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Everything you need to know about tipping in the US

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

International Travel

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

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

Body

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

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

Body

7 things you need to know about fear

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

Mind

If you have money anxiety, knowing your financial attachment style can help

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/ylva-baeckstrom-1463175">Ylva Baeckstrom</a>, <a href="https://theconversation.com/institutions/kings-college-london-1196">King's College London</a> The number of people struggling with money in Britain is at a <a href="https://www.theguardian.com/money/2024/mar/18/record-numbers-of-uk-people-in-debt-warns-charity">record high</a>. Financial charities say that people are contacting them for help with debt, paying bills and insolvency. The campaign group Debt Justice found in a <a href="https://debtjustice.org.uk/wp-content/uploads/2024/03/WalnutOmnibus-Debt-Justice-Policy-Development-Weighted.xlsx">survey</a> that 29% of 18- to 24-year-olds and 25% of 25- to 34-year-olds had missed three or more bill payments in the last six months. A majority (65%) of people don’t think they can survive on their savings for three months without <a href="https://www.money.co.uk/savings-accounts/savings-statistics">borrowing money</a>. Statistics from the UK’s financial markets regulator show that more than one-third of UK adults have less than £1,000 in savings. And a survey by Money.co.uk found that 30% of Brits aged 25-64 do not save at all <a href="https://www.pensionsage.com/pa/Nearly-one-third-of-Brits-are-not-saving-for-retirement.php">for retirement</a>. With figures like that, is it any wonder that 75% of people in the UK feel <a href="https://www.mentalhealth.org.uk/about-us/news/financial-strain-driving-uks-anxiety#:%7E:text=Almost%20three%2Dquarters%20of%20the,cited%20job%20insecurity%20or%20unemployment">anxious about money</a>? The current state of the economy is particularly scary for young people. Unless you were born with a trust fund (not most people), you are likely part of the first generation to be financially worse off than <a href="https://edition.cnn.com/2020/01/11/politics/millennials-income-stalled-upward-mobility-us/index.html">your parents</a>. Retirement seems like an impossibility, and you’re unlikely to own your own home. Eighty percent of people in their early 20s worry about <a href="https://www.youngminds.org.uk/parent/parents-a-z-mental-health-guide/money-and-mental-health/#Thelinksbetweenmoneyandmentalhealth">not earning enough</a>. It is important to start planning for your financial future early in your career, but you may find it overwhelming. The good news is, there are ways to overcome this. <h2>Finding your financial attachment style</h2> As a psychotherapist and finance researcher, I work with people to help them to increase their financial confidence and find the motivation to start planning. This often starts with understanding what influences their relationship with money. <a href="https://www.cambridge.org/core/journals/behavioral-and-brain-sciences/article/bowlbyainsworth-attachment-theory/6D35C7A344107195D97FD7ADAE06C807">Attachment theory</a> is a psychological concept introduced in the late 1950s. Your attachment style – which can be, for example, secure, anxious or avoidant – explains how you approach creating emotionally intimate relationships with other people. Some people feel secure building relationships, while others are extremely anxious. Some avoid close relationships altogether. Attachment style can also apply to your finances. If you feel confident and safe when it comes to money, you are secure in your relationship to saving and spending. But if the thought of opening an ISA or filling out a tax return, let alone planning for retirement, fills you with dread and panic, you may be anxiously attached. And if you if you push money worries to the back of your mind, you are likely avoidant. Attachment theorists and psychotherapists like me think that attachment styles are shaped by childhood experiences – for example, how well you were looked after by your parents or carers, and how safe and loved you felt. The way money was handled in your family growing up is likely to have set the blueprint for your <a href="https://www.sciencedaily.com/releases/2020/02/200225114410.htm">financial attachment style</a>. Outside influences like education or work experiences may shape this too. Although financial education is part of the <a href="https://maps.org.uk/en/work-with-us/financial-education-in-schools">school curriculum</a> in the UK, 76% of children leave school without sufficient <a href="https://maps.org.uk/en/media-centre/press-releases/2024/hundreds-of-thousands-leaving-school-without-money-skills#:%7E:text=In%20its%20poll%20of%201%2C012,knowledge%20they%20need%20for%20adulthood">financial knowledge</a> to manage their lives. Similarly, financial services like banks have done a poor job helping people establish secure financial relationships. Complex and <a href="https://www.pwmnet.com/private-view-blog-time-for-the-financial-industry-to-jettison-the-jargon">off-putting language</a> has placed a barrier between those who know about money and those who need to learn. If you feel unable to keep up with financial terms, or that you don’t understand money, this is likely to hurt your confidence in your financial planning abilities and fuel a more avoidant attachment style. Identifying your attachment style can help you nurture a better relationship with money. You will be able to understand and predict how and why you react to finances in certain ways. And, it can provide confidence by reminding you that money struggles are not necessarily your fault. <h2>Getting over financial anxiety</h2> Some of the recent financial trends spreading on social media may give an insight into your attachment style. Are you <a href="https://www.cnbc.com/select/what-is-loud-budgeting-trend-can-it-work/">“loud budgeting”</a> (being vocal about why you aren’t spending money)? This could be a sign of financial confidence and that you have secure financial attachment. Or are you “doom spending” (spending money you don’t have instead of creating a <a href="https://www.theguardian.com/lifeandstyle/2024/jan/31/are-you-loud-budgeting-or-doom-spending-finance-according-to-gen-z">nest egg</a> for the future)? You may be avoidant. Healthy relationships with <a href="https://www.nhs.uk/every-mind-matters/lifes-challenges/maintaining-healthy-relationships-and-mental-wellbeing/#:%7E:text=People%20with%20healthy%2C%20positive%20and,such%20as%20stress%20and%20anxiety">people</a> and <a href="https://www.nhs.uk/every-mind-matters/lifes-challenges/money-worries-mental-health/#:%7E:text=Our%20mental%20health%20might%20be,earning%20enough%20or%20currently%20unemployed">money</a> are both critical for our survival and mental health. As an adult, you have the power to improve these relationships. But because attachment patterns were formed early on, they are difficult to change. Therapy and other support can help you adopt healthier habits, as can increasing your financial knowledge. If you want to change your relationship with money, you should try to be mindful of what may be influencing you. While financial advice on social media may be useful and help young people feel more empowered to <a href="https://www.forbes.com/advisor/investing/financial-advisor/adults-financial-advice-social-media/">talk about money</a>, it can also <a href="https://www.mcleanhospital.org/essential/it-or-not-social-medias-affecting-your-mental-health">increase anxiety further</a> and be <a href="https://theconversation.com/if-you-get-your-financial-advice-on-social-media-watch-out-for-misinformation-222196">full of misinformation</a>. A good place to start for accurate and helpful information is the government’s <a href="https://www.moneyhelper.org.uk/en">Money Helper website</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/225243/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/ylva-baeckstrom-1463175">Ylva Baeckstrom</a>, Senior Lecturer in Finance, <a href="https://theconversation.com/institutions/kings-college-london-1196">King's College London</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/if-you-have-money-anxiety-knowing-your-financial-attachment-style-can-help-225243">original article</a>. </div>

