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Readers response: What seems too expensive but is really worth the price?

We asked our readers what items or experience seem, too expensive but are really worth the price, and the response was overwhelming. Here's what our audience will always justify the price of. Robbie Kirkwood - Travel insurance. Elizabeth Foster - Business class on long haul flights. Jeanette Wallis - Coffee beans. Mandy O'Connor - A good pair of Levi jeans, and a good pair of boots. Pamela McDonald - I would say electricity! Seems lots complain about the cost until you lose power, then you realise how hard life would be without it. Tess Witchell - Real butter! Three ply toilet rolls, frappe iced coffee from McDonald’s, and proper bakery bread. Sue Yunker - Wine! Michael Schulze - A decent cup of coffee. Suzanne Jones - A holiday. Rose Niemack - Fruits and vegetables. Image credits: Shutterstock

Money & Banking

5 items you’re cleaning too much

Cleaning the house is no easy feat. To make life a little easier for you, here are five items you are probably cleaning more than you need to. 1. Clothes worn once For particular items of clothing such as gym gear, shirts and tights it is fine to wash clothes after every wear. However, most other items can be worn up to three times advises Carolyn Forte, the director of the Cleaning Lab at the Good Housekeeping Institute. "Over-washing and over-drying fabrics can cause fading and wear,” she said. Studies have also shown that it is ideal to wash bath towels after three uses. 2. Dinner plates Instead of spending time rinsing your plates before putting them in the dishwasher, just make sure all the food is scrapped off. "Pre-washing dishes is a waste of time and energy,” said Carolyn. "If you aren't running it right away, let the dishwasher rinse them with a 'rinse only' cycle." 3. Light Fixtures It can be tempting to dust your light fixtures every week but Carolyn advises saving your strength from a different household task. She advises that you can get away with cleaning light fixtures once a month. 4. Jackets In the cooler months jackets are worn every day. However, this necessity only needs to be washed every three months. Jackets don’t usually come into contact with skin cells or natural oils, which allows them to go longer between washes than other clothes. 5. Curtains Curtains need to be washed if you get any marks on them but if they are in pristine condition, according to Carolyn they only need to be cleaned once a year. Image credits: Shutterstock

Home & Garden

Getting antivirals for COVID too often depends on where you live and how wealthy you are

