sore throats. So you might have heard people talk about having a “strep throat”.</p> <p>But what is that? Is it just a bad sore throat that goes away by itself in a day or two? Should you be worried?</p> <p>Here’s what we know about the similarities and differences between strep throat and a sore throat, and why they matter.</p> <h2>How are they similar?</h2> <p>It’s difficult to tell the difference between a sore throat and strep throat as they look and feel similar.</p> <p>People usually have a fever, a bright red throat and sometimes painful lumps in the neck (swollen lymph nodes). A throat swab can help diagnose strep throat, but the results can take a few days.</p> <p>Thankfully, both types of sore throat usually get better <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8655103/">by themselves</a>.</p> <h2>How are they different?</h2> <p>Most sore throats are caused by viruses such as common cold viruses, the flu (influenza virus), or the virus that causes glandular fever (Epstein-Barr virus).</p> <p>These viral sore throats can occur at any age. Antibiotics don’t work against viruses so if you have a viral sore throat, you won’t get better faster if you take antibiotics. You might even have some unwanted <a href="https://www.ncbi.nlm.nih.gov/books/NBK401243/#:%7E:text=People%20may%20then%20wonder%20whether,infection%2C%20such%20as%20bacterial%20tonsillitis.">antibiotic side-effects</a>.</p> <p>But strep throat is caused by <em>Streptococcus pyogenes</em> bacteria, also known as strep A. Strep throat is most common in <a href="https://www.tandfonline.com/doi/full/10.2217/fmb-2021-0077">school-aged children</a>, but can affect other age groups. In some cases, you may need antibiotics to avoid some rare but serious complications.</p> <p>In fact, the potential for complications is one key difference between a viral sore throat and strep throat.</p> <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/605956/original/file-20240710-19-irooun.png?ixlib=rb-4.1.0&amp;q=45&amp;auto=format&amp;w=1000&amp;fit=clip"><img src="https://images.theconversation.com/files/605956/original/file-20240710-19-irooun.png?ixlib=rb-4.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/605956/original/file-20240710-19-irooun.png?ixlib=rb-4.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=405&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/605956/original/file-20240710-19-irooun.png?ixlib=rb-4.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=405&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/605956/original/file-20240710-19-irooun.png?ixlib=rb-4.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=405&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/605956/original/file-20240710-19-irooun.png?ixlib=rb-4.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=508&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/605956/original/file-20240710-19-irooun.png?ixlib=rb-4.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=508&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/605956/original/file-20240710-19-irooun.png?ixlib=rb-4.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=508&amp;fit=crop&amp;dpr=3 2262w" alt="" /></a><figcaption></figcaption></figure> <p>Generally, a viral sore throat is <a href="https://www.bmj.com/content/347/bmj.f6867">very unlikely</a> to cause complications (one exception is those caused by Epstein-Barr virus which has been associated with illnesses such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3893202/">chronic fatigue syndrome</a>, <a href="https://www.science.org/doi/10.1126/science.abj8222">multiple sclerosis</a> and certain <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00404-7/fulltext">cancers</a>).</p> <p>But strep A can cause invasive disease, a rare but serious complication. This is when bacteria living somewhere on the body (usually the skin or throat) get into another part of the body where there shouldn’t be bacteria, such as the bloodstream. This can make people extremely sick.</p> <p>Invasive strep A infections and deaths have been <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON429">rising in recent years</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10786649/">around the world</a>, especially in young children and older adults. This may be due to a number of factors such as increased social mixing at this stage of the COVID pandemic and an increase in circulating common cold viruses. But overall the reasons behind the increase in invasive strep A infections are not clear.</p> <p>Another rare but serious side effect of strep A is autoimmune disease. This is when the body’s immune system makes antibodies that react against its own cells.</p> <p>The most common example is <a href="https://www.who.int/news-room/fact-sheets/detail/rheumatic-heart-disease">rheumatic heart disease</a>. This is when the body’s immune system damages the heart valves a few weeks or months after a strep throat or skin infection.</p> <p><a href="https://www.nejm.org/doi/10.1056/NEJMoa2102074?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub%20%200pubmed">Around the world</a> more than 40 million people live with rheumatic heart disease and more than 300,000 die from its complications every year, mostly in developing countries.</p> <p>However, parts of Australia have some of the <a href="https://onlinelibrary.wiley.com/doi/full/10.5694/mja2.50682">highest rates</a> of rheumatic heart disease in the world. <a href="https://www.aihw.gov.au/reports/heart-stroke-vascular-diseases/hsvd-facts/contents/all-heart-stroke-and-vascular-disease/arf-and-rhd">More than 5,300</a> Indigenous Australians live with it.</p> <h2>Why do some people get sicker than others?</h2> <p>We know strep A infections and rheumatic heart disease <a href="https://link.springer.com/chapter/10.1007/82_2012_280">are more common</a> in low socioeconomic communities where poverty and overcrowding lead to increased strep A transmission and disease.</p> <p>However, we don’t fully understand why some people only get a mild infection with strep throat while others get very sick with invasive disease.</p> <p>We also don’t understand why some people get rheumatic heart disease after strep A infections when most others don’t. Our research team is trying to find out.</p> <h2>How about a vaccine for strep A?</h2> <p>There is no strep A vaccine but <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6028081/">many</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8545125/">groups</a> in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6495378/">Australia</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902606/">New Zealand</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3620221/">and</a> <a href="https://www.clinicalkey.com.au/#!/content/playContent/1-s2.0-S0264410X19316457?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0264410X19316457%3Fshowall%3Dtrue&amp;referrer=https:%2F%2Fpubmed.ncbi.nlm.nih.gov%2F">worldwide</a> are working towards one.</p> <p>For instance, Murdoch Children’s Research Institute and Telethon Kids Institute have formed the <a href="https://www.asavi.org.au">Australian Strep A Vaccine Initiative</a> to develop strep A vaccines. There’s also a <a href="https://savac.ivi.int/">global consortium</a> working towards the same goal.</p> <p>Companies such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10747066/">Vaxcyte</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7696035/">GlaxoSmithKline</a> have also been developing strep A vaccines.</p> <h2>What if I have a sore throat?</h2> <p>Most sore throats will get better by themselves. But if yours doesn’t get better in a few days or you have ongoing fever, see your GP.</p> <p>Your GP can examine you, consider running some tests and help you decide if you need antibiotics.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><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/230292/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/kim-davis-1535254">Kim Davis</a>, General paediatrician and paediatric infectious diseases specialist, <a href="https://theconversation.com/institutions/murdoch-childrens-research-institute-1027">Murdoch Children's Research Institute</a>; <a href="https://theconversation.com/profiles/alma-fulurija-1535255">Alma Fulurija</a>, Immunologist and the Australian Strep A Vaccine Initiative project lead, <a href="https://theconversation.com/institutions/telethon-kids-institute-1608">Telethon Kids Institute</a>, and <a href="https://theconversation.com/profiles/myra-hardy-1535253">Myra Hardy</a>, Postdoctoral Researcher, Infection, Immunity and Global Health, <a href="https://theconversation.com/institutions/murdoch-childrens-research-institute-1027">Murdoch Children's Research Institute</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>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/whats-the-difference-between-strep-throat-and-a-sore-throat-were-developing-a-vaccine-for-one-of-them-230292">original article</a>.</em></p> </div>

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Taking too many medications can pose health risks. Here’s how to avoid them