Money & Banking

6 kitchen mistakes you don’t know you're making

The kitchen is the heart of the home, but it can also be an area where we make the most mistakes in the way we use it. Check out our top tips to help keep your kitchen ship-shape. Clean the inside of the dishwasher You may not realise that the appliance that keeps everything clean can in fact be quite dirty. The inside of the dishwasher can be a breeding ground for bacteria. Run a hot cycle with nothing but a cup of white vinegar in the top and bottom shelves. Then simply wipe clean the sides and seams of the dishwasher. Don’t wash your chicken You may think this is necessary, but in fact washing your chicken can spread bacteria across your work surface, towels, cloths, and your hands. You can avoid it altogether as cooking will get rid of anything harmful on your meat. Change your kitchen towel The towel can be harbouring many kinds of bacteria, so it’s best to change them daily. Don’t rely on the sniff test to see if it needs a wash. A dirty towel used to dry your clean dishes can quickly spread germs that can make you sick. Avoid putting wooden items in the dishwasher The heat from the appliance can cause wooden items to warp and crack. That means wooden chopping boards, salad servers, or pots and pans with wooden handles need to be hand washed. Never wipe up floor spills with the dishcloth or tea towel If you wipe up some spilled milk off the floor and then use that same cloth to wipe your bench, germs can quickly spread. Same goes with a tea towel. Always use paper towel for cleaning mess from the floor. Fix leaking taps It’s too easy to ignore the drip drip of a leaky tap. But did you know a leaking tap could use over 6,000L of water in a month? Save the Earth (and reduce your water bill) by staying on top of any leaks around the home. Have a separate chopping board for meat Cross contamination can occur if you chop raw meat on a chopping board and then use it later (even after cleaning) for chopping fruit or vegetables. It’s best to have a board designated just for meat – it’s great if it’s a different colour to your everyday boards. Wash in hot soapy water after each use. Image credits: Getty Images

Home & Garden

Everything you need to know before you travel to Vietnam

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

International Travel

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

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

Body

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

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

Body

Everything we know about Samantha Murphy's accused killer

The disappearance of Samantha Murphy, a beloved mother-of-three, sent shockwaves through the quiet community of Ballarat. As details emerged, the focus shifted towards Patrick Orren Stephenson, a young man <a href="https://www.oversixty.com.au/finance/legal/new-details-emerge-in-samantha-murphy-murder-charge" target="_blank" rel="noopener">accused of the crime</a>, whose life story offers a complex juxtaposition of privilege, athletic ambition and now, alleged tragedy. Patrick Stephenson, now 22 years old, grew up in the shadow of his father, <a href="https://www.afl.com.au/news/118551/orrens-family-affair" target="_blank" rel="noopener">Orren Stephenson</a>, a prominent figure in the world of AFL. Orren's late-life draft into the AFL introduced Patrick to the glamorous world of professional sports at a young age. Patrick, often seen tagging along with his father, had a firsthand view of the prestige and camaraderie within the football clubs, an experience many boys would envy. The Stephenson family, well-regarded in the Ballarat community, seemed to exude an aura of positivity. However, perceptions of Patrick were mixed among locals. While a local newspaper once featured him advocating for road safety alongside his football friends, news of his arrest painted a different picture, depicting him as a troubled teenager. On a fateful Thursday, Patrick Stephenson was charged with the murder of Samantha Murphy, <a href="https://www.oversixty.com.au/health/caring/please-come-home-family-s-emotional-plea-to-missing-woman" target="_blank" rel="noopener">whose disappearance</a> had gripped the community since February 4. Despite initial suppression orders, <a href="https://www.oversixty.com.au/finance/legal/new-details-emerge-in-samantha-murphy-murder-charge" target="_blank" rel="noopener">details about the accused</a> began to surface, shedding light on his upbringing and associations. Patrick's childhood was steeped in football culture, mirroring his father's passion for the sport. Orren Stephenson's stint in the AFL provided the family with unique opportunities, including access to elite football circles. Patrick, enamoured with the lifestyle his father's career afforded, embraced the world of football wholeheartedly. Neighbours recall a seemingly happy home life for the Stephensons, with Patrick attending private schools known for their conservative values and strong sporting traditions. However, in recent years, Patrick's involvement with the local football scene had waned, signalling a potential shift in his priorities. <a href="https://www.oversixty.com.au/finance/legal/man-arrested-in-search-for-samantha-murphy" target="_blank" rel="noopener">The arrest of Patrick Stephenson</a> in Scotsburn, a rural hamlet near Ballarat, left the community in disbelief. Residents, unaware of any motive or connection to the accused, expressed shock at the unfolding events. Despite extensive searches and appeals for information from the police, the whereabouts of Samantha Murphy's body remains unknown, adding to the sense of unease gripping the region. As the Ballarat community grapples with the loss of Samantha Murphy, questions linger about the events leading to her tragic demise. Patrick Stephenson's life, once intertwined with the glamour of professional football, now stands at the centre of a harrowing investigation that in many was has only just begun. Images: Redan Football Club / Supplied.

