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Australia’s fertility rate has reached a record low. What might that mean for the economy?

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/jonathan-boymal-392960">Jonathan Boymal</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>; <a href="https://theconversation.com/profiles/ashton-de-silva-3066">Ashton De Silva</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>, and <a href="https://theconversation.com/profiles/sarah-sinclair-385470">Sarah Sinclair</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a></em></p> <p>Australia’s fertility rate has fallen to a new <a href="https://www.abs.gov.au/statistics/people/population/births-australia/latest-release">record low</a> of 1.5 babies per woman. That’s well below the “<a href="https://pubmed.ncbi.nlm.nih.gov/7834459/#:%7E:text=PIP%3A%20Replacement%20level%20fertility%20is,of%202.1%20children%20per%20woman.">replacement rate</a>” of 2.1 needed to sustain a country’s population.</p> <p>On face value, it might not seem like a big deal. But we can’t afford to ignore this issue. The health of an economy is deeply intertwined with the size and structure of its population.</p> <p>Australians simply aren’t having as many babies as they used to, raising some serious questions about how we can maintain our country’s workforce, sustain economic growth and fund important services.</p> <p>So what’s going on with fertility rates here and around the world, and what might it mean for the future of our economy? What can we do about it?</p> <h2>Are lower birth rates always a problem?</h2> <p>Falling fertility rates can actually have some <a href="https://www.rand.org/content/dam/rand/pubs/monograph_reports/2007/MR1274.pdf">short-term benefits</a>. Having fewer dependent young people in an economy can increase workforce participation, as well as boost savings and wealth.</p> <p>Smaller populations can also benefit from <a href="https://www.sciencedirect.com/science/article/abs/pii/S0927537112000620.">increased investment</a> per person in education and health.</p> <p>But the picture gets more complex in the long term, and less rosy. An ageing population can strain pensions, health care and social services. This can hinder economic growth, unless it’s <a href="https://pubmed.ncbi.nlm.nih.gov/21302431/">offset by increased productivity</a>.</p> <p>Other scholars have <a href="https://www.gsb.stanford.edu/faculty-research/publications/end-economic-growth-unintended-consequences-declining-population">warned</a> that a falling population could stifle innovation, with fewer young people meaning fewer breakthrough ideas.</p> <h2>A global phenomenon</h2> <p>The trend towards women having fewer children is not unique to Australia. The global fertility rate has dropped over the past couple of decades, from 2.7 babies per woman in 2000 to <a href="https://www.macrotrends.net/global-metrics/countries/WLD/world/fertility-rate">2.4 in 2023</a>.</p> <p>However, the distribution is not evenly spread. In 2021, 29% of the world’s babies were born in sub-Saharan Africa. This is projected to <a href="https://www.healthdata.org/news-events/newsroom/news-releases/lancet-dramatic-declines-global-fertility-rates-set-transform">rise to 54% by 2100</a>.</p> <p>There’s also a <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/psp.2720">regional-urban divide</a>. Childbearing is often delayed in urban areas and late fertility is more common in cities.</p> <p>In Australia, we see <a href="https://www.abs.gov.au/statistics/people/population/births-australia/latest-release#data-downloads">higher fertility rates</a> in inner and outer regional areas than in metro areas. This could be because of more affordable housing and a better work-life balance.</p> <p>But it raises questions about whether people are moving out of cities to start families, or if something intrinsic about living in the regions promotes higher birth rates.</p> <p><iframe id="U1wEx" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/U1wEx/1/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe></p> <h2>Fewer workers, more pressure on services</h2> <p>Changes to the makeup of a population can be just as important as changes to its size. With fewer babies being born and increased life expectancy, the proportion of older Australians who have left the workforce will keep rising.</p> <p>One way of tracking this is with a metric called the old-age dependency ratio – the number of people aged 65 and over per 100 working-age individuals.</p> <p>In Australia, this ratio is currently about 27%. But according to the latest <a href="https://treasury.gov.au/publication/2023-intergenerational-report">Intergenerational Report</a>, it’s expected to rise to 38% by 2063.</p> <p>An ageing population means greater demand for medical services and aged care. As the working-age population shrinks, the tax base that funds these services will also decline.</p> <p>Unless this is offset by technological advances or policy innovations, it can mean higher taxes, longer working lives, or the government providing fewer public services in general.</p> <h2>What about housing?</h2> <p>It’s tempting to think a falling birth rate might be good news for Australia’s stubborn housing crisis.</p> <p>The issues are linked – rising real estate prices have made it difficult for many young people to afford homes, with a significant number of people in their 20s <a href="https://pursuit.unimelb.edu.au/articles/more-australian-adult-children-are-living-with-their-parents-longer">still living with their parents</a>.</p> <p>This can mean delaying starting a family and reducing the number of children they have.</p> <p>At the same time, if fertility rates stay low, demand for large family homes may decrease, impacting one of Australia’s most significant economic sectors and sources of household wealth.</p> <h2>Can governments turn the tide?</h2> <p>Governments worldwide, including Australia, have long experimented with policies that encourage families to have more children. Examples include paid parental leave, childcare subsidies and financial incentives, such as Australia’s “<a href="https://theconversation.com/what-the-baby-bonus-boost-looks-like-across-ten-years-81563">baby bonus</a>”.</p> <p>Many of these efforts have had only limited success. One reason is the rising average age at which women have their first child. In many developed countries, including Australia, the average age for first-time mothers has surpassed <a href="https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-babies/contents/overview-and-demographics/maternal-age">30</a>.</p> <p>As women delay childbirth, they become less likely to have multiple children, further contributing to declining birth rates. Encouraging women to start a family earlier could be one policy lever, but it must be balanced with women’s growing workforce participation and career goals.</p> <p>Research has previously highlighted the factors influencing fertility decisions, including levels of paternal involvement and workplace flexibility. Countries that offer part-time work or maternity leave without career penalties have seen a <a href="https://faculty.wcas.northwestern.edu/mdo738/research/Doepke_Hannusch_Kindermann_Tertilt_Handbook_23.pdf">stabilisation or slight increases</a> in fertility rates.</p> <h2>The way forward</h2> <p>Historically, one of the ways Australia has countered its low birth rate is through immigration. Bringing in a lot of people – especially skilled people of working age – can help offset the effects of a low fertility rate.</p> <p>However, relying on immigration alone is not a long-term solution. The global fertility slump means that the pool of young, <a href="https://www.imf.org/en/Publications/fandd/issues/2020/03/can-immigration-solve-the-demographic-dilemma-peri">educated workers from other countries</a> is shrinking, too. This makes it harder for Australia to attract the talent it needs to sustain economic growth.</p> <p>Australia’s record-low fertility rate presents both challenges and opportunities. On one hand, the shrinking number of young people will place a strain on public services, innovation and the labour market.</p> <p>On the other hand, advances in technology, particularly in artificial intelligence and robotics, may help ease the <a href="https://www.sciencedirect.com/science/article/abs/pii/S0164070420302020">challenges of an ageing population</a>.</p> <p>That’s the optimistic scenario. AI and other tech-driven productivity gains could reduce the need for large workforces. And robotics could assist in aged care, lessening the impact of this demographic shift.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/241577/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/jonathan-boymal-392960">Jonathan Boymal</a>, Associate Professor of Economics, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>; <a href="https://theconversation.com/profiles/ashton-de-silva-3066">Ashton De Silva</a>, Professor of Economics, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>, and <a href="https://theconversation.com/profiles/sarah-sinclair-385470">Sarah Sinclair</a>, Senior Lecturer in Economics, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/australias-fertility-rate-has-reached-a-record-low-what-might-that-mean-for-the-economy-241577">original article</a>.</em></p> </div>

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More Australians are using their superannuation for medical procedures. But that might put their financial health at risk

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/neera-bhatia-15189">Neera Bhatia</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a></em></p> <p>A record number of Australians are accessing their superannuation early on compassionate grounds, mainly to fund their own medical procedures – or those of a family member.</p> <p>Some 150,000 Australians have used the scheme in the last five years. Nearly 40,000 people <a href="https://www.ato.gov.au/about-ato/research-and-statistics/in-detail/super-statistics/early-release/compassionate-release-of-super">had applications approved</a> in 2022-23, compared to just under 30,000 in 2018-19 – an increase of 47%.</p> <p>Some people think this flexible use of funds is a good way to ensure people can fund their own medical needs. But more transparency and better oversight is needed.</p> <h2>What are compassionate grounds?</h2> <p>Since July 2018, the Australian Tax Office has administered the early release of superannuation – meaning before <a href="https://www.ato.gov.au/individuals-and-families/super-for-individuals-and-families/super/withdrawing-and-using-your-super/super-withdrawal-options#Preservationage">retirement</a> – under certain circumstances, including compassionate grounds.</p> <p><a href="https://www.ato.gov.au/individuals-and-families/super-for-individuals-and-families/super/withdrawing-and-using-your-super/early-access-to-super/access-on-compassionate-grounds/expenses-eligible-for-release-on-compassionate-grounds">Compassionate grounds</a> for you or your dependant (such as child or spouse) are:</p> <ul> <li>medical treatment or transport</li> <li>modifying your home or vehicle to accommodate special needs for a severe disability</li> <li>palliative care for a terminal illness</li> <li>death, funeral or burial expenses</li> <li>preventing foreclosure or forced sale of your home.</li> </ul> <p>The medical treatment must be for a life-threatening illness or injury, or to alleviate acute or chronic pain, or acute or chronic mental illness.</p> <p>The treatment cannot be “readily available” through the public system. Cosmetic procedures are excluded.</p> <p>You also have to prove you cannot afford to pay part or all of the expenses without accessing your super, for example, by spending your savings, selling assets or getting a loan.</p> <p>People who can access other funding for the expense, such as via the <a href="https://theconversation.com/lists-of-eligible-supports-could-be-a-backwards-step-for-the-ndis-and-people-with-disability-236578">National Disability Insurance Scheme</a>, are ineligible.</p> <h2>Why are people using this scheme more?</h2> <p>The ATO has not explained what is driving the surge. General cost-of-living pressures may play a role. People may have fewer savings to draw on for medical procedures.</p> <p>But the treatments most commonly being accessed using superannuation – fertility treatments, weight loss surgeries and dental care – point to other systemic issues.</p> <p>There have long been issues with IVF and <a href="https://theconversation.com/why-isnt-dental-included-in-medicare-its-time-to-change-this-heres-how-239086#:%7E:text=The%20real%20reason%20dental%20hasn,has%20a%20structural%20budget%20problem.">dental care</a> not being readily available or funded in the public health system.</p> <p>Weight loss surgeries (including <a href="https://www.mayoclinic.org/tests-procedures/bariatric-surgery/about/pac-20394258">bariatric surgery</a>) can help combat potentially life-threatening conditions such as heart disease. Recent <a href="https://www.monash.edu/news/articles/fewer-australians-having-bariatric-surgery-monash-university-led-report">research</a> suggests there has been an overall drop in the number of Australians having bariatric surgeries since 2016. But of those, 95% are performed through the private system.</p> <p>While early access to super can provide individuals access to critical treatment, there are issues with how compassionate grounds are defined and regulated.</p> <h2>Lack of clarity</h2> <p>As my co-author and I <a href="https://www.unswlawjournal.unsw.edu.au/wp-content/uploads/2021/06/Issue-442-PDF-3-Bhatia-and-Porceddu.pdf">have shown</a>, the vague wording of the <a href="https://www.legislation.gov.au/F1996B00580/2022-09-28/text">Superannuation Industry regulations</a> leaves them worryingly open to interpretation.</p> <p>For example, the meaning of “mental disturbance” is not defined.</p> <p>You may not meet the criteria of having an acute or life-threatening illness, or acute or chronic pain. But if you can show a certain condition causes you acute mental disturbance, you may qualify to release your superannuation early.</p> <p>People accessing their superannuation for IVF use this criterion, for example, by arguing they need to access funds to continue treatment and alleviate the acute mental distress caused by ongoing infertility issues.</p> <p>Two registered medical practitioners are each required to submit a report demonstrating the treatment is needed, and one must be a specialist in the field in which the treatment is required. However, the regulations do not specify clearly that the specialist should have relevant qualifications.</p> <p>In the IVF example, this means the specialist opinion can be provided by a fertility doctor rather than a mental health expert – and that person may stand to profit if they later also provide treatment.</p> <h2>A closed-loop system</h2> <p>Conflict of interest is another major issue.</p> <p>There is nothing in the regulations to stop a medical practitioner – such as a dentist – being involved in all steps and then financially benefiting. They could encourage a patient to access superannuation for a treatment, write the specialist report and then also receive payment for the treatment.</p> <p>Some clinics <a href="https://www.theguardian.com/australia-news/2024/apr/06/online-ads-promote-simple-access-to-super-to-pay-for-healthcare-despite-strict-rules">promote</a> accessing superannuation as an option to pay for expensive treatments.</p> <p>This raises important questions about the independence of the process, as well as professional ethics.</p> <p>Medical practitioners making recommendations for early release of superannuation should be doing so on genuinely compassionate grounds. But the potential for exploitation remains an ethical concern, when a practitioner can financially benefit from recommending early access to nest egg funds.</p> <p>Transparency around potential <a href="https://theconversation.com/people-are-using-their-super-to-pay-for-ivf-with-their-fertility-clinics-blessing-thats-a-conflict-of-interest-161278">conflicts of interest</a> are impossible to ensure without proper oversight.</p> <h2>What is needed?</h2> <p><strong>1. Mandatory financial counselling</strong></p> <p>The ATO <a href="https://www.theage.com.au/healthcare/worrying-trend-record-number-of-australians-raid-super-to-fund-medical-treatments-20240920-p5kc44.html">has warned</a> accessing super early is not “free money”, with a spokesperson urging people to get financial advice. But the law should go a step further and make this compulsory. That way people making decisions during an emotionally charged moment can understand any future implications.</p> <p><strong>2. Tightening of the criteria</strong></p> <p>Greater clarity in the legislation – such as defining “mental disturbance” – would help prevent loopholes being exploited.</p> <p><strong>3. Better oversight</strong></p> <p>Less health-care industry involvement would promote greater transparency and independence. An independent body of medical practitioners could assess applications rather than practitioners who could financially benefit if applications are approved. This would help alleviate perceived and actual conflicts of interest.</p> <p>Accessing superannuation early may be the only option for some people to start a family or access other life-changing medical care. But they should be able to make this decision in a fully informed way, safeguarded from exploitation and aware of the implications for their future.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/239588/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/neera-bhatia-15189"><em>Neera Bhatia</em></a><em>, Associate Professor in Law, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/more-australians-are-using-their-superannuation-for-medical-procedures-but-that-might-put-their-financial-health-at-risk-239588">original article</a>.</em></p> </div>

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What’s the difference between a psychopath and a sociopath? Less than you might think