<p><em><a href="https://theconversation.com/profiles/caroline-sirois-1524891">Caroline Sirois</a>, <a href="https://theconversation.com/institutions/universite-laval-1407">Université Laval</a></em></p> <p>When we see an older family member handling a bulky box of medications sorted by day of the week, we might stop and wonder, is it too much? How do all those pills interact?</p> <p>The fact is, as we get older we are more likely to develop different chronic illnesses that require us to take several different medications. This is known as polypharmacy. The concept applies to people taking five or more medications, but there are all sorts of <a href="https://doi.org/10.3390/pharmacy7030126">definitions with different thresholds</a> (for example, four, 10 or 15 medicines).</p> <p>I’m a pharmacist and pharmacoepidemiologist interested in polypharmacy and its impact on the population. The research I carry out with my team at the Faculty of Pharmacy at Université Laval focuses on the appropriate use of medication by older family members. We have published this <a href="https://doi.org/10.1093/ageing/afac244">study</a> on the perceptions of older adults, family carers and clinicians on the use of medication among persons over 65.</p> <h2>Polypharmacy among older adults</h2> <p>Polypharmacy is very common among older adults. In 2021, a quarter of persons over 65 in Canada were prescribed <a href="https://www.cihi.ca/en/drug-use-among-seniors-in-canada">more than ten different classes of medication</a>. In Québec, persons over 65 used an average of <a href="https://www.inspq.qc.ca/sites/default/files/publications/2679_portrait_polypharmacie_aines_quebecois.pdf">8.7 different drugs in 2016</a>, the latest year available for statistics.</p> <p>Is it a good idea to take so many drugs?</p> <p>According to <a href="https://journals.sagepub.com/doi/10.1177/07334648211069553">our study</a>, the vast majority of seniors and family caregivers would be willing to stop taking one or more medications if the doctor said it was possible, even though most are satisfied with their treatments, <a href="https://doi.org/10.1093/ageing/afac244">have confidence in their doctors</a> and feel that their doctors are taking care of them to the best of their ability.</p> <p>In the majority of cases, medicine prescribers are helping the person they are treating. Medications have a positive impact on health and are essential in many cases. But while the treatment of individual illnesses is often adequate, the whole package can sometimes become problematic.</p> <h2>The risks of polypharmacy: 5 points to consider</h2> <p>When we evaluate cases of polypharmacy, we find that the quality of treatment is often compromised when many medications are being taken.</p> <ol> <li> <p>Drug interactions: polypharmacy increases the risk of drugs interacting, which can lead to undesirable effects or reduce the effectiveness of treatments.</p> </li> <li> <p>A drug that has a positive effect on one illness may have a negative effect on another: what should you do if someone has both illnesses?</p> </li> <li> <p>The greater the number of drugs taken, the greater the risk of undesirable effects: for adults over 65, for example, there is an increased risk of confusion or falls, which have significant consequences.</p> </li> <li> <p>The more medications a person takes, the more likely they are to take a <a href="https://www.doi.org/10.1093/fampra/cmz060">potentially inappropriate medication</a>. For seniors, these drugs generally carry more risks than benefits. For example, benzodiazepines, medicine for anxiety or sleep, are the <a href="https://www.inspq.qc.ca/sites/default/files/publications/2575_utilisation_medicaments_potentiellement_inappropries_aines.pdf">most frequently used class</a> of medications. We want to reduce their use as much as possible <a href="https://www.canada.ca/en/health-canada/services/substance-use/controlled-illegal-drugs/benzodiazepines.html">to avoid negative impacts</a> such as confusion and increased risk of falls and car accidents, not to mention the risk of dependence and death.</p> </li> <li> <p>Finally, polypharmacy is associated with various adverse health effects, such as an <a href="https://www.doi.org/10.1007/s41999-021-00479-3">increase in frailty, hospital admissions and emergency room visits</a>. However, studies conducted to date have not always succeeded in isolating the effects specific to polypharmacy. As polypharmacy is more common among people with multiple illnesses, these illnesses may also contribute to the observed risks.</p> </li> </ol> <p>Polypharmacy is also a combination of medicines. There are almost as many as there are people. The risks of these different combinations can vary. For example, the risks associated with a combination of five potentially inappropriate drugs would certainly be different from those associated with blood pressure medication and vitamin supplements.</p> <p>Polypharmacy is therefore complex. <a href="https://doi.org/10.1186/s12911-021-01583-x">Our studies attempt to use artificial intelligence</a> to manage this complexity and identify combinations associated with negative impacts. There is still a lot to learn about polypharmacy and its impact on health.</p> <h2>3 tips to avoid the risks associated with polypharmacy</h2> <p>What can we do as a patient, or as a caregiver?</p> <ol> <li> <p>Ask questions: when you or someone close to you is prescribed a new treatment, be curious. What are the benefits of the medication? What are the possible side effects? Does this fit in with my treatment goals and values? How long should this treatment last? Are there any circumstances in which discontinuing it should be considered ?</p> </li> <li> <p>Keep your medicines up to date: make sure they are all still useful. Are there still any benefits to taking them? Are there any side effects? Are there any drug interactions? Would another treatment be better? Should the dose be reduced?</p> </li> <li> <p>Think about de-prescribing: this is an increasingly common clinical practice that involves stopping or reducing the dose of an inappropriate drug after consulting a health-care professional. It is a shared decision-making process that involves the patient, their family and health-care professionals. The <a href="https://www.deprescribingnetwork.ca">Canadian Medication Appropriateness and Deprescribing Network</a> is a world leader in this practice. It has compiled a number of tools for patients and clinicians. You can find them on their website and subscribe to the newsletter.</p> </li> </ol> <h2>Benefits should outweigh the risks</h2> <p>Medications are very useful for staying healthy. It’s not uncommon for us to have to take more medications as we age, but this shouldn’t be seen as a foregone conclusion.</p> <p>Every medication we take must have direct or future benefits that outweigh the risks associated with them. As with many other issues, when it comes to polypharmacy, the saying, “everything in moderation,” frequently applies.<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/230612/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/caroline-sirois-1524891">Caroline Sirois</a>, Professor in Pharmacy, <a href="https://theconversation.com/institutions/universite-laval-1407">Université Laval</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>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/taking-too-many-medications-can-pose-health-risks-heres-how-to-avoid-them-230612">original article</a>.</em></p>

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Why you should expect to pay more tourist taxes – even though the evidence for them is unclear

<p><em><a href="https://theconversation.com/profiles/rhys-ap-gwilym-1531623">Rhys ap Gwilym</a>, <a href="https://theconversation.com/institutions/bangor-university-1221">Bangor University</a> and <a href="https://theconversation.com/profiles/linda-osti-1431286">Linda Osti</a>, <a href="https://theconversation.com/institutions/bangor-university-1221">Bangor University</a></em></p> <p>In April 2024, Venice began its controversial experiment to <a href="https://www.timeout.com/news/venice-will-charge-tourists-5-to-enter-the-city-from-next-year-090823">charge day trippers</a> €5 (£4.30) to visit the city on some of the busiest days of the year. But it’s not just the lagoon city, with its <a href="https://www.bbc.co.uk/travel/article/20230928-venices-new-5-entry-fee-explained#:%7E:text=Over%20the%20past%20three%20decades%2C%20Venice%20has%20become,thirds%20of%20visitors%20come%20just%20for%20the%20day.">30 million visitors</a> a year which is interested in trying out new tourism taxes.</p> <p>In the UK, a council in the county of Kent <a href="https://eur01.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftheconversationuk.cmail20.com%2Ft%2Fr-l-tiuhhult-iukktlluuk-o%2F&amp;data=05%7C02%7Cr.a.gwilym%40bangor.ac.uk%7C39ac5db833674c1a026508dc63a24fa7%7Cc6474c55a9234d2a9bd4ece37148dbb2%7C0%7C0%7C638494795990617858%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=D6oVizx3pFoiwRaTcKaakQ079%2FIQx86jcbFpj2%2FS0RQ%3D&amp;reserved=0">has recommended</a> introducing a tourism tax on overnight stays in the county. In Scotland, it seems likely that <a href="https://edinburgh.org/planning/local-information/visitor-levy-for-edinburgh/#:%7E:text=The%20Edinburgh%20Visitor%20Levy%2C%20otherwise%20referred%20to%20as,would%20then%20be%20invested%20back%20into%20the%20city.">visitors to Edinburgh</a> will be paying a fee by 2026, and the Welsh government <a href="https://www.walesonline.co.uk/news/wales-news/welsh-government-announces-tourists-pay-26591498">plans to introduce</a> similar legislation later this year.</p> <p>Such taxes may seem new to the UK, but there are more than 60 destinations around the world where this type of tax is already in place. These vary from a nationwide tax in Iceland to various towns across the US. Some have been in place for a long time (France was the <a href="https://www.impots.gouv.fr/taxe-de-sejour">first in 1910</a>), but most were introduced during the last decade or two.</p> <p>Before the pandemic really struck (and tourism was put on hold), 2020 was described by one newspaper as the <a href="https://www.telegraph.co.uk/travel/news/tourist-tax-amsterdam-venice/">“year of the tourist tax”</a>, as Amsterdam joined an ever-growing list of destinations, which includes Paris, Malta and Cancun, to charge visitors for simply visiting.</p> <p>Introducing these tourist taxes has often been controversial, with industry bodies <a href="https://www.bbc.co.uk/news/uk-wales-62707152">voicing concerns</a> about the potential impacts on the tourist trade.</p> <p>And it appears that the link between such levies and visitor numbers is not simple, with several studies reaching different conclusions. For example, some have suggested that tourism levies have hindered <a href="https://www-sciencedirect-com.bangor.idm.oclc.org/science/article/pii/S0261517704000238">international tourism in the Balearics</a> and <a href="https://journals-sagepub-com.bangor.idm.oclc.org/doi/pdf/10.1177/00472875211053658">the Maldives</a>, and that they may dissuade people from participating in <a href="https://eprints.bournemouth.ac.uk/35087/1/ADEDOYIN%2C%20Festus%20Fatai_Ph.D._2020.pdf">domestic tourism</a>.</p> <p>Yet in one of the world’s most popular tourism spots with a levy, Barcelona, visitor numbers have <a href="https://groupnao.com/wp-content/uploads/2020/11/TOURISM-TAXES-BY-DESIGN-NOV12-2020_rettet-compressed-2.pdf">consistently risen</a>, with hotel guests increasing from 7.1 million in 2013 to 9.5 million in 2019.</p> <p>In fact, the relationship between a visitor levy and tourist flow is so complex that there is no unified view, even within the same country. Italy has been one of the most studied, and results <a href="https://crenos.unica.it/crenosterritorio/sites/default/files/allegati-pubblicazioni-tes/Indagine_Villasimius_Quaderno_Crenos_ISBN.pdf">are inconsistent</a> <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/jtr.2123">there too</a>.</p> <p>Another study, looking at three neighbouring Italian seaside spots finds that only in one destination has the visitor levy <a href="https://www.rivisteweb.it/doi/10.1429/77318">reduced tourist flow</a>. And a study on the Italian cities of Rome, Florence and Padua shows that these cities <a href="https://link-springer-com.bangor.idm.oclc.org/chapter/10.1007/978-3-030-61274-0_23">have not experienced any negative effects</a> either in terms of domestic or international demand.</p> <p>So the impact of tourism taxes on visitor numbers is inconclusive.</p> <p>But what about other effects, such as the potential benefits of spending the revenues raised? As part of an ongoing research project, we looked at seven different destinations in which tourist taxes are levied to look at how the money raised is then spent.</p> <p>For most places, tourism tax revenues were being used to fund marketing and branding – so invested directly into promoting more tourism. The income was also commonly used to fund tourism infrastructure, from public toilets and walking or cycling paths to a multi-billion dollar <a href="https://www.occc.net/About-Us-Media-Relations-Press-Releases/ArticleID/569/Orange%20County%20Board%20Votes%20to%20Approve%20Convention%20Center%20Completion%20with%20Tourist%20Development%20Tax%20Revenues">convention centre</a> in Orange County, Florida.</p> <p>In <a href="https://www.caib.es/sites/impostturisme/en/l/projects/?mcont=95762">the Balearics</a>, revenues tend to go to projects that mitigate the negative impacts of tourism on the environment, culture and society of the islands. These include waste management, conserving natural habitats and historical monuments, and social housing.</p> <p>But in general, tourism taxes have been implemented successfully across the destinations we looked at, and there is little evidence of tourists being put off from visiting.</p> <p>Research also suggests that when tourists are told what the levy is used for – and when it relates directly to <a href="https://www.mdpi.com/2227-7099/5/2/21">improving their experience</a> or <a href="https://ejtr.vumk.eu/index.php/about/article/view/2813/605">enhancing sustainable tourism</a> – <a href="https://www-sciencedirect-com.bangor.idm.oclc.org/science/article/pii/S2212571X20301621?casa_token=HcD-yQh65XcAAAAA:GhVRo4vX9JY1E3Lcx5ZPaTr5ZHArMGNrmK_2ASJCtMPjVpdCQLdun25BmFEYquGgz8-1riOWdg">tourists are willing to accept and pay</a> the levy.</p> <h2>Day trippers</h2> <p>For many tourism destinations, the major problem is not overnight tourists, but rather <a href="https://www.mirror.co.uk/news/uk-news/fuming-snowdonia-visitors-demand-self-30203642">day visitors</a> who use local resources while making little in the way of a financial contribution. For these reasons, taxes might also be used to deter day visits and instead encourage longer stays.</p> <p><a href="https://www.economist.com/why-venice-is-starting-to-charge-tourists-to-enter?utm_medium=cpc.adword.pd&amp;utm_source=google&amp;ppccampaignID=18156330227&amp;ppcadID=&amp;utm_campaign=a.22brand_pmax&amp;utm_content=conversion.direct-response.anonymous&amp;gad_source=1&amp;gclid=Cj0KCQjw_qexBhCoARIsAFgBleshST3IQMYR8hONLSLnA_loj9dukAqxURhdVCn1RmGeD5iOQzw_r2caAsqrEALw_wcB&amp;gclsrc=aw.ds">Venice is at the forefront</a> of this shift. And in April 2024, after long discussions between the local authority, residents and business owners, Venice started a <a href="https://cdamedia.veneziaunica.it/en/video/it-is-difficult-to-book-a-visit-to-venice/">trial</a> of a day visitor tax (a so-called <a href="https://cda.veneziaunica.it/en">“access fee”</a>).</p> <p>Back in Kent, it may take longer for any such radical plans to come to fruition. In contrast to Scotland and Wales, there are currently no national plans to <a href="http://www.parliament.uk/written-questions-answers-statements/written-question/commons/2023-09-13/199425">introduce tourist taxes</a> in England.</p> <p>This might be considered shortsighted, given the dire need of many destinations in England to improve local infrastructure that tourists rely on, including <a href="https://www.reading.ac.uk/news/2024/Research-News/Swimming-in-sewage-Bathing-forecasts-not-keeping-people-safe">clean bathing water</a> and <a href="https://www.lancs.live/news/cumbria-news/lake-district-warning-parking-issues-27173650">public transport</a>. In <a href="https://www.accountingweb.co.uk/business/finance-strategy/manchester-acts-as-trailblazer-for-tourist-tax">Manchester</a> and <a href="https://www.ft.com/content/0e0385e6-29ec-4302-9903-6fbf63d8854a">Liverpool</a>, businesses have implemented voluntary overnight charges on visitors, in the absence of the statutory basis to implement compulsory levies.</p> <p>Many other English towns and cities will probably follow their lead. Tourism taxes are something we might all have to consider budgeting for in our future travel plans, wherever we choose to visit.<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/229134/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/rhys-ap-gwilym-1531623">Rhys ap Gwilym</a>, Senior Lecturer in Economics, <a href="https://theconversation.com/institutions/bangor-university-1221">Bangor University</a> and <a href="https://theconversation.com/profiles/linda-osti-1431286">Linda Osti</a>, Senior Lecturer in Tourism Management, <a href="https://theconversation.com/institutions/bangor-university-1221">Bangor University</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>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-you-should-expect-to-pay-more-tourist-taxes-even-though-the-evidence-for-them-is-unclear-229134">original article</a>.</em></p>

