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Beyond the spin, beyond the handouts, here’s how to get a handle on what’s really happening on budget night

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/peter-martin-682709">Peter Martin</a>, <a href="https://theconversation.com/institutions/crawford-school-of-public-policy-australian-national-university-3292">Crawford School of Public Policy, Australian National University</a> Three weeks from now, some of us will be presented with a <a href="https://budget.gov.au/">mountain</a> of budget papers, and just about all of us will get to hear about them on radio, TV or news websites on budget night. The quickest way to find out what the budget is really doing will be to listen to the treasurer’s speech, or to peruse online the aptly-named “<a href="https://treasury.infoservices.com.au/page/budget2023">glossy</a>” – a document that last year was titled “<a href="https://archive.budget.gov.au/2023-24/overview/download/budget_overview.pdf">Stronger foundations for a better future</a>”. <figure class="align-right zoomable"><a href="https://images.theconversation.com/files/589444/original/file-20240422-23-vkinrm.png?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/589444/original/file-20240422-23-vkinrm.png?ixlib=rb-4.1.0&q=45&auto=format&w=237&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/589444/original/file-20240422-23-vkinrm.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=848&fit=crop&dpr=1 600w, https://images.theconversation.com/files/589444/original/file-20240422-23-vkinrm.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=848&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/589444/original/file-20240422-23-vkinrm.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=848&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/589444/original/file-20240422-23-vkinrm.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=1066&fit=crop&dpr=1 754w, https://images.theconversation.com/files/589444/original/file-20240422-23-vkinrm.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=1066&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/589444/original/file-20240422-23-vkinrm.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=1066&fit=crop&dpr=3 2262w" alt="Cover of 2023 budget glossy" /></a><figcaption>Glossies are used to make each budget attractive. <a class="source" href="https://archive.budget.gov.au/2023-24/overview/download/budget_overview.pdf">Commonwealth Treasury</a></figcaption></figure> But they will tell you exactly what the government wants you to hear, exactly as it wants you to hear it. If you are looking instead for the truth – what the government is actually trying to achieve and what it is holding itself and its officials to, I would suggest something else, tucked away on about page <a href="https://cdn.theconversation.com/static_files/files/3225/8787.pdf">87</a> of the main budget document. It is required by the <a href="https://www.legislation.gov.au/C2004A05333/latest/text">Charter of Budget Honesty Act</a> introduced in 1998 by Peter Costello, the treasurer under Prime Minister John Howard. On taking office in 1996, Costello set up a <a href="https://webarchive.nla.gov.au/awa/20101119021633/http://www.finance.gov.au/archive/archive-of-publications/ncoa/execsum.htm">National Commission of Audit</a> to examine the finances he had inherited from the Hawke and Keating governments, presumably with an eye to discovering they had been mismanaged. But the members of the commission weren’t much interested in that. Instead, they decided to deal with something more fundamental. <h2>Budget as you wish, but explain your strategy</h2> Governments were perfectly entitled to manage money in whatever way they wanted, and they were perfectly entitled to spend more money than they raised (which they usually do, it’s called a <a href="https://www.investopedia.com/terms/d/deficit.asp">budget deficit</a>). What the commission wanted was for governments to make clear what they were doing, and to spell out the strategy behind it. Only part of it was about being upfront with the public. The commission also wanted governments to be upfront with themselves – to actually develop frameworks for what they were doing, rather than doing whatever they felt like. The commission recommended a <a href="https://webarchive.nla.gov.au/awa/20101119021633/http://www.finance.gov.au/archive/archive-of-publications/ncoa/execsum.htm">Charter of Budget Honesty</a>, which among other things requires officials to prepare independent assessments of the finances before each election, requires budget updates six months after each budget, and requires <a href="https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/BriefingBook45p/TaxExpenditures">tax expenditures</a> (tax breaks) to be accounted for like other expenditures. And it requires the publication and regular updating of a <a href="https://cdn.theconversation.com/static_files/files/3227/CBH_Fiscal_strategy.pdf">fiscal strategy statement</a>. <h2>Where treasurers hold themselves accountable</h2> The <a href="https://cdn.theconversation.com/static_files/files/3225/8787.pdf">fiscal strategy</a> can be thought of as an exam question set by the student who is being examined – something along the lines of “this is what you say you want your budget to achieve, please set out the means by which you plan to achieve it”. It turns out to have been exceptionally effective in getting governments to organise their thoughts, make budgets at least try to achieve something, and let the rest of us know what they are trying to achieve. Every few years, treasurers change the strategy, as is their right. Treasurer Jim Chalmers says he’ll change it again this budget, to de-emphasise the fight against inflation and to more greatly emphasise the need to <a href="https://ministers.treasury.gov.au/ministers/jim-chalmers-2022/transcripts/press-conference-washington-dc-0">support economic growth</a>. His statement will tell us what’s behind his actions in a way the glossy words in his brochure and speech might not. <h2>The strategy that has signposted 26 years</h2> Previous statements have signposted all the important turns in what the budget is trying to do. The first, in <a href="https://images.theconversation.com/files/589686/original/file-20240423-16-rncqg3.PNG">1998</a>, committed Costello and Howard to achieving a budget surplus on average over the economic cycle and whenever “growth prospects remain sound”. Making that commitment more difficult was another “not to introduce new taxes or raise existing taxes over the term of this parliament”. Two years later, after the government had won an election promising a new goods and services tax, that commitment was <a href="https://images.theconversation.com/files/589692/original/file-20240423-18-q843xn.PNG">changed</a> to “no increase in the overall tax burden from its 1996-97 level”, a condition met by calling the GST a state tax. <h2>Hockey and Morrison wound back spending</h2> The Labor budgets from 2008 <a href="https://images.theconversation.com/files/589702/original/file-20240423-18-mikx6f.PNG">loosened</a> the tax target to the average share of GDP below the reference year, which they changed to the higher-tax year of 2007-08. The first Coalition budget under Treasurer Joe Hockey in 2014 changed the target from tax to spending, pledging to bring down the ratio of <a href="https://images.theconversation.com/files/589705/original/file-20240423-16-9spkdy.PNG">payments to GDP</a>, and pledging a surplus of 1% of GDP by 2023-24. Any new spending would be more than offset by cuts elsewhere, and if the budget did receive a burst of unexpected revenue it would be “banked” rather than spent. In 2018 Treasurer Scott Morrison reintroduced tax as a target, that he spelled out precisely. Tax was not to increase beyond <a href="https://images.theconversation.com/files/589706/original/file-20240423-16-b7gj5d.PNG">23.9%</a> of GDP. <h2>During COVID, Frydenberg spent big</h2> In 2020, in the face of a COVID-induced recession and soaring unemployment, Finance Minister Mathias Cormann and Treasurer Josh Frydenberg pushed the old strategy to one side. They would spend big now to keep the economy afloat so they wouldn’t have to spend more bailing it out later, and they wouldn’t return to their old concern about the deficit until the unemployment rate was “<a href="https://cdn.theconversation.com/static_files/files/3228/fs2020.pdf">comfortably below 6%</a>”. So well did they succeed that in 2021 Frydenberg made the momentous decision to keep going, abandoning the promise to return to worrying about the deficit when unemployment fell below 6%. Instead he promised to keep spending big until unemployment was “<a href="https://images.theconversation.com/files/589709/original/file-20240423-16-9pmpaf.PNG">back to pre-crisis levels or lower</a>”. The decision propelled unemployment down to a 50-year low of <a href="https://www.datawrapper.de/_/wPfXO/">3.5%</a>. Along with high iron ore prices, that one change of strategy has probably helped deliver Chalmers two consecutive budget surpluses – the one he announced last year for 2022-23, and the one he is set to announce this year for 2023-24. More of us have been in jobs <a href="https://www.finance.gov.au/publications/commonwealth-monthly-financial-statements/2024/mfs-january">paying tax</a>, and fewer have been out of jobs <a href="https://theconversation.com/half-a-million-more-australians-on-welfare-not-unless-you-double-count-227342">on benefits</a>. It’s a powerful demonstration of the real-world difference budget decisions can make, and the way in which the <a href="https://cdn.theconversation.com/static_files/files/3225/8787.pdf">fiscal strategy</a> tells the story.<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/228387/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/peter-martin-682709">Peter Martin</a>, Visiting Fellow, <a href="https://theconversation.com/institutions/crawford-school-of-public-policy-australian-national-university-3292">Crawford School of Public Policy, Australian National University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/beyond-the-spin-beyond-the-handouts-heres-how-to-get-a-handle-on-whats-really-happening-on-budget-night-228387">original article</a>. </div>

Money & Banking

What to expect from the federal budget

There's just three weeks left until Treasurer Jim Chalmers unveils the federal budget. With the cost of living crisis still a major issue across the country, we can expect to see some policies aimed at alleviating the pressure. Some policies, have already been announced and here are a few others that we can expect to hear from Chalmers on May 14. Stage 3 cuts announced in January, will form a key part of this year's budget, which will direct more benefit towards low- and middle-income earners – although Australians on high salaries will still receive a tax cut. The decision was made to alleviate the cost-of-living pressures and partly address the bracket creep. The cuts lower the threshold for the lowest two brackets (so they pay less tax on that income), and raise the threshold for the highest two brackets (so they need to earn more to be taxed at a higher rate). This means that someone with average income of around $73,000 will get $1504, but how much you actually receive will depend on your income. The new version of the stage 3 cuts will come into effect on July 1. Superannuation will be paid on government-funded parental leave, with the change due to kick in for parents with babies born after July 1, 2025. They will receive a 12 per cent superannuation on top of their government-funded parental leave, with around 180,000 families expected to benefit from it. The figures will be included in the May 14 budget. Although nothing has been officially announced, there will likely be HECS-HELP debt relief for current and former students. "I think there's a range of areas where we need to do much better with the younger generation, and HECS is one of them," Prime Minister Anthony Albanese said on radio on April 18. "We've received a review of that... and what that has said is that the system can be made simpler and be made fairer. "We're examining the recommendations and we'll be making announcements pretty soon on that. We, of course, have a budget coming up." There have also been some hints from the government that energy bill relief will continue in this year's budget. "Our government understands that for small business – as for Australian families – energy bills remain a source of financial pressure," Albanese said, citing the existing policy that gives eligible families up to $500 off their power bills and eligible small businesses up to $650. "Our government understands that for small business – as for Australian families – energy bills remain a source of financial pressure," he said. "That's why the energy bill relief package I negotiated with the states and territories delivered up to $650 in savings for around 1 million small businesses, along with 5 million families. "And as we put together next month's budget, small businesses and families will again be front and centre in our thinking." Energy bills are also set to go down, or remain stable for the most part from July 1. Image: Getty

Money & Banking

What happens when I stop taking a drug like Ozempic or Mounjaro?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Drugs like Ozempic are very <a href="https://dom-pubs.pericles-prod.literatumonline.com/doi/10.1111/dom.12932">effective</a> at helping most people who take them lose weight. Semaglutide (sold as Wegovy and Ozempic) and tirzepatide (sold as Zepbound and Mounjaro) are the most well known in the class of drugs that mimic hormones to reduce feelings of hunger. But does weight come back when you stop using it? The short answer is yes. Stopping <a href="https://jamanetwork.com/journals/jama/fullarticle/2812936">tirzepatide</a> and <a href="https://doi.org/10.1111/dom.14725">semaglutide</a> will result in weight regain in most people. So are these medications simply another (expensive) form of yo-yo dieting? Let’s look at what the evidence shows so far. <h2>It’s a long-term treatment, not a short course</h2> If you have a bacterial infection, antibiotics will help your body fight off the germs causing your illness. You take the full course of medication, and the infection is gone. For obesity, taking tirzepatide or semaglutide can help your body get rid of fat. However it doesn’t fix the reasons you gained weight in the first place because obesity is a chronic, complex condition. When you stop the medications, the weight returns. Perhaps a more useful comparison is with high blood pressure, also known as hypertension. Treatment for hypertension is lifelong. It’s the same with obesity. Medications work, but only while you are taking them. (Though obesity is more complicated than hypertension, as many different factors both cause and perpetuate it.) Therefore, several concurrent approaches are needed; taking medication can be an important part of effective management but on its own, it’s often insufficient. And in an unwanted knock-on effect, stopping medication can undermine other strategies to lose weight, like eating less. <h2>Why do people stop?</h2> Research trials show anywhere from <a href="https://asean-endocrinejournal.org/index.php/JAFES/article/view/1771">6%</a> to <a href="https://pubmed.ncbi.nlm.nih.gov/35015037/">13.5%</a> of participants stop taking these drugs, primarily because of <a href="https://www.health.harvard.edu/staying-healthy/glp-1-diabetes-and-weight-loss-drug-side-effects-ozempic-face-and-more">side effects</a>. But these studies don’t account for those forced to stop because of cost or <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023">widespread supply issues</a>. We don’t know how many people have needed to stop this medication over the past few years for these reasons. Understanding what stopping does to the body is therefore important. <h2>So what happens when you stop?</h2> When you stop using tirzepatide or semaglutide, it takes several days (or even a couple of weeks) to <a href="https://pubmed.ncbi.nlm.nih.gov/30565096/">move out of your system</a>. As it does, a number of things happen: <ul> <li>you start feeling hungry again, because both <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4119845/">your brain and your gut</a> no longer have the medication working to make you feel full</li> </ul> <ul> <li> blood sugars increase, because the medication is no longer acting on the pancreas to help control this. If you have diabetes as well as obesity you may need to take other medications to keep these in an acceptable range. Whether you have diabetes or not, you may need to eat foods with a <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/carbohydrates-and-the-glycaemic-index">low glycemic index</a> to stabilise your blood sugars </li> <li> over the longer term, most people experience a return to their <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10092593/">previous blood pressure and cholesterol levels</a>, as the weight comes back </li> <li> weight regain will mostly be in the form of fat, because it will be gained faster than skeletal muscle. </li> </ul> While you were on the medication, you will have lost <a href="https://academic.oup.com/jes/article/5/Supplement_1/A16/6240360">proportionally less skeletal muscle than fat</a>, muscle loss is inevitable when you lose weight, no matter whether you use medications or not. The problem is, when you stop the medication, your body preferentially puts on fat. <h2>Is stopping and starting the medications a problem?</h2> People whose weight fluctuates with tirzepatide or semaglutide may experience some of the downsides of <a href="https://pubmed.ncbi.nlm.nih.gov/21829159/">yo-yo dieting</a>. When you keep going on and off diets, it’s like a rollercoaster ride for your body. Each time you regain weight, your body has to <a href="https://www.jomes.org/journal/view.html?doi=10.7570/jomes.2017.26.4.237">deal with</a> spikes in blood pressure, heart rate, and how your body handles sugars and fats. This can <a href="https://cardiab.biomedcentral.com/articles/10.1186/s12933-022-01735-x">stress</a> your heart and overall cardiovascular system, as it has to respond to greater fluctuations than usual. Interestingly, the risk to the body from weight fluctuations is greater for people who are <a href="https://jech.bmj.com/content/74/8/662">not obese</a>. This should be a caution to those who are not obese but still using tirzepatide or semaglutide to try to lose unwanted weight. <h2>How can you avoid gaining weight when you stop?</h2> Fear of regaining weight when stopping these medications is valid, and needs to be addressed directly. As obesity has many causes and perpetuating factors, many evidence-based approaches are needed to reduce weight regain. This might include: <ul> <li> getting quality <a href="https://www.hindawi.com/journals/ije/2010/270832/">sleep</a> </li> <li> exercising in a way that builds and maintains muscle. While on the medication, you will <a href="https://pubmed.ncbi.nlm.nih.gov/32628589/">likely have lost muscle</a> as well as fat, although this is not inevitable, especially if you <a href="https://www.europeanreview.org/article/34169">exercise regularly</a> while taking it </li> </ul> <ul> <li> addressing emotional and cultural aspects of life that contribute to over-eating and/or eating unhealthy foods, and how you view your body. Stigma and shame around body shape and size is not cured by taking this medication. Even if you have a healthy relationship with food, we live in a culture that is <a href="https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2009.159491">fat-phobic and discriminates</a> against people in larger bodies </li> <li> eating in a healthy way, hopefully continuing with habits that were formed while on the medication. Eating meals that have high nutrition and fibre, for example, and lower overall portion sizes. </li> </ul> Many people will stop taking tirzepatide or semaglutide at some point, given it is expensive and in short supply. When you do, it is important to understand what will happen and what you can do to help avoid the consequences. Regular reviews with your GP are also important. <hr /> Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-series-154673">Ozempic series</a> here.<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/224972/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, General Practitioner, PhD Candidate, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-happens-when-i-stop-taking-a-drug-like-ozempic-or-mounjaro-224972">original article</a>. </div>