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/bruce-watt-1486350">Bruce Watt</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> and <a href="https://theconversation.com/profiles/katarina-fritzon-402205">Katarina Fritzon</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a></em></p> <p>Articles about badly behaved people and how to spot them are common. You don’t have to Google or scroll too much to find headlines such as <a href="https://psychologyeverywhere.com/articles/7-signs-your-boss-is-a-psychopath/">7 signs your boss is a psychopath</a> or <a href="https://www.elephantjournal.com/2022/08/how-to-avoid-the-sociopath-next-door-erica-leibrandt/">How to avoid the sociopath next door</a>.</p> <p>You’ll often see the terms psychopath and sociopath used somewhat interchangeably. That applies to perhaps the most famous badly behaved fictional character of all – Hannibal Lecter, the cannibal serial killer from <a href="https://www.imdb.com/title/tt0102926/">The Silence of the Lambs</a>.</p> <p>In the book on which the movie is based, Lecter is described as a “pure sociopath”. But in the movie, he’s described as a “pure psychopath”. Psychiatrists have diagnosed him with <a href="https://psychiatryonline.org/doi/pdf/10.1176/appi.psychotherapy.2002.56.1.100">something else</a> entirely.</p> <p>So what’s the difference between a psychopath and a sociopath? As we’ll see, these terms have been used at different times in history, and relate to some overlapping concepts.</p> <h2>What’s a psychopath?</h2> <p>Psychopathy has been mentioned in the psychiatric literature <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4059069/#:%7E:text=The%20term%20psychopathy%20comes%20from,which%20literally%20means%20suffering%20soul.">since the 1800s</a>. But the latest edition of the Diagnostic Statistical Manual of Mental Disorders (known colloquially as the DSM) <a href="https://www.psychiatry.org/psychiatrists/practice/dsm">doesn’t list</a> it as a recognised clinical disorder.</p> <p><a href="https://www.psychiatry.org/psychiatrists/practice/dsm/about-dsm/history-of-the-dsm#section_5">Since the 1950s</a>, labels have changed and terms such as “sociopathic personality disturbance” have been replaced with <a href="https://www.ncbi.nlm.nih.gov/books/NBK546673/">antisocial personality disorder</a>, which is what we have today.</p> <p>Someone with antisocial personality disorder has a persistent disregard for the rights of others. This includes breaking the law, repeated lying, impulsive behaviour, getting into fights, disregarding safety, irresponsible behaviours, and indifference to the consequences of their actions.</p> <p>To add to the confusion, the section in the DSM on antisocial personality disorder mentions psychopathy (and sociopathy) traits. In other words, according to the DSM the traits are part of antisocial personality disorder but are not mental disorders themselves.</p> <p>US psychiatrist <a href="https://psycnet.apa.org/record/2018-37736-001">Hervey Cleckley</a> provided the first formal description of psychopathy traits in his 1941 book <a href="https://gwern.net/doc/psychology/personality/psychopathy/1941-cleckley-maskofsanity.pdf">The Mask of Sanity</a>. He based his description on his clinical observations of nine male patients in a psychiatric hospital. He identified several key characteristics, including superficial charm, unreliability and a lack of remorse or shame.</p> <p><a href="https://psych.ubc.ca/profile/robert-hare/">Canadian psychologist</a> Professor <a href="http://www.hare.org/">Robert Hare</a> refined these characteristics by emphasising interpersonal, emotional and lifestyle characteristics, in addition to the antisocial behaviours listed in the DSM.</p> <p>When we draw together all these strands of evidence, we can say a psychopath manipulates others, shows superficial charm, is grandiose and is persistently deceptive. Emotional traits include a lack of emotion and empathy, indifference to the suffering of others, and not accepting responsibility for how their behaviour impacts others.</p> <p>Finally, a psychopath is easily bored, sponges off others, lacks goals, and is persistently irresponsible in their actions.</p> <h2>So how about a sociopath?</h2> <p>The term sociopath first appeared <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4059069/#:%7E:text=The%20term%20psychopathy%20comes%20from,which%20literally%20means%20suffering%20soul.">in the 1930s</a>, and was attributed to US psychologist George Partridge. He <a href="https://psychiatryonline.org/doi/abs/10.1176/ajp.85.6.1053?journalCode=ajp">emphasised</a> the societal consequences of behaviour that habitually violates the rights of others.</p> <p>Academics and clinicians often used the terms sociopath and psychopath interchangeably. But some <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4059069/#:%7E:text=The%20term%20psychopathy%20comes%20from,which%20literally%20means%20suffering%20soul.">preferred the term sociopath</a> because they said the public sometimes confused the word psychopath with psychosis.</p> <p>“Sociopathic personality disturbance” <a href="https://www.turkpsikiyatri.org/arsiv/dsm-1952.pdf">was the term</a> used in the first edition of the DSM in 1952. This aligned with the <a href="https://journals.sagepub.com/doi/epdf/10.1177/0306624X01453005">prevailing views</a> at the time that antisocial behaviours were largely the product of the <em>social</em> environment, and that behaviours were only judged as deviant if they broke <em>social</em>, legal, and/or cultural rules.</p> <p>Some of these early descriptions of sociopathy are more aligned with what we now call antisocial personality disorder. Others relate to emotional characteristics similar to Cleckley’s 1941 <a href="https://pubmed.ncbi.nlm.nih.gov/26618655/">definition</a> of a psychopath.</p> <p>In short, different people had different ideas about sociopathy and, even today, sociopathy is less-well defined than psychopathy. So there is no single definition of sociopathy we can give you, even today. But in general, its antisocial behaviours can be similar to ones we see with psychopathy.</p> <p>Over the decades, the term sociopathy fell out of favour. From the late 60s, psychiatrists used the term antisocial personality disorder instead.</p> <h2>Born or made?</h2> <p>Both “sociopathy” (what we now call antisocial personality disorder) and psychopathy have been associated with a wide range of developmental, biological and psychological causes.</p> <p>For example, people with psychopathic traits have <a href="https://www.theguardian.com/science/2013/may/12/how-to-spot-a-murderers-brain">certain brain differences</a> especially <a href="https://psycnet.apa.org/record/2006-01001-014">in regions</a> associated with emotions, inhibition of behaviour and problem solving. They also appear to have differences associated with their <a href="https://www.psypost.org/psychopathic-women-exhibit-low-cardiac-defense-responses-study-finds/">nervous system</a>, including a <a href="https://www.sciencedirect.com/science/article/pii/S0301051123001345?via%3Dihub">reduced heart rate</a>.</p> <p>However, sociopathy and its antisocial behaviours are a product of someone’s social environment, and tends to <a href="https://www.aic.gov.au/sites/default/files/2020-05/19-1415-FinalReport.pdf">run in families</a>. These behaviours has been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4801766/#:%7E:text=Childhood%20abuse%20is%20a%20risk,and%20psychopathic%20traits%20remain%20unclear">associated with</a> physical abuse and parental conflict.</p> <h2>What are the consequences?</h2> <p>Despite their fictional portrayals – such as Hannibal Lecter in Silence of the Lambs or Villanelle in the TV series <a href="https://www.imdb.com/title/tt7016936/">Killing Eve</a> – <a href="https://www.psychologytoday.com/au/blog/making-evil/201902/what-we-get-wrong-about-psychopaths#:%7E:text=Most%20psychopaths%20are%20not%20offenders,extreme%20violence%20or%20serial%20killing.">not all people</a> with psychopathy or sociopathy traits are serial killers or are physically violent.</p> <p>But psychopathy <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4059069/">predicts</a> a wide range of harmful behaviours. In the criminal justice system, psychopathy is strongly linked with re-offending, particularly of a violent nature.</p> <p>In the general population, psychopathy is <a href="https://www.sciencedirect.com/science/article/abs/pii/S0160252709000028?casa_token=5lSd35qRO7oAAAAA:CTu-KkDXxsoYEPvpceItex9go1Fn_YlfBQSW9O9_MwNEX6NxlZ23GRcWnS5YYV_kAig24E4Ahdj7">associated with</a> drug dependence, homelessness, and other personality disorders. Some research even showed psychopathy predicted <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8250605/">failure to follow</a> COVID restrictions.</p> <p>But sociopathy is less established as a key risk factor in identifying people at heightened risk of harm to others. And sociopathy is not a reliable indicator of future antisocial behaviour.</p> <h2>In a nutshell</h2> <p>Neither psychopathy nor sociopathy are classed as mental disorders in formal psychiatric diagnostic manuals. They are both personality traits that relate to antisocial behaviours and are associated with certain interpersonal, emotional and lifestyle characteristics.</p> <p>Psychopathy is thought to have genetic, biological and psychological bases that places someone at greater risk of violating other people’s rights. But sociopathy is less clearly defined and its antisocial behaviours are the product of someone’s social environment.</p> <p>Of the two, psychopathy has the greatest use in identifying someone who is most likely to cause damage to others.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/226714/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/bruce-watt-1486350">Bruce Watt</a>, Associate Professor in Psychology, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> and <a href="https://theconversation.com/profiles/katarina-fritzon-402205">Katarina Fritzon</a>, Associate Professor of Psychology, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/whats-the-difference-between-a-psychopath-and-a-sociopath-less-than-you-might-think-226714">original article</a>.</em></p> </div>

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Your gas stove might be making your asthma worse. Here’s what you can do about it

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/nusrat-homaira-1199433">Nusrat Homaira</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a></em></p> <p>We may think of air pollution as an outdoor problem, made up of car exhaust and smog. But if the air inside our homes is polluted, this can also affect our health.</p> <p>In Australia, around 12% of childhood asthma can <a href="https://pubmed.ncbi.nlm.nih.gov/29642816/">be attributed</a> to gas stoves and the toxic chemicals they release into the air. And while there’s a growing push to phase out gas indoors, some 38% of Australian households <a href="https://www.mja.com.au/journal/2018/208/7/damp-housing-gas-stoves-and-burden-childhood-asthma-australia">rely on natural gas</a> for cooking.</p> <p>Recommended interventions – such as replacing a gas stove with electric – may not be possible for those who are renting or struggling with the cost of living. This is important because, as our <a href="https://ghrp.biomedcentral.com/articles/10.1186/s41256-024-00361-2">research</a> shows, childhood asthma is more common in socioeconomically disadvantaged areas.</p> <p>If you’re living with gas, here’s how it can affect you or your child’s asthma, and what you can do to improve air quality.</p> <h2>What is asthma?</h2> <p>Asthma is the most common chronic condition in Australian children. The respiratory condition affects <a href="https://www.aihw.gov.au/reports/chronic-respiratory-conditions/asthma">almost</a> 400,000 of those aged aged 14 and under – close to 9% of that age group.</p> <p>Asthma narrows the airways and obstructs airflow, making it hard to breath. Many people manage the condition with inhalers and <a href="https://asthma.org.au/manage-asthma/asthma-action-plan/">asthma action plans</a>. But it can be serious and even fatal. Australian emergency departments saw <a href="https://www.aihw.gov.au/reports/chronic-respiratory-conditions/asthma">56,600 presentations</a> for asthma in 2020-21.</p> <p>While there is no single cause for asthma, both indoor and outdoor air pollution play a <a href="https://pubmed.ncbi.nlm.nih.gov/38247719/">significant role</a>.</p> <p>Being exposed to small <a href="https://aafa.org/asthma/asthma-triggers-causes/air-pollution-smog-asthma/#:%7E:text=Air%20pollution%20can%20increase%20your,if%20you%20already%20have%20asthma.&amp;text=Small%20airborne%20particles%2C%20found%20in,%E2%80%9Cparticulate%20matter%E2%80%9D%20or%20PM.">airborne particles</a> increases your risk of getting asthma, and can aggravate symptoms if you already have it.</p> <h2>Gas stoves release nitrogen dioxide</h2> <p>The gas stoves commonly found in Australian homes release toxic chemicals into the air. They include carbon monoxide (CO), PM₂.₅ (small particles, often from <a href="https://www.epa.vic.gov.au/for-community/environmental-information/air-quality/pm25-particles-in-the-air">smoke</a>), benzene, formaldehyde and nitrogen dioxide (NO₂). All are harmful, but nitrogen dioxide in particular is <a href="https://go.gale.com/ps/i.do?id=GALE%7CA656312383&amp;sid=googleScholar&amp;v=2.1&amp;it=r&amp;linkaccess=abs&amp;issn=00220892&amp;p=AONE&amp;sw=w&amp;userGroupName=anon%7E7027bb9f&amp;aty=open-web-entry">associated</a> with asthma developing and getting <a href="https://www.atsjournals.org/doi/10.1164/rccm.200408-1123OC">worse</a>.</p> <p>Gas heaters can also <a href="https://pubmed.ncbi.nlm.nih.gov/9731022/">produce</a> nitrogen dioxide.</p> <p>As nitrogen dioxide is a tasteless, invisible gas, it’s difficult to know how much is in your air at home unless you have an air monitor. However one US <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2662932/">study</a> showed houses with gas stoves can have nitrogen dioxide levels three times higher than houses with electric stoves.</p> <p>This is particularly concerning for households with children, given children tend to spend <a href="https://pubmed.ncbi.nlm.nih.gov/11477521/">most</a> of their time indoors.</p> <h2>Banning gas</h2> <p>There is a growing push across Australia to replace gas stoves with electric stoves, which are more energy efficient and can reduce indoor air pollution.</p> <p><a href="https://www.premier.vic.gov.au/new-victorian-homes-go-all-electric-2024">Victoria</a> and the <a href="https://www.climatechoices.act.gov.au/energy/canberras-electrification-pathway/preventing-new-gas-network-connections">Australian Capital Territory</a> have announced bans on gas connections in new homes from 2024. Sydney’s Waverley council recently made a similar <a href="https://www.waverley.nsw.gov.au/environment/climate_resilience_and_reducing_emissions/go_electric">move</a>.</p> <p>But until a ban on using household gas appliances is implemented across the country, the problem persists for children who are currently living in old homes or rented properties with gas stoves.</p> <h2>Do exhaust fans in the kitchen help?</h2> <p>Using a high-efficiency <a href="https://pubmed.ncbi.nlm.nih.gov/24750219/">exhaust hood</a> placed over an existing gas cooktop can be effective. They can <a href="https://www.mja.com.au/journal/2018/208/7/damp-housing-gas-stoves-and-burden-childhood-asthma-australia">capture</a> more than 75% of air pollutants and direct them outside.</p> <p>Cooking on the back burner – rather than the front burner – can also <a href="https://pubmed.ncbi.nlm.nih.gov/24750219/">improve their efficiency</a>.</p> <p>However exhaust hoods with lower flow rates, or hoods that don’t vent the air outside, are less effective.</p> <p>And an exhaust hood only improves air quality if you use it. One <a href="https://pubmed.ncbi.nlm.nih.gov/10520075/">study</a> in Melbourne found more than 40% of people didn’t use an exhaust hood regularly while cooking.</p> <p>For many people, installing high-efficiency exhaust hoods will not be practical – especially for those renting or experiencing socio-economic disadvantage.</p> <h2>Natural ventilation</h2> <p>There is a free way to ventilate your home. Keeping windows open during and after cooking will increase air flow and <a href="https://pubmed.ncbi.nlm.nih.gov/32970538/">evidence shows</a> this can improve overall air quality.</p> <p>However this is not always possible, especially during cooler months of the year which can be especially chilly in places such as Victoria and Tasmania.</p> <p>Unfortunately, people are also more likely to use gas heaters during those cooler months.</p> <h2>What about heaters?</h2> <p>There are two kinds of gas heaters, flued and unflued.</p> <p>Like cooking with gas, unflued gas heaters release air pollutants including nitrogen dioxide directly into the home. Flued heaters are better for air quality because they use a chimney, or “flue”, to send emissions outside.</p> <p>If you can, replacing your unflued gas heater with a flued one – or even better, an electric heater – can significantly <a href="https://pubmed.ncbi.nlm.nih.gov/15075170/">alleviate</a> asthma symptoms.</p> <p>If you can’t replace your unflued gas heater, <a href="https://www.health.nsw.gov.au/environment/factsheets/Pages/unflued-gas-heaters.aspx">do not use it overnight</a> in the room where you or your children sleep.</p> <p>Asthma can’t be cured, but its symptoms can be controlled by managing triggers – and this may be easier to do indoors than out. Improving air quality, even in a rented or old property, can help people with asthma breathe more easily.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/238787/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/nusrat-homaira-1199433">Nusrat Homaira</a>, Senior Lecturer, School of Clinical Medicine, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/your-gas-stove-might-be-making-your-asthma-worse-heres-what-you-can-do-about-it-238787">original article</a>.</em></p> </div>

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Flu shots play an important role in protecting against bird flu. But not for the reason you might think