Travel Trouble

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COVID vaccines saved millions of lives – linking them to excess deaths is a mistake

<p><a href="https://theconversation.com/profiles/paul-hunter-991309">Paul Hunter</a>, <em><a href="https://theconversation.com/institutions/university-of-east-anglia-1268">University of East Anglia</a></em></p> <p>A recent <a href="https://bmjpublichealth.bmj.com/content/2/1/e000282">study</a> has sparked another <a href="https://nypost.com/2024/06/06/us-news/covid-vaccines-may-have-helped-fuel-rise-in-excess-deaths-since-pandemic-study/">round of</a> <a href="https://www.telegraph.co.uk/news/2024/06/04/covid-vaccines-may-have-helped-fuel-rise-in-excess-deaths/">headlines</a> <a href="https://www.gbnews.com/health/covid-vaccine-side-effects-deaths">claiming</a> that COVID vaccines caused excess deaths. This was accompanied by a predictable outpouring of <a href="https://x.com/DrAseemMalhotra/status/1797922073798717524">I-told-you-sos</a> on social media.</p> <p>Excess deaths are a measure of how many more deaths are being recorded in a country over what would have been expected based on historical trends. In the UK, and in many other countries, death rates have been higher during the years 2020 to 2023 than would have been expected based on historic trends from before the pandemic. But that has been known for some time. A couple of years ago I wrote an article for <a href="https://theconversation.com/summer-2022-saw-thousands-of-excess-deaths-in-england-and-wales-heres-why-that-might-be-189351">The Conversation</a> pointing this out and suggesting some reasons. But has anything changed?</p> <p>The authors of the new study, published in BMJ Public Health, used publicly available data from <a href="https://ourworldindata.org/COVID-vaccinations">Our World in Data</a> to determine which countries had “statistically significant” excess deaths – in other words, excess deaths that couldn’t be explained by mere random variation.</p> <p>They studied the years 2020 to 2022 and found that many, but not all, countries did indeed report excess deaths. The authors did not try to explain why these excess deaths occurred, but the suggestion that COVID vaccines could have played a role is clear from their text – and indeed widely interpreted as such by certain newspapers.</p> <p>There is no doubt that a few deaths were associated with <a href="https://journals.sagepub.com/doi/full/10.1177/25166026211053485">the COVID vaccines</a>, but could the vaccination programme explain the large number of excess deaths – 3 million in 47 countries – that have been reported?</p> <p>Based on <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/excessdeathsinenglandandwales/march2020todecember2021">death certificates</a>, during 2020 and 2021 there were more deaths from COVID than estimated excess deaths in the UK. So during the year 2021 when most vaccine doses were administered, there were actually fewer non-COVID deaths than would have been expected. It was only in 2022 that excess deaths <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/deathregistrationsummarystatisticsenglandandwales/2022">exceeded COVID deaths</a>.</p> <p>If the vaccination campaign was contributing to the excess deaths that we have seen in recent years, then we should expect to see more deaths in people who have been vaccinated than in those who have not. The most reliable analysis in this regard was done by the UK’s <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/excessdeathsinenglandandwales/march2020todecember2021">Office for National Statistics (ONS)</a>. In this analysis, the ONS matched death registrations with the vaccine histories of each death recorded. They then calculated “age-standardised death rates” to account for age differences between those vaccinated and those not.</p> <p>What the ONS found was that in all months from April 2021 to May 2023, the death rate <a href="https://www.ons.gov.uk/redir/eyJ0eXAiOiJKV1QiLCJhbGciOiJIUzI1NiJ9.eyJpbmRleCI6MSwicGFnZVNpemUiOjEwLCJwYWdlIjoxLCJ1cmkiOiIvcGVvcGxlcG9wdWxhdGlvbmFuZGNvbW11bml0eS9iaXJ0aHNkZWF0aHNhbmRtYXJyaWFnZXMvZGVhdGhzL2RhdGFzZXRzL2V4Y2Vzc2RlYXRoc2luZW5nbGFuZGFuZHdhbGVzIiwibGlzdFR5cGUiOiJyZWxhdGVkZGF0YSJ9.Cot-XDe8Rr07paGllBNnVVz1nTqnXfVafn2woA3tk0c">from all causes was higher</a> in the unvaccinated than in people who had been vaccinated at least once.</p> <p>That deaths from all causes were lower in the vaccinated than the unvaccinated should come as no surprise given that COVID was a major cause of death in 2021 and 2022. And there is ample evidence of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10492612/">protective effect of vaccines</a> against severe COVID and death. But what is even more convincing is that, even when known COVID deaths were excluded in the ONS report, the death rate in the unvaccinated was still higher, albeit not by very much in more recent months.</p> <p>Some COVID deaths would certainly not have been recognised as such. But, on the other hand, people with chronic conditions, such as diabetes, were a high priority for vaccination. And these people would have been at increased risk of death even before the pandemic.</p> <h2>Possible causes</h2> <p>If the vaccine is not the cause of the excess deaths, what was?</p> <p>The major cause of the excess deaths reported in the first two years of the BMJ Public Health study was deaths from COVID. But by 2022, excess deaths exceeded COVID deaths in many countries.</p> <p>Possible <a href="https://theconversation.com/summer-2022-saw-thousands-of-excess-deaths-in-england-and-wales-heres-why-that-might-be-189351">explanations</a> for these excess deaths include longer-term effects of earlier COVID infections, the return of infections such as influenza that had been suppressed during the COVID control measures, adverse effects of lockdowns on physical and mental health, and delays in the diagnosis of life-threatening infections as health services struggled to cope with the pandemic and its aftermath.</p> <p>We do need to look very carefully at how the pandemic was managed. There is still considerable debate about the effectiveness of different behavioural control measures, such as self-isolation and lockdowns. Even when such interventions were effective at reducing transmission of COVID, what were the harms and were the gains worth the harms? Nevertheless, we can be confident that the excess deaths seen in recent years were not a consequence of the vaccination campaign.<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/231776/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/paul-hunter-991309">Paul Hunter</a>, Professor of Medicine, <a href="https://theconversation.com/institutions/university-of-east-anglia-1268">University of East Anglia</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>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/covid-vaccines-saved-millions-of-lives-linking-them-to-excess-deaths-is-a-mistake-231776">original article</a>.</em></p>

Body

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3 common travel illnesses (and how to avoid them)

<p>Nobody wants to fall sick when they’re on holidays but it happens and is actually quite common. Not every travel illness is foreseeable, but the most prevalent ones usually can be managed if you’re prepared and know what to look out for. Here are three of the most common illnesses travellers experience and what you can do to avoid them.</p> <p><strong>Traveller’s diarrhoea</strong></p> <p>It may be an unpleasant topic of conversation, but as diarrhoeais the most common travel sickness, it’s important to be prepared. It is estimated diarrhoeais experienced by almost half of travellers at some point on their holiday, but mainly by those visiting developing countries. It’s contracted by eating or drinking contaminated food and water and in severe cases can last for days.</p> <p><em><span style="text-decoration: underline;">How to avoid it</span>:</em> Stick to bottled or purified water, freshly cooked meals and fruits and vegetables you can peel yourself. Talk to your doctor for antibiotics you can take in case you are struck with traveller’s diarrhoea.</p> <p><strong>Motion sickness</strong></p> <p>Whether it’s by boat, plane, or car, many travellers experience motion sickness. This occurs when your eyes see motion but your body doesn’t register it, leading to a conflict of the senses. It often results in nausea, vomiting, headaches, and sweating.</p> <p><em><span style="text-decoration: underline;">How to avoid it</span>:</em> If flying, try to sit near the wings of plane. If cruising, get an outside cabin in the middle of ship, and if in a car, sit up front. Don’t play with your devices, as looking at a small screens often exacerbates the problem; instead try to look far to the horizon. Have a light meal before travelling and avoid spicy, greasy or rich foods. You can talk to your doctor about over-the-counter medication that can help motion sickness as well.  </p> <p><strong>Bug bites</strong></p> <p>There are all sorts of infectious diseases like malaria, dengue, chikungunya and yellow fever you can pick up from bug bites, especially in developing nations. While you should always talk to your doctor about the types of vaccines you need to take for your travel destination, it is always advisable to protect against insect bites.</p> <p><em><span style="text-decoration: underline;">How to avoid it</span>:</em> Apply insect repellent, wear long sleeves and pants where possible and try to avoid outside activity around dust and dawn when mosquitos are active. If sleeping outdoors, it is advisable to use curtain nettings.</p> <p><em>Image credits: Getty Images </em></p>