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/peter-breadon-1348098">Peter Breadon</a>, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> Medical experts <a href="https://www.health.gov.au/health-alerts/covid-19/treatments/eligibility">recommend</a> antivirals for people aged 70 and older who get COVID, and for other groups at risk of severe illness and hospitalisation from COVID. But many older Australians have missed out on antivirals after getting sick with COVID. It is yet another way the health system is failing the most vulnerable. <h2>Who missed out?</h2> We <a href="https://grattan.edu.au/wp-content/uploads/2024/10/How-we-analysed-COVID-antiviral-uptake-Grattan-Institute.pdf">analysed</a> COVID antiviral uptake between March 2022 and September 2023. We found some groups were more likely to miss out on antivirals including Indigenous people, people from disadvantaged areas, and people from culturally and linguistically diverse backgrounds. Some of the differences will be due to different rates of infection. But across this 18-month period, many older Australians were infected at least once, and rates of infection were higher in some disadvantaged communities. <h2>How stark are the differences?</h2> Compared to the national average, Indigenous Australians were nearly 25% less likely to get antivirals, older people living in disadvantaged areas were 20% less likely to get them, and people with a culturally or linguistically diverse background were 13% less likely to get a script. People in remote areas were 37% less likely to get antivirals than people living in major cities. People in outer regional areas were 25% less likely. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/620627/original/file-20240920-20-yc7sq5.png?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/620627/original/file-20240920-20-yc7sq5.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/620627/original/file-20240920-20-yc7sq5.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=329&fit=crop&dpr=1 600w, https://images.theconversation.com/files/620627/original/file-20240920-20-yc7sq5.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=329&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/620627/original/file-20240920-20-yc7sq5.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=329&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/620627/original/file-20240920-20-yc7sq5.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=413&fit=crop&dpr=1 754w, https://images.theconversation.com/files/620627/original/file-20240920-20-yc7sq5.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=413&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/620627/original/file-20240920-20-yc7sq5.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=413&fit=crop&dpr=3 2262w" alt="" /></a><figcaption>Dispensing rates by group. Grattan Institute</figcaption></figure> Even within the same city, the differences are stark. In Sydney, people older than 70 in the affluent eastern suburbs (including Vaucluse, Point Piper and Bondi) were nearly twice as likely to have had an antiviral as those in Fairfield, in Sydney’s south-west. Older people in leafy inner-eastern Melbourne (including Canterbury, Hawthorn and Kew) were 1.8 times more likely to have had an antiviral as those in Brimbank (which includes Sunshine) in the city’s west. <h2>Why are people missing out?</h2> COVID antivirals should be taken when symptoms first appear. While awareness of COVID antivirals is generally strong, people often <a href="https://link.springer.com/article/10.1007/s40121-024-01003-3">don’t realise</a> they would benefit from the medication. They <a href="https://www.phrp.com.au/?p=43363">wait</a> until symptoms get worse and it is too late. Frequent GP visits make a big difference. Our analysis found people 70 and older who see a GP more frequently were much more likely to be dispensed a COVID antiviral. Regular visits give an opportunity for preventive care and patient education. For example, GPs can provide high-risk patients with “COVID treatment plans” as a reminder to get tested and seek treatment as soon as they are unwell. Difficulty seeing a GP could help explain low antiviral use in rural areas. Compared to people in major cities, people in small rural towns have about 35% <a href="https://hwd.health.gov.au/resources/data/gp-primarycare.html">fewer</a> GPs, see their GP about half as often, and are 30% more likely to <a href="https://www.abs.gov.au/statistics/health/health-services/patient-experiences/latest-release">report</a> waiting too long for an appointment. Just like for <a href="https://grattan.edu.au/wp-content/uploads/2023/11/A-fair-shot-How-to-close-the-vaccination-gap-Grattan-Institute-Report.pdf">vaccination</a>, a GP’s focus on antivirals probably matters, as does providing care that is accessible to people from different cultural backgrounds. <h2>Care should go those who need it</h2> Since the period we looked at, evidence has emerged that raises <a href="https://url.au.m.mimecastprotect.com/s/FmjFC91ZVBSmBpXpZSEh9CqMtQx?domain=nejm.org">doubts</a> about how effective antivirals are, particularly for people at lower risk of severe illness. That means getting vaccinated is more important than getting antivirals. But all Australians who are eligible for antivirals should have the same chance of getting them. These drugs have cost more than A$1.7 billion, with the vast majority of that money coming from the federal government. While dispensing rates have fallen, more than <a href="http://medicarestatistics.humanservices.gov.au/statistics/do.jsp?