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/allen-cheng-94997">Allen Cheng</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a></em></p> <p>A current strain of highly pathogenic avian influenza, commonly known as bird flu, has become a global problem. The virus has affected <a href="https://www.cdc.gov/bird-flu/situation-summary/data-map-commercial.html">many millions</a> of birds, some other <a href="https://www.cdc.gov/bird-flu/situation-summary/mammals.html">animal species</a>, and a <a href="https://cdn.who.int/media/docs/default-source/influenza/avian-and-other-zoonotic-influenza/joint-fao-oie-who-preliminary-risk-assessment-associated-with-avian-influenza-a(h5n1)-virus.pdf?sfvrsn=faa6e47e_28&amp;download=true">small number of people</a>.</p> <p>Last week, the Australian government <a href="https://www.sbs.com.au/news/article/australians-issued-new-health-risks-travel-warning-for-europe-asia-and-the-americas/gmh1hk9py">issued a warning</a> to residents travelling to Europe, North America, South America and Asia about the risk of bird flu.</p> <p>The alert, published on the <a href="https://www.smartraveller.gov.au/news-and-updates/highly-pathogenic-avian-influenza-outbreak">Smartraveller website</a>, included advice to ensure your flu vaccine is up to date. If you are about to go travelling, this generally means if you’ve had a flu jab this year, although if it has been 3–6 months since your vaccine you should discuss this with your doctor.</p> <p>But the seasonal flu vaccine we get each year doesn’t actually prevent bird flu in humans. So why is it being recommended in this context?</p> <h2>Some bird flu background</h2> <p>Smartraveller notes <a href="https://www.smartraveller.gov.au/news-and-updates/highly-pathogenic-avian-influenza-outbreak">several strains</a> of bird flu are currently circulating.</p> <p>The most concerning strain, called the <a href="https://www.nature.com/articles/s41467-023-38415-7">2.3.4.4b clade</a>, emerged a few years ago from a type of influenza A (H5, or A/H5) that has been circulating for several decades.</p> <p>Clade 2.3.4.4b primarily affects birds, including wild birds and poultry. It has had <a href="https://theconversation.com/uk-poultry-can-roam-free-outside-again-but-bird-flu-risk-hasnt-gone-away-203361">devastating effects</a> on bird populations, as well as farmers and others involved in the poultry industry.</p> <p>In recent years, clade 2.3.4.4b has adapted to <a href="https://www.nature.com/articles/s44298-024-00039-z">infect some mammals</a>. Unfortunately it seems to cause severe disease in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11083745/">certain animals</a>. Some marine mammals have been hit particularly hard, with mass mortality events <a href="https://www.theguardian.com/environment/2023/dec/08/mass-deaths-elephant-seals-penguins-bird-flu-antarctic-ecological-disaster-aoe">reported</a> in elephant seals and sea lions. In the United States, bird flu has also spread <a href="https://www.cdc.gov/bird-flu/situation-summary/mammals.html">among dairy cows</a>.</p> <p>Compared to the huge number of animal cases, there have been a relatively small number of <a href="https://www.who.int/publications/m/item/joint-fao-who-woah-preliminary-assessment-of-recent-influenza-a(h5n1)-viruses">humans infected with bird flu</a>. Since 2003, <a href="https://www.who.int/publications/m/item/cumulative-number-of-confirmed-human-cases-for-avian-influenza-a(h5n1)-reported-to-who--2003-2023--3-october-2023">878 cases</a> of A/H5N1 influenza have been reported in humans, with a small proportion of these reported since 2020 when <a href="https://www.outbreak.gov.au/emerging-risks/high-pathogenicity-avian-influenza">clade 2.3.4.4b first emerged</a>. The reported cases have been people who have had close contact with infected animals. It does not appear to spread from person to person.</p> <p>As such, the <a href="https://www.ecdc.europa.eu/en/infectious-disease-topics/z-disease-list/avian-influenza/threats-and-outbreaks/risk-assessment-h5">risk to travellers is low</a>. There are some situations where the risk may be greater, such as for people visiting live markets, or those who are travelling specifically to work with wildlife or animals in food production.</p> <p><a href="https://www.who.int/publications/m/item/joint-fao-who-woah-preliminary-assessment-of-recent-influenza-a(h5n1)-viruses">Infections in humans</a> with H5 influenza can vary significantly in severity, from mild conjunctivitis up to fatal pneumonia. H5 influenza strains appear to be <a href="https://asm.org/articles/2024/june/what-you-should-know-about-avian-influenza-a-h5n1">sensitive to antivirals</a> (oseltamivir, also known as Tamiflu) and they are generally <a href="https://www.cdc.gov/bird-flu/hcp/novel-av-treatment-guidance/">recommended</a> as treatment for human infection, but it’s <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01307-2/fulltext">not clear</a> whether they reduce the risk of death in those with severe disease.</p> <p>To date, one case of A/H5 influenza (not 2.3.4.4b) has been <a href="https://www.abc.net.au/news/2024-05-22/bird-flu-avian-influenza-human-detection/103879886">reported in Australia</a>, in a child who had recently returned from overseas.</p> <p>While <a href="https://www.fao.org/animal-health/situation-updates/global-aiv-with-zoonotic-potential/en">clade 2.3.4.4b has been detected</a> in all continents <a href="https://www.outbreak.gov.au/emerging-risks/high-pathogenicity-avian-influenza">except Australia</a>, other avian influenza strains (A/H7) <a href="https://www.outbreak.gov.au/current-outbreaks/avian-influenza">have been reported here</a> earlier this year.</p> <h2>Seasonal flu vaccines are not effective against bird flu</h2> <p>Seasonal influenza refers to the flu strains that circulate each year. Since the COVID pandemic, three different strains have circulated in various proportions – influenza A H1N1 (descended from the <a href="https://www.nature.com/articles/nature08182">2009 swine flu strain</a>), influenza A H3N2 (which has <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6149781/">circulated since 1968</a>) and an influenza B strain. Interestingly, a second influenza B strain (the Yamagata lineage) <a href="https://www.nejm.org/doi/full/10.1056/NEJMp2314801">appears to have vanished</a> during the COVID pandemic.</p> <p>Seasonal influenza vaccines contain up-to-date variants of these types (A/H1N1, A/H3N2 and B) that are recommended by the World Health Organization each year. They are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5912669/">moderately effective</a>, reducing the risk of hospitalisation by about 40–60%.</p> <p>Influenza vaccines are quite specific in the protection that they provide. For seasonal vaccines, even the very small changes that occur in the virus from year to year are enough to allow them to “escape” vaccine-induced immunity. Therefore seasonal flu vaccines <a href="https://www.cdc.gov.au/topics/avian-influenza-bird-flu">do not provide any protection</a> against A/H5 influenza.</p> <h2>Preventing a hybrid bird-human strain</h2> <p>The rationale for recommending travellers have a flu shot in the context of the current bird flu outbreak is that seasonal flu vaccines may help reduce the risk of simultaneous infection with both A/H5 and a seasonal influenza strain.</p> <p>When this occurs, there is potential for a “recombination” of the genetic code from both viral strains. This could have the transmissibility of a seasonal human virus with the severity of an avian influenza virus. The 2009 swine flu strain <a href="https://www.nejm.org/doi/full/10.1056/NEJMra0904322">arose from the recombination</a> of several strains over years to become more transmissible in humans.</p> <p>Obviously a more effective vaccine would include a H5 strain, to generate immune responses specific to the H5 flu strain. Vaccine manufacturers have <a href="https://www.ema.europa.eu/en/medicines/human/EPAR/celldemic">developed H5 vaccines</a> over the years, but to date <a href="https://thl.fi/en/-/avian-influenza-vaccinations-begin-vaccine-to-be-offered-to-persons-at-increased-risk-of-infection">only Finland</a> has deployed a H5 vaccine in a small group of people who work closely with potentially infected animals.</p> <p>Currently the <a href="https://www.ecdc.europa.eu/en/infectious-disease-topics/z-disease-list/avian-influenza/threats-and-outbreaks/risk-assessment-h5">level of risk</a> posed by H5 to humans is not thought to be sufficient to require a specific vaccine program, as the potential benefits are small compared to the costs and the potential risks associated with any new vaccine program.</p> <h2>The value of a flu shot for travellers</h2> <p>Seasonal flu vaccines protect against influenza infection, and may also reduce the risk of simultaneous infection with human and bird flu strains. Bird flu aside, for most travellers who haven’t received a flu shot this year, reducing the risk of illness disrupting travel plans should be enough of a reason to get one.</p> <p>For those who have already received a flu shot this season, similar to COVID jabs, protection after vaccination appears to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8499703/">wane over time</a>. So if you’re travelling to the northern hemisphere during the winter months, and it’s been more than 3–6 months since you received a flu vaccine, your doctor may recommend you have another.</p> <p>Bird flu is only a small risk to most travellers, but people may want to take sensible precautions, such as avoiding close contact with birds at markets.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/237859/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/allen-cheng-94997">Allen Cheng</a>, Professor of Infectious Diseases, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/flu-shots-play-an-important-role-in-protecting-against-bird-flu-but-not-for-the-reason-you-might-think-237859">original article</a>.</em></p> </div>

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Do you have knee pain from osteoarthritis? You might not need surgery. Here’s what to try instead

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/belinda-lawford-1294188">Belinda Lawford</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a>; <a href="https://theconversation.com/profiles/giovanni-e-ferreira-1030477">Giovanni E. Ferreira</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/joshua-zadro-504754">Joshua Zadro</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/rana-hinman-1536232">Rana Hinman</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a></em></p> <p>Most people with knee osteoarthritis can control their pain and improve their mobility without surgery, according to <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard">updated treatment guidelines</a> from the Australian Commission on Safety and Quality in Health Care.</p> <p>So what is knee osteoarthritis and what are the best ways to manage it?</p> <h2>More than 2 million Australians have osteoarthritis</h2> <p>Osteoarthritis is the most common joint disease, affecting <a href="https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/osteoarthritis">2.1 million Australians</a>. It <a href="https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/osteoarthritis">costs the economy</a> A$4.3 billion each year.</p> <p>Osteoarthritis commonly <a href="https://pubmed.ncbi.nlm.nih.gov/33560326/">affects</a> the knees, but can also affect the hips, spine, hands and feet. It impacts the whole joint including bone, cartilage, ligaments and muscles.</p> <p>Most people with osteoarthritis have persistent pain and find it difficult to perform simple daily tasks, such as walking and climbing stairs.</p> <h2>Is it caused by ‘wear and tear’?</h2> <p>Knee osteoarthritis is most likely to affect older people, those who are overweight or obese, and those with previous knee injuries. But contrary to popular belief, knee osteoarthritis is <a href="https://pubmed.ncbi.nlm.nih.gov/31192807/">not caused by</a> “wear and tear”.</p> <p><a href="https://pubmed.ncbi.nlm.nih.gov/21281726/">Research shows</a> the degree of structural wear and tear visible in the knee joint on an X-ray does not correlate with the level of pain or disability a person experiences. Some people have a low degree of structural wear and tear and very bad symptoms, while others have a high degree of structural wear and tear and minimal symptoms. So X-rays are <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard">not required</a> to diagnose knee osteoarthritis or guide treatment decisions.</p> <p>Telling people they have wear and tear can make them worried about their condition and afraid of damaging their joint. It can also encourage them to try invasive and potentially unnecessary treatments such as surgery. We have <a href="https://pubmed.ncbi.nlm.nih.gov/37795555/">shown this</a> in people with osteoarthritis, and other common pain conditions such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9545091/">back</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/33789444/">shoulder</a> pain.</p> <p>This has led to a global call for a <a href="https://pubmed.ncbi.nlm.nih.gov/38354847/">change in the way</a> we think and communicate about osteoarthritis.</p> <h2>What’s the best way to manage osteoarthritis?</h2> <p>Non-surgical treatments work well for most people with osteoarthritis, regardless of their age or the severity of their symptoms. These <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard">include</a> education and self-management, exercise and physical activity, weight management and nutrition, and certain pain medicines.</p> <p>Education is important to dispel misconceptions about knee osteoarthritis. This includes information about what osteoarthritis is, how it is diagnosed, its prognosis, and the most effective ways to self-manage symptoms.</p> <p>Health professionals who use positive and reassuring language <a href="https://pubmed.ncbi.nlm.nih.gov/35750241/">can improve</a> people’s knowledge and beliefs about osteoarthritis and its management.</p> <p>Many people believe that exercise and physical activity will cause further damage to their joint. But it’s safe and can reduce pain and disability. Exercise has fewer side effects than commonly used pain medicines such as <a href="https://pubmed.ncbi.nlm.nih.gov/36593092/">paracetamol and anti-inflammatories</a> and can <a href="https://pubmed.ncbi.nlm.nih.gov/26488691/">prevent or delay</a> the need for joint replacement surgery in the future.</p> <p>Many types of exercise <a href="https://pubmed.ncbi.nlm.nih.gov/30830561/">are effective</a> for knee osteoarthritis, such as strength training, aerobic exercises like walking or cycling, Yoga and Tai chi. So you can do whatever type of exercise best suits you.</p> <p>Increasing general physical activity is also important, such as taking more steps throughout the day and reducing sedentary time.</p> <p>Weight management is important for those who are overweight or obese. Weight loss <a href="https://pubmed.ncbi.nlm.nih.gov/34843383/">can reduce knee pain and disability</a>, particularly when combined with exercise. Losing as little as 5–10% of your body weight <a href="https://pubmed.ncbi.nlm.nih.gov/36474793/">can be beneficial</a>.</p> <p>Pain medicines should not replace treatments such as exercise and weight management but can be used alongside these treatments to help manage pain. <a href="https://pubmed.ncbi.nlm.nih.gov/33786837/">Recommended medicines</a> include paracetamol and non-steroidal anti-inflammatory drugs.</p> <p>Opioids are <a href="https://pubmed.ncbi.nlm.nih.gov/35137418/">not recommended</a>. The risk of harm outweighs any potential benefits.</p> <h2>What about surgery?</h2> <p>People with knee osteoarthritis commonly undergo two types of surgery: knee arthroscopy and knee replacement.</p> <p>Knee arthroscopy is a type of keyhole surgery used to remove or repair damaged pieces of bone or cartilage that are thought to cause pain.</p> <p>However, high-quality research <a href="https://pubmed.ncbi.nlm.nih.gov/24369076/">has shown</a> arthroscopy is not effective. Arthroscopy should therefore not be used in the management of knee osteoarthritis.</p> <p>Joint replacement involves replacing the joint surfaces with artificial parts. In 2021–22, <a href="https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/osteoarthritis">53,500 Australians</a> had a knee replacement for their osteoarthritis.</p> <p>Joint replacement is often seen as being inevitable and “necessary”. But most people can effectively manage their symptoms through exercise, physical activity and weight management.</p> <p>The new guidelines (known as “care standard”) recommend joint replacement surgery only be considered for those with severe symptoms who have already tried non-surgical treatments.</p> <h2>I have knee osteoarthritis. What should I do?</h2> <p>The <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard">care standard</a> links to free evidence-based resources to support people with osteoarthritis. These include:</p> <ul> <li>education, such as a <a href="https://www.england.nhs.uk/wp-content/uploads/2023/07/making-a-decision-about-knee-osteoarthritis-v1.pdf.pdf">decision aid</a> and <a href="http://www.futurelearn.com/courses/taking-control-hip-and-knee-osteoarthritis">four-week online course</a></li> <li>self-directed <a href="https://healthsciences.unimelb.edu.au/departments/physiotherapy/chesm/patient-resources/my-knee-exercise">online exercise</a> and <a href="https://myjointyoga.com.au/">yoga</a> programs</li> <li><a href="https://www.gethealthynsw.com.au/program/standard-coaching/">weight management support</a></li> <li>pain management strategies, such as <a href="https://www.myjointpain.org.au/">MyJointPain</a> and <a href="http://www.paintrainer.org/">painTRAINER</a>.</li> </ul> <p>If you have osteoarthritis, you can use the <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard">care standard</a> to inform discussions with your health-care provider, and to make informed decisions about your care.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/236779/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/belinda-lawford-1294188"><em>Belinda Lawford</em></a><em>, Postdoctoral research fellow in physiotherapy, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a>; <a href="https://theconversation.com/profiles/giovanni-e-ferreira-1030477">Giovanni E. Ferreira</a>, NHMRC Emerging Leader Research Fellow, Institute of Musculoskeletal Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/joshua-zadro-504754">Joshua Zadro</a>, NHMRC Emerging Leader Research Fellow, Sydney Musculoskeletal Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/rana-hinman-1536232">Rana Hinman</a>, Professor in Physiotherapy, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/do-you-have-knee-pain-from-osteoarthritis-you-might-not-need-surgery-heres-what-to-try-instead-236779">original article</a>.</em></p> </div>

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Are you up to date with your COVID, flu and other shots? It might depend on who your GP is