Travel Tips

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

<p><em><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></em></p> <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> <p>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>.</p> <p>People usually buy micronutrients to protect against disease or as dietary “insurance”, in case they are not getting sufficient quantities from their diets.</p> <p>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.</p> <h2>Benefits</h2> <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> <h2>Warning bells</h2> <p>Most consumers use multivitamins. But others take large doses of single nutrients, especially vitamin C, iron and calcium.</p> <p>As lecturers in pharmacy practice, we think it’s important to highlight the potential adverse effects of commonly used vitamins and minerals:</p> <ul> <li> <p><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.</p> </li> <li> <p><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).</p> </li> <li> <p><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.</p> </li> <li> <p><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.</p> </li> <li> <p><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.</p> </li> <li> <p><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.</p> </li> <li> <p><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).</p> </li> <li> <p>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.</p> </li> <li> <p><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.</p> </li> <li> <p><a href="https://www.sciencedirect.com/science/article/pii/S0098299720300364#:%7E:text=Expert%20guidelines%20for%20oral%20iron%20supplementation&amp;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.</p> </li> </ul> <h2>Recommendations</h2> <p>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.</p> <p>Regular exercise and a well-balanced diet are more likely to do us good, as well as being lighter on the pocket.</p> <p>Seeking advice from a healthcare professional before consuming supplements can reduce the risk of adverse effects.</p> <p>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" /></p> <p><em><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></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>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>.</em></p>

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What are heart rate zones, and how can you incorporate them into your exercise routine?

<p><em><a href="https://theconversation.com/profiles/hunter-bennett-1053061">Hunter Bennett</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a></em></p> <p>If you spend a lot of time exploring fitness content online, you might have come across the concept of heart rate zones. Heart rate zone training has become more popular in recent years partly because of the boom in wearable technology which, among other functions, allows people to easily track their heart rates.</p> <p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537749/">Heart rate zones</a> reflect different levels of intensity during aerobic exercise. They’re most often based on a percentage of your maximum heart rate, which is the highest number of beats your heart can achieve per minute.</p> <p>But what are the different heart rate zones, and how can you use these zones to optimise your workout?</p> <h2>The three-zone model</h2> <p>While there are several models used to describe heart rate zones, the most common model in the scientific literature is the <a href="https://journals.humankinetics.com/view/journals/ijspp/9/1/article-p100.xml">three-zone model</a>, where the zones may be categorised as follows:</p> <ul> <li> <p>zone 1: 55%–82% of maximum heart rate</p> </li> <li> <p>zone 2: 82%–87% of maximum heart rate</p> </li> <li> <p>zone 3: 87%–97% of maximum heart rate.</p> </li> </ul> <p>If you’re not sure what your maximum heart rate is, it can be calculated using <a href="https://www.jacc.org/doi/full/10.1016/S0735-1097%2800%2901054-8">this equation</a>: 208 – (0.7 × age in years). For example, I’m 32 years old. 208 – (0.7 x 32) = 185.6, so my predicted maximum heart rate is around 186 beats per minute.</p> <p>There are also other models used to describe heart rate zones, such as the <a href="https://journals.humankinetics.com/view/journals/ijspp/14/8/article-p1151.xml">five-zone model</a> (as its name implies, this one has five distinct zones). These <a href="https://journals.humankinetics.com/view/journals/ijspp/9/1/article-p100.xml">models</a> largely describe the same thing and can mostly be used interchangeably.</p> <h2>What do the different zones involve?</h2> <p>The three zones are based around a person’s <a href="https://link.springer.com/article/10.2165/00007256-200939060-00003">lactate threshold</a>, which describes the point at which exercise intensity moves from being predominantly aerobic, to predominantly anaerobic.</p> <p>Aerobic exercise <a href="https://www.healthline.com/health/fitness-exercise/difference-between-aerobic-and-anaerobic">uses oxygen</a> to help our muscles keep going, ensuring we can continue for a long time without fatiguing. Anaerobic exercise, however, uses stored energy to fuel exercise. Anaerobic exercise also accrues metabolic byproducts (such as lactate) that increase fatigue, meaning we can only produce energy anaerobically for a short time.</p> <p>On average your lactate threshold tends to sit around <a href="https://www.tandfonline.com/doi/full/10.2147/OAJSM.S141657">85% of your maximum heart rate</a>, although this varies from person to person, and can be <a href="https://journals.physiology.org/doi/full/10.1152/japplphysiol.00043.2013">higher in athletes</a>.</p> <p>In the three-zone model, each zone loosely describes <a href="https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2015.00295/full">one of three types of training</a>.</p> <p><strong>Zone 1</strong> represents high-volume, low-intensity exercise, usually performed for long periods and at an easy pace, well below lactate threshold. Examples include jogging or cycling at a gentle pace.</p> <p><strong>Zone 2</strong> is threshold training, also known as tempo training, a moderate intensity training method performed for moderate durations, at (or around) lactate threshold. This could be running, rowing or cycling at a speed where it’s difficult to speak full sentences.</p> <p><strong>Zone 3</strong> mostly describes methods of high-intensity interval training, which are performed for shorter durations and at intensities above lactate threshold. For example, any circuit style workout that has you exercising hard for 30 seconds then resting for 30 seconds would be zone 3.</p> <h2>Striking a balance</h2> <p>To maximise endurance performance, you need to strike a balance between doing enough training to elicit positive changes, while avoiding over-training, injury and burnout.</p> <p>While zone 3 is thought to produce the largest improvements in <a href="https://www.sciencedirect.com/science/article/pii/S1440244018309198">maximal oxygen uptake</a> – one of the best predictors of endurance performance and overall health – it’s also the most tiring. This means you can only perform so much of it before it becomes too much.</p> <p>Training in different heart rate zones improves <a href="https://citeseerx.ist.psu.edu/document?repid=rep1&amp;type=pdf&amp;doi=38c07018c0636422d9d5a77316216efb3c10164f">slightly different physiological qualities</a>, and so by spending time in each zone, you ensure a <a href="https://link.springer.com/article/10.1007/bf00426304">variety of benefits</a> for performance and health.</p> <h2>So how much time should you spend in each zone?</h2> <p>Most <a href="https://www.frontiersin.org/articles/10.3389/fspor.2023.1258585/full">elite endurance athletes</a>, including runners, rowers, and even cross-country skiers, tend to spend most of their training (around 80%) in zone 1, with the rest split between zones 2 and 3.</p> <p>Because elite endurance athletes train a lot, most of it needs to be in zone 1, otherwise they risk injury and burnout. For example, some runners accumulate <a href="https://journals.humankinetics.com/view/journals/ijsnem/22/5/article-p392.xml?content=pdf">more than 250 kilometres per week</a>, which would be impossible to recover from if it was all performed in zone 2 or 3.</p> <p>Of course, most people are not professional athletes. The <a href="https://www.who.int/news-room/fact-sheets/detail/physical-activity">World Health Organization</a> recommends adults aim for 150–300 minutes of moderate intensity exercise per week, or 75–150 minutes of vigorous exercise per week.</p> <p>If you look at this in the context of heart rate zones, you could consider zone 1 training as moderate intensity, and zones 2 and 3 as vigorous. Then, you can use heart rate zones to make sure you’re exercising to meet these guidelines.</p> <h2>What if I don’t have a heart rate monitor?</h2> <p>If you don’t have access to a heart rate tracker, that doesn’t mean you can’t use heart rate zones to guide your training.</p> <p>The three heart rate zones discussed in this article can also be prescribed based on feel using a simple <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1600-0838.2004.00418.x">10-point scale</a>, where 0 indicates no effort, and 10 indicates the maximum amount of effort you can produce.</p> <p>With this system, zone 1 aligns with a 4 or less out of 10, zone 2 with 4.5 to 6.5 out of 10, and zone 3 as a 7 or higher out of 10.</p> <p>Heart rate zones are not a perfect measure of exercise intensity, but can be a useful tool. And if you don’t want to worry about heart rate zones at all, that’s also fine. The most important thing is to simply get moving.<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/228520/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/hunter-bennett-1053061">Hunter Bennett</a>, Lecturer in Exercise Science, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-are-heart-rate-zones-and-how-can-you-incorporate-them-into-your-exercise-routine-228520">original article</a>.</em></p>

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How people get sucked into misinformation rabbit holes – and how to get them out