Legal

Six surprising things about placebos everyone should know

<a href="https://theconversation.com/profiles/jeremy-howick-250620">Jeremy Howick</a>, <a href="https://theconversation.com/institutions/university-of-leicester-1053">University of Leicester</a> Placebos have been studied more than any treatment in the history of medicine, yet they remain mysterious. I’ve been studying placebos for 20 years and I’ve done some of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6288933/">key studies</a> that have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3655171/">advanced the scientific knowledge</a> in this area. Here are six facts about this strange effect that still fascinate me. <h2>1. Placebos have a dark cousin: nocebos</h2> A 29-year-old builder went to the hospital after having jumped onto a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5471339/">15cm nail</a> that pierced his boot. Moving the nail was so painful he had to be sedated with powerful drugs (fentanyl and midazolam) to remove it. But when he took off his boot, the medics discovered that the nail had gone between his toes. The builder’s pain was caused by the wrong belief that the nail had penetrated his foot. The detrimental effects of negative expectations are called nocebo effects. For evolutionary reasons (survival depends on avoiding danger), nocebo effects are larger than placebo effects. Unfortunately, patients are often told more about the bad things that might happen than the good things, which can result in a self-fulfilling prophecy. For example, learning that a drug has a possible side-effect of nausea or pain can actually <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7368797/">cause nausea or pain</a>. <h2>2. Placebos work even if people know they are placebos</h2> Linda Buonanno suffered so badly from irritable bowel syndrome that she often couldn’t <a href="https://www.theguardian.com/lifeandstyle/2017/may/22/knew-they-were-sugar-pills-felt-fantastic-rise-open-label-placebos">leave the house</a> for weeks. She signed up for a trial of “honest” (open-label) placebos, which is a placebo that patients know is a placebo. The Harvard doctors in the trial <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3008733/">told her</a> the pills were “placebo pills made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in [irritable bowel] symptoms through mind-body self-healing processes”. The honest placebos worked so well that she was able to resume a normal life. Honest placebos have <a href="https://pubmed.ncbi.nlm.nih.gov/28452193/">worked in other trials</a> for treating depression, back pain and attention deficit hyperactivity disorder (ADHD). Honest placebos work because of our subconscious expectations. Our past experiences of doctors and hospitals can generate subconscious expectations that activate our body’s inner pharmacy, which produces morphine (endorphins) and other beneficial drugs. <h2>3. Honest placebos are ethically acceptable</h2> It is often considered unethical for doctors to give placebos to patients because this supposedly <a href="https://link.springer.com/article/10.1007/s11724-014-0400-1">involves lying</a> (telling patients that a sugar pill is a powerful medication). But honest placebos do not involve lying, so there is no ethical barrier. In one <a href="https://pubmed.ncbi.nlm.nih.gov/34805194/#:%7E:text=Introduction%3A%20Open%2Dlabel%20placebos%20have,label%20placebos%20in%20acute%20pain.">ongoing trial</a>, doctors asked patients whether they would be willing to try a mix of real painkillers and honest placebos. Patients in this trial have the same level of pain relief following surgery, but are less likely to become dependent on painkillers. <h2>4. Placebo effects are part of most treatment effects</h2> When a doctor prescribes ibuprofen for back pain, the effects are due to the ibuprofen and the patient’s beliefs and expectations, which can be influenced by the doctor’s communication. Doctors who offer positive messages in a warm, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6047264/">empathic manner</a> will increase the effect of the drugs. The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2359128/">size and colour</a> of the pill can also influence the effect. A large, orange pill can reduce pain more than a small, red one. By contrast, blue pills generally have a sedative effect – except for Italian men, for whom blue pills have an <a href="https://www.amherst.edu/system/files/media/1601/moerman_explanatory%20mechanisms%20for%20placebo%20effects.pdf">excitative effect</a>), probably because their revered football team wears blue. Doctors’ ethical duty to benefit patients suggests it is an ethical duty to maximise the placebo effects of all treatments they provide. <h2>5. You don’t need placebos to have placebo effects</h2> In one trial, patients were given morphine <a href="https://pubmed.ncbi.nlm.nih.gov/15488461/">via an intravenous line</a> following surgery. However, only half of the patients were told they were receiving morphine. The patients who were told this had 50% more pain relief than those who were not told they were receiving morphine. This is an example of a placebo effect without a placebo. <h2>6. You can generate placebo (and nocebo) effects in yourself</h2> All communication can have a beneficial or harmful effect. One study found that teaching communication skills to families <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4915212/">reduced anxiety and depression</a>. On the other hand, couples who dwell on problems and negative aspects of their relationships were shown in a study to have <a href="https://www.sciencedirect.com/science/article/abs/pii/S0306453022003304?via%3Dihub">weaker immune systems</a>. Acts of altruism, focusing on a brighter future, or gratitude are proven ways to reduce the effect of negative communication. An easy way to generate positive placebo effects for yourself is by performing a <a href="https://www.mentalhealth.org.uk/explore-mental-health/kindness-and-mental-health/random-acts-kindness">random act of kindness</a>, such as making a colleague a cup of tea, or simply smiling and saying hello. You can learn more about the amazing effects of placebos and nocebos in my <a href="https://www.press.jhu.edu/books/title/12830/power-placebos">latest book</a>, The Power of Placebos: How the Science of Placebos and Nocebos can Improve Health Care.<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/220829/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/jeremy-howick-250620">Jeremy Howick</a>, Professor and Director of the Stoneygate Centre for Excellence in Empathic Healthcare, <a href="https://theconversation.com/institutions/university-of-leicester-1053">University of Leicester</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/six-surprising-things-about-placebos-everyone-should-know-220829">original article</a>.

Body

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

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

Money & Banking

More than a third of people with dementia don’t know they have it – what to do if you suspect your partner has the condition

<a href="https://theconversation.com/profiles/kate-irving-1493654">Kate Irving</a>, <a href="https://theconversation.com/institutions/dublin-city-university-1528">Dublin City University</a> Around <a href="https://www.bbc.co.uk/news/uk-england-67613465">36% of people</a> in England with dementia are unaware they have the condition, according to a new report from the Dementia Commission. <a href="https://chamberuk.com/wp-content/uploads/2023/12/231127-Dementia-Commission-Report-Embargoed.pdf">The report</a> suggests things health and care professionals can do to improve spotting early signs of dementia. But what can you do if you think your partner has the condition? And how can you broach the topic with them? If you are worried about your partner having dementia, here are some useful things to know. Dementia is a term for a range of diseases (for example, Alzheimer’s) which develop over time (months and years) and cause problems with memory and reasoning, communication, changes in personality and a reduction in a person’s ability to carry out daily activities, such as shopping, washing, paying bills or cooking. Dementia can present very differently in each person, so it’s about knowing what’s normal for your loved one. A person who has always been conscientious and organised starting to unravel is very different from a scatterbrained person just being slightly more scatterbrained. Grief and stress can affect memory yet not be the start of dementia. But they can also mask the start of dementia: we call this “diagnostic over-shadowing”. There are also age-related changes to cognition. For example, we take longer to learn when we get older. But a one-off event – no matter how dramatic – is not necessarily dementia. It’s about looking for a pattern of decline. If you see these changes happen in a short space of time (weeks or days) it is unlikely to be dementia and could be something more serious. This requires urgent investigation by a doctor. <h2>Greatest fear</h2> Dementia is one of the greatest fears of our age. The horror of perceived loss of self can cause people to avoid discussing the issue, discussing it in an unhelpful way (such as criticising or inadvertently humiliating) or discussing it with other relatives, but not the person they are noticing changes in. Over time, this can cause a lack of trust to develop. Discussing memory problems openly with the person at the point of a memory failure or if they raise the concern is best. Of course, it takes courage and makes us face our own vulnerability. Sometimes the person will be in denial or lack insight into the memory problems (this can be a symptom of dementia, but isn’t always). If someone raises a concern about their memory issues, I would urge you not to minimise this, as it probably took courage to admit their concerns. I heard a relative say to my mother: “Oh, you left the pot on the stove. I lost the car in the multistory the other day.” My mother had dementia – the relative did not. If they are adamant that they do not have concerns, this is harder to deal with. One approach is to say: “I know you are not concerned, but I am concerned and I wonder if you would see a doctor to ease my worries?” Also explaining that memory problems can at least to some extent have reversible causes means a visit to the doctor to at least rule these out is an important step. It may also be encouraging to say to the person: “If there is something with your memory that will get worse over time, would you want to know?” (Most people <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2408568/">answer yes</a> to this). <h2>Seeing a GP</h2> If your partner agrees to visit a GP, it is helpful to prepare by filling in a diary for a week with the kind of memory (or other) problems experienced, what was happening at the time and the effect of the memory failure. This can be shared with a GP to help them to understand the issues. When people hear even the suggestion of the word dementia, they are faced with the uncertainties of what will become of them, of what they will lose, what they can keep up and where they will end up. These uncertainties are often shared with family members. But research shows that positive aspects of timely diagnosis <a href="https://www.scie.org.uk/dementia/symptoms/diagnosis/early-diagnosis.asp">outweigh fears</a> over time. At the same time, there are often ongoing stresses to do with memory impairments or confusion. With these stresses, everyday life can be troublesome, family relationships can suffer, and people can find it difficult to be supportive of each other. Being honest and open is the best policy. Stating that we are in this together, I want to help, let’s meet whatever happens head on, can help. If a person becomes resistant, it may be there is another family member who might better assist the person.<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/219172/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/kate-irving-1493654">Kate Irving</a>, Professor of Clinical Nursing, <a href="https://theconversation.com/institutions/dublin-city-university-1528">Dublin City 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/more-than-a-third-of-people-with-dementia-dont-know-they-have-it-what-to-do-if-you-suspect-your-partner-has-the-condition-219172">original article</a>.