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/peter-breadon-1348098">Peter Breadon</a>, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> and <a href="https://theconversation.com/profiles/anika-stobart-1014358">Anika Stobart</a>, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a></em></p> <p>Too many older Australians are <a href="https://grattan.edu.au/wp-content/uploads/2023/11/A-fair-shot-How-to-close-the-vaccination-gap-Grattan-Institute-Report.pdf">missing out</a> on recommended vaccinations for COVID, flu, shingles and pneumococcal that can protect them from serious illness, hospitalisation and even death.</p> <p>A new <a href="https://grattan.edu.au/">Grattan Institute report</a> shows vaccination rates vary widely from GP to GP, highlighting an important place to look for opportunities to boost vaccination.</p> <p>Many people get vaccinated at pharmacies, and those vaccinations are counted in our analysis. But we looked at GPs because they have a unique role overseeing someone’s health care, and an important role promoting vaccination.</p> <p>We found that for some GPs, nine in ten of their older patients were vaccinated for flu. For others, the rate was only four in ten. The differences for shingles and COVID were even bigger. For pneumococcal disease, there was a 13-fold difference in GPs’ patient vaccination rates.</p> <p>While some variation is inevitable, these differences are large, and they result in too many people missing out on recommended vaccines.</p> <h2>Some GPs treat more complex patients</h2> <p>A lot of these differences reflect the fact that GPs see different types of patients.</p> <p>Our research shows older people who aren’t proficient in English are up to 15% less likely to be vaccinated, even after other factors are taken into account. And the problem seems to be getting worse.</p> <p>COVID vaccination rates for people 75 years and older fell to just 36% in May 2024. But rates were even lower – a mere 11% – for people who don’t speak English proficiently, and 15% for those who speak a language other than English at home.</p> <p>Given these results, it’s no surprise that GPs with fewer patients who are vaccinated also have more patients who struggle with English. For GPs with the lowest vaccination rates, one-quarter of their patients aren’t proficient in English. For GPs with the highest vaccination rates, it is only 1%.</p> <p>GPs with fewer vaccinated patients also saw more people who live in rural areas, are poorer, didn’t go to university, and don’t have regular access to a GP, all of which reduce the likelihood of getting vaccinated.</p> <p>Many of these barriers to vaccination are difficult for GPs to overcome. They point to structural problems in our health system, and indeed our society, that go well beyond vaccination.</p> <p>But GPs are also a key part of the puzzle. A <a href="https://www.ijidonline.com/article/S1201-9712(14)01379-4/fulltext">strong</a> <a href="https://www.tandfonline.com/doi/full/10.1080/21645515.2020.1780848">recommendation</a> from a GP can make a big difference to whether a patient gets vaccinated. <a href="https://www.aihw.gov.au/reports/primary-health-care/general-practice-allied-health-primary-care">Nearly all</a> older Australians visit a GP every year. And some GPs have room for improvement.</p> <h2>But GPs seeing similar patients can have very different vaccination rates</h2> <p>We compared GPs whose patients had a similar likelihood of being vaccinated, based on a range of factors including their health, wealth and cultural background.</p> <p>Among the GPs whose patients were least likely to get a flu vaccination, some saw less than 40% of their patients vaccinated, while for others in that group, the rate was over 70%.</p> <p>Among GPs with patients who face few barriers to vaccination, the share of their patients who were vaccinated also varied widely.</p> <p>Even within neighbourhoods, GP patient vaccination rates vary a lot. For example, in Bankstown in Sydney, there was a seven-fold difference in COVID vaccination rates and an 18-fold difference for pneumococcal vaccination.</p> <p>Not everything about clinics and patients can be measured in data, and there will be good reasons for some of these differences.</p> <p>But the results do suggest that some GPs are beating the odds to overcome patient barriers to getting vaccinated, while other GPs could be doing more. That should trigger focused efforts to raise vaccination rates where they are low.</p> <h2>So what should governments do?</h2> <p>A comprehensive national reform agenda is <a href="https://grattan.edu.au/wp-content/uploads/2023/11/A-fair-shot-How-to-close-the-vaccination-gap-Grattan-Institute-Report.pdf">needed to increase adult vaccination</a>. That includes clearer guidance, national advertising campaigns, SMS reminders, and tailored local programs that reach out to communities with very low levels of vaccination.</p> <p>But based on the big differences in GPs’ patient vaccination rates, Australia also needs a three-pronged plan to help GPs lift older Australians’ vaccination rates.</p> <p>First, the way general practice is funded needs to be overhauled, providing more money for the GPs whose patients face higher barriers to vaccination. Today, clinics with patients who are poorer, sicker and who struggle with English tend to get less funding. They should get more, so they can spend more time with patients to explain and promote vaccination.</p> <p>Second, GPs need to be given data, so that they can easily see how their vaccination rates compare to GPs with similar patients.</p> <p>And third, Primary Health Networks – which are responsible for improving primary care in their area – should give clinics with low vaccination rates the help they need. That might include running vaccination sessions, sharing information about best practices that work in similar clinics with higher vaccination rates, or offering translation support.</p> <p>And because pharmacies also play an important role in promoting and providing vaccines, governments should give them data too, showing how their rates compare to other pharmacies in their area, and support to boost vaccination uptake.</p> <p>These measures would go a long way to better protect some of the most vulnerable in our society. Governments have better data than ever before on who is missing out on vaccinations – and other types of health care.</p> <p>They shouldn’t miss the opportunity to target support so that no matter where you live, what your background is, or which GP or pharmacy you go to, you will have the best chance of being protected against disease.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/234175/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/peter-breadon-1348098"><em>Peter Breadon</em></a><em>, Program Director, Health and Aged Care, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> and <a href="https://theconversation.com/profiles/anika-stobart-1014358">Anika Stobart</a>, Senior Associate, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/are-you-up-to-date-with-your-covid-flu-and-other-shots-it-might-depend-on-who-your-gp-is-234175">original article</a>.</em></p> </div>

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Spending too much time on social media and doomscrolling? The problem might be FOMO

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/kim-m-caudwell-1258935">Kim M Caudwell</a>, <a href="https://theconversation.com/institutions/charles-darwin-university-1066">Charles Darwin University</a></em></p> <p>For as long as we have used the internet to <a href="https://www.theguardian.com/technology/2016/mar/07/email-ray-tomlinson-history">communicate and connect with each other</a>, it has influenced how we think, feel and behave.</p> <p>During the COVID pandemic, many of us were <a href="https://www.sciencedirect.com/science/article/pii/S0277953622007985">“cut off” from our social worlds</a> through restrictions, lockdowns and mandates. Understandably, many of us tried to <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0258344">find ways to connect online</a>.</p> <p>Now, as pandemic restrictions have lifted, some of the ways we use the internet have become concerning. Part of what drives problematic internet use may be something most of us are familiar with – the fear of missing out, or FOMO.</p> <p>In <a href="https://link.springer.com/article/10.1186/s12888-024-05834-9">our latest research</a>, my colleagues and I investigated the role FOMO plays in two kinds of internet use: problematic social media use and “doomscrolling”.</p> <h2>What are FOMO, problematic social media use and doomscrolling?</h2> <p>FOMO is the fear some of us experience when we get a sense of “missing out” on things happening in our social scene. Psychology researchers have been studying FOMO for <a href="https://doi.org/10.1016/j.chb.2013.02.014">more than a decade</a>, and it has consistently been linked to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8283615/">mental health and wellbeing</a>, <a href="https://www.sciencedirect.com/science/article/pii/S0376871624001947">alcohol use</a> and <a href="https://doi.org/10.1016/j.chb.2021.106839">problematic social media use</a>.</p> <p>Social media use becomes a problem for people when they have difficulty controlling urges to use social media, have difficulty cutting back on use, and where the use has a negative impact on their everyday life.</p> <p>Doomscrolling is characterised by a need to constantly look at and <a href="https://www.bbc.com/worklife/article/20210226-the-darkly-soothing-compulsion-of-doomscrolling">seek out “bad” news</a>. Doomscrollers may constantly refresh their news feeds or stay up late to read bad news.</p> <p>While problematic social media use has been around for a while, doomscrolling seems to be a more recent phenomenon – <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7735659/">attracting research attention</a> during and following the pandemic.</p> <h2>What we tried to find out</h2> <p>In our study, we wanted to test the idea that FOMO leads individuals to engage in problematic use behaviours due to their difficulty in managing the “fear” in FOMO.</p> <p>The key factor, we thought, was <a href="https://link.springer.com/article/10.1023/b:joba.0000007455.08539.94">emotion regulation</a> – our ability to deal with our emotions. We know some people tend to be good at this, while others find it difficult. In fact, greater difficulties with emotion regulation was linked to experiencing <a href="https://www.sciencedirect.com/science/article/pii/S088761852100058X">greater acute stress related to COVID</a>.</p> <p>However, an idea that has been gaining attention recently is <a href="https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2021.636919/full">interpersonal emotion regulation</a>. This means looking to others to help us regulate our emotions.</p> <p>Interpersonal emotion regulation can be helpful (such as “<a href="https://link.springer.com/article/10.1007/s11031-016-9569-3">affective engagement</a>”, where someone might listen and talk about your feelings) or unhelpful (such as “<a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2F0012-1649.43.4.1019">co-rumination</a>” or rehashing problems together), depending on the context.</p> <p>In our analyses, we sought to uncover how both <em>intrapersonal</em> emotion regulation (ability to self-manage our own emotional states) and <em>interpersonal</em> emotion regulation (relying on others to help manage our emotions) accounted for the link between FOMO and problematic social media use, and FOMO and doomscrolling, respectively.</p> <h2>What we found – and what it might mean for the future of internet use</h2> <p>Our findings indicated that people who report stronger FOMO engage in problematic social media use because of difficulty regulating their emotions (intrapersonally), and they look to others for help (interpersonally).</p> <p>Similarly, people who report stronger FOMO are drawn to doomscrolling because of difficulty regulating their emotions intrapersonally (within themselves). However, we found no link between FOMO and doomscrolling through interpersonal emotion regulation.</p> <p>We suspect this difference may be due to doomscrolling being more of a solitary activity, occurring outside more social contexts that facilitate interpersonal regulation. For instance, there are probably fewer people with whom to share your emotions while staying up trawling through bad news.</p> <p>While links between FOMO and doomscrolling have been observed before, our study is among the first to try and account for this theoretically.</p> <p>We suspect the link between FOMO and doomscrolling may be more about having more of an online presence <em>while things are happening</em>. This would account for intrapersonal emotion regulation failing to help manage our reactions to “bad news” stories as they unfold, leading to doomscrolling.</p> <p>Problematic social media use, on the other hand, involves a more complex interpersonal context. If someone is feeling the fear of being “left out” and has difficulty managing that feeling, they may be drawn to social media platforms in part to try and elicit help from others in their network.</p> <h2>Getting the balance right</h2> <p>Our findings suggest the current discussions around <a href="https://www.nbcnews.com/news/us-news/psychology-group-says-infinite-scrolling-social-media-features-are-par-rcna147876">restricting social media use for young people</a>, while controversial, are important. We need to balance our need for social connection – which is happening increasingly online – with the <a href="https://www.biomedcentral.com/collections/spia#tab-3">detrimental consequences </a> associated with problematic internet use behaviours.</p> <p>It is important to also consider the nature of social media platforms and how they have changed over time. For example, adolescent social media use patterns across various platforms are <a href="https://link.springer.com/article/10.1007/s10964-019-01060-9">associated with</a> different mental health and socialisation outcomes.</p> <p>Public health policy experts and legislators have quite the challenge ahead of them here. Recent work has shown how loneliness is <a href="https://doi.org/10.1371/journal.pone.0190033">a contributing factor</a> to all-cause mortality (death from any cause).</p> <p>We have long known, too, that social connectedness is <a href="https://doi.org/10.1371/journal.pone.0190033">good for our mental health</a>. In fact, last year, the World Health Organization established a <a href="https://www.who.int/news/item/15-11-2023-who-launches-commission-to-foster-social-connection">Commission on Social Connection</a> to help promote the importance of socialisation to our lives.</p> <p>The recent controversy in the United States around the ownership of TikTok illustrates how central social media platforms are to our lives and ways of interacting with one another. We need to <a href="https://www.theguardian.com/commentisfree/article/2024/may/27/dominic-andre-tiktok-ban">consider the rights of individuals</a> to use them as they please, but understand that governments carry the responsibility of <a href="https://www.theguardian.com/technology/2023/apr/04/what-does-tiktoks-ban-on-australian-government-devices-mean-for-its-future">protecting users from harm</a> and safeguarding their privacy.</p> <hr /> <p><em>If you feel concerned about problematic social media use or doomscrolling, you can speak to a healthcare or mental health professional. You can also call <a href="https://www.lifeline.org.au/">Lifeline</a> on 13 11 14, or <a href="https://www.13yarn.org.au/">13 YARN</a> (13 92 76) to yarn with Aboriginal or Torres Strait Islander crisis supporters.</em><!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/230980/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/kim-m-caudwell-1258935">Kim M Caudwell</a>, Senior Lecturer - Psychology | Chair, Researchers in Behavioural Addictions, Alcohol and Drugs (BAAD), <a href="https://theconversation.com/institutions/charles-darwin-university-1066">Charles Darwin University</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/spending-too-much-time-on-social-media-and-doomscrolling-the-problem-might-be-fomo-230980">original article</a>.</em></p> </div>

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Not all ultra-processed foods are bad for your health, whatever you might have heard

<div class="theconversation-article-body"> <p><em><a href="https://theconversation.com/profiles/gary-sacks-3957">Gary Sacks</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a>; <a href="https://theconversation.com/profiles/kathryn-backholer-10739">Kathryn Backholer</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a>; <a href="https://theconversation.com/profiles/kathryn-bradbury-1532662">Kathryn Bradbury</a>, <a href="https://theconversation.com/institutions/university-of-auckland-waipapa-taumata-rau-1305">University of Auckland, Waipapa Taumata Rau</a>, and <a href="https://theconversation.com/profiles/sally-mackay-1532685">Sally Mackay</a>, <a href="https://theconversation.com/institutions/university-of-auckland-waipapa-taumata-rau-1305">University of Auckland, Waipapa Taumata Rau</a></em></p> <p>In recent years, there’s been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11036430/">increasing</a> <a href="https://theconversation.com/ultra-processed-foods-heres-what-the-evidence-actually-says-about-them-220255#:%7E:text=Hype%20around%20ultra%2Dprocessed%20food,or%20worry%20about%20their%20health.">hype</a> about the potential health risks associated with so-called “ultra-processed” foods.</p> <p>But new evidence published <a href="https://www.bmj.com/content/385/bmj-2023-078476">this week</a> found not all “ultra-processed” foods are linked to poor health. That includes the mass-produced wholegrain bread you buy from the supermarket.</p> <p>While this newly published research and associated <a href="https://www.bmj.com/content/385/bmj.q793">editorial</a> are unlikely to end the wrangling about how best to define unhealthy foods and diets, it’s critical those debates don’t delay the implementation of policies that are likely to actually improve our diets.</p> <h2>What are ultra-processed foods?</h2> <p><a href="https://pubmed.ncbi.nlm.nih.gov/30744710/">Ultra-processed foods</a> are industrially produced using a variety of processing techniques. They typically include ingredients that can’t be found in a home kitchen, such as preservatives, emulsifiers, sweeteners and/or artificial colours.</p> <p>Common examples of ultra-processed foods include packaged chips, flavoured yoghurts, soft drinks, sausages and mass-produced packaged wholegrain bread.</p> <p>In <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7719194/#CR13">many other countries</a>, ultra-processed foods make up a large proportion of what people eat. A <a href="https://pubmed.ncbi.nlm.nih.gov/31676952/">recent study</a> estimated they make up an average of 42% of total energy intake in Australia.</p> <h2>How do ultra-processed foods affect our health?</h2> <p>Previous <a href="https://pubmed.ncbi.nlm.nih.gov/33167080/">studies</a> have linked increased consumption of ultra-processed food with poorer health. High consumption of ultra-processed food, for example, has been associated with a <a href="https://pubmed.ncbi.nlm.nih.gov/38418082/">higher risk</a> of type 2 diabetes, and death from heart disease and stroke.</p> <p>Ultra-processed foods are typically high in energy, added sugars, salt and/or unhealthy fats. These have long been <a href="https://www.who.int/news-room/fact-sheets/detail/healthy-diet">recognised</a> as risk factors for a range of diseases.</p> <p>It has also been suggested that structural changes that happen to ultra-processed foods as part of the manufacturing process <a href="https://pubmed.ncbi.nlm.nih.gov/31105044/">may</a> lead you to eat more than you should. Potential explanations are that, due to the way they’re made, the foods are quicker to eat and more palatable.</p> <p>It’s also <a href="https://pubmed.ncbi.nlm.nih.gov/35952706/">possible</a> certain food additives may impair normal body functions, such as the way our cells reproduce.</p> <h2>Is it harmful? It depends on the food’s nutrients</h2> <p>The <a href="https://www.bmj.com/content/385/bmj-2023-078476">new paper</a> just published used 30 years of data from two large US cohort studies to evaluate the relationship between ultra-processed food consumption and long-term health. The study tried to disentangle the effects of the manufacturing process itself from the nutrient profile of foods.</p> <p>The study found a small increase in the risk of early death with higher ultra-processed food consumption.</p> <p>But importantly, the authors also looked at diet quality. They found that for people who had high quality diets (high in fruit, vegetables, wholegrains, as well as healthy fats, and low in sugary drinks, salt, and red and processed meat), there was no clear association between the amount of ultra-processed food they ate and risk of premature death.</p> <p>This suggests overall diet quality has a stronger influence on long-term health than ultra-processed food consumption.</p> <p>When the researchers analysed ultra-processed foods by sub-category, mass-produced wholegrain products, such as supermarket wholegrain breads and wholegrain breakfast cereals, were not associated with poorer health.</p> <p>This finding matches another recent <a href="https://pubmed.ncbi.nlm.nih.gov/38417577/">study</a> that suggests ultra-processed wholegrain foods are not a driver of poor health.</p> <p>The authors concluded, while there was some support for limiting consumption of certain types of ultra-processed food for long-term health, not all ultra-processed food products should be universally restricted.</p> <h2>Should dietary guidelines advise against ultra-processed foods?</h2> <p>Existing national <a href="https://www.eatforhealth.gov.au/sites/default/files/2022-09/n55_australian_dietary_guidelines.pdf">dietary</a> <a href="https://www.health.govt.nz/system/files/documents/publications/eating-activity-guidelines-new-zealand-adults-updated-2020-oct22.pdf">guidelines</a> have been developed and refined based on decades of nutrition evidence.</p> <p>Much of the recent evidence related to ultra-processed foods tells us what we already knew: that products like soft drinks, alcohol and processed meats are bad for health.</p> <p>Dietary guidelines <a href="https://pubmed.ncbi.nlm.nih.gov/35184508/">generally</a> already advise to eat mostly whole foods and to limit consumption of highly processed foods that are high in refined grains, saturated fat, sugar and salt.</p> <p>But some nutrition researchers have <a href="https://www.bmj.com/content/384/bmj.q439">called</a> for dietary guidelines to be amended to recommend avoiding ultra-processed foods.</p> <p>Based on the available evidence, it would be difficult to justify adding a sweeping statement about avoiding all ultra-processed foods.</p> <p>Advice to avoid all ultra-processed foods would likely unfairly impact people on low-incomes, as many ultra-processed foods, such as supermarket breads, are relatively affordable and convenient.</p> <p>Wholegrain breads also provide important nutrients, such as fibre. In many countries, bread is the <a href="https://www.health.govt.nz/system/files/documents/publications/a-focus-on-nutrition-ch3_0.pdf">biggest contributor</a> to fibre intake. So it would be problematic to recommend avoiding supermarket wholegrain bread just because it’s ultra-processed.</p> <h2>So how can we improve our diets?</h2> <p>There is strong <a href="https://www.foodpolicyindex.org.au/_files/ugd/7ee332_a2fa1694e42f423195caf581044fccf1.pdf">consensus</a> on the need to implement evidence-based policies to improve population diets. This includes legislation to restrict children’s exposure to the marketing of unhealthy foods and brands, mandatory Health Star Rating nutrition labelling and taxes on sugary drinks.</p> <p>These policies are underpinned by <a href="https://pubmed.ncbi.nlm.nih.gov/37659696/">well-established systems</a> for classifying the healthiness of foods. If new evidence unfolds about mechanisms by which ultra-processed foods drive health harms, these classification systems can be updated to reflect such evidence. If specific additives are found to be harmful to health, for example, this evidence can be incorporated into existing nutrient profiling systems, such as the <a href="http://www.healthstarrating.gov.au/internet/healthstarrating/publishing.nsf/content/home">Health Star Rating</a> food labelling scheme.</p> <p>Accordingly, policymakers can confidently progress food policy implementation using the tools for classifying the healthiness of foods that we already have.</p> <p>Unhealthy diets and obesity are among the <a href="https://www.aihw.gov.au/reports/burden-of-disease/burden-of-disease-study-2018-key-findings/contents/key-findings">largest contributors</a> to poor health. We can’t let the hype and academic debate around “ultra-processed” foods delay implementation of globally recommended policies for improving population diets.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/229493/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/gary-sacks-3957">Gary Sacks</a>, Professor of Public Health Policy, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a>; <a href="https://theconversation.com/profiles/kathryn-backholer-10739">Kathryn Backholer</a>, Co-Director, Global Centre for Preventive Health and Nutrition, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a>; <a href="https://theconversation.com/profiles/kathryn-bradbury-1532662">Kathryn Bradbury</a>, Senior Research Fellow in the School of Population Health, <a href="https://theconversation.com/institutions/university-of-auckland-waipapa-taumata-rau-1305">University of Auckland, Waipapa Taumata Rau</a>, and <a href="https://theconversation.com/profiles/sally-mackay-1532685">Sally Mackay</a>, Senior Lecturer Epidemiology and Biostatistics, <a href="https://theconversation.com/institutions/university-of-auckland-waipapa-taumata-rau-1305">University of Auckland, Waipapa Taumata Rau</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/not-all-ultra-processed-foods-are-bad-for-your-health-whatever-you-might-have-heard-229493">original article</a>.</em></p> </div>