<p><em><a href="https://theconversation.com/profiles/emily-booth-715018">Emily Booth</a>, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a> and <a href="https://theconversation.com/profiles/marian-andrei-rizoiu-850922">Marian-Andrei Rizoiu</a>, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a></em></p> <p>As misinformation and radicalisation rise, it’s tempting to look for something to blame: the internet, social media personalities, sensationalised political campaigns, religion, or conspiracy theories. And once we’ve settled on a cause, solutions usually follow: do more fact-checking, regulate advertising, ban YouTubers deemed to have “gone too far”.</p> <p>However, if these strategies were the whole answer, we should already be seeing a decrease in people being drawn into fringe communities and beliefs, and less misinformation in the online environment. We’re not.</p> <p>In new research <a href="https://doi.org/10.1177/14407833241231756">published in the Journal of Sociology</a>, we and our colleagues found radicalisation is a process of increasingly intense stages, and only a small number of people progress to the point where they commit violent acts.</p> <p>Our work shows the misinformation radicalisation process is a pathway driven by human emotions rather than the information itself – and this understanding may be a first step in finding solutions.</p> <h2>A feeling of control</h2> <p>We analysed dozens of public statements from newspapers and online in which former radicalised people described their experiences. We identified different levels of intensity in misinformation and its online communities, associated with common recurring behaviours.</p> <p>In the early stages, we found people either encountered misinformation about an anxiety-inducing topic through algorithms or friends, or they went looking for an explanation for something that gave them a “bad feeling”.</p> <p>Regardless, they often reported finding the same things: a new sense of certainty, a new community they could talk to, and feeling they had regained some control of their lives.</p> <p>Once people reached the middle stages of our proposed radicalisation pathway, we considered them to be invested in the new community, its goals, and its values.</p> <h2>Growing intensity</h2> <p>It was during these more intense stages that people began to report more negative impacts on their own lives. This could include the loss of friends and family, health issues caused by too much time spent on screens and too little sleep, and feelings of stress and paranoia. To soothe these pains, they turned again to their fringe communities for support.</p> <p>Most people in our dataset didn’t progress past these middle stages. However, their continued activity in these spaces kept the misinformation ecosystem alive.</p> <p>When people did move further and reach the extreme final stages in our model, they were doing active harm.</p> <p>In their recounting of their experiences at these high levels of intensity, individuals spoke of choosing to break ties with loved ones, participating in public acts of disruption and, in some cases, engaging in violence against other people in the name of their cause.</p> <p>Once people reached this stage, it took pretty strong interventions to get them out of it. The challenge, then, is how to intervene safely and effectively when people are in the earlier stages of being drawn into a fringe community.</p> <h2>Respond with empathy, not shame</h2> <p>We have a few suggestions. For people who are still in the earlier stages, friends and trusted advisers, like a doctor or a nurse, can have a big impact by simply responding with empathy.</p> <p>If a loved one starts voicing possible fringe views, like a fear of vaccines, or animosity against women or other marginalised groups, a calm response that seeks to understand the person’s underlying concern can go a long way.</p> <p>The worst response is one that might leave them feeling ashamed or upset. It may drive them back to their fringe community and accelerate their radicalisation.</p> <p>Even if the person’s views intensify, maintaining your connection with them can turn you into a lifeline that will see them get out sooner rather than later.</p> <p>Once people reached the middle stages, we found third-party online content – not produced by government, but regular users – could reach people without backfiring. Considering that many people in our research sample had their radicalisation instigated by social media, we also suggest the private companies behind such platforms should be held responsible for the effects of their automated tools on society.</p> <p>By the middle stages, arguments on the basis of logic or fact are ineffective. It doesn’t matter whether they are delivered by a friend, a news anchor, or a platform-affiliated fact-checking tool.</p> <p>At the most extreme final stages, we found that only heavy-handed interventions worked, such as family members forcibly hospitalising their radicalised relative, or individuals undergoing government-supported deradicalisation programs.</p> <h2>How not to be radicalised</h2> <p>After all this, you might be wondering: how do you protect <em>yourself</em> from being radicalised?</p> <p>As much of society becomes more dependent on digital technologies, we’re going to get exposed to even more misinformation, and our world is likely going to get smaller through online echo chambers.</p> <p>One strategy is to foster your critical thinking skills by <a href="https://www.cell.com/trends/cognitive-sciences/abstract/S1364-6613(23)00198-5">reading long-form texts from paper books</a>.</p> <p>Another is to protect yourself from the emotional manipulation of platform algorithms by <a href="https://guilfordjournals.com/doi/10.1521/jscp.2018.37.10.751">limiting your social media use</a> to small, infrequent, purposefully-directed pockets of time.</p> <p>And a third is to sustain connections with other humans, and lead a more analogue life – which has other benefits as well.</p> <p>So in short: log off, read a book, and spend time with people you care about. <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/223717/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/emily-booth-715018">Emily Booth</a>, Research assistant, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a> and <a href="https://theconversation.com/profiles/marian-andrei-rizoiu-850922">Marian-Andrei Rizoiu</a>, Associate Professor in Behavioral Data Science, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>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-people-get-sucked-into-misinformation-rabbit-holes-and-how-to-get-them-out-223717">original article</a>.</em></p>

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Worried about getting a blood test? 5 tips to make them easier (and still accurate)

<p><em><a href="https://theconversation.com/profiles/sapha-shibeeb-1481231">Sapha Shibeeb</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a></em></p> <p>Blood tests are a common medical procedure, offering valuable insights into a person’s health. Whether you’re getting a routine check-up, diagnosing a medical condition or monitoring treatment progress, understanding the process can make the experience more comfortable and effective.</p> <p>For the majority of patients, blood collections are a minor inconvenience. Others may feel <a href="https://www.sciencedirect.com/science/article/abs/pii/S0887618506000041">uneasy and anxious</a>.</p> <p>Preparation strategies can help get you through the procedure.</p> <h2>How blood is collected</h2> <p>During venipuncture (blood draw), the phlebotomist (blood collector) inserts a needle through the skin into a vein and a small amount of blood is collected and transferred into a test tube.</p> <p>Tubes are sent to a laboratory, where the blood is analysed. A laboratory technician may count or examine cells and measure the levels of minerals/salts, enzymes, proteins or other substances in the sample. For some tests, blood plasma is separated out by spinning (centrifuging) the sample. Others pass a light beam through the sample to determine the amount of a chemical present.</p> <p>For collection, the phlebotomist usually selects a vein in the crook of your elbow, where veins are readily accessible. Blood can also be drawn from veins in the wrists, fingers or heels. A tourniquet may be applied to restrict blood flow and make the chosen vein puff out.</p> <h2>Different tests require different preparation</h2> <p>Before a blood test, the GP or health-care provider will give you specific instructions.</p> <p>These may include fasting for up to 12 hours or temporarily discontinuing certain medications.</p> <p>It is crucial to follow these guidelines meticulously as they can significantly impact the accuracy of your test results. For example, fasting is required before glucose (blood sugar) and lipids (blood fats) testing because blood sugar and cholesterol levels typically increase after a meal.</p> <p>If the blood test requires fasting, you will be asked not to eat or drink (no tea, coffee, juice or alcohol) for about eight to 12 hours. Water is allowed but smoking should be avoided because it can increase <a href="https://diabetesjournals.org/care/article/19/2/112/19825/Acute-Effect-of-Cigarette-Smoking-on-Glucose">blood sugar, cholesterol and triglyceride levels</a>.</p> <p>Generally, you will be asked to fast overnight and have the blood collection done in the morning. Fasting for longer than 15 hours could impact your results, too, by causing dehydration or the release of certain chemicals in the blood.</p> <p>If you have diabetes, you must consult your doctor prior to fasting because it can increase the risk of hypoglycemia (low blood sugar) in people with type 1 diabetes. Most type 2 diabetics can safely fast before a blood test but there are some exceptions, such as people who are taking certain medications including insulin.</p> <h2>5 tips for a better blood test</h2> <p>To improve your blood collection experience, consider these tips:</p> <p><strong>1. Hydrate</strong></p> <p>Drink plenty of water right up to 30 minutes before your appointment. Adequate hydration improves blood flow, making your veins more accessible. Avoid <a href="https://academic.oup.com/labmed/article/34/10/736/2657269">strenuous exercise</a> before your blood test, which can increase some blood parameters (such as liver function) while decreasing others (such as sodium).</p> <p><strong>2. Loose clothing</strong></p> <p>Wear clothing that allows easy access to your arms to ensure a less stressful procedure.</p> <p><strong>3. Manage anxiety</strong></p> <p>If the sight of blood or the procedure makes you anxious, look away while the needle is inserted and try to keep breathing normally. Distraction can help – virtual reality has been <a href="https://pubmed.ncbi.nlm.nih.gov/31889358/">trialled</a> to reduce needle anxiety in children. You could try bringing something to read or music to listen to.</p> <p><strong>4. Know your risk of fainting</strong></p> <p>If you’re prone to fainting, make sure to inform the phlebotomist when you arrive. You can have your blood drawn while lying down to minimise the risk of passing out and injury. Hydration helps maintain blood pressure and can also <a href="https://www.ahajournals.org/doi/10.1161/01.CIR.0000101966.24899.CB">reduce the risk</a> of fainting.</p> <p><strong>5. Discuss difficult veins</strong></p> <p>Some people have smaller or scarred veins, often due to repeated punctures, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989034/">chemotherapy</a> or blood thinner use. In such cases, venipuncture may require multiple attempts. It is important to talk to the phlebotomist if you feel discomfort or significant pain. A finger prick can be performed as an alternative for some tests, such as blood glucose levels. But other comprehensive tests require larger blood volume.</p> <h2>Blood draws after lymph node removal</h2> <p>Historically, there were concerns about drawing blood from an arm that had undergone lymph node removal. This was due to the risk of <a href="https://www.cancer.gov/about-cancer/treatment/side-effects/lymphedema/lymphedema-pdq#:%7E:text=Lymphedema%20is%20the%20build%2Dup,the%20way%20that%20it%20should.">lymphedema</a>, a condition marked by fluid build-up in the affected arm. Lymph nodes may have been removed (<a href="https://www.ncbi.nlm.nih.gov/books/NBK564397/#:%7E:text=Lymph%20node%20dissection%2C%20also%20known,surgical%20management%20of%20malignant%20tumors.">lymphadenectomy</a>) for cancer diagnosis or treatment.</p> <p>However, a <a href="https://ascopubs.org/doi/10.1200/JCO.2015.61.5948">2016 study</a> showed people who’ve had lymph nodes removed are not at a higher risk of developing lymphedema following blood draws, even when drawing blood from the affected arm.</p> <h2>After your blood test</h2> <p>The whole blood test procedure usually lasts no more than a few minutes. Afterwards, you may be asked to apply gentle pressure over a clean dressing to aid clotting and reduce swelling.</p> <p>If you do experience swelling, bruising or pain after a test, follow general first aid procedures to alleviate discomfort. These include applying ice to the site, resting the affected arm and, if needed, taking a pain killer.</p> <p>It is usually recommended you do not do heavy lifting for a few hours after a blood draw. This is to prevent surges in blood flow that could prevent clotting where the blood was taken.<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/216073/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/sapha-shibeeb-1481231">Sapha Shibeeb</a>, Senior lecturer in Laboratory Medicine , <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>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/worried-about-getting-a-blood-test-5-tips-to-make-them-easier-and-still-accurate-216073">original article</a>.</em></p>

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Name that rash: 6 common skin conditions (and how to treat them)