Mind

8 reasons everyone should know their blood type

Why you should know your blood type What’s in a blood type? Potentially a lot, according to research, including a review of studies published in the Wiley Interdisciplinary Reviews: Systems Biology and Medicine, that connects different blood groups to everything from risk of heart disease and dementia to urinary tract infections and the norovirus. While none of the studies are conclusive about cause and effect (they can’t say X blood type causes Y disease) and any increased risks are still pretty small, the research does highlight the importance of knowing your type – A, B, AB, or O – and how it could affect your wellbeing. Blood clots: Type AB, A, and B increases risk Danish researchers studied how blood type interacts with a genetic predisposition for deep-vein thrombosis (DVT), or blood clots in the lower legs that can travel to the lungs and become life-threatening. After analysing data on about 66,000 people over more than 30 years, they found that those with type AB, A, or B had a 40 per cent higher risk of DVT than people with type O, the most common type. When the scientists did further analysis to see which factors have the biggest impact on DVT risk on a population level, they found that an AB blood type contributed to about 20 per cent of blood clots; genetic mutations accounted for 11 per cent, being overweight accounted for 16 per cent, and smoking accounted for six per cent. Heart disease: Type AB, B, and A all increase risk People whose blood type is A, B, or AB have an increased risk of heart disease and shorter life spans than people who have type O blood, according to a large study published in BMC Medicine. After following more than 50,000 middle-age and elderly people for seven years, on average, researchers found that as many as nine per cent of cardiovascular deaths were attributed to having non-O blood types. However, as any doctor will tell you, lifestyle factors like weight, smoking and diet, which, unlike blood type, are modifiable, have a much greater impact on heart disease. Stomach cancer: Types A and AB increases risk Researchers have known for a while that people with blood type A are at risk for stomach cancer. But research published in BMC Cancer shows that people with blood type AB are also at risk. Using genetic data from a large number of cases and controls, researchers found a link between both blood types and gastric cancer in Chinese populations. A review of 39 previous studies confirmed their findings. Fertility: Type O reduces it Women with this blood type were twice as likely to have blood levels of the hormone FSH high enough to indicate low ovarian reserve, a measure of fertility, according to a study published in Human Reproduction. Researchers couldn’t say for sure why, though. Given that type O blood is the most prevalent, it doesn’t pay to worry too much about it. Age is a far more important risk factor for fertility problems. Pregnancy risks This has nothing to do with your “letter” blood type or the type determined by the ABO grouping system. This has to do with what’s known as the Rhesus (Rh) factor, which determines whether your blood type is positive or negative. This could cause complications in pregnant women if the baby’s Rh blood type is different from the mother’s. For instance, if the mother has a negative blood type and the baby has a positive one, the mother’s body can actually build up antibodies against the baby’s blood type. Luckily, this doesn’t affect the baby, but it could have a negative effect on future pregnancies. Fortunately, doctors can give pregnant women a shot early in their pregnancy that can prevent Rh-incompatibility problems. Dementia and memory loss: Type AB increases risk People with type AB blood have an 82 per cent greater risk for cognitive decline later in life, according to a study published in Neurology. That’s likely because they have larger amounts of what’s known as the Factor VIII protein, which helps with blood clotting. Study participants with higher levels of this protein were 24 per cent more likely to develop memory problems – regardless of their blood type – than people with lower levels. Blood type, however, is far from the only, or even most important, factor that affects your risk for cognitive decline. Stroke: Type O has the lowest risk People with a blood type other than O (the most common) have a higher risk of cardiovascular issues such as stroke, according to a study published in the Journal of Thrombosis and Haemostasis. Biologists are still investigating why this might be; one possible explanation is that non-O blood types contain more of the Von Willebrand factor, a protein that has been connected to blood clotting and stroke in the past. Mosquitos like Type O blood If you find yourself scratching bug bites all summer long, your blood type might be to blame. In a one small study, researchers found that type Os are up to twice as attractive to mosquitoes as type As, with type Bs falling somewhere in the middle. Image credits: Shutterstock This article originally appeared on <a href="https://www.readersdigest.com.au/healthsmart/8-reasons-everyone-should-know-their-blood-type" target="_blank" rel="noopener">Reader's Digest</a>.

Body

"You don’t know why they’re filming or what they’ll do with it": flight attendants on being unwilling stars of viral videos