Food & Wine

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Eye infections might seem like a minor complaint – but in some cases they can cause blindness and even death

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/adam-taylor-283950">Adam Taylor</a>, <a href="https://theconversation.com/institutions/lancaster-university-1176">Lancaster University</a></em></p> <p>When you think of eye infections, what comes to mind? Puffy, swollen bruised feeling eyelids that get glued together with gunk overnight? That feeling of having grit in your eye that can’t be cleaned away? Eye infections may seem like a relatively minor – if unsightly and inconvenient – complaint, but they can also be far more serious.</p> <p>Take the deadly outbreak of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5022785/">antibiotic resistant</a> bacteria <a href="https://www.cff.org/managing-cf/burkholderia-cepacia-complex-b-cepacia"><em>Burkholderia cepacia</em></a> in 2023-24, for example.</p> <p>Between January 2023 and February 2024, contaminated brands of lubricating eye gel were linked to the infection of at least 52 patients. <a href="https://www.independent.co.uk/news/health/contaminated-eye-gel-outbreak-death-b2523446.html">One person died</a> and at least 25 others suffered serious infections.</p> <p>The outbreak has now subsided and products are <a href="https://www.gov.uk/drug-device-alerts/specific-brands-of-carbomer-eye-gel-recall-of-aacarb-eye-gel-aacomer-eye-gel-and-puroptics-eye-gel-potential-risk-of-infection-dsi-slash-2023-slash-11#update-2-april-2024">back on the shelves</a> but it isn’t the first time that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8335909/">medicinal products</a> have led to outbreaks of <em>B cepacia</em>.</p> <p>The bacterium is an opportunistic pathogen known to pose a significant risk to people with cystic fibrosis, chronic lung conditions and weakened immune systems. The infection likely progresses from the mucous membranes of the eyelids to the lungs where it leads to pneumonia and septicaemia causing <a href="https://erj.ersjournals.com/content/17/2/295">death in days</a>.</p> <p>But it’s not just <em>B cepacia</em> that can threaten our health. Something as simple as rubbing our eyes can introduce pathogens leading to infection, blindness and, in the worst case, death.</p> <p>Bacteria account for up to <a href="https://pubmed.ncbi.nlm.nih.gov/16148850/">70% of eye infections</a> and globally <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9032492/">over 6 million people</a> have blindness or moderate visual impairment from ocular infection. Contact lens wearers are at <a href="https://www.aao.org/eye-health/diseases/contact-lens-related-eye-infections">increased risk</a>.</p> <figure><iframe src="https://www.youtube.com/embed/pWsx8i1kaxs?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p>The eye is a unique structure. It converts light energy to chemical and then electrical energy, which is transmitted to the brain and converted to a picture. The eye uses about <a href="https://www.ncbi.nlm.nih.gov/books/NBK11556/">6 million cones and 120 million rods</a> which detect colour and light.</p> <p>Eye cells have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8775779/">no ability to regenerate</a> so, once damaged or injured, cannot be repaired or replaced. The body tries its best to preserve the eyes by encasing them in a <a href="https://www.ncbi.nlm.nih.gov/books/NBK531490/">bony protective frame</a> and <a href="https://www.ncbi.nlm.nih.gov/books/NBK482428/">limiting exposure</a> having eyelids to defend against the environmental damage and ensure the eyes are kept lubricated.</p> <p>Despite our bodies’ best efforts to shield the eyes from harm, there are a number of common eye infections that can result from introducing potential pathogens into the eyes.</p> <h2>Conjunctivitis</h2> <p>The outer-most layer of the eye, the sclera, bears the brunt of exposure and to help protect it, it is lined by a thin moist membrane called the <a href="https://my.clevelandclinic.org/health/body/24329-conjunctiva">conjunctiva</a>.</p> <figure><iframe src="https://www.youtube.com/embed/RZ4danuJwd0?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p>The conjunctiva is <a href="https://innovations.bmj.com/content/9/4/253">highly vascularised</a>, which means it has lots of blood vessels. When microbes enter the eye, it is this layer that mounts an immune response causing <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8328962/">blood vessels to dilate</a> in the conjunctiva. This results in <a href="https://www.cdc.gov/conjunctivitis/about/symptoms.html">“pink eye”</a>, a common form of conjunctivitis. Conjunctivitis can be caused by bacteria, allergens or viruses and typically heals by itself.</p> <h2>Blepharitis</h2> <p>Blepharitis is an inflammation of the eyelid and usually affects both sides. It can cause itchy eyes and dandruff-like flakes. It’s most commonly caused by <a href="https://www.tandfonline.com/doi/pdf/10.3109/09273948.2013.870214"><em>Staphylococcus</em> bacteria</a>, or the <a href="https://cks.nice.org.uk/topics/blepharitis/background-information/causes/">dysfunction of the glands</a> of the eyelids. It can be treated by <a href="https://www.nhs.uk/conditions/blepharitis/">cleaning the eyes</a> regularly.</p> <h2>Stye</h2> <p>A stye (also called <a href="https://www.college-optometrists.org/clinical-guidance/clinical-management-guidelines/hordeolum">hordeolum</a>) is a painful infection of the upper or lower eyelid. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5370090/">Internal styes</a> are caused by infection of an oil-producing gland inside the eyelid, whereas <a href="https://pubmed.ncbi.nlm.nih.gov/28723014/">external styes</a> develop at the base of the eyelash because of an infection of the hair follicle. Both are caused by bacteria, typically <a href="https://jamanetwork.com/journals/jamaophthalmology/fullarticle/1874715">the <em>S aureus</em> form of the <em>Staphylococcus</em> species</a>.</p> <figure><iframe src="https://www.youtube.com/embed/INKrGOdy824?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p>Styes can be treated by holding a clean flannel soaked in warm water against the affected eye for five to ten minutes, three or four times a day. Do not try to burst styes – this could spread the infection.</p> <h2>Keratitis</h2> <p>Keratitis is the inflammation of the cornea, the transparent part of the eye that light passes through. The cornea is part of the eye’s main barrier against dirt, germs, and disease. Severe keratitis can cause ulcers, damage to the eye and even blindness.</p> <p>The most common type is bacterial keratitis; however, it can also be caused by <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7998329/">amoeba</a>, which can migrate to other parts of the body – including the brain – and cause infection and <a href="https://theconversation.com/nasal-rinsing-why-flushing-the-nasal-passages-with-tap-water-to-tackle-hay-fever-could-be-fatal-225811">even death</a>.</p> <p>Noninfectious keratitis is most commonly caused by wearing contact lenses for too long, especially while sleeping. This can cause scratches, dryness and soreness of the cornea, which leads to inflammation.</p> <h2>Uveitis</h2> <p><a href="https://www.nhs.uk/conditions/uveitis/">Uveitis</a> is inflammation of the middle layer of the eye. Although relatively rare, it is a serious condition and usually results from viral infections such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8501150/">herpes simplex</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/29023181/">herpes zoster</a> or <a href="https://link.springer.com/chapter/10.1007/978-3-319-09126-6_40">trauma</a>. Depending on where the inflammation is in the eye, the symptoms can be anything from redness, pain and floaters to blurred vision and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1772296/">partial blindness</a>.</p> <h2>Exogenous endophthalmitis</h2> <p>This is a rare but serious infection caused by eye surgery complications, penetrating ocular trauma (being stabbed in the eye with a sharp object) or foreign bodies in the eye. Foreign bodies can be anything from dirt and dust to small projectiles such as shards of metal from drilling, explosives or soil from farm machinery and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7286045/">many other sources</a>.</p> <h2>Dacryocystitis</h2> <p>Dacryocystitis is the inflammation of the nasolacrimal sac, which drains tears away from the eye into the nose. This condition can be <a href="https://pubmed.ncbi.nlm.nih.gov/8443113/">acute</a>, <a href="https://www.nature.com/articles/6700662">chronic</a> or <a href="https://www.jebmh.com/articles/a-study-of-congenital-dacryocystitis.pdf.pdf">acquired at birth</a>. Most cases are caused by <a href="https://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-020-01792-4"><em>Streptococcus pneumoniae</em> and <em>Staphylococcus aureus</em></a> bacteria.</p> <p>The condition mainly affects newborns and those over 40. Seventy-five per cent of cases are women and it’s most commonly found in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6039673/">white adults</a>. It can lead to the stagnation of tears, creating a breeding ground for microbes.</p> <h2>Careful with contacts</h2> <p>Proper eye hygiene reduces the risk of all these conditions – and this is even more important for contact lens wearers.</p> <figure><iframe src="https://www.youtube.com/embed/uENHAntJOIA?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p>Appropriate hygienic cleaning of lenses is paramount. <a href="https://pubmed.ncbi.nlm.nih.gov/30789440/">Non-sterile water</a>, <a href="https://www.aao.org/eye-health/glasses-contacts/contact-lens-care">spit</a> and other fluids can transfer <a href="https://www.science.org/content/article/bacteria-living-your-contact-lens-solution">potentially dangerous</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3482476/">microbes</a> into the eye – a warm, moist environment that makes an ideal breeding ground for bacteria – leading to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9542356/">localised infection</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3972779/">blindness</a> or progress to a more serious <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9835757/">systemic infection or death</a>.</p> <p>Any persistent and painful redness or swelling of eyes should be checked by a registered health professional.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/227252/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/adam-taylor-283950">Adam Taylor</a>, Professor and Director of the Clinical Anatomy Learning Centre, <a href="https://theconversation.com/institutions/lancaster-university-1176">Lancaster University</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/eye-infections-might-seem-like-a-minor-complaint-but-in-some-cases-they-can-cause-blindness-and-even-death-227252">original article</a>.</em></p> </div>

Body

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Drugs like Ozempic won’t ‘cure’ obesity but they might make us more fat-phobic

<p><em><a href="https://theconversation.com/profiles/emma-beckett-22673">Emma Beckett</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a></em></p> <p>Many have <a href="https://www.economist.com/leaders/2023/03/02/new-drugs-could-spell-an-end-to-the-worlds-obesity-epidemic">declared</a> drugs like Ozempic could “end obesity” by reducing the appetite and waistlines of millions of people around the world.</p> <p>When we look past the hype, this isn’t just untrue – it can also be harmful. The focus on weight, as opposed to health, is a feature of <a href="https://www.sciencedirect.com/science/article/abs/pii/S0277539521001217">diet culture</a>. This frames the pursuit of thinness as more important than other aspects of physical and cultural wellbeing.</p> <p>The Ozempic buzz isn’t just rooted in health and medicine but plays into ideas of <a href="https://butterfly.org.au/weight-bias-fatphobia-diet-culture/#:%7E:text=Weight%20bias%2C%20sometimes%20also%20called,or%20being%20around%20fat%20people.">fat stigma and fat phobia</a>. This can perpetuate fears of fatness and fat people, and the behaviours that <a href="https://link.springer.com/article/10.1186/S12916-018-1116-5">harm people who live in larger bodies</a>.</p> <h2>Not the first ‘miracle’ weight-loss drug</h2> <p>This isn’t the first time we have heard that weight-loss drugs will change the world. Ozempic and <a href="https://www.ncbi.nlm.nih.gov/books/NBK551568/">its family</a> of GLP-1-mimicking drugs are the <a href="https://theconversation.com/ozempic-is-in-the-spotlight-but-its-just-the-latest-in-a-long-and-strange-history-of-weight-loss-drugs-209324">latest in a long line of weight loss drugs</a>. Each looked promising at the time. But none have lived up to the hype in the long term. Some have even been withdrawn from sale due to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5126837/">severe side effects</a>.</p> <p>Science does improve <a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(20)30028-8/fulltext">incrementally</a>, but diet culture also keeps us on a cycle of hope for the next <a href="https://sahrc.org/2022/04/diet-culture-a-brief-history/">miracle cure</a>. So drugs like Ozempic might not deliver the results individuals expect, continuing the cycle of hope and shame.</p> <h2>Ozempic doesn’t work the same for everyone</h2> <p>When we talk about the results of studies using Ozempic, we often <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719041/">focus on the average</a> (also known as the mean) results or the maximum (or peak) results. So, studies might <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">show</a> those using the drug lost an average of 10.9% of their body weight, but some lost more than 20% and others less than 5%</p> <p>What we don’t talk about as much is that responses are variable. Some people are “<a href="https://www.sciencedirect.com/science/article/pii/S2212877820301769">non-responders</a>”. This means not everyone loses as much weight as the average, and some don’t lose weight at all. For some people, the side-effects will outweigh the benefits.</p> <p>When people are on drugs like Ozempic, their blood sugar is better controlled by enhancing the release of insulin and reducing the levels of another hormone called glucagon.</p> <p>But there is greater variability in the amount of <a href="https://www.sciencedirect.com/science/article/pii/S2212877820301769#bib88">weight lost</a> than the variability in blood sugar control. It isn’t clear why, but is likely due to differences in genetics and lifestyles, and weight being more complex to regulate.</p> <h2>Treatment needs to be ongoing. What will this mean?</h2> <p>When weight-loss drugs do work, they are only effective while they’re being taken. This means that to keep the weight off people need to keep taking them long term. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9542252/">One study found</a> an average weight loss of more than 17% after a year on Ozempic became an average net weight loss of 5.6% more than two years after stopping treatment.</p> <p>Short-term side effects of drugs like Ozempic include dizziness, nausea, vomiting and other gastrointestinal upsets. But because these are new drugs, we simply don’t have data to tell us if side effects will increase as people take them for longer periods.</p> <p>Nor do we know if <a href="https://www.medicalnewstoday.com/articles/why-weight-loss-drugs-stop-working-how-to-break-past-ozempic-plateau#:%7E:text=A%20lifetime%20commitment%20to%20Ozempic&amp;text=By%20these%20standards%2C%20such%20drugs,long%2Dterm%20risk%20is%20unknown.">effectiveness will be reduced</a> in the long term. This is called <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/drug-tolerance#:%7E:text=A%20condition%20that%20occurs%20when,or%20different%20medicine%20is%20needed.">drug tolerance</a> and is documented for other long-term treatments such as antidepressants and chemotherapies.</p> <h2>Biology is only part of the story</h2> <p>For some people, using GLP-1-mimicking drugs like Ozempic will be validating and empowering. They will feel like their biology has been “normalised” in the same way that blood pressure or cholesterol medication can return people to the “normal” range of measures.</p> <p>But biologically, obesity <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202176/#:%7E:text=Obesity%20behaves%20as%20complex%20polygenic,about%2080%25%20(3).">isn’t solely about GLP-1 activity</a> with <a href="https://www.worldobesity.org/what-we-do/our-policy-priorities/the-roots-of-obesity">many other</a> hormones, physical activity, and even our gut microbes involved.</p> <p>Overall, <a href="https://www.ncbi.nlm.nih.gov/books/NBK278977/">obesity is complex and multifaceted</a>. Obesity isn’t just driven by personal biology and choice; it has social, cultural, political, environmental and economic determinants.</p> <h2>A weight-centred approach misses the rest of the story</h2> <p>The weight-centred approach <a href="https://butterfly.org.au/body-image/health-not-weight/#:%7E:text=Health%20and%20wellbeing%20are%20multi,on%20their%20size%20or%20appearance.">suggests that leading with thinness means health will follow</a>. But changing appetite is only part of the story when it comes to health.</p> <p>Obesity often <a href="https://www.sciencedirect.com/science/article/pii/S2667368123000335#:%7E:text=Obesity%20related%20malnutrition%20can%20also,%5D%2C%20%5B7%5D%5D.">co-exists with malnutrition</a>. We try to separate the effects in research using statistics, but focusing on the benefits of weight-loss drugs without addressing the underlying malnutrition means we aren’t likely to see the <a href="https://www.wsj.com/articles/ozempic-diet-exercise-healthy-43eee86c">improved health outcomes in everyone who loses weight</a>.</p> <h2>Obesity isn’t an issue detached from people</h2> <p>Even when it is well-intentioned, the rhetoric around the joy of “ending the obesity epidemic” can <a href="https://theconversation.com/ozempic-the-miracle-drug-and-the-harmful-idea-of-a-future-without-fat-211661">harm people</a>. Obesity doesn’t occur in isolation. It is people who are obese. And the celebration and hype of these weight-loss drugs can reinforce harmful fat stigma.</p> <p>The framing of these drugs as a “cure” exacerbates the binary view of thin versus fat, and healthy versus unhealthy. These are not binary outcomes that are good or bad. Weight and health exist on a spectrum.</p> <p>Ironically, while fat people are told they need to lose weight for their health, they are also <a href="https://www.dailytelegraph.com.au/news/nsw/ozempic-shame-why-users-are-embarrassed-to-admit-using-weight-loss-wonder-drug/news-story/ee52a819c69459afe6576d25988f9bd6">shamed for “cheating” or taking shortcuts</a> by using medication.</p> <h2>Drugs are tools, not silver bullets</h2> <p>The creation of these drugs is a start, but they remain expensive, and the hype has been followed by <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023#:%7E:text=Consumer%20Medicine%20Information%20.-,Why%20the%20Ozempic%20shortage%20happened,label%20prescribing%20for%20weight%20loss.">shortages</a>. Ultimately, complex challenges aren’t addressed with simple solutions. This is particularly true when people are involved, and even more so when there isn’t even an agreement on what the challenge is.</p> <p>Many organisations and individuals see obesity is a disease and believe this framing helps people to seek treatment.</p> <p>Others think it’s unnecessary to attach medical labels to body types and <a href="https://www.forbes.com/sites/geoffreykabat/2013/07/09/why-labeling-obesity-as-a-disease-is-a-big-mistake/?sh=5ca95cc2103b">argue</a> it confuses risk factors (things that are linked to increased risk of illness) with illness itself.</p> <p>Regardless, two things will always remain true. Drugs can only ever be tools, and those tools need to be applied in a context. To use these tools ethically, we need to remain mindful of who this application harms along the way.</p> <hr /> <p><em>Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-series-154673">Ozempic series</a> here.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/219309/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></em></p> <p><em><a href="https://theconversation.com/profiles/emma-beckett-22673">Emma Beckett</a>, Adjunct Senior Lecturer, Nutrition, Dietetics &amp; Food Innovation - School of Health Sciences, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/drugs-like-ozempic-wont-cure-obesity-but-they-might-make-us-more-fat-phobic-219309">original article</a>.</em></p>