<p><strong>Psoriasis</strong></p> <p><span style="text-decoration: underline;"><em>What psoriasis is like:</em></span> Psoriasis is made of red, scaly plaques that can be itchy and painful. It can show up anywhere but is most commonly found on the scalp, as well as the outside of the elbows and knees. It usually starts between age 10 and 30 and tends to be a chronic condition. “It’s a stubborn disease that waxes and wanes, so people have it for their whole lives,” says dermatologist Paul Cohen.</p> <p><span style="text-decoration: underline;"><em>What causes psoriasis:</em></span> This skin rash is the result of your immune system attacking the skin’s cells, and creating new ones too quickly, which then build up into the plaques. There’s no one single cause, but the condition runs in families. Stress, obesity, smoking and having many infections (particularly strep throat) increase your risk.</p> <p><span style="text-decoration: underline;"><em>How to treat psoriasis:</em></span> The first step is generally topical steroids, which can be used for a week or two at a time to clear up the plaques. For ongoing treatment, people use a synthetic form of vitamin D (which slows skin growth), medicated shampoos and retinoids (a topical version of vitamin A). Daily exposure to sunlight also seems to help, as does moisturising well. For more serious cases, options include oral medications that suppress the immune system and phototherapy done in a doctor’s office with a special light. (Discover more applications of light therapy.)</p> <p><span style="text-decoration: underline;"><em>Possible red flag:</em></span> Serious cases can involve the joints, a condition called psoriatic arthritis. Also, psoriasis increases your chances of having some other diseases, including type 2 diabetes, cardiovascular disease and autoimmune conditions such as Crohn’s – all of which are, like psoriasis, linked to inflammation.</p> <p><strong>Hives</strong></p> <p><span style="text-decoration: underline;"><em>What hives are like:</em></span> Hives are itchy, raised welts that often have a red ring around them. Their most salient characteristic is that they disappear after about a day, only to show up later in a different location. They come in two forms: acute, which lasts six weeks or less, and chronic.</p> <p><span style="text-decoration: underline;"><em>What causes hives:</em></span> Hives are often the result of the body releasing histamine as part of an allergic reaction to drugs, food or some other irritant. They also commonly appear after a viral illness, as a side effect of your immune system revving up to battle the disease. “There are a number of potential triggers,” says dermatologist Katie Beleznay. In most cases, she adds, the specific origin is never determined.</p> <p><span style="text-decoration: underline;"><em>How to treat hives:</em></span> Since hives are a histamine reaction, over-the-counter antihistamines are the first line of defence. If that doesn’t clear them up, ask a doctor if you should use a stronger antihistamine or oral prednisone, an anti-inflammatory medication.</p> <p><span style="text-decoration: underline;"><em>Possible red flag:</em></span> Rarely, people suffer from ongoing outbreaks of hives almost daily for six weeks or more, a condition called chronic idiopathic urticaria (CIU). The treatment for CIU is the same as for regular hives, but in some cases, it can also be a sign of an underlying thyroid disease or cancer.</p> <p><strong>Eczema</strong></p> <p><span style="text-decoration: underline;"><em>What eczema is like:</em></span> Eczema presents as patches of red, scaly skin that are extremely itchy, especially at night. These rashes often appear on the inside of your elbows and knees. If it’s more serious, the skin might blister or look thickened and white in those areas.</p> <p><span style="text-decoration: underline;"><em>What causes eczema:</em></span> Eczema is the result of having a weakened skin barrier, which can lead to inflammation and an overreaction from your immune system. Most people are born with it, and your genes are partly to blame. “You’re more predisposed to eczema if you have a family history of asthma, hay fever or the condition itself,” says Lisa Kellett, a dermatologist in Toronto. Some research also suggests that it might be a reaction to pollution, or to not being exposed to enough germs in childhood. (Kids who have dogs, for example, are less likely to have eczema.)</p> <p><span style="text-decoration: underline;"><em>How to treat eczema:</em></span> For general maintenance, apply a thick, hypoallergenic moisturizer to affected areas immediately after a bath or shower and at night. More serious flares will need topical prescription steroid creams or non-steroid immunosuppressant creams. People with stubborn eczema might also try phototherapy, which uses UVB light to help calm your immune system and reduce itchiness.</p> <p><span style="text-decoration: underline;"><em>Possible red flag:</em></span> Rarely, what looks like eczema is actually skin cancer, as both can appear red and scaly. “The difference with skin cancer is that it doesn’t go away if you use a steroid,” says Kellett.</p> <p><strong>Contact Dermatitis</strong></p> <p><span style="text-decoration: underline;"><em>What contact dermatitis is like:</em></span> Contact dermatitis is a variation of eczema, and it looks similar – red, itchy patches on your skin. But unlike that chronic condition, this skin rash is a reaction to something specific and appears only where the offending object has made contact. “Poison ivy, for instance, will show up as a streak where the branch touched the skin,” says Beleznay.</p> <p><span style="text-decoration: underline;"><em>What causes contact dermatitis:</em></span> Besides poison ivy, other common culprits that can cause the immune system to go into overdrive are face cream, jewellery or fragrances. You can also develop a new intolerance to something you’ve used for a long time, such as Polysporin. If it’s not clear what caused it, your dermatologist can do a patch test, putting small amounts of suspected substances on your skin to see if you react.</p> <p><span style="text-decoration: underline;"><em>How to treat contact dermatitis:</em></span> Contact dermatitis is treated with topical steroids, or a stronger oral one, to calm down your immune system and stop the reaction.</p> <p><span style="text-decoration: underline;"><em>Possible red flag:</em></span> Like eczema, the red and scaly presentation of contact dermatitis could be confused for skin cancer, which is another reason to visit your doctor if you’re not sure what caused it.</p> <p><strong>Rosacea</strong></p> <p><span style="text-decoration: underline;"><em>What rosacea is like:</em></span> As rosacea is a dilation of the blood vessels in your cheeks and nose, it often presents as red, sensitive skin in those places. Another form of the condition also includes bumps that resemble acne. For some people, the skin on their nose thickens, making it appear larger.</p> <p><span style="text-decoration: underline;"><em>What causes rosacea:</em></span> We don’t know what brings rosacea on, but, as with eczema, you’re more likely to have it if others in your family do, too. You’re also prone to acquire the condition if you have sun-damaged skin. “Rosacea usually begins around the age of 35 and gets worse with time,” says Kellett. People often find their flare-ups come after eating or drinking specific things.</p> <p><span style="text-decoration: underline;"><em>How to treat rosacea:</em></span> For many, preventing activation of their rosacea is as simple as avoiding triggers – but that’s easier than it sounds and can be a serious test of a sufferer’s willpower. “Those are often the good things in life,” says Beleznay, citing coffee, spicy foods and alcohol as common aggravators. Some women find that everyday makeup is enough to cover up the cosmetic impact of the condition, while others use prescription creams or laser or light therapy to constrict the blood vessels in the cheeks and reduce redness. For those whose rosacea includes bumps, topical creams or oral antibiotics often get rid of them.</p> <p><span style="text-decoration: underline;"><em>Possible red flag:</em></span> Rarely, what looks like rosacea can be confused for the butterfly rash that’s a symptom of lupus, a serious autoimmune disease. The butterfly rash is named as such because of the shape it makes on the nose and both cheeks.</p> <p><strong>Shingles</strong></p> <p><span style="text-decoration: underline;"><em>What shingles is like:</em></span> Shingles normally starts out as a tingly, numb or bruised feeling in a small area, most commonly a patch on the abdomen. A few days later, a painful skin rash with blisters appears over those places. As the condition follows the path of a nerve, the rash eventually presents as a stripe that lasts from two to six weeks.</p> <p><span style="text-decoration: underline;"><em>What causes shingles:</em></span> This one’s easy: chicken pox. Even once you have fully recovered from that virus, your body never totally beats it; it simply retreats and lies dormant in your nerve cells, where, decades later, it can re-erupt as shingles. You’re more likely to get them if you’re immunocompromised or over 50, the age at which most public health agencies recommend you get the vaccine.</p> <p><span style="text-decoration: underline;"><em>How to treat shingles:</em></span> If you suspect you have shingles, see your doctor immediately. “You have to go right away because studies show that people do much better if the antiviral pills are started within 72 hours of the rash onset,” says Cohen. Additionally, sufferers are often given medication, like a local anaesthetic or codeine, to help control the pain.</p> <p><span style="text-decoration: underline;"><em>Possible red flag:</em></span> The real worry with shingles is that for some people, if it is not contained quickly, the virus can lead to longer-term pain lasting over three months and in some cases over a year. If the skin rash appears on the face, it can even cause blindness.</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a href="https://www.readersdigest.co.nz/healthsmart/name-that-rash-6-common-skin-conditions-and-how-to-treat-them" target="_blank" rel="noopener">Reader's Digest</a>. </em></p>

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Forcing people to repay welfare ‘loans’ traps them in a poverty cycle – where is the policy debate about that?