Body

"What has to happen?" Kyle Sandilands' controversial take after knife attacks

Kyle Sandilands has shared his controversial opinion on arming security guards in the wake of two violent stabbing attacks in Sydney. On Saturday, six people were killed at the hands of Joel Cauchi who went on a stabbing rampage through Bondi Junction Westfield, while on Monday night, a teenage boy stabbed a bishop and a priest during a church service in western Sydney. One of Joel Cauchi's victims was Faraz Tahir, a security guard at the shopping centre, while another guard was injured during the rampage. In the days after the eastern suburbs tragedy, Kyle, who has a <a href="https://oversixty.com.au/health/caring/kyle-sandilands-family-member-among-first-victims-stabbed-in-bondi" target="_blank" rel="noopener">connection</a> to one of the people injured during Cauchi's attack, launched into a tirade live on-air, calling for security guards to be given firearms. "I saw the [NSW] premier [Chris Minns] last night on TV saying firearms for security guards are not on the agenda. And I was like, 'Well, what has to happen before a security guard can actually secure the place for us?'" Sandilands raged. "Every shopping centre and every school should have armed security guards, trained specialists, not just some guy getting a little firearms licence. I mean, proper trained." Most retail security staff in NSW are unarmed, with batons classified as prohibited weapons that require special licensing and training. "There's people that work at Westfield, for example, women that work in shops that have told their husbands, 'I ain't never going back to Westfield. I'm never going back to work again'," Sandilands continued, adding that those retail workers are "traumatised forever" following Saturday's stabbings. Sandilands' opinions have been echoed by fellow controversial broadcaster Ray Hadley, who on Monday demanded on his 2GB Sydney radio show that security guards be armed across the state. "For years I've been arguing that all security guards in the state in hospitals and shopping centres should be better equipped," he said. "And these poor security guards, unarmed, unable to do what they should do - protecting the people that they are there to protect." Image credits: KIISFM

Legal

Surgery won’t fix my chronic back pain, so what will?

<a href="https://theconversation.com/profiles/christine-lin-346821">Christine Lin</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/christopher-maher-826241">Christopher Maher</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/fiona-blyth-448021">Fiona Blyth</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/james-mcauley-1526139">James Mcauley</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a>, and <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> This week’s ABC Four Corners episode <a href="https://www.abc.net.au/news/2024-04-08/pain-factory/103683180">Pain Factory</a> highlighted that our health system is failing Australians with chronic pain. Patients are receiving costly, ineffective and risky care instead of effective, low-risk treatments for chronic pain. The challenge is considering how we might reimagine health-care delivery so the effective and safe treatments for chronic pain are available to millions of Australians who suffer from chronic pain. <a href="https://www.aihw.gov.au/getmedia/10434b6f-2147-46ab-b654-a90f05592d35/aihw-phe-267.pdf.aspx">One in five</a> Australians aged 45 and over have chronic pain (pain lasting three or more months). This costs an estimated <a href="https://www.aihw.gov.au/getmedia/10434b6f-2147-46ab-b654-a90f05592d35/aihw-phe-267.pdf.aspx">A$139 billion a year</a>, including $12 billion in direct health-care costs. The most common complaint among people with chronic pain is low back pain. So what treatments do – and don’t – work? <h2>Opioids and invasive procedures</h2> Treatments offered to people with chronic pain include strong pain medicines such as <a href="https://pubmed.ncbi.nlm.nih.gov/30561481/">opioids</a> and invasive procedures such as <a href="https://pubmed.ncbi.nlm.nih.gov/36878313/">spinal cord stimulators</a> or <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/imj.14120">spinal fusion surgery</a>. Unfortunately, these treatments have little if any benefit and are associated with a risk of significant harm. <a href="https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-06900-8">Spinal fusion surgery</a> and <a href="https://privatehealthcareaustralia.org.au/consumers-urged-to-be-cautious-about-spinal-cord-stimulators-for-pain/#:%7E:text=Australian%20health%20insurance%20data%20shows,of%20the%20procedure%20is%20%2458%2C377.">spinal cord stimulators</a> are also extremely costly procedures, costing tens of thousands of dollars each to the health system as well as incurring costs to the individual. <h2>Addressing the contributors to pain</h2> Recommendations from the latest <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/low-back-pain-clinical-care-standard">Australian</a> and <a href="https://www.who.int/publications/i/item/9789240081789">World Health Organization</a> clinical guidelines for low back pain focus on alternatives to drug and surgical treatments such as: <ul> <li>education</li> <li>advice</li> <li>structured exercise programs</li> <li>physical, psychological or multidisciplinary interventions that address the physical or psychological contributors to ongoing pain.</li> </ul> Two recent Australian trials support these recommendations and have found that interventions that address each person’s physical and psychological contributors to pain produce large and sustained improvements in pain and function in people with chronic low back pain. The interventions have minimal side effects and are cost-effective. In the <a href="https://jamanetwork.com/journals/jama/fullarticle/2794765">RESOLVE</a> trial, the intervention consists of pain education and graded sensory and movement “retraining” aimed to help people understand that it’s safe to move. In the <a href="https://pubmed.ncbi.nlm.nih.gov/37146623/">RESTORE</a> trial, the intervention (cognitive functional therapy) involves assisting the person to understand the range of physical and psychological contributing factors related to their condition. It guides patients to relearn how to move and to build confidence in their back, without over-protecting it. <h2>Why isn’t everyone with chronic pain getting this care?</h2> While these trials provide new hope for people with chronic low back pain, and effective alternatives to spinal surgery and opioids, a barrier for implementation is the out-of-pocket costs. The interventions take up to 12 sessions, lasting up to 26 weeks. One physiotherapy session <a href="https://www.sira.nsw.gov.au/__data/assets/pdf_file/0005/1122674/Physiotherapy-chiropractic-and-osteopathy-fees-practice-requirements-effective-1-February-2023.pdf">can cost</a> $90–$150. In contrast, <a href="https://www.servicesaustralia.gov.au/chronic-disease-individual-allied-health-services-medicare-items">Medicare</a> provides rebates for just five allied health visits (such as physiotherapists or exercise physiologists) for eligible patients per year, to be used for all chronic conditions. Private health insurers also limit access to reimbursement for these services by typically only covering a proportion of the cost and providing a cap on annual benefits. So even those with private health insurance would usually have substantial out-of-pocket costs. Access to trained clinicians is another barrier. This problem is particularly evident in <a href="https://www.ruralhealth.org.au/15nrhc/sites/default/files/B2-1_Bennett.pdf">regional and rural Australia</a>, where access to allied health services, pain specialists and multidisciplinary pain clinics is limited. Higher costs and lack of access are associated with the increased use of available and subsidised treatments, such as pain medicines, even if they are ineffective and harmful. The <a href="https://www.safetyandquality.gov.au/publications-and-resources/resource-library/data-file-57-opioid-medicines-dispensing-2016-17-third-atlas-healthcare-variation-2018">rate of opioid use</a>, for example, is higher in regional Australia and in areas of socioeconomic disadvantage than metropolitan centres and affluent areas. <h2>So what can we do about it?</h2> We need to reform Australia’s health system, private and <a href="https://www.health.gov.au/sites/default/files/documents/2020/12/taskforce-final-report-pain-management-mbs-items-final-report-on-the-review-of-pain-management-mbs-items.docx">public</a>, to improve access to effective treatments for chronic pain, while removing access to ineffective, costly and high-risk treatments. Better training of the clinical workforce, and using technology such as telehealth and artificial intelligence to train clinicians or deliver treatment may also improve access to effective treatments. A recent Australian <a href="https://pubmed.ncbi.nlm.nih.gov/38461844/">trial</a>, for example, found telehealth delivered via video conferencing was as effective as in-person physiotherapy consultations for improving pain and function in people with chronic knee pain. Advocacy and <a href="https://pubmed.ncbi.nlm.nih.gov/37918470/">improving the public’s understanding</a> of effective treatments for chronic pain may also be helpful. Our hope is that coordinated efforts will promote the uptake of effective treatments and improve the care of patients with chronic pain.<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/227450/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/christine-lin-346821">Christine Lin</a>, Professor, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/christopher-maher-826241">Christopher Maher</a>, Professor, Sydney School of Public Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/fiona-blyth-448021">Fiona Blyth</a>, Professor, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/james-mcauley-1526139">James Mcauley</a>, Professor of Psychology, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a>, and <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, Professor of Physiotherapy, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/surgery-wont-fix-my-chronic-back-pain-so-what-will-227450">original article</a>.

Body

Do optimists really live longer? Here’s what the research says

<a href="https://theconversation.com/profiles/fuschia-sirois-331254">Fuschia Sirois</a>, <a href="https://theconversation.com/institutions/durham-university-867">Durham University</a> Do you tend to see the glass as half full, rather than half empty? Are you always looking on the bright side of life? If so, you may be surprised to learn that this tendency could actually be good for your health. A <a href="https://content.apa.org/record/2020-71981-001">number of studies</a> have shown that optimists enjoy higher levels of wellbeing, better sleep, lower stress and even better cardiovascular health and immune function. And now, <a href="https://pubmed.ncbi.nlm.nih.gov/35674052/">a recent study</a> has shown that being an optimist is linked to longer life. To conduct their study, researchers tracked the lifespan of nearly 160,000 women aged between 50 to 79 for a period of 26 years. At the beginning of the study, the women completed a <a href="https://local.psy.miami.edu/people/faculty/ccarver/availbale-self-report-instruments/lot-r/">self-report measure of optimism</a>. Women with the highest scores on the measure were categorised as optimists. Those with the lowest scores were considered pessimists. Then, in 2019, the researchers followed up with the participants who were still living. They also looked at the lifespan of participants who had died. What they found was that those who had the highest levels of optimism were more likely to live longer. More importantly, the optimists were also more likely than those who were pessimists to live into their nineties. Researchers refer to this as “exceptional longevity”, considering the average lifespan for women is about 83 years in developed countries. What makes these findings especially impressive is that the results remained even after accounting for other factors known to predict a long life – including education level and economic status, ethnicity, and whether a person suffered from depression or other chronic health conditions. But given this study only looked at women, it’s uncertain whether the same would be true for men. However, <a href="https://www.pnas.org/doi/abs/10.1073/pnas.1900712116">another study</a> which looked at both men and women also found that people with the highest levels of optimism enjoyed a lifespan that was between 11% and 15% longer than those who were the least optimistic. <h2>The fountain of youth?</h2> So why is it that optimists live longer? At first glance it would seem that it may have to do with their healthier lifestyle. For example, <a href="https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.117.310828">research from several studies</a> has found that optimism is linked to eating a healthy diet, staying physically active, and being less likely to smoke cigarettes. These healthy behaviours are well known to improve heart health and <a href="https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases">reduce the risk</a> for cardiovascular disease, which is a <a href="https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)">leading cause of death</a> globally. Adopting a healthy lifestyle is also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3857242/">important for reducing the risk</a> of other potentially deadly diseases, such as diabetes and cancer. But having a healthy lifestyle may only be part of the reason optimists live a longer than average life. This latest study found that lifestyle only accounted for 24% of the link between optimism and longevity. This suggests a number of other factors affect longevity for optimists. Another possible reason could be due to the way optimists manage stress. When faced with a stressful situation, optimists tend to deal with it head-on. They <a href="https://pubmed.ncbi.nlm.nih.gov/16859439/">use adaptive coping strategies</a> that help them resolve the source of the stress, or view the situation in a less stressful way. For example, optimists will problem-solve and plan ways to deal with the stressor, call on others for support, or try to find a “silver lining” in the stressful situation. All of these approaches are well-known to reduce feelings of stress, as well as the biological reactions that occur when we feel stressed. It’s these <a href="https://www.apa.org/topics/stress/body">biological reactions to stress</a> –- such as elevated cortisol (sometimes called the “stress hormone”), increased heart rate and blood pressure, and impaired immune system functioning –- that can take a toll on health over time and increase the risk for developing <a href="https://www.sciencedirect.com/science/article/pii/S0889159115004316?via%3Dihub">life-threatening diseases</a>, such as cardiovascular disease. In short, the way optimists cope with stress may help protect them somewhat against its harmful effects. <h2>Looking on the bright side</h2> Optimism is typically viewed by researchers as a relatively stable personality trait that is determined by both <a href="https://www.cambridge.org/core/journals/twin-research-and-human-genetics/article/sex-differences-in-the-genetic-architecture-of-optimism-and-health-and-their-interrelation-a-study-of-australian-and-swedish-twins/58F21AA11943D44B4BA4C63A966E6AC7">genetic</a> and early childhood influences (such as having a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6541423/">secure and warm relationship</a> with your parents or caregivers). But if you’re not naturally prone to seeing the glass as half full, there are some ways you can increase your <a href="https://www.tandfonline.com/doi/abs/10.1080/17439760.2016.1221122?journalCode=rpos20">capacity to be optimistic</a>. Research shows optimism can change over time, and can be cultivated by engaging in simple exercises. For example, visualising and then writing about your “<a href="https://www.psychologytoday.com/us/blog/what-matters-most/201303/what-is-your-best-possible-self">best possible self</a>” (a future version of yourself who has accomplished your goals) is a technique that studies have found can <a href="https://www.tandfonline.com/doi/full/10.1080/17439760.2016.1221122">significantly increase optimism</a>, at least temporarily. But for best results, the goals need to be both positive and reasonable, rather than just wishful thinking. Similarly, simply <a href="https://www.tandfonline.com/doi/abs/10.3200/SOCP.149.3.349-364">thinking about positive future events</a> can also be effective for boosting optimism. It’s also crucial to temper any expectations for success with an accurate view of what you can and can’t control. Optimism is reinforced when we experience the positive outcomes that we expect, and <a href="https://psycnet.apa.org/record/1970-20680-001">can decrease</a> when these outcomes aren’t as we want them to be. Although more research is needed, it’s possible that regularly envisioning yourself as having the best possible outcomes, and taking realistic steps towards achieving them, can help develop an optimistic mindset. Of course, this might be easier said than done for some. If you’re someone who isn’t naturally optimistic, the best chances to improve your longevity is by <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003332">living a healthy lifestyle</a> by staying physically active, eating a healthy diet, managing stress, and getting a good night’s sleep. Add to this cultivating a more optimistic mindset and you might further increase your chances for a long life.<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/184785/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/fuschia-sirois-331254">Fuschia Sirois</a>, Professor in Social & Health Psychology, <a href="https://theconversation.com/institutions/durham-university-867">Durham University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/do-optimists-really-live-longer-heres-what-the-research-says-184785">original article</a>.

Caring

Flash droughts are becoming more common in Australia. What’s causing them?