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

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

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Might we see child-free zones on flights?

<p>Ah, the joys of air travel. The excitement of jetting off to exotic locales, the thrill of new adventures, and of course, the endless possibilities for unexpected entertainment. And what's more exhilarating than finding yourself seated next to a rowdy toddler or an inconsolable infant? It's the stuff of dreams, truly.</p> <p>Picture this: you're settling into your seat, envisioning a serene journey ahead, perhaps catching up on your favourite Netflix series or finally finishing that novel you've been meaning to read.</p> <p>But wait, what's this?</p> <p>A couple with a baby approaching your row.</p> <p>You can already hear the distant wails of despair echoing through the cabin. Your heart sinks as you realise that your peaceful flight just took a nosedive before it even began.</p> <p>Yes, it's the age-old dilemma of child-free travellers everywhere. Whether it's the cacophony of a crying baby or the rhythmic drumming of tiny feet on the back of your seat, flying with children nearby can be an experience like no other. And let's not forget the classic game of "Will they or won't they?" as you anxiously await to see if the parents will be able to tame their pint-sized companions or if chaos will reign supreme at 30,000 feet.</p> <p>But fear not, dear passengers, for there may be a solution on the horizon. Could child-free zones be the answer to our airborne woes? According to a <a href="https://travel.nine.com.au/latest/planes-should-there-be-child-free-zones/d463b299-5258-418f-831c-f5fb218f1d77" target="_blank" rel="noopener">recent poll conducted by Nine News</a>, a whopping 73 per cent of respondents were in favour of such a proposition. Finally, a sanctuary where one can escape the unpredictable antics of tiny humans and bask in the tranquility of uninterrupted inflight bliss.</p> <p>Of course, implementing such a scheme may prove to be a tad challenging. After all, how does we go about segregating the child-rearing masses from the child-free elite without inciting a riot at the boarding gate? It's a logistical nightmare that even the most seasoned airline execs would hesitate to tackle.</p> <p>So, for now, it seems we child-free flyers will have to make do with our trusty noise-cancelling headphones, our steadfast eye masks, and a healthy dose of empathy for our fellow passengers. After all, parenting is no easy feat, especially at 35,000 feet.</p> <p><em>Image: Getty</em></p>

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We talked to dozens of people about their experience of grief. Here’s what we learned (and how it’s different from what you might think)

<p><em><a href="https://theconversation.com/profiles/michelle-peterie-564209">Michelle Peterie</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/alex-broom-121063">Alex Broom</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p>Have you ever felt a sudden pang of sadness? A bird seems to stop and look you in the eye. A photo drops out of a messy drawer from long ago, in the mundanity of a weekend spring clean.</p> <p>Your day is immediately derailed, unsettled. You are pulled into something you thought was past. And yet, in being pulled back, you are grateful, reconnected, and grief-stricken all over again.</p> <p>“You’ll get over it”. “Give it time”. “You need time to move on”. These are common cultural refrains in the face of loss. But what if grief doesn’t play by the rules? What if grief is a different thing altogether?</p> <p>We talked to 95 people about their experiences of grief surrounding the loss of a loved one, and <a href="https://journals.sagepub.com/doi/10.1177/00380261241228412">their stories</a> provided a fundamentally different account of grief to the one often presented to us culturally.</p> <h2>Disordered grief?</h2> <p>Grief is often imagined as a time-bound period in which one processes the pain of loss – that is, adjusts to absence and works toward “moving on”. The bereaved are expected to process their pain within the confines of what society deems “normal”.</p> <p>The <a href="https://theconversation.com/explainer-what-is-the-dsm-and-how-are-mental-disorders-diagnosed-9568">DSM-5 psychiatric manual</a> says if grief drags on too long, in fact, it becomes a pathology (a condition with a medical diagnosis). “Prolonged grief disorder” is the name given to “persistent difficulties associated with bereavement that exceeded expected social, cultural, or religious expectations”.</p> <p>While there can be <a href="https://theconversation.com/why-prolonged-grief-should-be-listed-as-a-mental-disorder-4262">value</a> in clinical diagnostic categories such as this, the danger is they put artificial boundaries around emotions. The pathologisation of grief can be deeply alienating to those experiencing it, for whom the pressure to “move on” can be hurtful and counterproductive.</p> <p>The stories we gathered in our research were raw, complex and often fraught. They did not sit comfortably with commonsense understandings of how grief “should” progress. As bereaved daughter Barbara told us: "Grief is not in the little box, it doesn’t even come close to a little box."</p> <h2>Grief starts early</h2> <p>The tendency is to think of grief as something that happens post death. The person we love dies, we have a funeral, and the grief sets in. Then it slowly subsides with the steady march of time.</p> <p>In fact, grief often begins earlier, often in a clinical consultation where the words “terminal” or “nothing more we can do” are used. Or when a loved one is told “go home and get your life in order”. Grief can begin months or even years before bereavement.</p> <p>As the people we interviewed experienced it, loss was also cumulative. The gradual deterioration of a loved one’s health in the years or months before their death imposed other painful losses: the loss of chosen lifestyles, the loss of longstanding relational rhythms, the loss of shared hopes and anticipated futures.</p> <p>Many participants felt their loved ones – and, indeed, the lives they shared with them – slipping away long before their physical deaths.</p> <h2>Living with the dead</h2> <p>Yet the dead do not simply leave us. They remain with us, in memories, rituals and cultural events. From <a href="https://theconversation.com/what-ancient-cultures-teach-us-about-grief-mourning-and-continuity-of-life-86199">Mexico’s Dia de los Muertos</a> to <a href="https://theconversation.com/japans-obon-festival-how-family-commemoration-and-ancestral-worship-shapes-daily-life-179890">Japan’s Opon</a>, festivals of the dead play a key role in cultures around the world. In that way, remembering the dead remains a critical aspect of living. So too does <a href="https://theconversation.com/theres-not-always-closure-in-the-never-ending-story-of-grief-3096">the ongoing experience of grief</a>.</p> <p>Events of this kind are not merely celebratory. They are critical forms through which life and death, joy and grief, are brought together and integrated. The absence of remembering can hold its own trouble, as our participants’ accounts revealed.</p> <p>As bereaved wife Anna explained: "I just find it really frustrating and I do get quite angry and upset sometimes. I know that life goes on. I’d be talking to girlfriends and stuff like that and it’s like they’ve forgotten that I’ve lost my husband. They haven’t, but nothing really changed in their life. But for me, and my family, it has."</p> <p>Part of the problem, here, is the ambivalent role grief plays in advanced industrialised societies like ours. Many of our participants felt pressure to perform resilience or (in clinical terms) to <a href="https://journals.sagepub.com/doi/full/10.1177/1363459317724854">“recover” quickly after loss</a>.</p> <p>But whose interests does a swift recovery serve? An employer’s? Friends who just want to get on with a death-free life? And, even more importantly, mightn’t ongoing connections with the dead enable better living? Might bringing the dead along with us actually make for better deaths and better lives?</p> <p>Many of our participants felt their loved ones remained with them, and experienced their “absent presence” as a source of comfort. Grieving, in this context, involved spending time “with” the dead.</p> <p>Anna described her practice as follows: "I had a diary, so I just write stuff in it about how I’m feeling or something happened and I’ll say to [my deceased husband], it’s all to [my deceased husband], “Do you remember, blah, blah, blah.” I’ll just talk about that memory that I have of that particular time and I find that that helps."</p> <h2>Caring for those who grieve</h2> <p>Grief does not begin at death, but neither do relationships end there.</p> <p>To rush the bereaved through grief – to usher them towards “recovery” and the more comfortable territories of happiness and productivity – is to do them a disservice.</p> <p>And, perhaps more critically, ridding our lives of the dead and grief may, in the end, make for more limited and muted emotional lives.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/223848/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/michelle-peterie-564209"><em>Michelle Peterie</em></a><em>, Research Fellow, Sydney Centre for Healthy Societies, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/alex-broom-121063">Alex Broom</a>, Professor of Sociology &amp; Director, Sydney Centre for Healthy Societies, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/we-talked-to-dozens-of-people-about-their-experience-of-grief-heres-what-we-learned-and-how-its-different-from-what-you-might-think-223848">original article</a>.</em></p>

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‘Self-love’ might seem selfish. But done right, it’s the opposite of narcissism

<p><em><a href="https://theconversation.com/profiles/ian-robertson-1372650">Ian Robertson</a>, <a href="https://theconversation.com/institutions/university-of-wollongong-711">University of Wollongong</a></em></p> <p>“To love what you are, the thing that is yourself, is just as if you were embracing a glowing red-hot iron” <a href="https://archive.org/details/jungsseminaronni0000jung">said psychonalyst Carl Jung</a>.</p> <p>Some may argue this social media generation does not seem to struggle with loving themselves. But is the look-at-me-ism so easily found on TikTok and Instagram the kind of self-love we need in order to flourish?</p> <p>The language of <a href="https://theconversation.com/teaching-positive-psychology-skills-at-school-may-be-one-way-to-help-student-mental-health-and-happiness-217173">positive psychology</a> can be – and often is – appropriated for all kinds of self-importance, as well as cynical marketing strategies.</p> <p>Loving yourself, though, psychological experts stress, is not the same as behaving selfishly. There’s a firm line between healthy and appropriate forms of loving yourself, and malignant or <a href="https://theconversation.com/how-many-types-of-narcissist-are-there-a-psychology-expert-sets-the-record-straight-207610">narcissistic</a> forms. But how do we distinguish between them?</p> <p>In 2023, researchers Eva Henschke and Peter Sedlmeier conducted <a href="https://www.researchgate.net/publication/355152846_What_is_self-love_Redefinition_of_a_controversial_construct">a series of interviews</a> with psychotherapists and other experts on what self-love is. They’ve concluded it has three main features: self-care, self-acceptance and self-contact (devoting attention to yourself).</p> <p>But as an increasingly individualistic society, are we already devoting too much attention to ourselves?</p> <h2>Philosophy and self-love</h2> <p>Philosophers and psychology experts alike have considered the ethics of self-love.</p> <p>Psychology researcher Li Ming Xue and her colleagues, <a href="https://www.frontiersin.org/articles/10.3389/fpsyg.2021.585719/full">exploring the notion of self-love in Chinese culture</a>, claim “Western philosophers believe that self-love is a virtue”. But this is a very broad generalisation.</p> <p>In the Christian tradition and in much European philosophy, <a href="https://www.tandfonline.com/doi/full/10.1080/10848770.2020.1839209">says philosopher Razvan Ioan</a>, self-love is condemned as a profoundly damaging trait.</p> <p>On the other hand, <a href="https://www.jstor.org/stable/2107991">many of the great Christian philosophers</a>, attempting to make sense of the instruction to love one’s neighbour as oneself, admitted certain forms of self-love were virtuous. In order to love your neighbour as yourself, you must, it would seem, love yourself.</p> <p>In the Western philosophical context, claim Xue and her colleagues, self-love is concerned with individual rights – “society as a whole only serves to promote an individual’s happiness”.</p> <p>This individualistic, self-concerned notion of self-love, they suggest, might come from the Ancient Greek philosophers. In particular, Aristotle. But <a href="https://www.psychologytoday.com/intl/blog/philosophy-stirred-not-shaken/201502/love-yourself-love-your-character">Aristotle thought only the most virtuous</a>, who benefited the society around them, should love themselves. By making this connection, he avoided equating self-love with self-centredness.</p> <p>We should love ourselves not out of vanity, he argued, but in virtue of our capacity for good. Does Aristotle, then, provide principled grounds for distinguishing between proper and improper forms of self-love?</p> <h2>Bar too high?</h2> <p>Aristotle might set the bar too high. If only the most virtuous should try to love themselves, this collides head-on with the idea loving yourself can help us improve and become more virtuous – as <a href="https://link.springer.com/chapter/10.1057/9781137383310_6">philosophers Kate Abramson and Adam Leite have argued</a>.</p> <p>Many psychologists claim self-love is important for adopting the kind and compassionate self-perception crucial for overcoming conditions that weaponise self-criticism, like <a href="https://theconversation.com/clinical-perfectionism-when-striving-for-excellence-gets-you-down-43704">clinical perfectionism</a> and <a href="https://theconversation.com/how-many-people-have-eating-disorders-we-dont-really-know-and-thats-a-worry-121938">eating disorders</a>.</p> <p>More broadly, some argue compassion for oneself is necessary to support honest insights into your own behaviour. They believe we need warm and compassionate self-reflection to avoid the defensiveness that comes with the fear of judgement – even if we’re standing as our own judge.</p> <p>For this reason, a compassionate form of self-love is often necessary to follow Socrates’ advice to “know thyself”, says <a href="https://link.springer.com/article/10.1007/s10677-015-9578-4">philosopher Jan Bransen</a>. Positive self-love, by these lights, can help us grow as people.</p> <h2>Self-love ‘misguided and silly’</h2> <p>But not everyone agrees you need self-love to grow. The late philosopher <a href="https://www.theguardian.com/news/2005/nov/29/guardianobituaries.obituaries">Oswald Hanfling</a> was deeply sceptical of this idea. In fact, he argued the notion of loving oneself was misguided and silly. His ideas are mostly rejected by philosophers of love, but pointing out where they go wrong can be useful.</p> <p>When you love someone, he said, you’re prepared to sacrifice your own interests for those of your beloved. But he thought the idea of sacrificing your own interests made no sense – which shows, he concluded, we can’t love ourselves.</p> <p><a href="https://www.jstor.org/stable/3751159">He wrote</a>: "I may sacrifice an immediate satisfaction for the sake of my welfare in the future, as in the case of giving up smoking. In this case, however, my motive is not love but self-interest. What I reveal in giving up smoking is not the extent of my love for myself, but an understanding that the long-term benefits of giving it up are likely to exceed the present satisfaction of going on with it."</p> <p>We often have conflicting interests (think of someone who is agonising over two different career paths) – and it’s not at all strange to sacrifice certain interests for the sake of others.</p> <p>This is not just a question of sacrificing short-term desires in favour of a long-term good, but a matter of sacrificing something of value for your ultimate benefit (or, so you hope).</p> <h2>Self-compassion</h2> <p>Hanfling fails to consider the role of compassionate self-love. While we might understand it’s in our interests to do something (for instance, repair bridges with someone we’ve fallen out with), it might take a compassionate and open disposition towards ourselves to recognise what’s in our best interests.</p> <p>We might need this self-compassion, too, in order to admit our failures – so we can overcome our defensiveness and see clearly how we’re failing to fulfil <a href="https://link.springer.com/article/10.1007/s10677-015-9578-4">these interests</a>.</p> <p>Self-acceptance in this context does not mean giving ourselves licence to run roughshod over the interests of those around us, nor to justify our flaws as “valid” rather than work on them.</p> <p>Self-love, as promoted by contemporary psychologists, means standing in a compassionate relationship to ourselves. And there’s nothing contradictory about this idea.</p> <p>Just as we strive to develop a supportive, kind relationship to the people we care about – and just as this doesn’t involve uncritical approval of everything they do – compassionate self-love doesn’t mean abandoning valid self-criticism.</p> <p>In fact, self-compassion has the opposite effect. It promotes comfort with the kind of critical self-assessment that helps us grow – which leads to resilience. It breeds the opposite of narcissistic self-absorption.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/205938/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/ian-robertson-1372650">Ian Robertson</a>, PhD Candidate (Teaching roles at Macquarie &amp; Wollongong), <a href="https://theconversation.com/institutions/university-of-wollongong-711">University of Wollongong</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/self-love-might-seem-selfish-but-done-right-its-the-opposite-of-narcissism-205938">original article</a>.</em></p>