<a href="https://theconversation.com/profiles/liz-simmons-1376255">Liz Simmons</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a>; <a href="https://theconversation.com/profiles/gui-lohmann-1476773">Gui Lohmann</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a>, and <a href="https://theconversation.com/profiles/rawan-nimri-1482182">Rawan Nimri</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> As any frequent social media user knows, airline passengers often record and post in-flight incidents – from frightening turbulence to unruly members of the public. Often, these viral videos feature flight attendants just trying to do their duties, while being filmed without their consent. These videos usually portray flight attendants either as heroes effortlessly managing difficult passengers or “villains” accused of being rude and unprofessional. Either way, the trend is emerging as an industrial issue, with unions arcing up about it and airlines bringing in new rules aimed at curbing the practice. <h2>Unkind comments about appearance and age</h2> Going to work knowing that at any moment you may become the unwilling star of a viral video can exact a considerable toll on the wellbeing of flight attendants. I (Liz Simmons) speak daily with flight attendants in Australia and abroad as part of my PhD research. From these discussions, I’ve heard from attendants who worry often about discovering videos of themselves featuring unkind comments about their appearance, age or employer. One flight attendant, Kate*, described the disconcerting feeling of someone aiming a smartphone camera at her while she was simply trying to do her job, saying: "You don’t know why they’re filming or what they’ll do with it." Marie spoke of being featured in a TikTok video during a safety demonstration, with viewers making fun of her appearance. Charlotte, after refusing to serve more alcohol to an intoxicated passenger, had a camera thrust in her face, accompanied by threats to her job. Mark told of how uncomfortable he felt having to ask a passenger to stop taking photos of the crew during service. These personal accounts illustrate the <a href="https://www.news.com.au/travel/travel-updates/health-safety/flight-attendant-reveals-creepy-passenger-behaviour/news-story/3b2b1ad25f758e24ef37b74794684ea6">distress</a> flight attendants can experience when being filmed or photographed without their knowledge. <h2>A broader industrial issue</h2> This issue is drawing the attention of policymakers, airlines and the unions that represent flight attendants. Japan recently introduced <a href="https://japannews.yomiuri.co.jp/society/crime-courts/20230408-102309/">laws</a> aimed at curbing sneak photography in a range of settings, which may be used to prevent passengers voyeuristically filming flight attendants. <a href="https://mondortiz.com/japan-flight-attendants-call-for-action-versus-stolen-photo-taking/">Research</a> by Japan’s aviation workers union found that about 70% of the 1,573 flight attendants surveyed believed they’d had their pictures taken surreptitiously while they were working. Passengers have been arrested in <a href="https://www.jpost.com/israel-news/crime-in-israel/article-748799">Turkey</a> and <a href="https://www.dailymail.co.uk/travel/travel_news/article-3554181/IndiGo-passenger-arrested-recording-video-flight-attendants.html">India</a> after unauthorised filming. And flight attendant unions in <a href="https://www.japantimes.co.jp/news/2023/03/09/national/crime-legal/flight-attendant-photo/">Japan</a>, <a href="https://www.thestandard.com.hk/breaking-news/section/4/204104/Union-says-flight-attendants-can-ask-passengers-to-delete-photos-and-videos-taken-without-consent">Hong Kong</a> and <a href="https://www.stuff.co.nz/travel/news/300750512/why-you-shouldnt-film-your-cabin-crew">Australia</a> have voiced concerns about the issue. Of course, videos can occasionally play a crucial role in understanding what transpired during an <a href="https://www.nbcnews.com/news/us-news/passenger-assault-attendant-detained-fbi-american-airlines-mexico-cabo-rcna48884">in-flight incident</a>, and flight attendants themselves can also be found on social media sharing their stories, consenting to the video. But many videos still feature airline staff simply going about their job (while being filmed, without their consent). <h2>Unclear rules</h2> News <a href="https://www.smh.com.au/traveller/reviews-and-advice/why-you-shouldnt-film-your-cabin-crew-20221122-h2813d.html">reports</a> suggest staff aboard Dutch carrier KLM “now commonly make an announcement during the safety briefing asking passengers not to take photos of any crew members.” The <a href="https://www.klm.com.au/information/legal/conditions-carriage">rules</a> on the KLM website are less clear, saying only that, "Recording videos and/or taking photographs other than personal videos and photographs is prohibited on board the aircraft." Virgin Australia’s rules state anyone travelling on their planes must "use cameras or photographic devices (including mobile phones) for personal use only. You must comply with the directions of flight crew when using cameras or photographic devices while on board. In November 2023, Qantas introduced new <a href="https://www.qantas.com/au/en/book-a-trip/flights/conditions-of-carriage.html#conduct-during-flight">rules</a> requiring passengers to "seek consent before filming or photographing Qantas Group staff, contractors or other customers." This is a start. For most airlines, however, there is a notable absence of clear guidelines against recording and publishing footage of flight attendants in their workplace. The existing rules are often buried in the fine print of terms and conditions, which few passengers take the time to read. This underscores the necessity for airlines to reconsider how these restrictions are communicated to passengers. Looking ahead, it may be timely for more airlines to establish clearer rules on filming cabin crew while they work. There should be an acknowledgement that unsolicited filming is frequently unfair, invasive and distressing. Developing a framework to enforce these provisions and enhancing communication about these rules would help inform passengers about how to respect the privacy and comfort of flight attendants in their workplace. * All names have been changed to protect identities.<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/217089/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/liz-simmons-1376255">Liz Simmons</a>, PhD Candidate, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a>; <a href="https://theconversation.com/profiles/gui-lohmann-1476773">Gui Lohmann</a>, Professor in Air Transport and Tourism Management, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a>, and <a href="https://theconversation.com/profiles/rawan-nimri-1482182">Rawan Nimri</a>, Lecturer in Tourism and Hospitality, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith 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/you-dont-know-why-theyre-filming-or-what-theyll-do-with-it-flight-attendants-on-being-unwilling-stars-of-viral-videos-217089">original article</a>.

Travel Trouble

"You're entitled to know": Piers Morgan reveals names of "royal racists"

Piers Morgan has revealed the names of the senior royal family members who allegedly made "racist" <a href="https://oversixty.com.au/entertainment/books/new-royal-book-pulled-from-shelves-over-huge-legal-blunder" target="_blank" rel="noopener">comments</a> about baby Archie's skin colour. Mystery has surrounded the new royal family exposé Endgame, written by Omid Scobie, after he claimed to know which royals allegedly made the comments when Meghan Markle was pregnant with her first child. Then, in a Dutch translation of the book being sold in The Netherlands, the names were <a href="https://oversixty.com.au/finance/legal/second-royal-racist-accidentally-named-in-new-book" target="_blank" rel="noopener">accidentally</a> printed in an "error", but kept out of the press for legal reason. But now, controversial British journalist Piers Morgan has revealed the names that feature in the translated book, which is quickly being cleared from shelves, saying people have the right to know. On Wednesday’s episode of Piers Morgan Uncensored, the British broadcaster revealed the names of the two royals who allegedly had “concerns” about baby Archie's skin tone, although saying he doesn't believe any such comments were made. He explained to his viewers that he doesn’t “believe any racist comments were ever made by any of the royal family,” he felt that his fellow citizens had a right to know information that only a handful of readers from another country were inadvertently privy to. “Frankly, if Dutch people wandering into a bookshop can pick it up and see these names, then you — the British people here, who actually pay for the British royal family — you’re entitled to know, too.” According to <a href="https://www.news.com.au/entertainment/celebrity-life/royals/piers-morgan-reveals-names-of-royals-exposed-in-bombshell-book-questioning-archies-skin-colour/news-story/7b499c1baa1a40116cbc07c7b26069d6" target="_blank" rel="noopener">news.com.au</a> and <a href="https://pagesix.com/2023/11/29/royal-family/piers-morgan-reveals-names-of-royals-exposed-in-book-for-commenting-on-archies-skin-color/" target="_blank" rel="noopener">Page Six</a>, Morgan said the names are King Charles III and Princess Kate Middleton. Despite Morgan's claims, Page Six has been unable to verify which names were accidentally revealed. Given the controversy surrounding the book, Xander Publishers announced that it received a request from the United States to abruptly halt sales of the book. “I can’t talk about the details,” a spokesperson for the publishing house said in a statement. “We have, however, received a request to put the title on hold, and that is what we have done. We are awaiting further instructions. I do not know how long this will be.” Image credits: Piers Morgan Uncensored