<a href="https://theconversation.com/profiles/milton-speer-703091">Milton Speer</a>, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a> and <a href="https://theconversation.com/profiles/lance-m-leslie-437774">Lance M Leslie</a>, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a> <a href="https://www.drought.gov/what-is-drought/flash-drought">Flash droughts</a> strike suddenly and intensify rapidly. Often the affected areas are in drought after just weeks or a couple of months of well-below-average rainfall. They happen worldwide and are <a href="https://www.researchgate.net/publication/377274397_Flash_drought_A_state_of_the_science_review?_tp=eyJjb250ZXh0Ijp7ImZpcnN0UGFnZSI6InB1YmxpY2F0aW9uRG93bmxvYWQiLCJwYWdlIjoicHVibGljYXRpb24iLCJwcmV2aW91c1BhZ2UiOiJwdWJsaWNhdGlvbiJ9fQ#read">becoming more common</a>, including in Australia, due to global warming. Flash droughts can occur anywhere and at any time of the year. Last year, a flash drought <a href="https://www.abc.net.au/news/2023-10-20/dams-dry-up-as-drought-takes-hold-in-hunter-valley/102996364">hit the Upper Hunter</a> region of New South Wales, roughly 300 kilometres north-west of Sydney. These sudden droughts can have devastating economic, social and environmental impacts. The damage is particularly severe for agricultural regions heavily dependent on reliable rain in river catchments. One such region is the Upper Hunter Valley, the subject of our <a href="https://www.mdpi.com/2225-1154/12/4/49">new research</a>. We identified two climate drivers – the <a href="http://www.bom.gov.au/climate/about/?bookmark=enso">El Niño Southern Oscillation</a> and <a href="http://www.bom.gov.au/climate/about/?bookmark=iod">Indian Ocean Dipole</a>) – that became influential during this drought. In addition, the waning influence of a third climate driver, the <a href="http://www.bom.gov.au/climate/about/?bookmark=sam">Southern Annular Mode</a>), would typically bring rain to the east coast. However, this rain did not reach the Upper Hunter. Flash droughts are set to get more common as the world heats up. This year, a flash drought developed over western and central Victoria over just two months. While heavy rain this month in Melbourne ended the drought there, it continues in the west. <h2>What makes a flash drought different?</h2> Flash droughts differ from more slowly developing droughts. The latter result from extended drops in rainfall, such as the <a href="http://www.bom.gov.au/climate/drought/">drought affecting</a> parts of southwest Western Australia due to the much shortened winter wet season last year. Flash droughts develop when sudden large drops in rainfall coincide with above-average temperatures. They mostly occur in summer and autumn, as was the case for Asia and Europe in 2022. That year saw flash droughts appear across the northern hemisphere, such as the megadrought affecting China’s <a href="https://iopscience.iop.org/article/10.1088/1748-9326/acfe21">Yangtze river basin</a> and <a href="https://www.sciencedirect.com/science/article/pii/S2352340923000264?via%3Dihub">Spain</a>. The flash drought devastating the Upper Hunter from May to October 2023 developed despite the region being drought-free just one month earlier. At that stage, almost nowhere in NSW showed any sign of an impending drought. <figure class="align-center "><img src="https://images.theconversation.com/files/586776/original/file-20240409-18-n82npo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/586776/original/file-20240409-18-n82npo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=276&fit=crop&dpr=1 600w, https://images.theconversation.com/files/586776/original/file-20240409-18-n82npo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=276&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/586776/original/file-20240409-18-n82npo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=276&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/586776/original/file-20240409-18-n82npo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=347&fit=crop&dpr=1 754w, https://images.theconversation.com/files/586776/original/file-20240409-18-n82npo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=347&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/586776/original/file-20240409-18-n82npo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=347&fit=crop&dpr=3 2262w" alt="Maps of drought conditions in NSW in April 2023 compared to the next six months" /><figcaption>NSW Department of Primary Industries’ combined drought indicator in April 2023 (a) and combined drought indicator for May–October 2023 (b) show how rapidly a flash drought developed in the Upper Hunter region. Milton Speer et al 2024, using NSW Department of Primary Industries' data</figcaption></figure> The flash drought greatly affected agricultural production in the Upper Hunter region, due to the region’s reliance on water from rivers. Low rainfall in river catchments means less water for crops and pasture. It also dries up drinking water supplies. Flash droughts are characterised by abrupt periods of low rainfall leading to rapid drought onset, particularly when accompanied by above-average temperatures. Higher temperatures increase both the evaporation of water from the soil and transpiration from plants (evapotranspiration). This causes soil moisture to drop rapidly. <h2>The Upper Hunter drought is part of a trend</h2> Flash droughts will be more common in the future. That’s because higher temperatures will more often coincide with dry conditions, as relative humidity falls <a href="https://www.researchgate.net/publication/377274397_Flash_drought_A_state_of_the_science_review_tp=eyJjb250ZXh0Ijp7ImZpcnN0UGFnZSI6InB1YmxpY2F0aW9uRG93bmxvYWQiLCJwYWdlIjoicHVibGljYXRpb24iLCJwcmV2aW91c1BhZ2UiOiJwdWJsaWNhdGlvbiJ9fQ#read">across many parts</a> of Australia and globally. Climate change is <a href="https://climate.ec.europa.eu/climate-change/consequences-climate-change_en">linked to</a> shorter, heavier bursts of rain followed by longer periods of little rainfall. <figure class="align-center "><img src="https://images.theconversation.com/files/586777/original/file-20240409-16-n82npo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/586777/original/file-20240409-16-n82npo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=196&fit=crop&dpr=1 600w, https://images.theconversation.com/files/586777/original/file-20240409-16-n82npo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=196&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/586777/original/file-20240409-16-n82npo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=196&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/586777/original/file-20240409-16-n82npo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=246&fit=crop&dpr=1 754w, https://images.theconversation.com/files/586777/original/file-20240409-16-n82npo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=246&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/586777/original/file-20240409-16-n82npo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=246&fit=crop&dpr=3 2262w" alt="Map of Upper Hunter region showing drought indicators in December 2023" /><figcaption>Intense drought conditions continued in the Upper Hunter in December 2023. Milton Speer et al 2024</figcaption></figure> <figure class="align-right "><img src="https://images.theconversation.com/files/586778/original/file-20240409-16-www3a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/586778/original/file-20240409-16-www3a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=376&fit=crop&dpr=1 600w, https://images.theconversation.com/files/586778/original/file-20240409-16-www3a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=376&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/586778/original/file-20240409-16-www3a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=376&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/586778/original/file-20240409-16-www3a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=472&fit=crop&dpr=1 754w, https://images.theconversation.com/files/586778/original/file-20240409-16-www3a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=472&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/586778/original/file-20240409-16-www3a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=472&fit=crop&dpr=3 2262w" alt="Map of NSW showing average temperature ranges recorded for May–October 2023." /><figcaption>The sharp drop in rainfall coincided with the Upper Hunter’s highest average maximum temperatures on record for May–October 2023. Milton Speer et al 2024</figcaption></figure> In south-east and south-west Australia, flash droughts can also occur in winter. In May 2023 rainfall over south-east Australia dropped abruptly. The much lower rainfall continued until November in the Upper Hunter. Over this same period, mean maximum temperatures in the region were the highest on record, increasing the loss of moisture through evapotranspiration. The result was a flash drought. While flash droughts occurred in other parts of south-east Australia, we focused on the Upper Hunter as it remained in drought the longest. <h2>What were the climate drivers of this drought?</h2> We used machine-learning techniques to identify the key climate drivers of the drought. We found the dominant driver of the flash drought was global warming, modulated by the phases of the three major climate drivers in our region, the El Niño Southern Oscillation, Indian Ocean Dipole and the Southern Annular Mode. From 2020 to 2022, the first two drivers became favourable for rain in the Upper Hunter in late winter through spring, before changing phase to one supporting drought over south-east Australia. Meanwhile, the Southern Annular Mode remained mostly positive, meaning rain-bearing westerly winds and weather fronts had moved to middle and higher latitudes of the southern hemisphere, away from Australia’s south-east coast. Combined, the impact of global warming with the three climate drivers made rainfall much more variable. The net result was an atmospheric environment highly conducive to a flash drought appearing anywhere in south-east Australia. <figure class="align-right zoomable"><a href="https://images.theconversation.com/files/586248/original/file-20240405-16-ti5j3m.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/586248/original/file-20240405-16-ti5j3m.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/586248/original/file-20240405-16-ti5j3m.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=464&fit=crop&dpr=1 600w, https://images.theconversation.com/files/586248/original/file-20240405-16-ti5j3m.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=464&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/586248/original/file-20240405-16-ti5j3m.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=464&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/586248/original/file-20240405-16-ti5j3m.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=583&fit=crop&dpr=1 754w, https://images.theconversation.com/files/586248/original/file-20240405-16-ti5j3m.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=583&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/586248/original/file-20240405-16-ti5j3m.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=583&fit=crop&dpr=3 2262w" alt="Map of Upper Hunter region showing drought indicators in December 2023" /></a><figcaption>Intense drought conditions continued in the Upper Hunter in December 2023. Milton Speer et al 2024</figcaption></figure> <h2>Victoria, too, fits the global warming pattern</h2> As for the flash drought that developed in early 2024 over western and central Victoria, including Melbourne, it continues in parts of <a href="http://www.bom.gov.au/climate/drought/#msdynttrid=_ytsVsw1a3IFZ7xGCnQz8mw1Gum_n_0JUdQyt2hUVCo">western Victoria</a>. The flash drought followed very high January rainfall (top 5% of records) dropping rapidly to very low rainfall (bottom 5%) in February and March. It was the <a href="http://www.bom.gov.au/climate/maps/rainfall/?variable=rainfall&map=decile&period=2month&region=vc&year=2024&month=03&day=31">driest February-March period</a> on record for Melbourne and south-west Victoria. At the beginning of April, a storm front <a href="https://www.9news.com.au/national/severe-weather-storm-warning-for-victoria-and-melbourne-easter-monday/41d5d383-b70d-4d36-a649-38632bc607de">brought heavy rainfall</a> over an 18-hour period to central Victoria, including Melbourne. The rains ended the flash drought in these areas, but it continues in parts of western Victoria, which missed out on the rain. The pattern of the 2024 flash drought in Victoria typifies the increasing trend under global warming of long dry periods, interspersed by short, heavy rainfall events. <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/227052/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/milton-speer-703091">Milton Speer</a>, Visiting Fellow, School of Mathematical and Physical Sciences, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a> and <a href="https://theconversation.com/profiles/lance-m-leslie-437774">Lance M Leslie</a>, Professor, School of Mathematical And Physical Sciences, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/flash-droughts-are-becoming-more-common-in-australia-whats-causing-them-227052">original article</a>.

Domestic Travel

Stay or go? Most older Australians want to retire where they are, but renters don’t always get a choice

<a href="https://theconversation.com/profiles/christopher-phelps-378137">Christopher Phelps</a>, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>; <a href="https://theconversation.com/profiles/rachel-ong-viforj-113482">Rachel Ong ViforJ</a>, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>, and <a href="https://theconversation.com/profiles/william-clark-1488932">William Clark</a>, <a href="https://theconversation.com/institutions/university-of-california-los-angeles-1301">University of California, Los Angeles</a> As Australia’s population gets older, more people are confronted with a choice: retire where they are or seek new horizons elsewhere. Choosing to grow old in your existing home or neighbourhood is known as “ageing in place”. It enables older people to stay connected to their community and maintain familiarity with their surroundings. For many, the decision to “age in place” will be tied to their connection to the family home. But for many, secure and affordable housing is increasingly <a href="https://theconversation.com/ageing-in-a-housing-crisis-growing-numbers-of-older-australians-are-facing-a-bleak-future-209237">beyond reach</a>. This choice may then be impeded by a lack of suitable accommodation in their current or desired neighbourhoods. Our recently published <a href="https://doi.org/10.1177/01640275231209683">study</a> asks what motivates older homeowners and renters to age in place or relocate, and what factors disrupt these preferences. It suggests older renters are often not given a fair choice. <h2>Most older Australians want to age in place</h2> Having the option to age in place enables older people to retain autonomy over their lifestyles and identity, promoting emotional wellbeing. Using 20 years of data from the government-funded Household, Income and Labour Dynamics in Australia (HILDA) survey, we tracked the preferences of Australians aged 55 and over. Encouragingly, most older Australians are already where they want to be. Two-thirds (67%) of respondents strongly preferred to stay in their current neighbourhood, and an additional one-fifth (19%) had a moderate preference to stay. Only 6% showed a moderate or strong desire to leave. Ageing in place is then the natural choice for a vast majority of older Australians. <iframe id="s3LTM" class="tc-infographic-datawrapper" style="border: none;" src="https://datawrapper.dwcdn.net/s3LTM/1/" width="100%" height="400px" frameborder="0"></iframe> Our study highlights several motivations for people to stay put as they retire. For homeowners, family ties matter. Owners with children residing nearby were around one and a half times more likely to have a higher preference to stay. Older owners might then have a reason to call on their substantial <a href="https://theconversation.com/the-housing-wealth-gap-between-older-and-younger-australians-has-widened-alarmingly-in-the-past-30-years-heres-why-197027">housing wealth</a> and keep their children nearby via the <a href="https://360info.org/how-to-help-the-young-buy-a-home/">“bank of mum and dad”</a>. For renters, how long they stay is important. Those renting their home for 10 years or more were 1.7 times more likely to have a higher preference to stay than short-term renters. <h2>Renters face the most disruption</h2> The survey enabled us to follow where older people lived a year after they provided their preferences. This helped us gauge how often they turned their desires into reality. The chart below indicates that private renters face greater obstacles to ageing in place. Around one in 10 private renters that desired to age in place were disrupted – they wanted to stay in their neighbourhood but didn’t. This suggests they moved out of their neighbourhood involuntarily. Only 2% of homeowners and social renters experienced the same disruption. However, for those in these tenures that did not desire to age in place, involuntary immobility was a greater concern. Only 15% of those that wanted to leave succeeded, leaving the vast majority “stuck in place”. <iframe id="IlliV" class="tc-infographic-datawrapper" style="border: none;" src="https://datawrapper.dwcdn.net/IlliV/1/" width="100%" height="400px" frameborder="0"></iframe> The private rental market is the least secure of tenures, and so private tenants are often exposed to involuntary moves. Australia’s private rental system is lightly regulated compared to many other countries, creating tenure insecurity concerns. On the other hand, social renters were particularly susceptible to involuntary immobility. Social housing is scarce in Australia and subject to <a href="https://theconversation.com/its-soul-destroying-how-people-on-a-housing-wait-list-of-175-000-describe-their-years-of-waiting-210705">lengthy waiting lists</a>. A neighbourhood move often requires transferring to the less affordable and less secure private rental housing. Even after considering financial status, social renters were four times as likely to be stuck as compared to private renters. Social tenants are strongly deterred from moving in the current system. <h2>How can we support older Australians’ preferences?</h2> Our study exposes some barriers in the housing system that hinder people from being able to age in place, or move when they want to. Clearly, older renters enjoy fewer protections against disruptions to their preferences to age in place than older owners. For private renters, tenure insecurity in the <a href="https://theconversation.com/insecure-renting-ages-you-faster-than-owning-a-home-unemployment-or-obesity-better-housing-policy-can-change-this-216364">private rental sector</a> is a key reform priority. This can be achieved through stronger regulation that improves tenants’ rights. For example, more states could adopt <a href="https://theconversation.com/how-5-key-tenancy-reforms-are-affecting-renters-and-landlords-around-australia-187779?utm_source=twitter&utm_medium=bylinetwitterbutton">recent regulatory rental reforms</a> that support the rights of pet owners and protect against no-grounds evictions. Large numbers of older private renters also face severe <a href="https://www.oldertenants.org.au/publications/ageing-in-a-housing-crisis-older-peoples-housing-insecurity-homelessness-in-australia">rental stress</a>, which may force them to move from their preferred neighbourhood. <a href="https://theconversation.com/1-billion-per-year-or-less-could-halve-rental-housing-stress-146397">Commonwealth rent assistance reform</a> would alleviate some of this stress through an increase in rates and better targeting. An increase in the supply of social housing would play an important role in improving both tenure security and housing affordability. Older social renters enjoy fewer obstacles to ageing in place than older private renters. However, if social renters want to move into the private rental market to relocate, they face difficulty securing accommodation. This will likely discourage moves as it would require sacrificing the tenure security offered by social housing. However, policy initiatives that improve the <a href="https://www.ahuri.edu.au/sites/default/files/migration/documents/PES-358-Lessons-from-public-housing-urban-renewal-evaluation.pdf">quality of the public housing stock</a> can reduce feelings of being stuck. As <a href="https://www.aihw.gov.au/reports/australias-welfare/home-ownership-and-housing-tenure">homeownership rates decline</a> both among young people and those nearing retirement, we can expect the population of older renters to grow. Overall, our findings support a strong case for policy reform in the rental sectors to address the needs and preferences of older renters.<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/218024/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/christopher-phelps-378137">Christopher Phelps</a>, Research Fellow, School of Accounting, Economics and Finance, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>; <a href="https://theconversation.com/profiles/rachel-ong-viforj-113482">Rachel Ong ViforJ</a>, ARC Future Fellow & Professor of Economics, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>, and <a href="https://theconversation.com/profiles/william-clark-1488932">William Clark</a>, Research Professor of Geography, <a href="https://theconversation.com/institutions/university-of-california-los-angeles-1301">University of California, Los Angeles</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/stay-or-go-most-older-australians-want-to-retire-where-they-are-but-renters-dont-always-get-a-choice-218024">original article</a>.