<p><em><a href="https://theconversation.com/profiles/hanna-wilberg-1466649">Hanna Wilberg</a>, <a href="https://theconversation.com/institutions/university-of-auckland-1305">University of Auckland</a></em></p> <p>The National Party’s <a href="https://www.1news.co.nz/2023/09/26/more-sanctions-for-unemployed-beneficiaries-under-national/">pledge to apply sanctions</a> to unemployed people receiving a welfare payment, if they are “persistently” failing to meet the criteria for receiving the benefit, has attracted plenty of comment and <a href="https://www.1news.co.nz/2023/09/26/nationals-benefit-sanctions-plan-cruel-dehumanising-greens/">criticism</a>.</p> <p>Less talked about has been the party’s promise to index benefits to inflation to keep pace with the cost of living. This might at least provide some relief to those struggling to make ends meet on welfare, though is not clear how much difference it would make to the current system of indexing benefits to wages.</p> <p>In any case, this alone it is unlikely to break the cycle of poverty many find themselves in.</p> <p>One of the major drivers of this is the way the welfare system pushes some of the most vulnerable people into debt with loans for things such as school uniforms, power bills and car repairs.</p> <p>The government provides one-off grants to cover benefit shortfalls. But most of these grants are essentially loans.</p> <p>People receiving benefits are required to repay the government through weekly deductions from their normal benefits – which leaves them with even less money to survive on each week.</p> <p>With <a href="https://www.stuff.co.nz/pou-tiaki/132980318/auckland-mother-serves-up-cereal-for-dinner-due-to-rising-food-costs">rising costs</a>, the situation is only getting worse for many of the 351,756 New Zealanders <a href="https://figure.nz/chart/TtiUrpceJruy058e-ITw010dHsM6bvA2a">accessing one of the main benefits</a>.</p> <h2>Our whittled down welfare state</h2> <p>Broadly, there are three levels of government benefits in our current system.</p> <p>The main benefits (such as jobseeker, sole parent and supported living payment) <a href="https://www.workandincome.govt.nz/products/benefit-rates/benefit-rates-april-2023.html">pay a fixed weekly amount</a>. The jobseeker benefit rate is set at NZ$337.74 and sole parents receive $472.79 a week.</p> <p>Those on benefits have access to a second level of benefits – weekly supplementary benefits such as an <a href="https://www.workandincome.govt.nz/products/a-z-benefits/accommodation-supplement.html">accommodation supplement</a> and other allowances or tax credits.</p> <p>The third level of support is one-off discretionary payments for specific essential needs.</p> <p>Those on benefits cannot realistically make ends meet without repeated use of these one-off payments, unless they use assistance from elsewhere – such as family, charity or borrowing from loan sharks.</p> <p>This problem has been building for decades.</p> <h2>Benefits have been too low for too long</h2> <p>In the 1970s, the <a href="https://mro.massey.ac.nz/handle/10179/12967">Royal Commission on Social Security</a> declared the system should provide “a standard of living consistent with human dignity and approaching that enjoyed by the majority”.</p> <p>But Ruth Richardson’s “<a href="https://www.stuff.co.nz/the-press/christchurch-life/124978983/1991-the-mother-of-all-budgets">mother of all budgets</a>” in 1991 slashed benefits. Rates never recovered and today’s <a href="https://www.1news.co.nz/2022/03/29/benefit-increases-will-still-leave-families-locked-in-poverty/">benefits are not enough to live on</a>.</p> <p>In 2018, the <a href="https://www.weag.govt.nz/">Welfare Expert Advisory Group</a> looked at how much money households need in two lifestyle scenarios: bare essentials and a minimum level of participation in the community, such as playing a sport and taking public transport.</p> <p>The main benefits plus supplementary allowances did not meet the cost of the bare essentials, let alone minimal participation.</p> <p>The Labour government has since <a href="https://www.beehive.govt.nz/release/government-delivers-income-increases-over-14-million-new-zealanders">increased benefit rates</a>, meaning they are now slightly above those recommended by the advisory group. But those recommendations were made in 2019 and don’t take into account the <a href="https://www.stats.govt.nz/news/annual-inflation-at-6-0-percent">sharp rise in inflation</a> since then.</p> <p>Advocacy group <a href="https://fairerfuture.org.nz/">Fairer Future</a> published an updated assessment in 2022 – nine out of 13 types of households still can’t meet their core costs with the current benefit rates.</p> <h2>How ‘advances’ create debt traps</h2> <p>When they don’t have money for an essential need, people on benefits can receive a “special needs grant”, which doesn’t have to be repaid. But in practice, Work and Income virtually never makes this type of grant for anything except food and some other specific items, such as some health travel costs or emergency dental treatment.</p> <p>For <a href="https://www.1news.co.nz/2023/02/27/very-stressful-beneficiary-says-he-cant-afford-msd-debt/">all other essential needs</a> – such as school uniforms, car repairs, replacing essential appliances, overdue rent, power bills and tenancy bonds – a one-off payment called an “advance” is used. Advances are loans and have to be paid back.</p> <p>There are several issues with these types of loans.</p> <p>First, people on benefits are racking up thousands of dollars worth of debts to cover their essential needs. It serves to trap them in financial difficulties for the foreseeable future.</p> <p>As long as they remain on benefits or low incomes, it’s difficult to repay these debts. And the <a href="https://www.legislation.govt.nz/act/public/2018/0032/latest/whole.html">Social Security Act 2018</a> doesn’t allow the Ministry of Social Development (MSD) to waive debts.</p> <h2>Contradictory policies</h2> <p>Another problem is that people on benefits have to start repaying their debt straight away, with weekly deductions coming out of their already limited benefit.</p> <p>Each new advance results in a further weekly deduction. Often these add up to $50 a week or more. MSD policy says repayments should not add up to more than $40 a week, but that is often ignored.</p> <p>This happens because the law stipulates that each individual debt should be repaid in no more than two years, unless there are exceptional circumstances. Paying this debt off in two years often requires total deductions to be much higher than $40.</p> <p>The third issue is that one-off payments can be refused regardless of the need. That is because there are two provisions pulling in opposite directions.</p> <p>On the one hand the law says a payment should be made if not making it would cause serious hardship. But on the other hand, the law also says payments should not be made if the person already has too much debt.</p> <p>People receiving benefits and their case managers face the choice between more debt and higher repayments, or failing to meet an essential need.</p> <h2>Ways to start easing the burden</h2> <p>So what is the fix? A great deal could be achieved by just changing the policies and practices followed by Work and Income.</p> <p>Case managers have the discretion to make non-recoverable grants for non-food essential needs. These could and should be used when someone has an essential need, particularly when they already have significant debt.</p> <p>Weekly deductions for debts could also be automatically made very low.</p> <p>When it comes to changing the law, the best solution would be to make weekly benefit rates adequate to live on.</p> <p>The government could also make these benefit debts similar to student loans, with no repayments required until the person is off the benefit and their income is above a certain threshold.</p> <p>However we do it, surely it must be time to do something to fix this poverty trap.<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/212528/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><a href="https://theconversation.com/profiles/hanna-wilberg-1466649"><em>Hanna Wilberg</em></a><em>, Associate professor - Law, <a href="https://theconversation.com/institutions/university-of-auckland-1305">University of Auckland</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>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/forcing-people-to-repay-welfare-loans-traps-them-in-a-poverty-cycle-where-is-the-policy-debate-about-that-212528">original article</a>.</em></p>

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The rental housing crisis is hurting our most vulnerable and demands a range of solutions (but capping rents isn’t one of them)

<p><em><a href="https://theconversation.com/profiles/andrew-beer-111469">Andrew Beer</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/emma-baker-172081">Emma Baker</a>, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a></em></p> <p>Roughly <a href="https://www.abs.gov.au/statistics/people/housing/housing-occupancy-and-costs/2019-20">one in three Australians</a> rent their homes. It’s Australia’s fastest-growing tenure, but renting is increasingly unaffordable. From 2020 to 2022, our <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4253168">research</a> found a large increase in the proportion of renters who said their housing was unaffordable.</p> <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/542737/original/file-20230815-25187-p7vxqo.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=1000&amp;fit=clip"><img src="https://images.theconversation.com/files/542737/original/file-20230815-25187-p7vxqo.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/542737/original/file-20230815-25187-p7vxqo.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=217&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/542737/original/file-20230815-25187-p7vxqo.png?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=217&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/542737/original/file-20230815-25187-p7vxqo.png?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=217&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/542737/original/file-20230815-25187-p7vxqo.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=273&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/542737/original/file-20230815-25187-p7vxqo.png?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=273&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/542737/original/file-20230815-25187-p7vxqo.png?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=273&amp;fit=crop&amp;dpr=3 2262w" alt="horizontal bar chart showing changes in Australian renters' assessments of affordability form 2020 to 2022" /></a><figcaption><span class="caption">Change in Australian renters’ assessments of affordability from 2020 to 2022.</span> <span class="attribution"><span class="source">Baker, Daniel, Beer, et al, forthcoming, The Australian Housing Conditions Dataset, doi:10.26193/SLCU9J, ADA Dataverse</span></span></figcaption></figure> <p>Australians are concerned about the <a href="https://www.theguardian.com/australia-news/2023/jul/05/rents-rise-again-across-australia-with-sydney-seeing-fastest-rise-in-20-years">pace</a> of <a href="https://www.sbs.com.au/news/article/how-much-has-rent-increased-around-australia/8ljlnf0zm">rent rises</a>. Prime Minister Anthony Albanese <a href="https://www.pm.gov.au/media/national-cabinet-meeting">says</a> increasing housing supply and affordability is the “key priority” for tomorrow’s national cabinet meeting.</p> <p>The crisis has impacts well beyond affordability. The rental sector is where the worst housing accommodates the poorest Australians with the worst health.</p> <h2>The unhealthy state of rental housing</h2> <p>Forthcoming data from the <a href="https://dataverse.ada.edu.au/dataverse/ahcdi">Australian Housing Conditions Dataset</a> highlight some of these parallel challenges:</p> <ul> <li> <p>it’s often insecure – the average lease is less than 12 months, and less than a third of formal rental agreements extend beyond 12 months</p> </li> <li> <p>rental housing quality is often very poor – 45% of renters rate the condition of their dwelling as “average, poor, or very poor”</p> </li> <li> <p>poor housing conditions put the health of renters at risk – 43% report problems with damp or mould, and 35% have difficulty keeping their homes warm in winter or cool in summer</p> </li> <li> <p>compounding these health risks, people with poorer health are over-represented in the rental sector. Renters are almost twice as likely as mortgage holders to have poorer general health.</p> </li> </ul> <p>Measures that potentially restrict the supply of lower-cost rental housing – such as rent caps – will <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4253168">worsen these impacts</a>. More households will be left searching in a shrinking pool of affordable housing.</p> <h2>It’s all about supply</h2> <p>Fixing the rental crisis needs more than a single focus on private rental housing. The movement between households over time between renting and buying homes means the best solutions are those that boost the supply of affordable housing generally. No one policy can provide all the answers.</p> <p>Governments should be looking at multiple actions, including:</p> <ul> <li> <p>requiring local councils to adopt affordable housing strategies as well as mandating <a href="https://www.ahuri.edu.au/analysis/brief/understanding-inclusionary-zoning">inclusionary zoning</a>, which requires developments to include a proportion of affordable homes</p> </li> <li> <p>improving land supply through better forecasting at the national, state and local levels</p> </li> <li> <p>giving housing and planning ministers the power to deliver affordable housing targets by providing support for demonstration projects, subsidised land to social housing providers and access to surplus land</p> </li> <li> <p>boosting the recruitment and retention of skilled construction workers from both domestic and international sources.</p> </li> </ul> <h2>The biggest landlord subsidy isn’t helping</h2> <p>More than <a href="https://data.gov.au/data/dataset/taxation-statistics-2020-21/resource/ebbd32e3-4556-41e1-a8b9-33387457d518">1 million Australians</a> claim a net rent loss (negative gearing) each year. Even though negative gearing is focused on rental investment losses, it is not strictly a housing policy as it applies to many types of investment.</p> <p>The impact of negative gearing on the housing system is untargeted and largely uncontrolled. As a result, it’s driving outcomes that are sometimes at odds with the need to supply well-located affordable housing.</p> <p>The most impactful action the Australian government could take to deliver more affordable rental housing nationwide would involve refining negative-gearing arrangements to boost the supply of low-income rentals. These measures may involve</p> <ul> <li>limiting negative gearing to dwellings less than ten years old</li> <li>introducing a low-income tax credit scheme similar to the one in the United States.</li> </ul> <p>We can learn much from the US, where the Low-Income Housing Tax Credit (<a href="https://www.huduser.gov/portal/datasets/lihtc.html">LIHTC</a>) scheme subsidises the acquisition, construction and renovation of affordable rental housing for tenants on low to moderate incomes. Since the mid-1990s, the program has supported the construction or renovation of about 110,000 affordable rental units each year. That adds up to over <a href="https://www.taxpolicycenter.org/briefing-book/what-low-income-housing-tax-credit-and-how-does-it-work">2 million units</a> at an estimated annual cost of US$9billion (A$13.8billion).</p> <p>This scheme is much less expensive per unit of affordable housing delivered than Australia’s system of negative gearing.</p> <p>Closer to home, the previous National Rental Affordability Scheme showed the value of targeted financial incentives in encouraging affordable housing. This scheme, available to private and disproved investors, generated positive outcomes for tenants. The benefits included better health for low-income tenants who were able to moved into quality new housing.</p> <p>A <a href="https://cityfutures.ada.unsw.edu.au/documents/81/Next_moves_report.pdf">raft</a> of <a href="https://apo.org.au/node/260431">evaluations</a> have <a href="https://www.ahuri.edu.au/research/final-reports/267">demonstrated</a> the achievements of this scheme.</p> <h2>Crisis calls for lasting solutions</h2> <p>Short-term measures such as rent caps or eviction bans will not provide a solution in the near future or even the medium or long term. Instead, these are likely to worsen both the housing costs and health of low-income tenants.</p> <p>Reform focused on ongoing needs is called for. Solutions that can be implemented quickly include the tighter targeting of negative gearing and the introduction of a low-income housing tax credit.</p> <p>Talking about change, as the national cabinet is doing, will begin that process of transformation, but it must be backed up by a range of measures to boost the supply of affordable housing. This, in turn, will improve the housing market overall as affordable options become more widely available.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><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/211275/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/andrew-beer-111469">Andrew Beer</a>, Executive Dean, UniSA Business, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/emma-baker-172081">Emma Baker</a>, Professor of Housing Research, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/the-rental-housing-crisis-is-hurting-our-most-vulnerable-and-demands-a-range-of-solutions-but-capping-rents-isnt-one-of-them-211275">original article</a>.</em></p>