Mind

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Your skin is a mirror of your health – here’s what yours might be saying

<p><em><a href="https://theconversation.com/profiles/dan-baumgardt-1451396">Dan Baumgardt</a>, <a href="https://theconversation.com/institutions/university-of-bristol-1211">University of Bristol</a></em></p> <p><a href="https://pubmed.ncbi.nlm.nih.gov/12095893/">Skin accounts for around 15% of our body mass</a>. It is the largest and most visible organ in the human body.</p> <p>Yet many of the skin’s functions are often overlooked. It’s a sunscreen, a shield from germs, a reservoir of <a href="https://pubmed.ncbi.nlm.nih.gov/28994020/">vitamin D</a> and a means of tightly regulating our body temperature.</p> <p>Being the most visible of our organs, the skin also offers us a view into the body tissues that it protects. So don’t think of your skin merely aesthetically – think of it as a reflection of your health. Disorders of the gut, blood, hormones and even the heart might first be seen on the skin in the form of a rash.</p> <p>Here are a few to look out for.</p> <h2>Bullseye</h2> <p>Ticks are pesky creatures that no one will want to return home from a country walk with.</p> <p>But while the vast majority of tick bites <a href="https://pubmed.ncbi.nlm.nih.gov/36116831/">won’t make you ill</a>, there is one rash that should prompt a visit to your doctor if you spot it.</p> <p>Erythema migrans, a rash named for its ability to rapidly expand across the skin, is a hallmark of <a href="https://www.bmj.com/content/369/bmj.m1041.long">Lyme disease</a>, a potentially severe bacterial illness. This rash forms a classic target pattern, like a bullseye on a dartboard.</p> <p>Be vigilant for a few weeks after being bitten to check this rash doesn’t make an appearance – especially if you noticed a red lump that wasn’t there before or if you had to remove a tick from your skin. You should also keep an eye out for other associated symptoms of Lyme disease – such as swinging temperatures, muscle and joint pains and headache.</p> <p>The condition is treated with antibiotics, which can prevent long-term complications, including chronic fatigue symptoms.</p> <h2>Purpura</h2> <p>Some rashes are given a <a href="https://linkinghub.elsevier.com/retrieve/pii/S1538-7836(22)01880-3">colourful namesake</a> – purpura is one such example. This rash’s name is derived from a mollusc which was used to make purple dye.</p> <p>Purpura refers to a rash of small purple or red dots. The cause is pooling of blood into a deeper layer of the skin (dermis). When pressed with a finger – or even better, the side of a glass – it refuses to blanch away.</p> <p>Purpura signals an issue with either the walls of the tiny blood vessels that feed the skin or the blood within them. This might be from a deficiency in platelets, the tiny cell fragments that allow blood to clot – perhaps from bone marrow failure, or an autoimmune condition where the body turns on itself and attacks its own cells.</p> <p>At worst, purpura may signal the life-threatening condition <a href="https://www.magonlinelibrary.com/doi/full/10.12968/hmed.2017.78.8.468">septicaemia</a>, where an infection has spread into the bloodstream – perhaps from the lungs, kidneys or even from the skin itself.</p> <h2>Skin spiders</h2> <p>Skin rashes can also take on <a href="https://pubmed.ncbi.nlm.nih.gov/32513406/">recognisable shapes</a>.</p> <p>Spider naevi represent an issue within skin arterioles (small arteries which supply the skin with blood). Arterioles open and close to control the loss of heat from the body’s surface. But sometimes they can get stuck open – and a spider-like pattern will appear.</p> <p>The open arteriole is the spider’s body, and the even tinier capillaries fanning out in all directions are the thready legs. Crush the body under a fingertip and the whole thing disappears, as your touch temporarily stops the blood flow.</p> <p>Often, these are benign and not associated with any specific condition – especially if you only have one or two. However, more than three suggest higher circulating levels of the <a href="https://dermnetnz.org/topics/spider-telangiectasis">hormone oestrogen</a>, often due to liver disease or from the hormonal changes seen in pregnancy. Treat the underlying cause, and the spiders often vanish with time – though they may persist or reappear later.</p> <h2>Black velvet</h2> <p>Changes to the folds of your skin (usually around the armpits or neck) – especially if it becomes thickened and velveteen to the touch – may suggest a condition known as <a href="https://onlinelibrary.wiley.com/doi/10.1111/jocd.13544">acanthosis nigricans</a>. This “black velvet” skin appearance is more commonly seen in darker skins.</p> <p>Usually, the condition is associated with <a href="https://pubmed.ncbi.nlm.nih.gov/29241752/">disorders of the metabolism</a> – namely type 2 diabetes and polycystic ovary syndrome. If either of these conditions are successfully treated, the rash may fade. In rare cases, it can also be a sign of <a href="https://www.hkmj.org/abstracts/v29n4/355.htm">stomach cancer</a>, which should be considered in patients with few or none of the key signs of metabolic disease (obesity and high blood pressure).</p> <h2>Butterfly rashes</h2> <p>Even disorders of the heart can be visible on the skin.</p> <p>Cardiac valves have the important role of correctly directing the journey of blood through the heart and preventing backflow. The valve between the chambers on the left side of the heart (the mitral valve – so called because of its resemblance to a bishop’s hat, or mitre) can sometimes become narrowed, causing the heart’s function to deteriorate. The body’s natural response is to preserve core blood volume, shutting off flow towards the skin.</p> <p>The net effect can produce a purple-red rash, high across the cheeks and the bridge of the nose, like the outstretched wings of a butterfly. We call this <a href="https://journals.sagepub.com/doi/10.1177/2050313X231200965?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub%20%200pubmed">mitral facies</a> which, depending on the extent of damage to the heart and great vessels, may persist despite treatment.</p> <p>It’s important to pay heed to your skin. It’s constantly talking to you, and any changes in its texture, colour or if new marks or patterns appear, may indicate something is going on beneath the surface.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/221937/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/dan-baumgardt-1451396">Dan Baumgardt</a>, Senior Lecturer, School of Physiology, Pharmacology and Neuroscience, <a href="https://theconversation.com/institutions/university-of-bristol-1211">University of Bristol</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/your-skin-is-a-mirror-of-your-health-heres-what-yours-might-be-saying-221937">original article</a>.</em></p>

Body

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

<p><em><a href="https://theconversation.com/profiles/nick-fuller-219993">Nick Fuller</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p>If you’re one of the <a href="https://www.finder.com.au/new-years-resolutions-statistics">one in three</a> Australians whose New Year’s resolution involved losing weight, it’s likely you’re now contemplating what weight-loss goal you should actually be working towards.</p> <p>But type “setting a weight loss goal” into any online search engine and you’ll likely be left with more questions than answers.</p> <p>Sure, the many weight-loss apps and calculators available will make setting this goal seem easy. They’ll typically use a body mass index (BMI) calculator to confirm a “healthy” weight and provide a goal weight based on this range.</p> <p>Your screen will fill with trim-looking influencers touting diets that will help you drop ten kilos in a month, or ads for diets, pills and exercise regimens promising to help you effortlessly and rapidly lose weight.</p> <p>Most sales pitches will suggest you need to lose substantial amounts of weight to be healthy – making weight loss seem an impossible task. But the research shows you don’t need to lose a lot of weight to achieve health benefits.</p> <h2>Using BMI to define our target weight is flawed</h2> <p>We’re a society fixated on numbers. So it’s no surprise we use measurements and equations to score our weight. The most popular is BMI, a measure of our body weight-to-height ratio.</p> <p>BMI classifies bodies as underweight, normal (healthy) weight, overweight or obese and can be a useful tool for weight and health screening.</p> <p>But it shouldn’t be used as the single measure of what it means to be a healthy weight when we set our weight-loss goals. This is <a href="https://theconversation.com/using-bmi-to-measure-your-health-is-nonsense-heres-why-180412">because</a> it:</p> <ul> <li> <p>fails to consider two critical factors related to body weight and health – body fat percentage and distribution</p> </li> <li> <p>does not account for significant differences in body composition based on gender, ethnicity and age.</p> </li> </ul> <h2>How does losing weight benefit our health?</h2> <p>Losing just 5–10% of our body weight – between 6 and 12kg for someone weighing 120kg – can significantly improve our health in four key ways.</p> <p><strong>1. Reducing cholesterol</strong></p> <p>Obesity increases the chances of having too much low-density lipoprotein (LDL) cholesterol – also known as bad cholesterol – because carrying excess weight changes how our bodies produce and manage lipoproteins and triglycerides, another fat molecule we use for energy.</p> <p>Having too much bad cholesterol and high triglyceride levels is not good, narrowing our arteries and limiting blood flow, which increases the risk of heart disease, heart attack and stroke.</p> <p>But <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4987606/">research</a> shows improvements in total cholesterol, LDL cholesterol and triglyceride levels are evident with just 5% weight loss.</p> <p><strong>2. Lowering blood pressure</strong></p> <p>Our blood pressure is considered high if it reads more than 140/90 on at least two occasions.</p> <p>Excess weight is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082272/">linked to</a> high blood pressure in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082272/">several ways</a>, including changing how our sympathetic nervous system, blood vessels and hormones regulate our blood pressure.</p> <p>Essentially, high blood pressure makes our heart and blood vessels work harder and less efficiently, damaging our arteries over time and increasing our risk of heart disease, heart attack and stroke.</p> <p>Like the improvements in cholesterol, a 5% weight loss <a href="https://onlinelibrary.wiley.com/doi/10.1002/oby.21358">improves</a> both systolic blood pressure (the first number in the reading) and diastolic blood pressure (the second number).</p> <p>A <a href="https://www.ahajournals.org/doi/10.1161/01.hyp.0000094221.86888.ae">meta-analysis of 25 trials</a> on the influence of weight reduction on blood pressure also found every kilo of weight loss improved blood pressure by one point.</p> <p><strong>3. Reducing risk for type 2 diabetes</strong></p> <p>Excess body weight is the primary manageable risk factor for type 2 diabetes, particularly for people carrying a lot of visceral fat around the abdomen (belly fat).</p> <p>Carrying this excess weight can cause fat cells to release pro-inflammatory chemicals that disrupt how our bodies regulate and use the insulin produced by our pancreas, leading to high blood sugar levels.</p> <p>Type 2 diabetes can lead to serious medical conditions if it’s not carefully managed, including damaging our heart, blood vessels, major organs, eyes and nervous system.</p> <p><a href="https://www.nejm.org/doi/full/10.1056/nejmoa012512">Research</a> shows just 7% weight loss reduces risk of developing type 2 diabetes by 58%.</p> <p><strong>4. Reducing joint pain and the risk of osteoarthritis</strong></p> <p>Carrying excess weight can cause our joints to become inflamed and damaged, making us more prone to osteoarthritis.</p> <p><a href="https://pubmed.ncbi.nlm.nih.gov/21425246/">Observational studies</a> show being overweight doubles a person’s risk of developing osteoarthritis, while obesity increases the risk fourfold.</p> <p>Small amounts of weight loss alleviate this stress on our joints. <a href="https://pubmed.ncbi.nlm.nih.gov/15986358/">In one study</a> each kilogram of weight loss resulted in a fourfold decrease in the load exerted on the knee in each step taken during daily activities.</p> <h2>Focus on long-term habits</h2> <p>If you’ve ever tried to lose weight but found the kilos return almost as quickly as they left, you’re not alone.</p> <p>An <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/">analysis</a> of 29 long-term weight-loss studies found participants regained more than half of the weight lost within two years. Within five years, they regained more than 80%.</p> <p>When we lose weight, we take our body out of its comfort zone and trigger its survival response. It then counteracts weight loss, triggering several <a href="https://pubmed.ncbi.nlm.nih.gov/25896063/">physiological responses</a> to defend our body weight and “survive” starvation.</p> <p>Just as the problem is evolutionary, the solution is evolutionary too. Successfully losing weight long-term comes down to:</p> <ul> <li> <p>losing weight in small manageable chunks you can sustain, specifically periods of weight loss, followed by periods of weight maintenance, and so on, until you achieve your goal weight</p> </li> <li> <p>making gradual changes to your lifestyle to ensure you form habits that last a lifetime.</p> </li> </ul> <p>Setting a goal to reach a healthy weight can feel daunting. But it doesn’t have to be a pre-defined weight according to a “healthy” BMI range. Losing 5–10% of our body weight will result in immediate health benefits.</p> <p><em>At the Boden Group, Charles Perkins Centre, we are studying the science of obesity and running clinical trials for weight loss. You can <a href="https://redcap.sydney.edu.au/surveys/?s=RKTXPPPHKY">register here</a> to express your interest.</em><!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/217287/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/nick-fuller-219993">Nick Fuller</a>, Charles Perkins Centre Research Program Leader, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-much-weight-do-you-actually-need-to-lose-it-might-be-a-lot-less-than-you-think-217287">original article</a>.</em></p>

Body

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Squats and lunges might help you avoid knee surgery