Retirement Income

50 years on, Advance Australia Fair no longer reflects the values of many. What could replace it?

<a href="https://theconversation.com/profiles/wendy-hargreaves-1373285">Wendy Hargreaves</a>, <a href="https://theconversation.com/institutions/university-of-southern-queensland-1069">University of Southern Queensland</a> On April 8 1974, Prime Minister Gough Whitlam announced to parliament the nation’s new national anthem: <a href="https://www.pmc.gov.au/honours-and-symbols/australian-national-symbols/australian-national-anthem">Advance Australia Fair</a>. Australia was growing up. We could stop saving “<a href="https://en.wikipedia.org/wiki/God_Save_the_King">our gracious Queen</a>” and rejoice in being “young” and “girt”. Finding a new anthem hadn’t been easy. There were unsuccessful <a href="https://www.naa.gov.au/help-your-research/fact-sheets/australias-national-anthem">songwriting competitions</a> and an unconvincing opinion poll. Finally, we landed on rebooting an Australian favourite from 1878. After Whitlam’s announcement, Australians argued, state officials declined the change and the next government reinstated the British anthem in part. It took another ten years, another poll and an official proclamation in 1984 to adopt the new anthem uniformly and get on with looking grown-up. Advance Australia Fair was never the ideal answer to “what shall we sing?”. The original lyrics ignored First Nations people and overlooked women. Like a grunting teenager, it both answered the question and left a lot out. On its 50th anniversary, it’s time to consider whether we got it right. Advance Australia Fair may have helped Australia transition through the 1970s, but in 2024, has it outstayed its welcome? <h2>How do you pick a national anthem?</h2> A national anthem is a government-authorised song performed at official occasions and celebrations. It unifies people and reinforces national identity. Often, governments nominate a tune by searching through historical patriotic songs to find a <a href="https://dictionary.cambridge.org/dictionary/english/golden-oldie">golden oldie</a> with known public appeal. For example, the lyrics of the Japanese anthem <a href="https://en.wikipedia.org/wiki/Kimigayo">Kimigayo</a> came from pre-10th-century poetry. Germany’s anthem <a href="https://www.britannica.com/topic/Deutschlandlied">Deutschlandlied</a> adopted a 1797 melody from renowned composer <a href="https://www.britannica.com/biography/Joseph-Haydn">Joseph Haydn</a>. An enduring song or text offers star quality, proven popularity and the prestige of age. In the 1970s, Australia’s attempt at finding a golden oldie was flawed. In that era, many believed Australia’s birth occurred at the arrival of explorer <a href="https://www.britannica.com/biography/James-Cook">James Cook</a> in 1770. Hence, we narrowed our search to hymns, marches and fanfares from our colonial history for possible anthems. With 2020s hindsight (pun intended), <a href="https://theconversation.com/our-national-anthem-is-non-inclusive-indigenous-australians-shouldnt-have-to-sing-it-118177">expecting First Nations</a> people to sing Advance Australia Fair was hypocritical. We wanted to raise Australia’s visibility internationally, yet the custodians of the lands and waterways were unseen by our country’s eyes. We championed “history’s page” with a 19th-century song that participated in racial discrimination. <h2>Changing anthems</h2> With a half-century on the scoreboard, are we locked in to singing Advance Australia Fair forever? No. Anthems can change. Just ask <a href="https://en.wikipedia.org/wiki/James_Morrison_(jazz_musician)">James Morrison</a>. In 2003, the Australian trumpeter played the Spanish national anthem beautifully at the <a href="https://www.daviscup.com/en/home.aspx">Davis Cup</a> tennis final. Unfortunately, he <a href="https://www.abc.net.au/news/2003-11-28/spanish-angry-over-anthem-mix-up/1516684">played the old anthem</a> that heralded civil war. Morrison’s accidental performance incited a fist-shaking dignitary and an enraged Spanish team who temporarily refused to play. Morrison did, however, to his embarrassment, later receive some excited fan mail from Spanish revolutionists. If we want to change our anthem, where could we begin? We could start by revisiting the golden-oldie approach with a more inclusive ear. Perhaps there’s a song from contemporary First Nations musicians we could consider, or a song from their enduring oral tradition that they deem appropriate (and grant permission to use). If we have learnt anything from Australian history, it’s that we must include and ask – not exclude and take. We could also consider Bruce Woodley and Dobe Newton’s 1987 song <a href="https://www.nfsa.gov.au/collection/curated/asset/101146-i-am-australian-various">I Am Australian</a>, which reached golden-oldie status last year when the <a href="https://www.nfsa.gov.au/slip-slop-slap-i-am-australian-join-sounds-australia">National Film and Sound Archive</a> added it to their registry. The lyrics show the acknowledgement and respect of First Nations people that our current anthem lacks. The line “we are one, but we are many” captures the inclusivity with diversity we now value. <figure><iframe src="https://www.youtube.com/embed/KrLTe1_9zso?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> I Am Australian wouldn’t be a problem-free choice. Musically, the style is a “light rock” song, not a grand “hymn”, which could be a plus or minus depending on your view. Lyrically, romanticising convicted killer <a href="https://adb.anu.edu.au/biography/kelly-edward-ned-3933">Ned Kelly</a> is controversial, and mispronouncing “Australians” could be considered inauthentic (fair dinkum Aussies say “Au-strail-yins”, not “Au-stray-lee-uhns”). That said, Australians are quite experienced at patching holes in our anthem. Advance Australia Fair required many adjustments. If the golden-oldie approach fails again, how about composing a new anthem? We could adopt <a href="https://nationalanthems.info/ke.htm">Kenya’s approach</a> of commissioning an anthem, or could revive the good ol’ songwriting competition. Our past competitions weren’t fruitful, but surely our many talented musicians and poets today can meet the challenge. <h2>It’s time to ask</h2> Fifty years on, we acknowledge Advance Australia Fair as the anthem that moved our nation forward. That was the first and hardest step. Today, if Australians choose, we can retire the song gracefully and try again with a clearer voice. Changing our anthem begins with asking whether the current song really declares who we are. Have our values, our perspectives and our identity changed in half a century? Australia, it’s your song. Are you happy to sing Advance Australia Fair for another 50 years? <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/226737/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/wendy-hargreaves-1373285">Wendy Hargreaves</a>, Senior Learning Advisor, <a href="https://theconversation.com/institutions/university-of-southern-queensland-1069">University of Southern Queensland</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/50-years-on-advance-australia-fair-no-longer-reflects-the-values-of-many-what-could-replace-it-226737">original article</a>. Images: Shutterstock | Wikimedia Commons

Music

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

<a href="https://theconversation.com/profiles/justin-stebbing-1405462">Justin Stebbing</a>, <a href="https://theconversation.com/institutions/anglia-ruskin-university-1887">Anglia Ruskin University</a> The recent revelations about the Princess of Wales’s <a href="https://www.bbc.com/news/uk-68640917">cancer diagnosis</a> highlight a crucial aspect of cancer detection – the disease’s sometimes silent nature. Silent cancers are those without noticeable symptoms. They pose a unique challenge in early detection and treatment. Contrary to common perception, cancer does not always announce its presence through overt symptoms or obvious signs. Many people receive a <a href="https://academic.oup.com/clinchem/article-abstract/70/1/179/7283928">cancer diagnosis incidentally</a>, when it’s found during routine medical examinations or investigations for unrelated health concerns – as seems to be the case for both <a href="https://www.wsj.com/health/kate-middleton-catherine-cancer-what-is-preventative-chemotherapy-9625370d">the princess</a> and <a href="https://www.bbc.co.uk/news/health-68171163">King Charles III</a>. While even silent cancers can sometimes be <a href="https://pubmed.ncbi.nlm.nih.gov/22584215/">aggressive and advance rapidly</a>, they can also remain <a href="https://pubmed.ncbi.nlm.nih.gov/20363069/">dormant</a> for years or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8819710/">even decades</a>. Some <a href="https://ascopubs.org/doi/10.14694/EdBook_AM.2012.32.98">prostate</a>, <a href="https://ascopubs.org/doi/10.14694/EdBook_AM.2012.32.301">breast</a> and <a href="https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2020.571421/full">thyroid</a> cancers, for example, <a href="https://www.tmlep.com/clinical-learning/2023-01-23-when-did-this-tumour-start-the-need-for-a-gompertzian-understanding-of-tumour-growth-kinetics">often evolve slowly</a> without obvious symptoms or spreading beyond the original area. Research suggests that some of these cancers are <a href="https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2020.571421/full">overtreated</a>. Sometimes patients are best left alone or treated much more gently, perhaps even without medical intervention, using a <a href="https://www.nejm.org/doi/full/10.1056/nejmoa1311593">“watch and wait”</a> strategy. This approach may be taken with prostate cancer in the elderly, for example. <h2>The importance of early diagnosis</h2> Whatever the cancer, it’s always important to get an early diagnosis though – and for silent cancers, this is obviously a challenge. Some cancer symptoms <a href="https://pubmed.ncbi.nlm.nih.gov/36702593/">can be vague</a> and easily mistaken for benign ailments. Fatigue, unexplained weight loss and persistent pain are among the nonspecific symptoms that may signal an underlying malignancy. But such symptoms can be misinterpreted or easily dismissed, which contributes to delayed diagnosis and treatment. <figure><iframe src="https://www.youtube.com/embed/MGMy6BzBvp0?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> Fortunately, in many countries including the UK, we have <a href="https://www.england.nhs.uk/cancer/early-diagnosis/screening-and-earlier-diagnosis/">screening</a> tests for diseases like breast or colon cancer, to increase early diagnoses. Early diagnosis is a <a href="https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.32887">key factor</a> for successful cancer treatment. Detecting cancer in its silent phase offers a window of opportunity for early intervention and improved outcomes. The discovery of asymptomatic cancers through diagnostic imaging or screening tests underscores the importance of these proactive healthcare measures. Identifying cancer at an early stage means the disease is confined to its site of origin, smaller and potentially easier to cure. Diagnosing a smaller cancer often means that if an operation is needed, it may be a less invasive surgery. There may also be a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6825992/">lower chance</a> of needing post-operative preventative chemotherapy, to mop up any residual cells. Colorectal cancer (CRC) is a good example to show the critical importance of screening. Studies show that patients who participate in CRC <a href="https://www.nice.org.uk/guidance/dg56/chapter/1-Recommendations">screening</a>, such as colonoscopies or tests that look for blood in the stool, are more likely to be diagnosed while asymptomatic and have more positive prognoses after treatment. Those diagnosed with CRC after showing symptoms, such as rectal bleeding or changes in bowel habits, tend to have more <a href="https://bmjopengastro.bmj.com/content/4/1/e000146%20">advanced tumors and poorer outcomes</a>. <figure><iframe src="https://www.youtube.com/embed/nA9_Io3LDpA?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> Public health initiatives aimed at raising awareness about the importance of both cancer screening and symptom recognition play a pivotal role in reducing diagnostic delays. Empowering people to engage in <a href="https://healthcaredelivery.cancer.gov/prevention/#:%7E:text=Cancer%20can%20be%20prevented%20through,they%20are%20more%20easily%20treated.">preventive healthcare measures</a> such as HPV vaccinations and lifestyle changes that decrease risk can facilitate early detection and intervention, potentially altering the trajectory of the disease. <h2>Biomarker discovery</h2> The latest advances in diagnostic technologies, often known as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8012218/#:%7E:text=During%20biomarker%20discovery%2C%20evaluation%20of,design%20of%20future%20validation%20studies.">“biomarker discovery”</a>, hold promise for improving early detection rates and refining treatment strategies for silent cancers. From <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/molecular-profiling">molecular profiling</a> to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9922467/">liquid biopsy techniques</a> (blood tests to diagnose cancer), innovative approaches are reshaping the landscape of cancer diagnosis, offering new avenues for personalised and precision medicine. For example, I worked with a team using blood tests to identify cancers in more than <a href="https://www.nature.com/articles/s41388-023-02591-z">1,000 women recalled after screening for mammography</a>. We looked at the DNA that tumour cells release – so-called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10496721/">cell-free DNA</a> – and also metabolomics (rare markers related to metabolism in the blood). From this information, we found healthy patients, benign disease, pre-cancer and breast cancer. Although there’s increasing awareness and use of this <a href="https://www.sciencedirect.com/science/article/abs/pii/S1769721218307110">approach in Europe</a>, it isn’t standard in the UK. Asymptomatic cancers represent a formidable challenge for patient care. But, by encouraging patients to adopt preventive lifestyles and engage with screenings and tests, asymptomatic cancers don’t have to be a hidden threat to health.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/226536/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/justin-stebbing-1405462">Justin Stebbing</a>, Professor of Biomedical Sciences, <a href="https://theconversation.com/institutions/anglia-ruskin-university-1887">Anglia Ruskin University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/silent-cancers-heres-what-you-need-to-know-when-there-are-no-obvious-symptoms-226536">original article</a>.