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1 in 6 women are diagnosed with gestational diabetes. But this diagnosis may not benefit them or their babies

<p><em><a href="https://theconversation.com/profiles/paul-glasziou-13533">Paul Glasziou</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> and <a href="https://theconversation.com/profiles/jenny-doust-12412">Jenny Doust</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a></em></p> <p>When Sophie was pregnant with her first baby, she had an <a href="https://www.ncbi.nlm.nih.gov/books/NBK279331/#:%7E:text=Oral%20glucose%20tolerance%20tests%20(OGTT,enough%20by%20the%20body's%20cells.)">oral glucose tolerance</a> blood test. A few days later, the hospital phoned telling her she had gestational diabetes.</p> <p>Despite having only a slightly raised glucose (blood sugar) level, Sophie describes being diagnosed as affecting her pregnancy tremendously. She tested her blood glucose levels four times a day, kept food diaries and had extra appointments with doctors and dietitians.</p> <p>She was advised to have an induction because of the risk of having a large baby. At 39 weeks her son was born, weighing a very average 3.5kg. But he was separated from Sophie for four hours so his glucose levels could be monitored.</p> <p>Sophie is not alone. About <a href="https://www.aihw.gov.au/reports/diabetes/diabetes/contents/how-many-australians-have-diabetes/gestational-diabetes">one in six</a> pregnant women in Australia are now diagnosed with gestational diabetes.</p> <p>That was not always so. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2827530/">New criteria</a> were developed in 2010 which dropped an initial screening test and lowered the diagnostic set-points. Gestational diabetes diagnoses have since <a href="https://www.aihw.gov.au/reports/diabetes/diabetes/contents/how-many-australians-have-diabetes/gestational-diabetes">more than doubled</a>.</p> <figure class="align-center "><img src="https://images.theconversation.com/files/536691/original/file-20230710-23-v8weyw.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/536691/original/file-20230710-23-v8weyw.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=388&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/536691/original/file-20230710-23-v8weyw.png?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=388&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/536691/original/file-20230710-23-v8weyw.png?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=388&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/536691/original/file-20230710-23-v8weyw.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=487&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/536691/original/file-20230710-23-v8weyw.png?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=487&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/536691/original/file-20230710-23-v8weyw.png?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=487&amp;fit=crop&amp;dpr=3 2262w" alt="" /><figcaption><span class="caption">Gestational diabetes rates more than doubled after the threshold changed.</span> <span class="attribution"><span class="source">AIHW</span>, <span class="license">Author provided</span></span></figcaption></figure> <p>But <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2204091">recent</a> <a href="https://pubmed.ncbi.nlm.nih.gov/33704936/">studies</a> cast doubt on the ways we diagnose and manage gestational diabetes, especially for women like Sophie with only mildly elevated glucose. Here’s what’s wrong with gestational diabetes screening.</p> <h2>The glucose test is unreliable</h2> <p>The test used to diagnose gestational diabetes – the oral glucose tolerance test – has poor reproducibility. This means subsequent tests may give a different result.</p> <p>In a <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2214956">recent Australian trial</a> of earlier testing in pregnancy, one-third of the women initially classified as having gestational diabetes (but neither told nor treated) did not have gestational diabetes when retested later in pregnancy. That is a problem.</p> <p>Usually when a test has poor reproducibility – for example, blood pressure or cholesterol – we repeat the test to confirm before making a diagnosis.</p> <p>Much of the increase in the incidence of gestational diabetes after the introduction of new diagnostic criteria was due to the switch from using two tests to only using a single test for diagnosis.</p> <h2>The thresholds are too low</h2> <p>Despite little evidence of benefit for either women or babies, the current Australian criteria diagnose women with only mildly abnormal results as having “gestational diabetes”.</p> <p>Recent studies have shown this doesn’t benefit women and may cause harms. A <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2204091">New Zealand trial</a> of more than 4,000 women randomly assigned women to be assessed based on the current Australian thresholds or to higher threshold levels (similar to the pre-2010 criteria).</p> <p>The trial found no additional benefit from using the current low threshold levels, with overall no difference in the proportion of infants born large for gestational age.</p> <p>However, the trial found several harms, including more neonatal hypoglycaemia (low blood sugar in newborns), induction of labour, use of diabetic medications including insulin injections, and use of health services.</p> <p>The study authors also looked at the subgroup of women who were diagnosed with glucose levels between the higher and lower thresholds. In this subgroup, there was some reduction in large babies, and in shoulder problems at delivery.</p> <p>But there was also an increase in small babies. This is of concern because being small for gestational age can also have consequences for babies, including long-term health consequences.</p> <figure class="align-center "><img src="https://images.theconversation.com/files/540643/original/file-20230802-29-1dw2rw.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/540643/original/file-20230802-29-1dw2rw.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=349&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/540643/original/file-20230802-29-1dw2rw.png?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=349&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/540643/original/file-20230802-29-1dw2rw.png?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=349&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/540643/original/file-20230802-29-1dw2rw.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=438&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/540643/original/file-20230802-29-1dw2rw.png?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=438&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/540643/original/file-20230802-29-1dw2rw.png?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=438&amp;fit=crop&amp;dpr=3 2262w" alt="" /><figcaption><span class="attribution"><span class="source">NEJM</span>, <span class="license">Author provided</span></span></figcaption></figure> <h2>Testing too early</h2> <p>Some centres have begun testing women at higher risk of gestational diabetes earlier in the pregnancy (between 12 and 20 weeks).</p> <p>However, a <a href="https://pubmed.ncbi.nlm.nih.gov/37144983/">recent trial</a> showed no clear benefit compared with testing at the usual 24–28 weeks: possibly fewer large babies, but again matched by more small babies.</p> <p>There was a reduction in transient “respiratory distress” – needing extra oxygen for a few hours – but not in serious clinical events.</p> <h2>Impact on women with gestational diabetes</h2> <p>For women diagnosed using the higher glucose thresholds, dietary advice, glucose monitoring and, where necessary, insulin therapy has been shown to reduce complications during delivery and the post-natal period.</p> <p>However, current models of care can also cause harm. Women with gestational diabetes are often denied their preferred model of care – for example, midwifery continuity of carer. In rural areas, they may have to transfer to a larger hospital, requiring longer travel to antenatal visits and moving to a larger centre for their birth – away from their families and support networks for several weeks.</p> <p>Women say the diagnosis often dominates their antenatal care and their whole <a href="https://pubmed.ncbi.nlm.nih.gov/32028931/">experience of pregnancy</a>, reducing time for other issues or concerns.</p> <p>Women from culturally and linguistically diverse communities <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-021-03981-5">find it difficult</a> to reconcile the advice given about diet and exercise with their own cultural practices and beliefs about pregnancy.</p> <p>Some women with gestational diabetes <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-020-2745-1">become</a> extremely anxious about their eating and undertake extensive calorie restrictions or disordered eating habits.</p> <h2>Time to reassess the advice</h2> <p>Recent evidence from both randomised controlled trials and from qualitative studies with women diagnosed with gestational diabetes suggest we need to reassess how we currently diagnose and manage gestational diabetes, particularly for women with only slightly elevated levels.</p> <p>It is time for a review to consider all the problems described above. This review should include the views of all those impacted by these decisions: women in childbearing years, and the GPs, dietitians, diabetes educators, midwives and obstetricians who care for them.</p> <p><em>This article was co-authored by maternity services consumer advocate Leah Hardiman.</em><!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><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/205919/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><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> and <a href="https://theconversation.com/profiles/jenny-doust-12412">Jenny Doust</a>, Clinical Professorial Research Fellow, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>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/1-in-6-women-are-diagnosed-with-gestational-diabetes-but-this-diagnosis-may-not-benefit-them-or-their-babies-205919">original article</a>.</em></p>

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