Legal

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

<a href="https://theconversation.com/profiles/clare-collins-7316">Clare Collins</a>, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> What is a “detox”? It’s a process that involves using particular products, diets or other detoxification methods to try and rid the body of so-called “toxins”. Detoxes are <a href="https://www.sciencedirect.com/science/article/abs/pii/S1499404619308127">prevalent on social media</a> and spruiked by brands offering detox products, celebrities and influencers. A documentary airing on Channel 10 this week – Todd Sampson’s <a href="https://tvblackbox.com.au/page/2023/11/06/todd-sampson-returns-with-new-mirror-mirror-testing-wellness-industry/">Mirror Mirror: Are You Well?</a> – explores our fascination with detoxing, and the science (or lack thereof) behind it. So if you’re thinking of trying a detox, here’s what you need to know. <h2>Detoxing is not new</h2> Detoxing has held an attraction since the time of <a href="https://bcmj.org/premise/history-bloodletting">Hippocrates</a>, who believed four bodily fluids or “humors” – blood, phlegm, black bile and yellow bile – had to remain in balance to maintain good health. Being unwell meant the body’s organs and fluids were somehow imbalanced and in need of correction. Throughout the centuries these “imbalances” have been treated with everything from <a href="https://www.smh.com.au/national/nsw/leeches-bloodletting-enemas-and-emetics-the-uncomfortable-history-of-medicine-20220726-p5b4u2.html">enemas and emetics</a> to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3757849/">leech therapy</a> and <a href="https://en.wikipedia.org/wiki/Bloodletting">bloodletting</a>. An enema sees a tube <a href="https://www.healthline.com/health/enema-administration#administration">inserted into the anus</a> to deliver medication or fluids to the rectum or colon. An <a href="https://www.britannica.com/science/emetic">emetic</a> is a compound designed to make you vomit. <a href="https://bcmj.org/premise/history-bloodletting">Bloodletting</a> involved using certain techniques – not for the faint of heart – to remove blood from a patient and supposedly cure disease. Meanwhile, throughout history, the <a href="https://pubmed.ncbi.nlm.nih.gov/26133274/">ritual of fasting</a> as a display of self-discipline, purity and holiness was common, particularly among women. <h2>What are the different types of detox?</h2> Fast forward to today, and detoxes look a bit different. Detox products sold over the counter or online are typically teas or drinks to be consumed instead of food. These approaches sometimes start with a fasting phase or use intermittent fasting throughout the program. The “detox” tag is appearing on a growing range of teas, coffee, infused waters, drinks with added fruit, vegetables, herbal mixes, nutrients or added blends of “natural” ingredients. These products often claim to flush toxins from the body, or to boost immunity. <a href="https://www.fortunebusinessinsights.com/detox-drinks-market-107122">Global predictions</a> indicate the detox drink market, estimated at more than US$5 billion in 2022, will grow in value by another 50% before 2030. A <a href="https://pubmed.ncbi.nlm.nih.gov/22103982/">survey of detoxification therapies</a> used by naturopaths in the United States reported that more than three-quarters recommended dietary measures, including “cleansing foods” (such as beetroot), vitamin, mineral or antioxidant supplements, organic foods, elimination diets and probiotics. While drinks and dietary measures represent typical approaches to a detox, there are also some more unusual detox practices. One-third of patients in that same US study had undergone colonic irrigation, which involves <a href="https://www.healthline.com/health/digestive-health/pros-cons-colon-cleanse#what-is-it?">infusing fluids into the colon</a> to remove digestive waste. More than one-quarter had used <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/homeopathy">homeopathic remedies</a> or laxative herbs. While we don’t have equivalent data for Australia, a survey of <a href="https://pubmed.ncbi.nlm.nih.gov/30470778/">more than 2,000 Australian adults</a> found 63% had either used or consulted someone about complementary therapies in the previous year. A portion of these were likely detox therapies. <h2>Do detoxes work?</h2> The short answer is no. A <a href="https://pubmed.ncbi.nlm.nih.gov/35866077/">review published in 2022</a> found detox diets failed to identify plausible pathways by which toxins could be eliminated, or the specific toxins supposedly removed by a particular diet. This review also pointed out that detoxes defy the general principles of human physiology, in that the liver and kidneys are quite efficient at removing toxins from our bodies. A previous <a href="https://pubmed.ncbi.nlm.nih.gov/25522674/">review from 2015</a> similarly found studies did not provide convincing evidence to support the use of detox diets. Detox products don’t have to prove they’re effective to be on the market. In Australia, complementary medicines sold over the counter are regulated by the <a href="https://www.tga.gov.au/what-tga-regulates">Therapeutic Goods Administration</a>, with ingredients assessed for quality and safety, but not whether the products actually work. You should check any product and marketing claims before purchasing to see what the manufacturers say. Big promises to be sceptical about include eliminating toxins, rapid weight loss, stronger willpower, improved self-esteem, an energy or immunity boost, feeling happier, inner peace, or better skin, hair and nails. <h2>Potential dangers of detoxing</h2> Consuming detox products in place of a regular diet leads to a very low total kilojoule intake, and therefore may lead to <a href="https://pubmed.ncbi.nlm.nih.gov/29124370/">weight loss</a> in the short term. But they’re not a sustainable way to lose weight. Detox diets that severely restrict kilojoules or food groups increase the risk of nutrient deficiencies. Adverse effects <a href="https://www.healthline.com/nutrition/detox-diets-101#safety-and-side-effects">include</a> fatigue, irritability and <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/halitosis-or-bad-breath">bad breath</a>. There’s also a risk detox product ingredient labels <a href="https://pubmed.ncbi.nlm.nih.gov/35866077/">might not be accurate</a>, increasing the risk of side effects, potential overdoses or other adverse events. In Spain, a <a href="https://pubmed.ncbi.nlm.nih.gov/22884574/">50-year-old man</a> died after an incorrect ingredient was added to a liver cleanse detox product he used, leading to manganese poisoning. A 2018-19 <a href="https://www.phrp.com.au/issues/july-2023-volume-33-issue-2/compliance-audit-of-colonic-lavage-businesses/">audit of premises in New South Wales</a> performing colonic irrigation found failures to meet infection control standards. Some people should definitely not try detoxing. This includes people with chronic medical conditions, eating disorders, older adults, children and women who are pregnant or breastfeeding. One positive aspect of detox programs is that they may help raise awareness of your current food, alcohol or lifestyle habits that could be improved. Reflecting on these can potentially provide the motivation to try and eat more healthily.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/212776/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/clare-collins-7316">Clare Collins</a>, Laureate Professor in Nutrition and Dietetics, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/thinking-of-trying-a-detox-heres-what-you-need-to-know-first-212776">original article</a>.