Body

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

<a href="https://theconversation.com/profiles/allen-cheng-94997">Allen Cheng</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Influenza is a common respiratory infection. Although most cases are relatively mild, flu can cause more severe illness in young children and older people. Influenza virtually <a href="https://pubmed.ncbi.nlm.nih.gov/33243355/">disappeared</a> from Australia during the first years of the COVID-19 pandemic when public health restrictions reduced contact between people. Since 2022, it has returned to a seasonal pattern, although the flu season has started and peaked a few months earlier than before 2020. It’s difficult to predict the intensity of the flu season at this point in the year, but we can sometimes get clues from the northern hemisphere. There, the season <a href="https://www.who.int/tools/flunet">started</a> <a href="https://gis.cdc.gov/grasp/fluview/flu_by_age_virus.html">earlier</a> than usual for the third year running (peaking in early January rather than late February/March), with a similar number of reported cases and hospitalisations to the previous year. Influenza vaccines are recommended annually, but there are now an increasing number of different vaccine types. Here’s what to know about this year’s shots, available from <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">this month</a>. <h2>What goes into a flu vaccine?</h2> Like other vaccines, influenza vaccines work by “training” the immune system on a harmless component of the influenza virus (known as an antigen), so it can respond appropriately when the body encounters the real virus. Influenza strains are constantly changing due to genetic mutation, with the pace of genetic change <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10421855">much higher</a> than for SARS-CoV-2 (the virus that causes COVID). The strains that go into the vaccine are <a href="https://www.who.int/teams/global-influenza-programme/vaccines/who-recommendations">reviewed</a> twice each year by the World Health Organization (WHO), which selects vaccine strains to match the next season’s predicted circulating strains. All current influenza vaccines in <a href="https://www.tga.gov.au/resources/publication/meeting-statements/aivc-recommendations-composition-influenza-vaccines-australia-2024">Australia</a> contain four different strains (known as quadrivalent vaccines). One of the strains appeared to <a href="https://www.nejm.org/doi/full/10.1056/NEJMp2314801">disappear</a> during the COVID pandemic, and the WHO has recently <a href="https://cdn.who.int/media/docs/default-source/influenza/who-influenza-recommendations/vcm-southern-hemisphere-recommendation-2024/202309_qanda_recommendation.pdf?sfvrsn=7a6906d1_5">recommended</a> dropping this strain from the vaccine. It’s expected trivalent (three strain) vaccines will become available in the near future. <h2>What’s different about new flu vaccines?</h2> There are eight brands of flu vaccines <a href="https://www.health.gov.au/resources/publications/atagi-statement-on-the-administration-of-seasonal-influenza-vaccines-in-2024?language=en">available</a> in Australia in 2024. These include egg-based vaccines (Vaxigrip Tetra, Fluarix Tetra, Afluria Quad, FluQuadri and Influvac Tetra), cell-based vaccines (Flucelvax Quad), adjuvanted vaccines (Fluad Quad) and high-dose vaccines (Fluzone High-Dose Quad). Until recently, the process of manufacturing flu vaccines has remained similar. Since the development of the influenza vaccine in the <a href="https://www.who.int/news-room/spotlight/history-of-vaccination/history-of-influenza-vaccination">1940s</a>, influenza viruses were grown in chicken eggs, then extracted, inactivated, purified and processed to make up the egg-based vaccines that are still used widely. However, there have been several enhancements to influenza vaccines in recent years. Older people’s immune systems tend not to respond as strongly to vaccines. In some flu vaccines, adjuvants (components that stimulate the immune system) are included with the influenza antigens. For example, an adjuvant is used in the Fluad Quad vaccine, recommended for over 65s. Studies <a href="https://ncirs.org.au/sites/default/files/2021-02/Adjuvanted%20influenza%20vaccine%20vs%20standard%20dose%20influenza%20vaccine%20SoF%20EP%20E2D%20tables_26%20Feb%202021_Final.pdf">suggest</a> adjuvanted influenza vaccines are slightly better than standard egg-based vaccines without adjuvant in older people. An alternative approach to improving the immune response is to use higher doses of the vaccine strains. An example is Fluzone High-Dose Quad – another option for older adults – which contains the equivalent of four doses of a standard influenza vaccine. Studies <a href="https://ncirs.org.au/sites/default/files/2022-05/HD%20vs%20sIV%20SoF%20EP%20E2D_March%202022_Final.pdf">suggest</a> the high dose vaccine is better than the standard dose vaccine (without an adjuvant) in preventing hospitalisation and complications in older people. Other manufacturers have updated the manufacturing process. Cell-based vaccines, such as Flucelvax Quad, use cells instead of eggs in the manufacturing process. Other vaccines that are <a href="https://www.cdc.gov/flu/prevent/advances.htm">not yet available</a> also use different technologies. In the past, <a href="https://pubmed.ncbi.nlm.nih.gov/31151913/">manufacturing issues</a> with egg-based vaccines have reduced their effectiveness. Using an alternative method of production provides some degree of insurance against this in the future. <h2>What should I do this year?</h2> Given indications this year’s flu season may be earlier than usual, it’s probably safest to get your vaccine early. This is particularly <a href="https://www.health.gov.au/resources/publications/atagi-statement-on-the-administration-of-seasonal-influenza-vaccines-in-2024?language=en">important</a> for those at highest risk of severe illness, including older adults (65 years and over), those with chronic medical conditions, young children (six months to five years) and Aboriginal and Torres Strait Islander people. Influenza vaccines are also recommended in pregnancy to protect both the mother and the baby for the first months of life. Influenza vaccines are widely available, including at GP clinics and pharmacies, while many workplaces have occupational programs. For high-risk groups, <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">four of the vaccines</a> are subsidised by the Australian government through the <a href="https://www.health.gov.au/our-work/national-immunisation-program">National Immunisation Program</a>. In older people, a number of vaccines are now recommended: <a href="https://www.health.gov.au/sites/default/files/2024-03/atagi-statement-on-the-administration-of-covid-19-vaccines-in-2024.pdf">COVID</a> and influenza, as well as one-off courses of <a href="https://www.health.gov.au/sites/default/files/documents/2020/06/national-immunisation-program-pneumococcal-vaccination-schedule-from-1-july-2020-clinical-advice-for-vaccination-providers.pdf">pneumococcal</a> and <a href="https://www.health.gov.au/topics/immunisation/vaccines/shingles-herpes-zoster-immunisation-service">shingles</a> vaccines. In general, most vaccines can be given in the same visit, but talk to your doctor about which ones you need. <h2>Are there side effects?</h2> All influenza vaccines can <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">cause</a> a sore arm and sometimes more generalised symptoms such as fever and tiredness. These are expected and reflect the immune system reacting appropriately to the vaccine, and are mostly mild and short-term. These side effects are slightly more common in <a href="https://ncirs.org.au/sites/default/files/2021-02/Adjuvanted%20influenza%20vaccine%20vs%20standard%20dose%20influenza%20vaccine%20SoF%20EP%20E2D%20tables_26%20Feb%202021_Final.pdf">adjuvanted</a> and <a href="https://ncirs.org.au/sites/default/files/2022-05/HD%20vs%20sIV%20SoF%20EP%20E2D_March%202022_Final.pdf">high dose</a> vaccines. As with all medications and vaccines, allergic reactions such as anaphylaxis can occur after the flu vaccine. All vaccine providers are trained to recognise and respond to anaphylaxis. People with egg allergies should discuss this with their doctor, but in general, <a href="https://www.allergy.org.au/patients/food-allergy/egg-allergy-flu-vaccine">studies suggest</a> they can safely receive any (including egg-based) influenza vaccines. Serious side effects from the influenza vaccine, such as Guillain-Barré syndrome, a neurological complication, are very rare (one case per million people vaccinated). They are <a href="https://pubmed.ncbi.nlm.nih.gov/23810252/">thought</a> to be less common after influenza vaccination than after infection with influenza.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/226623/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/allen-cheng-94997">Allen Cheng</a>, Professor of Infectious Diseases, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/there-are-new-flu-vaccines-on-offer-for-2024-should-i-get-one-what-do-i-need-to-know-226623">original article</a>.

Body

Eating some chocolate really might be good for you – here’s what the research says

<a href="https://theconversation.com/profiles/dan-baumgardt-1451396">Dan Baumgardt</a>, <a href="https://theconversation.com/institutions/university-of-bristol-1211">University of Bristol</a> Although it always makes me scoff slightly to see Easter eggs making their first appearance in supermarkets at the end of December, there are few people who aren’t delighted to receive a bit of chocolate every year. It makes sense that too much chocolate would be bad for you because of the high fat and sugar content in most products. But what should we make of common claims that eating some chocolate is actually good for you? Happily, there is a fair amount of evidence that shows, in the right circumstances, chocolate may be both beneficial for your heart and good for your mental state. In fact, chocolate – or more specifically cacao, the raw, unrefined bean – is a medicinal wonder. It contains many different active compounds which can evoke pharmacological effects within the body, like medicines or drugs. Compounds that lead to neurological effects in the brain have to be able to cross the <a href="https://link.springer.com/chapter/10.1007/978-3-642-13443-2_7">blood-brain barrier</a>, the protective shield which prevents harmful substances – like toxins and bacteria – entering the delicate nervous tissue. One of these is the compound <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3672386/">theobromine</a>, which is also found in tea and contributes towards its bitter taste. Tea and chocolate also contain caffeine, which theobromine is related to as part of the purine family of chemicals. These chemicals, among others, contribute to chocolate’s addictive nature. They have the ability to cross the blood-brain barrier, where they can influence the nervous system. They are therefore known as <a href="https://pubmed.ncbi.nlm.nih.gov/15549276/">psychoactive</a> chemicals. <figure><iframe src="https://www.youtube.com/embed/HloqayQdR6M?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> What effects can chocolate have on mood? Well, <a href="https://academic.oup.com/nutritionreviews/article/71/10/665/1931144?login=false">a systematic review</a> looked at a group of studies which examined the feelings and emotions associated with consuming chocolate. Most demonstrated improvements in mood, anxiety, energy and states of arousal. Some noted the feeling of guilt, which is perhaps something we’ve all felt after one too many Dairy Milks. <h2>Health benefits of cocoa</h2> There are other organs, aside from the brain, that might benefit from the medicinal effects of cocoa. For centuries, chocolate has been used as a medicine to treat a <a href="https://pubmed.ncbi.nlm.nih.gov/10917925/">long list of diseases</a> including anaemia, tuberculosis, gout and even low libido. These might be spurious claims but there is evidence to suggest that eating cacao has a positive effect on the cardiovascular system. First, it can prevent <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8068178/">endothelial dysfunction</a>. This is the process through which arteries harden and get laden down with fatty plaques, which can in turn lead to heart attacks and strokes. Eating dark chocolate may also reduce <a href="https://www.sciencedirect.com/science/article/pii/S1537189115001135?via%3Dihub">blood pressure</a>, which is another risk factor for developing arterial disease, and prevent formation of clots which block up blood vessels. <figure><iframe src="https://www.youtube.com/embed/8VUcPCbSSCY?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> Some studies have suggested that dark chocolate might be useful in adjusting ratios of <a href="https://pubmed.ncbi.nlm.nih.gov/20968113/">high-density lipoprotein cholesterol</a>, which can help protect the heart. Others have examined insulin resistance, the phenomenon associated with Type 2 diabetes and weight gain. They suggest that the <a href="https://www.sciencedirect.com/science/article/pii/S0963996900000697#:%7E:text=Cocoa%20is%20rich%20in%20polyphenols%20particularly%20in%20catechins,and%20cocoa%20powder%20have%20been%20published%20only%20recently.">polyphenols</a> – chemical compounds present in plants – found in foodstuffs like chocolate may also lead to <a href="https://pubmed.ncbi.nlm.nih.gov/29993262/">improved control of blood sugars</a>. <h2>Chocolate toxicity</h2> As much as chocolate might be considered a medicine for some, it can be a poison for others. It’s well documented that the ingestion of caffeine and theobromine is highly toxic for domestic animals. Dogs are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4801869/">particularly affected</a> because of their often voracious appetites and generally unfussy natures. The culprit is often dark chocolate, which can provoke symptoms of agitation, rigid muscles and even seizures. In certain cases, if ingested in high enough quantities, it can lead to comas and abnormal, even fatal heart rhythms. Some of the compounds found in chocolate have also been found to have potentially negative effects in humans. Chocolate is a source of oxalate which, along with calcium, is one of the main components of <a href="https://pubmed.ncbi.nlm.nih.gov/20301742/">kidney stones</a>. Some clinical groups have advised against consuming oxalate rich foods, such as spinach and rhubarb – and chocolate, for those who suffer from recurrent kidney stones. So, what should all this mean for our chocolate consumption habits? Science points in the direction of chocolate that has as high a cocoa solid content as possible, and the minimum of extras. The potentially harmful effects of chocolate are more related to fat and sugar, and may counteract any possible benefits. A daily dose of 20g-30g of plain or dark chocolate with cocoa solids above 70% – rather than milk chocolate, which contains fewer solids and white chocolate, which contains none – could lead to a greater health benefit, as well as a greater high. But whatever chocolate you go for, please don’t share it with the dog.<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/226759/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/dan-baumgardt-1451396">Dan Baumgardt</a>, Senior Lecturer, School of Physiology, Pharmacology and Neuroscience, <a href="https://theconversation.com/institutions/university-of-bristol-1211">University of Bristol</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/eating-some-chocolate-really-might-be-good-for-you-heres-what-the-research-says-226759">original article</a>.

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What are the most common symptoms of menopause? And which can hormone therapy treat?