<p>Whether it’s another round of squats and lunges, or a longer wall sit, researchers say working those quads could help lower your risk of a knee replacement.</p> <div> <p>In Australia, <a href="https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/musculoskeletal-conditions/contents/arthritis" target="_blank" rel="noopener">about 9% of the population</a> has osteoarthritis, a condition known to lead to hip and knee surgery in severe cases. About 14 million Americans suffer from knee osteoarthritis, about half are expected to face knee replacement surgery. </p> <p>But new research offers hope, finding stronger quadricep muscles could play a role in avoiding knee replacement surgery.</p> <p>A study presented to <a href="https://press.rsna.org/timssnet/media/rsna/newsroom2023.cfm" target="_blank" rel="noopener">annual meeting</a> of the Radiological Society of North America, offers hope to people with arthritis, finding stronger quadriceps could help in avoiding a knee replacement.</p> <p>The two most important muscles in the knee are the extensors or quadriceps, and the hamstrings. Quads are the strong muscles located at the front of the thigh, which play a key role in gait. Hammies at the back of the thigh, are essential for hip and knee flexibility.</p> <p>The two muscles act as opposing forces, allowing physical activity while also protecting the knee. An imbalance can change the body’s biomechanics, and may progress to osteoarthritis.</p> <p>Using MRI scans – from the time of surgery as well as 2 and 4 years prior – researchers analysed thigh muscle volume in 134 participants from a national study called the Osteoarthritis Initiative. </p> <p>Using artificial intelligence to compute muscle volume from the MRI scans, the researchers compared 67 of the cohort who had a total, single knee replacement with 67 control participants who had not undergone knee replacement surgery.</p> <p>They found patients who had a higher ratio of quadricep to hamstring volume had significantly lower odds of a total knee replacement. Higher volume hamstrings were also associated with lower odds of surgery.</p> <p>The results suggest strength training – focusing on the quadriceps – may be beneficial, both in people with arthritis as well as the general population.</p> <p><!-- Start of tracking content syndication. Please do not remove this section as it allows us to keep track of republished articles --> <em><img id="cosmos-post-tracker" src="https://syndication.cosmosmagazine.com/?id=289325&amp;title=Squats+and+lunges+might+help+you+avoid+knee+surgery" width="1" height="1" loading="lazy" aria-label="Syndication Tracker" data-spai-target="src" data-spai-orig="" data-spai-exclude="nocdn" />Image credits: Getty Images</em></div> <div> </div> <div><em><a href="https://cosmosmagazine.com/health/body-and-mind/squats-and-lunges-might-help-you-avoid-knee-surgery/">This article</a> was originally published on <a href="https://cosmosmagazine.com">Cosmos Magazine</a> and was written by <a href="https://cosmosmagazine.com/contributor/petra-stock/">Petra Stock</a>. </em></div>

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Trying to spend less on food? Following the dietary guidelines might save you $160 a fortnight

<p><em><a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a> and <a href="https://theconversation.com/profiles/lauren-ball-14718">Lauren Ball</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a></em></p> <p>A rise in the <a href="https://www.aph.gov.au/About_Parliament/Parliamentary_departments/Parliamentary_Library/pubs/BriefingBook47p/CostOfLiving#:%7E:text=Consumer%20Price%20Index%20over%20time,but%205.1%25%20in%20the%20second">cost of living</a> has led many households to look for ways to save money.</p> <p>New research suggests maintaining a healthy diet, in line with the <a href="https://www.eatforhealth.gov.au/guidelines/guidelines">Australian Dietary Guidelines</a>, is cheaper than an unhealthy diet and <a href="https://southwesthealthcare.com.au/wp-content/uploads/SWH-HP-Healthy-Diets-ASAP-Protocol-Warrnambool-Report-2023.pdf">could save A$160</a> off a family of four’s fortnightly shopping bill.</p> <p>Poor diet is the most common preventable risk factor contributing to chronic disease in <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30752-2/fulltext">Australia</a>. So improving your diet can also be an important way to reduce the chance of developing chronic disease.</p> <h2>First, what are the dietary guidelines?</h2> <p>The guidelines provide information on the quantity and types of foods most Australians should consume to promote overall health and wellbeing.</p> <p>Recommendations include eating a wide variety of nutritious foods from the main five food groups:</p> <ul> <li>vegetables and legumes</li> <li>fruit</li> <li>grains</li> <li>lean meats and meat alternatives such as tofu, nuts and legumes</li> <li>dairy products.</li> </ul> <p>The guidelines recommend limiting our intake of foods high in saturated fat, added salt, added sugars and alcohol.</p> <h2>What are Australians eating?</h2> <p>Fewer than <a href="https://www.abs.gov.au/statistics/health/health-conditions-and-risks/dietary-behaviour/latest-release">7%</a> of Australians eat sufficient vegetables, in line with the Australian Dietary Guidelines. In fact, Australians have an average healthy diet score of <a href="https://www.csiro.au/-/media/News-releases/2023/Total-Wellbeing-Diet-Health-Score/Diet-score-2023-Report_September.pdf">55 out of 100</a> – barely passing.</p> <p>Foods that aren’t part of a food group are known as “discretionary” items, which includes alcohol, cakes, biscuits, chocolate and confectionery and most takeaway foods. Because they’re typically high in kilojoules, saturated fat, sodium and added sugars, the Australian Dietary Guidelines recommend they only be eaten occasionally and in small amounts (ideally zero serves).</p> <p>For many households, discretionary items make up a big portion of their grocery shop. Australians consume an average of <a href="https://www.csiro.au/-/media/News-releases/2023/Total-Wellbeing-Diet-Health-Score/Diet-score-2023-Report_September.pdf">28 serves</a> of discretionary choices per week (equal to 28 doughnuts, 28 slices of cake, or 28 cans of soft drink or beer). This is an increase of ten serves since 2015.</p> <p>One recent <a href="https://link.springer.com/article/10.1186/s12966-022-01389-8">study</a> estimated 55% of Australians’ total energy intake was from discretionary items.</p> <h2>What did the researchers find?</h2> <p>Researchers from the Health Promotion Team at South West Healthcare <a href="https://southwesthealthcare.com.au/wp-content/uploads/SWH-HP-Healthy-Diets-ASAP-Protocol-Warrnambool-Report-2023.pdf">recently</a> visited four local supermarkets and takeaway stores in Warrnambool, Victoria, and purchased two baskets of groceries.</p> <p>One basket met the Australian Dietary Guidelines (basket one), the other aligned with the typical dietary intake of Australians (basket two).</p> <p>They compared prices between the two and found basket one would cost approximately $167 less per fortnight for a family of four at the most affordable supermarket. That’s equal to $4,342 a year.</p> <p>Basket one was sufficient to supply a family of four for a fortnight, and aligned with the Australian Dietary Guidelines. It cost $724 and included:</p> <ol> <li>fruit and vegetables (made up 31% of the fortnightly shop)</li> <li>grains and cereals (oats, cornflakes, bread, rice, pasta, Weet-bix)</li> <li>lean meats and alternatives (mince, steak, chicken, tuna, eggs, nuts)</li> <li>milk, yoghurt and cheese</li> <li>oils and spreads (olive oil).</li> </ol> <p>Basket two reflected the current average Australian fortnightly shop for a family of four.</p> <p>In the project, the team spent over half of the fortnightly shop on processed and packaged foods, of which 21% was spent on take-away. This is based on actual dietary intake of the general population reported in the 2011-2012 <a href="https://www.abs.gov.au/statistics/health/health-conditions-and-risks/australian-health-survey-nutrition-first-results-foods-and-nutrients/latest-release#:%7E:text=Food%20consumption,across%20the%20major%20food%20groups.">Australian Health Survey</a>.</p> <p>Basket two cost $891 and included:</p> <ol> <li>fruit and vegetables (made up 13% of the fortnightly shop)</li> <li>grains and cereals (oats, cornflakes, bread, rice, pasta, Weet-bix)</li> <li>lean meats and alternatives (mince, steak, chicken, tuna, eggs, nuts)</li> <li>milk, yogurt and cheese</li> <li>oils and spreads (olive oil, butter)</li> <li>drinks (soft drink, fruit juice)</li> <li>desserts and snacks (muffins, sweet biscuits, chocolate, ice cream, potato chips, muesli bars)</li> <li>processed meats (sausages, ham)</li> <li>convenience meals</li> <li>fast food (pizza, meat pie, hamburger, fish and chips)</li> <li>alcohol (beer, wine).</li> </ol> <h2>But a healthy basket is still unaffordable for many</h2> <p>While this piece of work, and other <a href="https://www.mdpi.com/1660-4601/15/11/2469">research</a>, suggests a healthy diet is less expensive than an unhealthy diet, affordability is still a challenge for many families.</p> <p>The Warrnambool research found basket one (which aligned with guidelines) was still costly, requiring approximately 25% of a median household income.</p> <p>This is unaffordable for many. For a household reliant on welfare, basket one would require allocating 26%-38% of their income. This highlights how the rising cost of living crisis is affecting those already facing financial difficulties.</p> <p>Around 3.7 <a href="https://reports.foodbank.org.au/foodbank-hunger-report-2023/">million</a> Australian households did not have access to enough food to meet their basic needs at some point in the last 12 months.</p> <p>Policy action is needed from the Australian government to make recommended diets more affordable for low socioeconomic groups. This means lowering the costs of healthy foods and ensuring household incomes are sufficient.</p> <h2>What else can you do to cut your spending?</h2> <p>To help reduce food costs and support your health, reducing discretionary foods could be a good idea.</p> <p>Other ways to reduce your grocery bill and keep your food healthy and fresh include:</p> <ul> <li> <p>planning for some meatless meals each week. Pulses (beans, lentils and legumes) are nutritious and cheap (a can is <a href="https://coles.com.au/product/coles-chick-peas-420g-8075852?uztq=46abcbb7e16253b0cdc3e6c5bbe6a3f0&amp;cid=col_cpc_Generic%7cColesSupermarkets%7cPLA%7cCatchAll%7cAustralia%7cBroad&amp;s_kwcid=AL!12693!3!675842378376!!!g!326304616489!&amp;gad_source=1&amp;gclid=CjwKCAjwkY2qBhBDEiwAoQXK5SceYhU2VtKepNLXWN218GH8Cp8Vs9cnYynCBwRqQPaW3UYNX2SVIBoC_6EQAvD_BwE&amp;gclsrc=aw.ds">less than $1.50</a>. Here are some great pulse recipes to <a href="https://nomoneynotime.com.au/healthy-easy-recipes/filter/keywords--vegetarian/p2">try</a></p> </li> <li> <p>checking the specials and buy in bulk (to store or freeze) when items are cheaper</p> </li> <li> <p>making big batches of meals and freezing them. Single-serve portions can help save time for lunches at work, saving on takeaway</p> </li> <li> <p>Australian supermarkets are <a href="https://www.theguardian.com/australia-news/datablog/2023/jul/27/cost-of-living-grocery-store-price-rises-cheapest-fresh-produce-australia-woolworths-coles#:%7E:text=The%20results%20showed%20independent%20and,best%20place%20for%20affordable%20groceries">almost never</a> the cheapest place for fresh produce, so shop around for farmers markets or smaller local grocery shops</p> </li> <li> <p>buying generic brands when possible, as they are <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/streamlined-datagathering-techniques-to-estimate-the-price-and-affordability-of-healthy-and-unhealthy-diets-under-different-pricing-scenarios/872EA6396533166E0C6FA94C809D9CAC#r">notably cheaper</a>. Supermarkets usually <a href="https://theconversation.com/the-science-that-makes-us-spend-more-in-supermarkets-and-feel-good-while-we-do-it-23857">promote</a> the items they want you to buy at eye-level, so check the shelves above and below for cheaper alternatives.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/216749/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> </li> </ul> <p><em><a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, Dietitian &amp; Academic, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a> and <a href="https://theconversation.com/profiles/lauren-ball-14718">Lauren Ball</a>, Professor of Community Health and Wellbeing, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a></em></p> <p><em>Image credits: Getty </em><em>Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/trying-to-spend-less-on-food-following-the-dietary-guidelines-might-save-you-160-a-fortnight-216749">original article</a>.</em></p>

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Do you think you have a penicillin allergy? You might be wrong

<p><em><a href="https://theconversation.com/profiles/winnie-tong-1468274">Winnie Tong</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> and <a href="https://theconversation.com/profiles/jacqueline-loprete-1468275">Jacqueline Loprete</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a></em></p> <p>Penicillins are the most prescribed class of antibiotics in Australia. Originally derived from a fungus, penicillin antibiotics such as amoxicillin are used to treat common infections, including chest, sinus, ear, urinary tract and skin infections.</p> <p>Penicillins are effective against a wide range of bacteria that cause common infections. But their activity is not so broad as to impact on good bacteria in our gut like other antibiotic classes do. They’re also cheap and readily accessible.</p> <p>Up to <a href="https://www.sciencedirect.com/science/article/pii/S2772829322000376#bib1">20%</a> of Australians admitted in hospital say they have a penicillin allergy.</p> <p>But not everyone who thinks they’re allergic to penicillin actually is. Research from <a href="https://www.sciencedirect.com/science/article/pii/S2772829322000376?via%3Dihub">our team</a> and others suggests that if we assess all these patients, up to 90% are not allergic to it.</p> <h2>Why does it matter?</h2> <p>People who mistakenly think they’re allergic to penicillin may not get the most effective or safest antibiotics to treat their infection.</p> <p>They are also at greater risk of developing <a href="https://www.sciencedirect.com/science/article/abs/pii/S009167491301467X">multidrug-resistant infections</a> or “superbugs”. This is because the antibiotic will kill off the bacteria that are susceptible to it, but the resistant bacteria are left behind to proliferate and cause further infection.</p> <p>People who receive second-line antibiotics are more likely to have complications, such as <a href="https://www.sciencedirect.com/science/article/abs/pii/S009167491301467X">antibiotic-induced gut infections</a>. Second-line antibiotics tend to have a wider range of activity, killing both the bacteria causing infection, and the good bacteria required to keep our gut in balance. This allows bugs like <em>Clostridium difficile</em>, which normally lives in our gut but is controlled by other bacteria, to overgrow and cause inflammation.</p> <p>For the health system, using second-line antibiotics means longer, more complicated hospital stays. Hospital stays for patients with penicillin allergies cost up to <a href="https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1365-2222.2003.01638.x">63% more</a> more than those without. It also results in greater costs for medications and greater resources required to treat the patient.</p> <h2>Why do people think they’re allergic?</h2> <p>People incorrectly believe they are allergic to penicillin for a number of reasons.</p> <p>They may have experienced side effects from penicillin, such as nausea or diarrhoea. But though unpleasant, this doesn’t mean an allergy.</p> <p>Others had a rash as a child, but this could have been due to the illness itself or an interaction between the virus and the antibiotic. An Epstein-Barr viral infection treated with amoxicillin, for example, <a href="https://pubmed.ncbi.nlm.nih.gov/23589810/">causes</a> a fine, red rash.</p> <p>Some believe a family history of reactions to penicillin means they cannot take them. But there is no evidence penicillin allergy is inherited.</p> <p>If some time has passed between exposure, people can lose the allergic response. This is typically seen in adults who had a mild allergy as a child, but lose the response with time, so are said to have “grown out” of their allergy.</p> <p>Then there are people who have had a genuine and serious reaction to penicillin. This includes anaphylaxis, with profound swelling, breathing difficulties and low blood pressure, and severe life-threatening reactions such as <a href="https://www.ncbi.nlm.nih.gov/books/NBK459323/#:%7E:text=Stevens%2DJohnson%20syndrome%2Ftoxic%20epidermal,in%20over%2080%25%20of%20cases.">Steven-Johnson’s syndrome</a>, which causes widespread blisters and wounds that resemble burns.</p> <h2>Testing for penicillin</h2> <p>When someone says they have a penicillin allergy, we first get them to explain what happened with the reaction, including to what antibiotic, in what context and how severe it was.</p> <p>Then we perform skin tests to further assess the person’s risk of reaction. If skin tests are negative, we can then give the patient the penicillin in question under supervision (a “challenge”) to see if they react.</p> <p>Some people can skip the skin tests altogether and go straight to the challenge if the history tells us they are at low risk of reacting.</p> <p><a href="https://www.sciencedirect.com/science/article/pii/S2772829322000376?via%3Dihub">Our study</a> followed 195 patients who reported a penicillin allergy across six Sydney hospitals. In the first phase, we assessed 85 people and found 82% weren’t allergic to penicillin.</p> <p>In the second phase, we assessed 110 people, of whom 69% weren’t allergic. This is slightly lower than research on the population as a whole, because we only looked at people who were referred for an allergy assessment. Many more patients carry an allergy label than those referred for testing.</p> <p>In our study, eight weeks after their test, just 54% of participants in phase one correctly knew their penicillin allergy status. Some allergic people believed they were not allergic, and many non-allergic people believed they were allergic.</p> <p>For phase two, we ensured people received a standardised letter outlining their results in addition to having a doctor or nurse explain them. This time, 92% were correct in their understanding when contacted eight weeks later.</p> <h2>Reducing long waits for allergy tests</h2> <p>Ruling out allergies among people who think they can’t have penicillin is time- and labour-intensive. The wait time from someone first being referred to an allergy clinic to having testing can be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10026071/">up to two years</a>. And it’s usually not available outside major metropolitan hospitals.</p> <p>We need to improve access to testing and also look at <em>when</em> people can access allergy services. When a person is sick in hospital with a serious infection, it’s not the right time for testing.</p> <p>We also need to ensure the results of allergy tests translate to the real world so people know their true allergy status. The fragmentation of our medical records are a barrier to clear and effective communication of a patient’s true allergy status, and urgently need to be improved.<!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/winnie-tong-1468274"><em>Winnie Tong</em></a><em>, Clinical Immunologist &amp; Allergist, Immunopathologist and Senior Lecturer, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> and <a href="https://theconversation.com/profiles/jacqueline-loprete-1468275">Jacqueline Loprete</a>, Postdoctoral fellow, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/do-you-think-you-have-a-penicillin-allergy-you-might-be-wrong-212874">original article</a>.</em></p>

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