Body

Do racehorses even know they’re ‘racing’ each other? It’s unlikely

<a href="https://theconversation.com/profiles/cathrynne-henshall-572585">Cathrynne Henshall</a>, <a href="https://theconversation.com/institutions/charles-sturt-university-849">Charles Sturt University</a> When racing season arrives, everyone becomes an expert on the horses that are the stars of the spectacle. TV personalities, professional pundits and form guides talk confidently about the favourite’s “<a href="https://www.racenet.com.au/news/tony-brassel-on-the-great-unmeasurable-ticker">will to win</a>”. In close races, the equine contestants “<a href="https://www.justhorseracing.com.au/news/australian-racing/war-machine-to-battle-it-out/120326">battle it out</a>”, demonstrating “heart”, “grit” and “determination”. But do horses even know they are in a race, let alone have a desire to win it? Do they understand what it means when their nose is the first one to pass the post? Based on decades of experience and everything we know about horse behaviour, I think the most plausible answer is “no”. <h2>From the horse’s perspective</h2> From a horse’s perspective, there are few intrinsic rewards for winning a race. Reaching the end might mean relief from the pressure to keep galloping at high speed and hits from the jockey’s whip, but the same is true for all the horses once they pass the finishing post. If the race is close, the horse that eventually wins might even be <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0015622">whipped more often</a> in the final stages than horses further back in the field. So while being first to reach the winning post can be crucially important to the horse’s human connections, there is very little direct, intrinsic benefit to the horse that would motivate it to voluntarily gallop faster to achieve this outcome. So does a horse even know it’s in a race? Again, the answer is likely “no”. Running (cantering or galloping) is a quintessential horse behaviour and horses voluntarily run together in groups when given the opportunity – even in races <a href="https://www.thenationalnews.com/world/2022/08/22/riderless-race-horses-take-to-the-streets-in-central-italy-in-pictures/">without jockeys</a>. However, there are a number of reasons to think horses have not evolved a desire to “win” during a group gallop. Horses are social animals. In the wild, to minimise their individual exposure to predators, they <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0258944">synchronise their movement</a> with other horses in their group. This synchronisation includes maintaining similar speeds to other group members (to keep the group together), being alert to the positions of their own body and their neighbours’ to avoid collisions, and adapting their speed to the terrain and environmental cues that indicate upcoming danger or obstacles. In the wild, “winning” – that is, arriving first, long before other group members – could even be a negative, exposing the “winner” to an increased risk of predation. This collective behaviour is the opposite of what owners, trainers and punters want from horses during a race. <h2>The horse’s preferences (and how riders override them)</h2> Horse races depend on two horse-related factors: the horse’s innate tendency to synchronise with other horses, and its ability to be trained to ignore these tendencies in response to cues from the jockey during a race. Trainers and jockeys also harness the preferences of individual horses. Some horses are averse to bunching up with others during the race, so jockeys let them move to the front of the field (these are “<a href="https://www.racingnsw.com.au/news/feature-articles/the-art-of-the-front-runner-timing-a-jockeys-best-friend/">front runners</a>”). Other horses seek the security of the group, so jockeys let them remain in the bunch until closer to the winning post (these are “come-from-behind” winners). Jockeys use several different interventions to override the horse’s innate tendency to synchronise. These might include: <ul> <li> directing the horses to travel much closer to the other horses (risking the sometimes fatal injuries we sometimes see at the track) </li> <li> travelling at speeds not of the horse’s choosing (usually at far higher speeds and for longer durations, and often maintained by use of the whip) </li> <li> preventing the horse from changing course to adapt its position relative to other horses in the field (directing its path via pressure on the mouth from the bit or taps from the whip). </li> </ul> During the early stages of a race, jockeys rely on horses’ innate desire to remain with the group to ensure they maintain the physical effort required to keep in touch with the front runners. This tendency may then be overruled so the horse will act independently of the group, leave it behind and come to the front to hopefully win. <h2>No concept of being in a race</h2> So horses most likely have no concept of being in a “race”, where the goal of their galloping is to get to a certain location on the track before any of the other horses. However, they undoubtedly know what it’s like to be in a race. That is, they learn through prior experience and training what is likely to happen and what to do during a race. And with jockeys and trainers who understand the individual preferences of their horses to maximise their chances during the race, there will always be one horse that reaches that part of the track designated the winning post before the other horses in the group. But as for winning horses understanding they are there to “win”? It’s far more likely it is the combination of natural ability, physical fitness and jockey skill that accounts for which horse wins, rather than any innate desire by that horse to get to the winning post before the other horses.<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/216641/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/cathrynne-henshall-572585">Cathrynne Henshall</a>, Lecturer, School of Agricultural, Environmental and Veterinary Sciences, <a href="https://theconversation.com/institutions/charles-sturt-university-849">Charles Sturt 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/do-racehorses-even-know-theyre-racing-each-other-its-unlikely-216641">original article</a>.

Money & Banking

Everything you need to know about major Medicare shake-up

Medicare is undergoing its biggest shake-up in decades, making it easier for more than 12 million Aussies to visit their GP. Thanks to the sweeping reforms that came into effect on Wednesday, Aussies can now get cheaper visits to GPs and increased access to telehealth services. It is estimated that 12 millions Australians, or three in every five patients, will find it easier to see a bulk-billing GP after incentive payments for the practice tripled in a major boost. General practitioners who bulk-bill concession card holders, pensioners and patients aged under the age of 16 will now receive a $20.65 bonus if they are in a metropolitan area, while the incentive has risen to $39.65 for GPs in regional areas. The previous rates were $6.85 and $13.15 respectively. The tripling of the bulk-billing incentive payment applies to all face-to-face and telehealth GP consultations of up to 20 minutes. The plan was hailed as a "game changer" by the Albanese government, as Health Minister Mark Butler said, "Today is the biggest investment in Medicare for decades." Prime Minister Anthony Albanese added, "Medicare is at the centre of our health system [and] the primary healthcare that GPs deliver makes an enormous difference to people." "[This] happens to be good for the taxpayer as well because... a slight condition dealt with early [and] treated properly ensures it doesn't become an acute condition." Medical and GP advocates welcomed the reforms, saying it will make a big difference to millions of Aussies facing cost-of-living pressures. "But we know more work can be done," Australian Medical Association president Steve Robson said. "We will continue working with the government on developing new programs and initiatives that strengthen primary care and ensure GP-led care is affordable and accessible for all patients." Image credits: Shutterstock

Caring

What’s insomnia like for most people who can’t sleep? You’d never know from the movies