<a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Despite decades of research, navigating menopause seems to have become harder – with conflicting information on the internet, in the media, and from health care providers and researchers. Adding to the uncertainty, a recent <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00462-8/fulltext">series in the Lancet</a> medical journal challenged some beliefs about the symptoms of menopause and which ones menopausal hormone therapy (also known as hormone replacement therapy) can realistically alleviate. So what symptoms reliably indicate the start of perimenopause or menopause? And which symptoms can menopause hormone therapy help with? Here’s what the evidence says. <h2>Remind me, what exactly is menopause?</h2> Menopause, simply put, is complete loss of female fertility. Menopause is traditionally defined as the final menstrual period of a woman (or person female at birth) who previously menstruated. Menopause is diagnosed after 12 months of no further bleeding (unless you’ve had your ovaries removed, which is surgically induced menopause). Perimenopause starts when menstrual cycles first vary in length by seven or more days, and ends when there has been no bleeding for 12 months. Both perimenopause and menopause are hard to identify if a person has had a hysterectomy but their ovaries remain, or if natural menstruation is suppressed by a treatment (such as hormonal contraception) or a health condition (such as an eating disorder). <h2>What are the most common symptoms of menopause?</h2> <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">Our study</a> of the highest quality menopause-care guidelines found the internationally recognised symptoms of the perimenopause and menopause are: <ul> <li>hot flushes and night sweats (known as vasomotor symptoms)</li> <li>disturbed sleep</li> <li>musculoskeletal pain</li> <li>decreased sexual function or desire</li> <li>vaginal dryness and irritation</li> <li>mood disturbance (low mood, mood changes or depressive symptoms) but not clinical depression.</li> </ul> However, none of these symptoms are menopause-specific, meaning they could have other causes. In <a href="https://journals.lww.com/menopausejournal/abstract/2015/07000/moderate_to_severe_vasomotor_and_sexual_symptoms.6.aspx">our study of Australian women</a>, 38% of pre-menopausal women, 67% of perimenopausal women and 74% of post-menopausal women aged under 55 experienced hot flushes and/or night sweats. But the severity of these symptoms <a href="https://journals.lww.com/menopausejournal/abstract/2015/07000/moderate_to_severe_vasomotor_and_sexual_symptoms.6.aspx">varies greatly</a>. Only 2.8% of pre-menopausal women reported moderate to severely bothersome hot flushes and night sweats symptoms, compared with 17.1% of perimenopausal women and 28.5% of post-menopausal women aged under 55. So bothersome hot flushes and night sweats appear a reliable indicator of perimenopause and menopause – but they’re not the only symptoms. Nor are hot flushes and night sweats a western society phenomenon, as has been suggested. Women in Asian countries are <a href="https://journals.lww.com/menopausejournal/fulltext/2022/05000/prevalence,_severity,_and_associated_factors_in.9.aspx">similarly affected</a>. Depressive symptoms and anxiety are also often linked to menopause but they’re less menopause-specific than hot flushes and night sweats, as they’re common across the entire adult life span. The <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">most robust guidelines</a> do not stipulate women must have hot flushes or night sweats to be considered as having perimenopausal or post-menopausal symptoms. They acknowledge that new mood disturbances may be a primary manifestation of <a href="https://www.cell.com/cell/abstract/S0092-8674(23)00905-4?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867423009054%3Fshowall%3Dtrue">menopausal hormonal changes</a>. The extent to which menopausal hormone changes impact memory, concentration and problem solving (frequently talked about as “brain fog”) is uncertain. <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2022.2122792">Some studies</a> suggest perimenopause may impair verbal memory and resolve as women transition through menopause. But strategic thinking and planning (executive brain function) <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2022.2122792">have not been shown to change</a>. <h2>Who might benefit from hormone therapy?</h2> The Lancet papers <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00462-8/fulltext">suggest</a> menopause hormone therapy <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02799-X/fulltext">alleviates</a> hot flushes and night sweats, but the likelihood of it improving sleep, mood or “brain fog” is limited to those bothered by vasomotor symptoms (hot flushes and night sweats). In contrast, the highest quality <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">clinical guidelines</a> consistently identify both vasomotor symptoms and mood disturbances associated with menopause as reasons for menopause hormone therapy. In other words, you don’t need to have hot flushes or night sweats to be prescribed menopause hormone therapy. Often, menopause hormone therapy is prescribed alongside a topical vaginal oestrogen to treat vaginal symptoms (dryness, irritation or urinary frequency). However, none of these guidelines recommend menopause hormone therapy for cognitive symptoms often talked about as “brain fog”. Despite musculoskeletal pain being the most common menopausal symptom in <a href="https://journals.lww.com/menopausejournal/abstract/2016/07000/prevalence_and_severity_of_vasomotor_symptoms_and.6.aspx">some populations</a>, the effectiveness of menopause hormone therapy for this specific symptoms still needs to be studied. Some guidelines, such as an <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783">Australian endorsed guideline</a>, support menopause hormone therapy for the prevention of osteoporosis and fracture, but not for the prevention of any other disease. <h2>What are the risks?</h2> The greatest concerns about menopause hormone therapy have been about breast cancer and an increased risk of a deep vein clot which might cause a lung clot. Oestrogen-only menopause hormone therapy is <a href="https://www.nice.org.uk/guidance/ng23">consistently considered</a> to cause little or no change in breast cancer risk. Oestrogen taken with a progestogen, which is required for women who have not had a hysterectomy, <a href="https://www.moh.gov.my/moh/resources/Penerbitan/CPG/Women%20Health/CPG_Management_of_Menopause_2022_e-version-1.pdf">has been associated with a small increase</a> in the risk of breast cancer, although any <a href="https://www.bmj.com/content/bmj/371/bmj.m3873.full.pdf">risk appears to vary</a> according to the type of therapy used, the dose and duration of use. Oestrogen taken orally has also been associated with an increased risk of a deep vein clot, although the risk varies according to the formulation used. This risk is avoided by using estrogen patches or gels <a href="https://www.bmj.com/content/bmj/364/bmj.k4810.full.pdf">prescribed at standard doses</a> <h2>What if I don’t want hormone therapy?</h2> If you can’t or don’t want to take menopause hormone therapy, there are also effective non-hormonal prescription therapies available for troublesome hot flushes and night sweats. In Australia, most of these options are “off-label”, although the new medication <a href="https://australianprescriber.tg.org.au/articles/management-of-menopause.html">fezolinetant</a> has just been <a href="https://www.tga.gov.au/resources/artg/401401">approved</a> in Australia for postmenopausal hot flushes and night sweats, and is expected to be available by mid-year. Fezolinetant, taken as a tablet, acts in the brain to stop the chemical neurokinin 3 triggering an inappropriate body heat response (flush and/or sweat). Unfortunately, most over-the-counter treatments promoted for menopause are either <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">ineffective or unproven</a>. However, cognitive behaviour therapy and hypnosis <a href="https://journals.lww.com/menopausejournal/abstract/2023/06000/the_2023_nonhormone_therapy_position_statement_of.4.aspx">may provide symptom relief</a>. The Australasian Menopause Society has useful <a href="https://www.menopause.org.au/health-info/fact-sheets">menopause fact sheets</a> and a <a href="https://www.menopause.org.au/health-info/find-an-ams-doctor">find-a-doctor</a> page. The <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783">Practitioner Toolkit for Managing Menopause</a> is also freely available.<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/225174/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, Chair of Women's Health, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-are-the-most-common-symptoms-of-menopause-and-which-can-hormone-therapy-treat-225174">original article</a>.

Body

What if there was a hearing aid that understood your listening intentions?

<div class="page" title="Page 1"> <div class="section"> <div class="layoutArea"> <div class="column">Hearing conversations in noisy environments can be especially hard for people with impaired hearing. Unfortunately, traditional hearing aids adopt a ‘one-size-fits-all’ approach to processing sounds, regardless of the listening needs of individual users. This may make listening and engaging with others more difficult. Users may also experience a lack of sound clarity and be reluctant to engage in conversations with others.</div> <div class="column"> </div> <div class="column">Hearing aid manufacturer <a href="https://www.oticon.co.nz/hearing-aid-users" target="_blank" rel="noopener">Oticon</a> is taking the next important step on the journey to solve the No.1 challenge for people with hearing loss – hearing speech in noise2. With new groundbreaking 4D Sensor technology, <a href="https://www.oticon.co.nz/hearing-aid-users/hearing-aids/products/intent" target="_blank" rel="noopener">Oticon Intent</a> is capable of understanding the user’s listening intentions by recognising what they want and need to listen to, in order to deliver truly personalised support.</div> <div class="column"> <div class="page" title="Page 1"> <div class="section"> <div class="layoutArea"> <div class="column"> </div> <div class="column">The Brain And Sound</div> <div class="column"> </div> <div class="column">Our ears gather the sounds around us, but the true hero in sound processing is the brain, as it is constantly working to make sense of sound. Oticon uses their BrainHearingTM philosophy to develop technology that provides the brain with access to the full sound environment.</div> <div class="column"> </div> <div class="column">The latest <a href="https://www.oticon.co.nz/hearing-aid-users/hearing-loss/understand-hearing-loss/how-hearing-works" target="_blank" rel="noopener">BrainHearingTM</a> insights reveal that people’s communication behaviour reflects their listening needs and intentions at a given moment via head and body movements. In conversation, users tend to keep their heads still to engage with a single person or move their heads in a group conversation to engage with different people. When struggling to hear what someone is saying, users are likely to lean in to listen.</div> <div class="column"> </div> <div class="column">The technology in Oticon Intent understands and adapts to the user through sensors that monitor head and body movements, conversation activity and the acoustic environment. Oticon Intent helps users move beyond just hearing and listening, helping them to communicate and fully engage in life.</div> <div class="column"> </div> <div class="column">Ease Of Communication</div> <div class="column"> </div> <div class="column">In challenging, noisy environments, Oticon Intent makes it possible to: <ul> <li>Move through a crowd with seamless awareness, while orienting to the surrounding sounds.</li> <li>Begin chatting with a group of people, thanks to heightened access to voices and balanced background sounds so they are not intrusive, while still accessible.</li> <li>Start an intimate conversation with one person, easily hearing the speaker’s voice amid the noise all around.</li> </ul> </div> </div> </div> </div> </div> </div> </div> </div> <img class="alignnone size-full wp-image-50989" src="https://oversixtydev.blob.core.windows.net/media/2024/03/Oticon_Intent_HA_In_Hand_Hero3_KC_1321_Expires_On_2_8_2029_1280.jpg" alt="" width="1280" height="720" /> Engage More In Life “If you have a hearing loss, you can actually protect your brain from cognitive decline by using active hearing aids which enable you to connect with others and let you engage in life to the fullest,” says Thomas Behrens, Vice President of Audiology at Oticon. “You can also enjoy future-proof, next- generation connectivity technology, crafted into the smallest form factor we have designed to date within this category.” Open Up The Digital World Offering easy connection to compatible smart devices through Bluetooth® Low Energy technology, Oticon Intent also enables users to engage in the digital world like never before. It allows a detailed, high-quality sound experience for hands-free calls and delivers direct streaming of music, audio book and much more3. With up to 20 hours of battery life, users will never have to worry about running out of battery. When they need a recharge, they’d simply drop the hearing aids into the charger for just 30 minutes for up to 8 hours of battery life4. Your hearing matters. Take a step towards better hearing by contacting your nearest <a href="https://www.oticon.co.nz/hearing-aid-users/find-audiologist" target="_blank" rel="noopener">hearing care professional</a>. To explore this revolutionary hearing aid that helps users to engage in life like never before, visit <a href="https://www.oticon.co.nz/oticon-intent" target="_blank" rel="noopener">www.oticon.co.nz/oticon-intent</a> For more information and to find your nearest hearing clinic, visit <a href="https://www.oticon.co.nz" target="_blank" rel="noopener">oticon.co.nz</a> *4D Sensor technology only available in Oticon Intent 1 & 2. [2.] Jorgensen, L., & Novak, M. (2020). Factors Influencing Hearing Aid Adoption. Seminars in hearing, 41(1), 6–20. [3.] Hands-free communication is available on select devices. See which hearing aids and devices are compatible here: oticon.co.nz/compatibility. [4.] Expected use time for rechargeable battery depends on use pattern, active feature set, hearing loss, sound environment, battery age and use of wireless accessories. Images: Supplied. This is a sponsored article produced in partnership with Oticon.

Hearing

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

<a href="https://theconversation.com/profiles/graeme-coulson-1378778">Graeme Coulson</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> and <a href="https://theconversation.com/profiles/helena-bender-98800">Helena Bender</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> There’s almost no warning. A dark shape appears on the side of the road, then you feel a jolt as something goes under the car. Or worse, the shape rears up, hits the front of your vehicle, then slams into the windscreen. You have just experienced a wildlife-vehicle collision. This gruesome scene plays out <a href="https://www.bbcearth.com/news/australias-road-kill-map">every night across Australia</a>. When these collisions happen, many animals become instant roadkill. An <a href="https://ses.library.usyd.edu.au/bitstream/handle/2123/23121/Thesis%20updated%20for%20library%20submission.pdf?sequence=1">estimated 10 million</a> native mammals, reptiles, birds and other species are killed each year. Others are injured and die away from the road. Some survive with <a href="https://theconversation.com/10-million-animals-are-hit-on-our-roads-each-year-heres-how-you-can-help-them-and-steer-clear-of-them-these-holidays-149733">terrible injuries and have to be euthanised</a>. The lucky ones might <a href="https://kb.rspca.org.au/knowledge-base/who-should-i-contact-about-injured-wildlife/">be rescued</a> by groups such as <a href="https://wildliferescue.net.au/">Wildlife Rescue</a>, <a href="https://www.wildlifevictoria.org.au/">Wildlife Victoria</a> and <a href="https://www.wires.org.au/">WIRES</a>. Wildlife-vehicle collisions also increase the risk to whole populations of some threatened species, such as <a href="https://doi.org/10.1071/WR17143">Lumholtz’s tree-kangaroo</a> on the Atherton Tablelands in Queensland. People are affected, too. Human <a href="https://doi.org/10.1111/1742-6723.13361">deaths and injuries</a> from these collisions are rising, with motorcyclists at greatest risk. Vehicle repairs are <a href="https://www.mynrma.com.au/-/media/wildlife-road-safety-report--final.pdf">inconvenient and costly</a>. Added to this is the distress for people when dealing with a dead or dying animal on the roadside. How can we reduce the wildlife toll on our roads? Many measures have been tried and proven largely ineffective. However, other evidence-based approaches can help avoid collisions. <h2>Evidence for what works is limited</h2> Many communities are worried about the growing impacts of wildlife-vehicle collisions and are desperate for solutions. Recent reports from <a href="https://www.diva-portal.org/smash/get/diva2:1822182/FULLTEXT01.pdf">Europe</a> and <a href="https://westerntransportationinstitute.org/wp-content/uploads/2021/12/4w7576_Huijser_etal_WVC_ConnectivityLiteratureReview_PooledFundStudyFinalReport_2021.pdf">North America</a> review the many methods to reduce such collisions. Do these findings apply to Australia’s unique fauna? Unfortunately, we don’t have a detailed analysis of options for our wildlife, but here’s what we know now. Well-designed fences keep wildlife off our highways but also fragment the landscape. Happily, animals will use crossing structures – overpasses and <a href="https://theconversation.com/good-news-highway-underpasses-for-wildlife-actually-work-187434">underpasses</a> – to get to food and mates on the other side of the road. Fences and crossings do work, but are regarded as too costly over Australia’s vast road network. As for standard wildlife warning signs, drivers <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4494358/">ignore most of them</a> after a while, making them ineffective. Signs with graphic images and variable messages get <a href="https://doi.org/10.3390/ani3041142">more attention</a>, but we need road trials to assess their effect on drivers and collision rates. <h2>Whistling in the dark</h2> Some drivers install cheap, wind-driven, high-pitched wildlife whistles on their vehicles. Tests in the United States 20 years ago found humans and deer <a href="https://doi.org/10.1121/1.1582071">could not hear any whistling sound</a> above the road noise of the test vehicle. Yet these devices are still sold in Australia as kangaroo deterrents. The Shu-Roo, an Australian invention, is an active wildlife whistle. It is fitted to the bumper bar, producing a high-pitched electronic sound, which is claimed to scare wildlife away from the road. Sadly, <a href="https://rest.neptune-prod.its.unimelb.edu.au/server/api/core/bitstreams/3c3154e0-2f48-5b73-a6cd-a7423c2a75ee/content">our tests</a> show the Shu-Roo signal can’t be heard above road noise 50 metres away and has no effect on captive kangaroo behaviour. We also recruited fleets of trucks, buses, vans, utes and cars to field test the Shu-Roo. Nearly 100 vehicles covered more than 4 million kilometres across Australia over 15,500 days. The drivers reported just over one wildlife-vehicle collision per 100,000km travelled, but <a href="https://doi.org/10.7882/AZ.2021.042">there was no difference in the rate</a> for vehicles fitted with a Shu-Roo versus those without one. The virtual fence is the latest attempt to reduce wildlife-vehicle collisions. It uses a line of posts spaced along the roadside, each with a unit producing loud sounds and flashing lights aimed away from the road. Vehicle headlights activate the units, which are claimed to alert animals and reduce the risk of collision. Early results from Tasmania were encouraging. A 50% drop in possum and wallaby deaths was reported, but <a href="https://doi.org/10.1071/AM19009">this trial had many design flaws</a>. Recent trials in <a href="https://www.mdpi.com/2076-2615/9/10/752">Tasmania</a>, <a href="https://www.mdpi.com/2076-2615/12/10/1323">New South Wales</a> and <a href="https://www.redland.qld.gov.au/downloads/download/292/virtual_fence_to_reduce_vehicle_collisions_with_wallabies_on_heinemann_rd_-_final_report_2020">Queensland</a> show no effect of virtual fencing on collisions with possums, wallabies or wombats. Our concern is that this system is being <a href="https://www.abc.net.au/news/2020-06-02/wildlife-fence-trial-underway-in-queensland-and-phillip-island/12268110">rolled out</a> in <a href="https://www.townsville.qld.gov.au/about-council/news-and-publications/media-releases/2023/june/councils-innovative-trial-helping-keep-local-wildlife-safe">many</a> <a href="https://www.abc.net.au/news/2022-10-26/nsw-south-coast-council-first-virtual-fence-to-protect-wildlife/101571600">parts</a> of <a href="https://www.theage.com.au/politics/victoria/the-stealth-tech-aiming-to-stop-roos-from-becoming-roadkill-20231222-p5etda.html">Australia</a>. It gives the impression of action to reduce collisions with wildlife, but without an evidence base, solid study design or adequate monitoring. <h2>A very messy problem</h2> The problem has many dimensions. We need to consider all of them to achieve safe travel for people and animals on our roads. At a landscape level, collision hotspots occur where wildlife frequently cross roads, which can help us predict the collision risk for species such as <a href="https://doi.org/10.1111/aec.13465">koalas</a>. But the risk differs between species. For example, <a href="https://doi.org/10.1016/j.gecco.2021.e01530">on Phillip Island</a> most wallaby collisions happen on rural roads, while most involving possums and birds are in urban streets. Traffic volume and speed are key factors for many species, including <a href="https://doi.org/10.1002/ece3.2306">kangaroos</a>. Driver training and experience are also important. In the Royal National Park in New South Wales, <a href="https://www.mdpi.com/2076-2615/6/6/40">half the drivers surveyed</a> had struck animals, including wallabies and deer. Yet most still <a href="https://theconversation.com/10-million-animals-are-hit-on-our-roads-each-year-heres-how-you-can-help-them-and-steer-clear-of-them-these-holidays-149733">weren’t keen</a> to slow down or avoid driving at dawn and dusk. Road design has a major influence on wildlife-vehicle collions too, but the planning process too often <a href="https://www.frontiersin.org/articles/10.3389/fenvs.2022.959918">neglects wildlife studies</a>. Smarter cars are <a href="https://www.diva-portal.org/smash/get/diva2:1822182/FULLTEXT01.pdf">being developed</a>. One day these will use AI to spot animal hazards, apply automatic emergency braking and alert other drivers of real-time risk. To explore potential technological solutions, Transport for NSW is running a <a href="https://www.eianz.org/events/event/symposium-using-technology-to-reduce-wildlife-vehicle-collisions">symposium</a> at the University of Technology Sydney on May 21. The symposium will cover wildlife ecology and the evidence base for options to reduce wildlife-vehicle collisions in Australia. <hr /> If you see an injured animal on the road, call <a href="https://www.wildliferescue.net.au/">Wildlife Rescue Australia</a> on 1300 596 457. for specific state and territory numbers, go to the <a href="https://kb.rspca.org.au/knowledge-base/who-should-i-contact-about-injured-wildlife/">RSPCA injured wildlife site</a>.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/222367/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/graeme-coulson-1378778">Graeme Coulson</a>, Honorary Principal Fellow, School of BioSciences, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> and <a href="https://theconversation.com/profiles/helena-bender-98800">Helena Bender</a>, Senior Lecturer, Environmental Social Sciences, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/10-million-animals-die-on-our-roads-each-year-heres-what-works-and-what-doesnt-to-cut-the-toll-222367">original article</a>.