<a href="https://theconversation.com/profiles/aaron-schokman-1463327">Aaron Schokman</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/nick-glozier-94435">Nick Glozier</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Hollywood appears fascinated by sleep’s impact on the mind and body. Blockbuster movies featuring someone living with insomnia include <a href="https://www.imdb.com/title/tt0108160/">Sleepless in Seattle</a> (1993), <a href="https://www.imdb.com/title/tt0137523/">Fight Club</a> (1999) and <a href="https://www.imdb.com/title/tt0278504/?ref_=fn_al_tt_1">Insomnia</a> (2002). But how well do these and other portrayals compare with what it’s really like to live with insomnia? As we’ll see, most movies tend to either minimise or exaggerate symptoms. Insomnia is rarely depicted as a treatable illness. And these portrayals have implications for the estimated <a href="https://www.sleep.theclinics.com/article/S1556-407X(22)00022-4/fulltext">one in three</a> of us with at least one insomnia symptom. <h2>Back in the real world</h2> Insomnia is a common <a href="https://doi.org/10.1378/chest.14-0970">sleep disorder</a> where a person struggles to fall asleep, stay asleep, or wakes up too early – despite having adequate opportunity for sleep. <a href="https://doi.org/10.1111/j.1753-6405.2012.00845.x">Around 5%</a> of adults experience significant insomnia to the degree that it causes distress or impairs daily life. It’s a common misconception that insomnia is only a night-time issue. <a href="https://www.healthdirect.gov.au/insomnia">Insomnia</a> can impact your ability to stay awake and alert during the day. It can also affect your <a href="https://theconversation.com/explainer-whats-the-link-between-insomnia-and-mental-illness-49597">mental health</a>. At work, you might be more prone to accidents, more forgetful, or make poorer decisions. At home, you might be irritable or short with your friends and family. So what is it like living with insomnia? Apart from the effects of poor sleep quality, many people experience <a href="https://doi.org/10.1016/j.smrv.2021.101583">anxiety or dread</a> about the night ahead from the moment they wake up. From early in the day, people plan how they can improve their sleep that night. <a href="https://doi.org/10.1016/j.smrv.2016.01.003">A review</a> found people living with insomnia felt their sleep concerns were often trivialised or misunderstood by health-care professionals, and stigmatised by others. <h2>Movies can minimise symptoms …</h2> Nicholas Galitzine’s character in the recent romcom <a href="https://www.imdb.com/title/tt10172266/?ref_=fn_al_tt_1">Red, White and Royal Blue</a> (2023) has insomnia. We’re briefly told he struggles to fall asleep at night. However, we never see any meaningful impact on his life or depiction of the difficulty living with insomnia entails. That said, minimising the impact of insomnia can have benefits. It shows insomnia is an invisible illness, doesn’t have obvious visual symptoms and anyone can have it. But this can perpetuate the expectation someone with insomnia should be able to function unencumbered. Or it can fuel the misconception having insomnia may be beneficial, as in <a href="https://www.imdb.com/title/tt0050543/?ref_=fn_al_tt_1">Insomnia Is Good for You</a> (1957). <h2>… or exaggerate symptoms</h2> But most Hollywood portrayals of insomnia tend to depict the most extreme cases. These usually feature insomnia as a symptom of another condition rather than a disorder itself, as is commonly experienced. These movies tend to be psychological thrillers. Here, insomnia is often used as an enigma to keep the audience guessing about which events are real or figments of a character’s imagination. Take <a href="https://www.imdb.com/title/tt0361862/?ref_=fn_al_tt_1">The Machinist</a> (2004), for example. The main character is emaciated, ostracised and plagued by paranoia, hallucinations and delusions. It’s only towards the end of the movie we learn his insomnia may be the result of a <a href="https://doi.org/10.9740/mhc.n101819">psychiatric disorder</a>, such as post-traumatic stress disorder. <figure><iframe src="https://www.youtube.com/embed/-R4rQMImHwE?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>In The Machinist, the main character has paranoia, hallucinations and delusions.</figcaption></figure> Hollywood’s focus on extreme cases of insomnia is a recurring pattern (for instance, <a href="https://www.imdb.com/title/tt0137523/">Fight Club</a> 1999, <a href="https://www.imdb.com/title/tt0434165/?ref_=fn_al_tt_3">Lucid</a> 2005). It’s understandable why Hollywood latches onto these extreme portrayals – to entertain us. Yet these portrayals of insomnia as something more severe or threatening, like psychosis, can increase anxiety or stigma among people living with insomnia. While it’s true other medical conditions including <a href="https://theconversation.com/explainer-whats-the-link-between-insomnia-and-mental-illness-49597">mental illnesses</a> can lead to insomnia, insomnia often exists on its own. Insomnia is often <a href="https://theconversation.com/explainer-what-is-insomnia-and-what-can-you-do-about-it-36365">caused by</a> more mundane things like too much stress, lifestyle and habits, or longer daylight hours at higher latitudes (such as in <a href="https://www.imdb.com/title/tt0278504/?ref_=fn_al_tt_1">Insomnia</a>, 2002). Something these exaggerated portrayals do well is highlight the impact sleep deprivation can have on safety, albeit extremely dramatised. Regardless of profession, <a href="https://doi.org/10.1037/xge0000717">not getting enough sleep</a> at night can substantially impact cognitive function, increasing the chance of making a mistake. <figure><iframe src="https://www.youtube.com/embed/emIHzg4VH8A?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>In Insomnia, one character has insomnia because of extended daylight hours.</figcaption></figure> <h2>Movies rarely depict treatment</h2> It is rare to see insomnia depicted as a health condition requiring medical care. Very few characters struggling with insomnia seek or receive help for it. An exception is the narrator in <a href="https://www.imdb.com/title/tt0137523/">Fight Club</a> (1999). But he has to pretend to have other illnesses to receive therapy, again suggesting insomnia is not a legitimate condition. <figure><iframe src="https://www.youtube.com/embed/BdJKm16Co6M?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>The narrator in Fight Club pretends to have other illnesses to receive therapy for insomnia.</figcaption></figure> <h2>Why does accurate representation matter?</h2> Many people only learn about the symptoms and impact of sleep disorders through pop culture and film. These portrayals can affect how others think about these disorders and can impact how people living with these disorders think about themselves. Uniform and stereotypical portrayals of insomnia can also impact people’s <a href="https://doi.org/10.1080/15402002.2011.620671">likelihood of seeking help</a>. Most of these films show young or middle-aged men experiencing insomnia. Yet women are <a href="https://doi.org/10.1093/sleep/29.1.85">more likely</a> to have insomnia than men. Insomnia is also <a href="https://doi.org/10.1016/j.jsmc.2022.03.003">more common</a> in older adults, people with a lower socioeconomic background and those living alone. People at higher risk of developing insomnia might not recognise their risk or symptoms if their experience doesn’t match what they’ve seen. <h2>We can do better</h2> While the reality of living with insomnia may not be particularly cinematic, filmmakers can surely do better than using it as a convenient plot point. There are a number of main characters living with different health conditions across pop culture. For instance, the movie <a href="https://www.imdb.com/title/tt4034228/">Manchester by the Sea</a> (2016) features someone with <a href="https://www.rcpsych.ac.uk/news-and-features/blogs/detail/cultural-blog/2017/07/08/manchester-by-the-sea">prolonged grief disorder</a> and the TV series <a href="https://www.imdb.com/title/tt6315640/?ref_=nv_sr_srsg_0_tt_8_nm_0_q_Atypical">Atypical</a> (2017-2021) features someone’s experience living with autism. But if you’re looking for an accurate portrayal of insomnia, Hollywood still has some way to go. It’s about time insomnia is depicted in a way that accurately reflects people’s experiences.<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/211823/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/aaron-schokman-1463327">Aaron Schokman</a>, PhD Candidate, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/nick-glozier-94435">Nick Glozier</a>, Professor of Psychological Medicine, BMRI & Disciplne of Psychiatry, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/whats-insomnia-like-for-most-people-who-cant-sleep-youd-never-know-from-the-movies-211823">original article</a>.

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