Domestic Travel

What’s the difference between autism and Asperger’s disorder?

<a href="https://theconversation.com/profiles/andrew-cashin-458270">Andrew Cashin</a>, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a> Swedish climate activist Greta Thunberg describes herself as having <a href="https://www.theguardian.com/environment/2019/sep/02/greta-thunberg-responds-to-aspergers-critics-its-a-superpower">Asperger’s</a> while others on the autism spectrum, such as Australian comedian Hannah Gatsby, <a href="https://www.theguardian.com/stage/2022/mar/19/hannah-gadsby-autism-diagnosis-little-out-of-whack">describe</a> themselves as “autistic”. But what’s the difference? Today, the previous diagnoses of “Asperger’s disorder” and “autistic disorder” both fall within the diagnosis of autism spectrum disorder, or ASD. Autism describes a “neurotype” – a person’s thinking and information-processing style. Autism is one of the forms of diversity in human thinking, which comes with strengths and challenges. When these challenges become overwhelming and impact how a person learns, plays, works or socialises, a diagnosis of <a href="https://www.psychiatry.org/patients-families/autism/what-is-autism-spectrum-disorder">autism spectrum disorder</a> is made. <h2>Where do the definitions come from?</h2> The Diagnostic and Statistical Manual of Mental Disorders (DSM) outlines the criteria clinicians use to diagnose mental illnesses and behavioural disorders. Between 1994 and 2013, autistic disorder and Asperger’s disorder were the two primary diagnoses related to autism in the fourth edition of the manual, the DSM-4. In 2013, the DSM-5 collapsed both diagnoses into one <a href="https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596">autism spectrum disorder</a>. <h2>How did we used to think about autism?</h2> The two thinkers behind the DSM-4 diagnostic categories were Baltimore psychiatrist Leo Kanner and Viennese paediatrician Hans Asperger. They described the challenges faced by people who were later diagnosed with autistic disorder and Asperger’s disorder. Kanner and Asperger observed patterns of behaviour that differed to typical thinkers in the domains of communication, social interaction and flexibility of behaviour and thinking. The variance was associated with challenges in adaptation and distress. Between the 1940s and 1994, the majority of those diagnosed with autism also had an intellectual disability. Clinicians became focused on the accompanying intellectual disability as a necessary part of autism. The introduction of Asperger’s disorder shifted this focus and acknowledged the diversity in autism. In the DSM-4 it superficially looked like autistic disorder and Asperger’s disorder were different things, with the Asperger’s criteria stating there could be no intellectual disability or delay in the development of speech. Today, as a legacy of the recognition of the autism itself, the <a href="https://www.aihw.gov.au/reports/disability/autism-in-australia/contents/autism">majority of people</a> diagnosed with autism spectrum disorder – the new term from the DSM-5 – don’t a have an accompanying intellectual disability. <h2>What changed with ‘autism spectrum disorder’?</h2> The move to autism spectrum disorder brought the previously diagnosed autistic disorder and Asperger’s disorder under the one new diagnostic umbrella term. It made clear that other diagnostic groups – such as intellectual disability – can co-exist with autism, but are separate things. The other major change was acknowledging communication and social skills are intimately linked and not separable. Rather than separating “impaired communication” and “impaired social skills”, the diagnostic criteria changed to “impaired social communication”. The introduction of the spectrum in the diagnostic term further clarified that people have varied capabilities in the flexibility of their thinking, behaviour and social communication – and this can change in response to the context the person is in. <h2>Why do some people prefer the old terminology?</h2> Some people feel the clinical label of Asperger’s allowed a much more refined understanding of autism. This included recognising the achievements and great societal contributions of people with known or presumed autism. The contraction “Aspie” played an enormous part in the shift to positive identity formation. In the time up to the release of the DSM-5, <a href="https://xminds.org/resources/Documents/Web%20files/Aspie%20Criteria%20by%20Attwood.pdf">Tony Attwood and Carol Gray</a>, two well known thinkers in the area of autism, highlighted the strengths associated with “being Aspie” as something to be proud of. But they also raised awareness of the challenges. <h2>What about identity-based language?</h2> A more recent shift in language has been the reclamation of what was once viewed as a slur – “autistic”. This was a shift from person-first language to identity-based language, from “person with autism spectrum disorder” to “autistic”. The neurodiversity rights movement describes its aim to <a href="https://researchonline.jcu.edu.au/71531/1/JCU_71531_AAM.pdf">push back</a> against a breach of human rights resulting from the wish to cure, or fundamentally change, people with autism. The movement uses a “social model of disability”. This views disability as arising from societies’ response to individuals and the failure to adjust to enable full participation. The inherent challenges in autism are seen as only a problem if not accommodated through reasonable adjustments. However the social model contrasts itself against a very outdated medical or clinical model. Current clinical thinking and practice focuses on <a href="https://www.collegianjournal.com/article/S1322-7696(22)00122-6/fulltext">targeted</a> supports to reduce distress, promote thriving and enable optimum individual participation in school, work, community and social activities. It doesn’t aim to cure or fundamentally change people with autism. A diagnosis of autism spectrum disorder signals there are challenges beyond what will be solved by adjustments alone; individual supports are also needed. So it’s important to combine the best of the social model and contemporary clinical model.<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/223643/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/andrew-cashin-458270">Andrew Cashin</a>, Professor of Nursing, School of Health and Human Sciences, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/whats-the-difference-between-autism-and-aspergers-disorder-223643">original article</a>.

Mind

Guy Sebastian reveals what happened when Marcia Hines collapsed

Guy Sebastian has revealed what really happened on the set of Australian Idol when Marcia Hines <a href="https://oversixty.com.au/health/caring/marcia-hines-rushed-to-hospital" target="_blank" rel="noopener">collapsed</a> behind the scenes and was rushed to hospital. Sebastian appeared on Sunrise on Monday morning, explaining how he was meant to perform on the talent show that launched his career, and ended up having to fill in as co-host. The 42-year-old told Nat Barr and Shirvo that he showed up on set to rehearse the performance of his new single Antidote when he was asked to step in to co-host the show in Marcia's absence. "We were just sound checking and when we got there, it was quite a sombre mood," he explained. "Marcia had to leave but from what I know she was ok. And then Kyle [Sandilands] made a joke about them getting me to fill in and I laughed." "And literally at the same time, my manager [walked over] and said 'Guy we need to speak', and then I jumped in to fill in." He went on to say it was a "full circle moment for me, because I will never forget Marcia's reassuring, affirming, beautiful nature when I was on Idol." "I know I don't possess quite the same nurturing energy, but I did my best." The Australian entertainment industry was struck with concern on Sunday night as news broke that Marcia had been rushed to the hospital just before filming for Australian Idol was about to begin. Fortunately, reports indicate that she is now in stable condition, though the precise nature of her illness remains undisclosed. Image credits: Instagram / Sunrise

Caring

Kate Middleton is having ‘preventive chemotherapy’ for cancer. What does this mean?

<a href="https://theconversation.com/profiles/ian-olver-1047">Ian Olver</a>, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a> Catherine, Princess of Wales, is undergoing treatment for cancer. In a video thanking followers for their messages of support after her major abdominal surgery, the Princess of Wales explained, “tests after the operation found cancer had been present.” “My medical team therefore advised that I should undergo a course of preventative chemotherapy and I am now in the early stages of that treatment,” she said in the two-minute video. No further details have been released about the Princess of Wales’ treatment. But many have been asking what preventive chemotherapy is and how effective it can be. Here’s what we know about this type of treatment. <h2>It’s not the same as preventing cancer</h2> To <a href="https://www.cancer.org.au/about-us/how-we-help/prevention">prevent cancer developing</a>, lifestyle changes such as diet, exercise and sun protection are <a href="https://www.cancer.org.au/about-us/how-we-help/prevention">recommended</a>. Tamoxifen, a hormone therapy drug can be used to reduce the risk of cancer for some patients at <a href="https://www.mayoclinic.org/diseases-conditions/breast-cancer/in-depth/breast-cancer/art-20045353">high risk of breast cancer</a>. Aspirin <a href="https://www.cancer.gov/about-cancer/causes-prevention/research/aspirin-cancer-risk">can also be used</a> for those at high risk of bowel and other cancers. <h2>How can chemotherapy be used as preventive therapy?</h2> In terms of treating cancer, prevention refers to giving chemotherapy after the cancer has been removed, to prevent the cancer from returning. If a cancer is localised (limited to a certain part of the body) with no evidence on scans of it spreading to distant sites, local treatments such as surgery or radiotherapy can remove all of the cancer. If, however, cancer is first detected after it has spread to distant parts of the body at diagnosis, clinicians use treatments such as chemotherapy (anti-cancer drugs), hormones or immunotherapy, which circulate <a href="https://www.healthline.com/health/cancer/metastatic-cancer">around the body</a> . The other use for chemotherapy is to add it before or after surgery or radiotherapy, to prevent the primary cancer <a href="https://www.verywellhealth.com/adjuvant-therapy-5198903">coming back</a>. The surgery may have cured the cancer. However, in some cases, undetectable microscopic cells may have spread into the bloodstream to distant sites. This will result in the cancer returning, months or years later. With some cancers, treatment with chemotherapy, given before or after the local surgery or radiotherapy, can kill those cells and prevent the cancer coming back. If we can’t see these cells, how do we know that giving additional chemotherapy to prevent recurrence is effective? We’ve learnt this from clinical trials. Researchers have compared patients who had surgery only with those whose surgery was followed by additional (or often called adjuvant) chemotherapy. The additional therapy resulted in patients not relapsing and surviving longer. <h2>How effective is preventive therapy?</h2> The effectiveness of preventive therapy depends on the type of cancer and the type of chemotherapy. Let’s consider the common example of bowel cancer, which is at high risk of returning after surgery because of its size or spread to local lymph glands. The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564362/">first chemotherapy tested</a> improved survival by 15%. With more intense chemotherapy, the chance of surviving six years is approaching 80%. Preventive chemotherapy is usually given for three to six months. <h2>How does chemotherapy work?</h2> Many of the chemotherapy drugs stop cancer cells dividing by disrupting the DNA (genetic material) in the centre of the cells. To improve efficacy, drugs which work at different sites in the cell are given in combinations. Chemotherapy is not selective for cancer cells. It kills any dividing cells. But cancers consist of a higher proportion of dividing cells than the normal body cells. A <a href="https://www.canceraustralia.gov.au/cancer-types/breast-cancer/treatment/chemotherapy/how-does-chemotherapy-work#:%7E:text=Chemotherapy%20works%20by%20killing%20cells%20that%20are%20rapidly,cells%20can%20repair%20the%20damage%20and%20can%20recover.">greater proportion of the cancer is killed</a> with each course of chemotherapy. Normal cells can recover between courses, which are usually given three to four weeks apart. <h2>What are the side effects?</h2> The side effects of chemotherapy are usually reversible and are seen in parts of the body where there is normally a high turnover of cells. The production of blood cells, for example, is temporarily disrupted. When your white blood cell count is low, there is an increased risk of infection. Cell death in the lining of the gut leads to mouth ulcers, nausea and vomiting and bowel disturbance. Certain drugs sometimes given during chemotherapy can attack other organs, such as causing numbness in the hands and feet. There are also generalised symptoms such as <a href="https://www.cancervic.org.au/cancer-information/treatments/treatments-types/chemotherapy/side_effects_of_chemotherapy.html">fatigue</a>. Given that preventive chemotherapy given after surgery starts when there is no evidence of any cancer remaining after local surgery, patients can usually resume normal activities within weeks of completing the courses of chemotherapy.<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/226461/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/ian-olver-1047">Ian Olver</a>, Adjunct Professsor, School of Psychology, Faculty of Health and Medical Sciences, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/kate-middleton-is-having-preventive-chemotherapy-for-cancer-what-does-this-mean-226461">original article</a>.

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What is minoxidil, the anti-balding hair growth treatment? Here’s what the science says

<a href="https://theconversation.com/profiles/jacinta-l-johnson-1441348">Jacinta L. Johnson</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/kirsten-staff-1494356">Kirsten Staff</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> Hair loss (also known as alopecia) often affects the scalp but can occur anywhere on the body. It’s very common and usually nothing to worry about; about <a href="https://www.sciencedirect.com/science/article/pii/S0022202X15525840">half of Australian men</a> show signs of visible baldness at age 50 and <a href="https://www.sciencedirect.com/science/article/pii/S0022202X15525840">over a quarter of Australian women</a> report hair thinning by the same age. It’s often genetic. But if you’ve noticed hair loss and are worried by it, see a GP or dermatologist for a diagnosis before trying any treatments. Products claiming to reverse hair loss are everywhere, but few have been scientifically tested for how well they work. One group of products that have actually been scientifically tested, however, are known as topical minoxidil products. These include products such as Regaine®. So, do they work? Here’s what the research evidence says, what you can realistically expect and what you need to know if you’re considering this treatment. <h2>What is minoxidil – and does it work?</h2> Topical minoxidil usually comes as a kind of foam or serum you apply to your scalp. It’s been approved by the <a href="https://www.tga.gov.au/">Therapeutic Goods Administration</a>, Australia’s regulatory authority for therapeutic goods, for the treatment of hereditary hair loss in males and females. Minoxidil is also available in tablet form, but this isn’t currently approved for hair loss (more on that later). So, is topical minoxidil effective? In short – yes, but the results vary widely from person to person, and it needs to be used consistently over several months to see results. Scientists don’t know exactly how minoxidil works. It may affect the different phases of the hair life cycle, thereby encouraging growth. It also <a href="https://www.tandfonline.com/doi/full/10.1080/09546634.2021.1945527?casa_token=KhIM_u0u8nwAAAAA:5njp_XE5cHhip454ycvU1p9p_t0VVzpjRu0ozDZ9YqNb04fmhmngWzYeiowZcG5UugLQkTVIzCcj7A">opens up blood vessels</a> near hair follicles. This increases blood flow, which in turn delivers more oxygen and nutrients to the hair. While minoxidil is unlikely to restore a full head of thick, lush, hair, it can slow down hair loss and can <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007628.pub4/full?highlightAbstract=minoxidil">stimulate regrowth</a>. It is the over-the-counter option with the most evidence. Two strengths are available: 5% and 2%. An analysis of randomised controlled trials found minoxidil applied to the scalp twice a day increased the number of hairs per square centimetre by <a href="https://pubmed.ncbi.nlm.nih.gov/28396101/">eight to 15 hairs</a>, with the higher strength treatment having a slightly greater effect. <h2>Can I use it for non-genetic balding?</h2> There are many causes of hair loss. The main cause in both males and females is a hereditary condition called androgenic alopecia. Although topical minoxidil is only approved for use in Australia for androgenic alopecia, there is some evidence it can also help in other conditions that cause hair loss. For example, it may hasten hair regrowth in patients who have lost hair due to <a href="https://www.jaad.org/article/S0190-9622(96)90500-9/abstract">chemotherapy</a>. Unfortunately, minoxidil is not effective when the hair follicle is gone, like after a burn injury. Although small studies have found promising results using minoxidil to promote hair growth on the face (for <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/1346-8138.13312">beard</a> or <a href="https://pubmed.ncbi.nlm.nih.gov/24471459/">eyebrow</a> enhancement), topical minoxidil products are not currently approved for this use. More research is required. <h2>What else do I need to know?</h2> Minoxidil won’t work well for everyone. Early in treatment you might notice a temporary increase in <a href="https://pubmed.ncbi.nlm.nih.gov/22409453/">hair shedding</a>, as it alters the hair cycle to make way for new growth. Minoxidil needs to be trialled for three to six months to determine if it’s effective. And as it doesn’t cure hair loss, you must <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jdv.14624?casa_token=P-zW7kDNRs8AAAAA%3AaUgUzxU7lbwBpg1BYPajOfXFhpb_mU5g_ounZ6GtjsLLkHO_AdVQ2Kf-8zZkW80ykBj3N_sOsyn392uc">continue</a> to use it each day to maintain the effect. If you stop, you will start losing the new hair growth <a href="https://www.nps.org.au/assets/medicines/1f8127a5-2a98-4013-a7c3-a53300feb0e5-reduced.pdf">within three to four months</a>. Minoxidil products may not be suitable for everyone. If you have any medical conditions or take any medications, you should speak with your doctor or pharmacist before using minoxidil products. It has not been tested for safety in <a href="https://www.nps.org.au/assets/medicines/1f8127a5-2a98-4013-a7c3-a53300feb0e5-reduced.pdf">people under 18, over 65, or those who are pregnant</a>. You can read the <a href="https://www.nps.org.au/medicine-finder/regaine-for-men-regular-strength-application">consumer medicines information sheet</a> for more information about using over-the-counter minoxidil products. Many people do not like to use minoxidil solution or foams long-term because they need to be applied everyday day, which can be inconvenient. Or they may notice side effects, such as scalp irritation and changes to hair texture. Some people <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jdv.14624?casa_token=P-zW7kDNRs8AAAAA%3AaUgUzxU7lbwBpg1BYPajOfXFhpb_mU5g_ounZ6GtjsLLkHO_AdVQ2Kf-8zZkW80ykBj3N_sOsyn392uc">tolerate the foam products better</a> than the solution, as the solution contains more of a compound called propylene glycol (which can irritate the skin). <h2>What about the oral tablet form of minoxidil?</h2> Minoxidil is also available on prescription as an oral tablet. While traditionally used for high blood pressure, it has also been used as a treatment for hair loss. In 2020, a <a href="https://www.jaad.org/article/S0190-9622(20)32109-5/abstract">systematic review</a> identified 17 studies involving 634 patients using oral minoxidil for various hair loss conditions. The authors found oral minoxidil was effective and generally well tolerated in healthy people who were having trouble using the topical products. The review noted oral minoxidil may increase hair growth over the whole body and may cause heart-related side effects in some patients. More research is required. In Australia, oral minoxidil is available under the trade name <a href="https://www.nps.org.au/assets/medicines/df29e16f-6464-4652-ba1f-a53300fed275.pdf">Loniten</a>®. However, it is currently only approved for use in high blood pressure. When people seek a prescription treatment for a non-approved purpose, this is called “off-label” prescribing. Off-label prescribing of oral minoxidil, potentially for use in alopecia, may have contributed to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10170338/">shortages</a> of Loniten® tablets in recent years. This can reduce availability of this medicine for people who need it for high blood pressure.<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/223736/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/jacinta-l-johnson-1441348">Jacinta L. Johnson</a>, Senior Lecturer in Pharmacy Practice, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/kirsten-staff-1494356">Kirsten Staff</a>, Senior Lecturer in Pharmacy, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-is-minoxidil-the-anti-balding-hair-growth-treatment-heres-what-the-science-says-223736">original article</a>. Image: Getty

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Bunnings has toppled Woolworths as Australia’s most ‘trusted’ brand – what makes us trust a brand in the first place?

<a href="https://theconversation.com/profiles/louise-grimmer-212082">Louise Grimmer</a>, <a href="https://theconversation.com/institutions/university-of-tasmania-888">University of Tasmania</a> Think of some of the world’s biggest brands: Nike, McDonald’s, Coca-Cola, Apple. With what do you associate them? Are they positive associations? Now consider, do you trust them? Brand trust is a measure of how customers feel about a brand in terms of how well the brand delivers on its promises. Trust is an important measure for any organisation, large or small. Whether or not customers trust a brand can be the difference between choosing that brand’s products or services over another. In Australia, Woolworths <a href="https://www.roymorgan.com/findings/9472-risk-monitor-quartely-update-december-2023">held the title</a> of our most trusted brand for three and a half years. But recent cost-of-living pressures have put supermarkets in the spotlight for all the wrong reasons. Roy Morgan Research’s <a href="https://www.roymorgan.com/findings/9472-risk-monitor-quartely-update-december-2023">most recent trust rankings</a> show Woolworths has slipped to number two, handing its crown to hardware behemoth Bunnings. It’s clear that trust is fragile and can be quickly squandered when brands lose touch with those they serve. So what makes us trust a brand in the first place? And why do we trust some more than others? <h2>What makes us trust a brand?</h2> According to customer experience management firm Qualtrics, <a href="https://www.qualtrics.com/au/experience-management/brand/brand-trust/">brand trust</a> is <blockquote> the confidence that customers have in a brand’s ability to deliver on what it promises. As a brand consistently meets the expectations it has set in the minds of customers, trust in that brand grows. </blockquote> There are many ways to go about measuring brand trust. A typical first step is to ask lots of people what they think, collating their general opinions on product quality and the brand’s customer service experience. This can be strengthened with more quantifiable elements, including: <ul> <li>online ratings and reviews</li> <li>social media “sentiment” (positive, negative or neutral)</li> <li>corporate social responsibility activities</li> <li>philanthropic efforts</li> <li>customer data security and privacy.</li> </ul> Some surveys go even deeper, asking respondents to consider a brand’s vision and mission, its approaches to sustainability and worker standards, and how honest its advertising appears. <h2>Is this a real and useful metric?</h2> The qualitative methodology used by <a href="https://www.roymorgan.com/findings/9472-risk-monitor-quartely-update-december-2023">Roy Morgan</a> to determine what Australian consumers think about 1,000 brands has been administered over two decades, so the data can be reliably compared across time. On measures of both trust and distrust, it asks respondents which brands they trust and why. This approach is useful because it tells us which elements factor into brand trust judgements. <a href="https://roymorgan-cms-prod.s3.ap-southeast-2.amazonaws.com/wp-content/uploads/2024/03/07035120/9472-Risk-Monitor-Quartely-Update-December-2023-1-1.pdf">Customer responses</a> about the survey’s most recent winner, Bunnings, show that customer service, product range, value-for-money pricing and generous returns policies are the key drivers of strong trust in its brand. Here are some examples: <blockquote> Great customer service. Love their welcoming staff. Whether it’s nuts and bolts or a new toilet seat, they have it all, value for money. Great products and price and have a no quibble refund policy. Great stock range, help is there if you need it and it is my go-to for my gardening and tool needs. Really convenient trading hours, and their return policy is good. </blockquote> In addition to trust, there are three other metrics commonly used to assess brand performance: <ul> <li> brand equity – the commercial or social value of consumer perceptions of a brand </li> <li> brand loyalty – consumer willingness to consistently choose one brand over others regardless of price or competitor’s efforts </li> <li> brand affinity – the emotional connection and common values between a brand and its customers. </li> </ul> However, trust is becoming a disproportionately important metric as consumers demand that companies provide <a href="https://www.forbes.com/sites/bernhardschroeder/2020/01/16/from-the-traditional-to-the-outrageous-four-brands-that-use-honest-transparency-to-build-loyal-customers-with-non-traditional-marketing-and-branding/?sh=6689f81320a1">increased transparency</a> and exhibit greater care for their customers, not just their shareholders. <h2>Why do Australians trust retailers so much?</h2> Of Australia’s top ten most trusted brands, seven are retailers – Bunnings, Woolworths, Aldi, Coles, Kmart, Myer and Big W. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/582082/original/file-20240314-28-h0xdf4.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/582082/original/file-20240314-28-h0xdf4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/582082/original/file-20240314-28-h0xdf4.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=279&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582082/original/file-20240314-28-h0xdf4.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=279&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582082/original/file-20240314-28-h0xdf4.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=279&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582082/original/file-20240314-28-h0xdf4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=350&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582082/original/file-20240314-28-h0xdf4.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=350&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582082/original/file-20240314-28-h0xdf4.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=350&fit=crop&dpr=3 2262w" alt="table shows that Bunnings is now Australia's most trusted brand, and Optus the least trusted brand." /></a><figcaption>The latest changes to Australia’s most trusted and most distrusted brand rankings. <a class="source" href="https://www.roymorgan.com/findings/9472-risk-monitor-quartely-update-december-2023">Roy Morgan Single Source (Australia)</a></figcaption></figure> This <a href="https://www.fastcompany.com/90901331/america-most-trusted-brands-companies-report-2023-morning-consult">stands in contrast</a> with the United States, where the most trusted brands are predominantly from the healthcare sector. So why do retail brands dominate our trust rankings? They certainly aren’t small local businesses. Our retail sector is <a href="https://www.afr.com/companies/retail/in-the-shopping-trolley-war-the-supermarkets-have-to-give-20240122-p5ez4k">highly concentrated</a>, dominated by a few giant retail brands. We have only two major department stores (David Jones and Myer), three major discount department stores (Big W, Target and Kmart) and a <a href="https://www.abc.net.au/news/2024-02-23/a-history-of-the-duopoly-coles-woolworths/103494070">supermarket “duopoly”</a> (Coles and Woolworths). It’s most likely then that these brands have been enjoying leftover goodwill from the pandemic. As Australia closed down to tackle COVID-19, the retail sector, and in particular the grocery sector, was credited with enabling customers to <a href="https://www.smh.com.au/business/companies/inside-story-how-woolworths-and-coles-joined-forces-to-avert-covid-19-disaster-20200611-p551lk.html">safely access</a> food and household goods. Compared with many other countries, we did not see a predominance of empty shelves across Australia. Retailers in this country stepped up – implementing or improving their online shopping capabilities and ensuring physical stores followed health guidelines and protocols. Now, with the pandemic behind us and in an environment of high inflation, the <a href="https://www.abc.net.au/news/2024-02-20/woolworths-coles-supermarket-tactics-grocery-four-corners/103405054">big two supermarkets</a> face <a href="https://www.theguardian.com/australia-news/2024/feb/20/do-coles-woolworths-specials-actually-offer-savings-choice-survey-supermarket-price-gouging-inquiry">growing distrust</a> and a <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Supermarket_Prices/SupermarketPrices">public inquiry</a>. <h2>Lessons from the losers</h2> After <a href="https://www.theguardian.com/business/2023/nov/20/optus-scandals-network-outage-cyberattack-ceo-resignation-kelly-bayer-rosmarin">two high profile disasters</a>, Optus finds itself the most distrusted brand in Australia. Its companions in the “most distrusted” group include social media brands Meta (Facebook), TikTok and X. Qantas, Medibank Private, Newscorp, Nestle and Amazon also made the top 10. The main reason consumers distrust brands is for a perceived failure to live up to their promises and responsibilities. For example, <a href="https://www.washingtonpost.com/technology/2023/09/18/amazon-working-conditions-safety-osha-doj/">worker conditions at multinational firm Amazon</a> are seen by some consumers as a reflection of questionable business practices. Other brands may have earned a reputation for failing to deliver the basics, like when chronic <a href="https://www.afr.com/companies/transport/compensating-travellers-for-cancelled-flights-long-overdue-20240212-p5f45c">flight delays and cancellations</a> plagued many Qantas customers. <h2>Lessons from the winners</h2> On the flip side, consumers have rewarded budget-friendly retailers with increased trust in the most recent rankings. Aldi, Kmart and Bunnings have improved their standing as trusted brands, no doubt in part because they have helped many Australian consumers deal with tight household budgets. As discretionary consumer spending continues to tighten, we may see a more permanent consumer shopping <a href="https://www.theaustralian.com.au/business/retail/rise-of-the-value-shopper-as-budgets-are-crunched-a-threat-and-opportunity-for-retailers/news-story/9b7a355cfb3866ec60d2ee42b7cbd567">shift towards value for money</a> brands and discounters. Trust is a fragile thing to maintain once earned. As we move through 2024, Australian companies must pay close attention to their most important asset – strong relationships with those they serve.<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/225578/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/louise-grimmer-212082">Louise Grimmer</a>, Senior Lecturer in Retail Marketing, <a href="https://theconversation.com/institutions/university-of-tasmania-888">University of Tasmania</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/bunnings-has-toppled-woolworths-as-australias-most-trusted-brand-what-makes-us-trust-a-brand-in-the-first-place-225578">original article</a>.

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Bunnings has toppled Woolworths as Australia’s most ‘trusted’ brand – what makes us trust a brand in the first place?

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Beyond the spin, beyond the handouts, here’s how to get a handle on what’s really happening on budget night

What to expect from the federal budget

What happens when I stop taking a drug like Ozempic or Mounjaro?

"What has to happen?" Kyle Sandilands' controversial take after knife attacks

Surgery won’t fix my chronic back pain, so what will?

Do optimists really live longer? Here’s what the research says

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50 years on, Advance Australia Fair no longer reflects the values of many. What could replace it?

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What if there was a hearing aid that understood your listening intentions?

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

What’s the difference between autism and Asperger’s disorder?

Guy Sebastian reveals what happened when Marcia Hines collapsed

Kate Middleton is having ‘preventive chemotherapy’ for cancer. What does this mean?

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Bunnings has toppled Woolworths as Australia’s most ‘trusted’ brand – what makes us trust a brand in the first place?

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