_PROGRAM=%2Fstatistics%2Fpbs_item_standard_report&itemlst=%2712910L%27%2C%2712996B%27&ITEMCNT=2&LIST=12910L%2C12996B&VAR=SERVICES&RPT_FMT=6&start_dt=202201&end_dt=202408">30,000</a> packs of COVID antivirals were dispensed in August, costing about $35 million. Such a huge investment shouldn’t be leaving so many people behind. Getting treatment shouldn’t depend on your income, cultural background or where you live. Instead, care should go to those who need it the most. People born overseas have been <a href="https://www.abs.gov.au/articles/covid-19-mortality-australia-deaths-registered-until-31-january-2024#deaths-due-to-covid-19-country-of-birth">40% more likely</a> to die from COVID than those born here. Indigenous Australians have been <a href="https://www.abs.gov.au/articles/covid-19-mortality-australia-deaths-registered-until-31-january-2024#covid-19-mortality-among-aboriginal-and-torres-strait-islander-people">60% more likely</a> to die from COVID than non-Indigenous people. And the most disadvantaged people have been <a href="https://www.abs.gov.au/articles/covid-19-mortality-australia-deaths-registered-until-31-january-2024#deaths-due-to-covid-19-socio-economic-status-seifa-">2.8 times</a> more likely to die from COVID than those in the wealthiest areas. All those at-risk groups have been more likely to miss out on antivirals. It’s not just a problem with antivirals. The same groups are also disproportionately missing out on COVID <a>vaccination</a>, compounding their risk of severe illness. The pattern is repeated for other important preventive health care, such as <a href="https://www.aihw.gov.au/getmedia/54a38a6a-9e3c-4f58-b2f6-cdef977a7d60/aihw-can-155_15sept.pdf?v=20230915162104&inline=true">cancer</a> <a href="https://www.aihw.gov.au/getmedia/27f32443-5206-4189-8775-0c1f55a26bc4/aihw-can-160.pdf?v=20240617095924&inline=true">screening</a>. <h2>A 3-step plan to meet patients’ needs</h2> The federal government should do three things to close these gaps in preventive care. First, the government should make Primary Health Networks (PHNs) responsible for reducing them. PHNs, the regional bodies responsible for improving primary care, should share data with GPs and step in to boost uptake in communities that are missing out. Second, the government should extend its <a href="https://www.health.gov.au/our-work/mymedicare">MyMedicare</a> reforms. MyMedicare gives general practices flexible funding to care for patients who live in residential aged care or who visit hospital frequently. That approach should be <a href="https://grattan.edu.au/report/a-new-medicare-strengthening-general-practice/">expanded</a> to all patients, with more funding for poorer and sicker patients. That will give GP clinics time to advise patients about preventive health, including COVID vaccines and antivirals, before they get sick. Third, team-based pharmacist prescribing should be introduced. Then pharmacists could quickly dispense antivirals for patients if they have a prior agreement with the patient’s GP. It’s an approach that would also <a href="https://theconversation.com/pharmacists-should-be-able-to-work-with-gps-to-prescribe-medicines-for-long-term-conditions-212359">work</a> for medications for chronic diseases, such as cardiovascular disease. COVID antivirals, unlike vaccines, have been <a href="https://theconversation.com/covid-wave-whats-the-latest-on-antiviral-drugs-and-who-is-eligible-in-australia-218423">keeping up</a> with new variants without the need for updates. If a new and more harmful variant emerges, or when a new pandemic hits, governments should have these systems in place to make sure everyone who needs treatment can get it fast. In the meantime, fairer access to care will help close the big and persistent <a href="https://www.aihw.gov.au/getmedia/0cbc6c45-b97a-44f7-ad1f-2517a1f0378c/hiamhbrfhsu.pdf?v=20230605184558&inline=true">gaps</a> in health between different groups of Australians. <a href="https://theconversation.com/profiles/peter-breadon-1348098">Peter Breadon</a>, Program Director, Health and Aged Care, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/getting-antivirals-for-covid-too-often-depends-on-where-you-live-and-how-wealthy-you-are-239497">original article</a>. </div>

Caring

Men have a biological clock too. Here’s what’s more likely when dads are over 50

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/karin-hammarberg-113096">Karin Hammarberg</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> We hear a lot about women’s biological clock and how age affects the chance of pregnancy. <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2821811#google_vignette">New research shows</a> men’s fertility is also affected by age. When dads are over 50, the risk of pregnancy complications increases. Data from more than 46 million births in the <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2821811#google_vignette">United States</a> between 2011 and 2022 compared fathers in their 30s with fathers in their 50s. While taking into account the age of the mother and other factors known to affect pregnancy outcomes, the researchers found every ten-year increase in paternal age was linked to more complications. The researchers found that compared to couples where the father was aged 30–39, for couples where the dad was in his 50s, there was a: <ul> <li>16% increased risk of preterm birth</li> <li>14% increased risk of low birth weight</li> <li>13% increase in gestational diabetes.</li> </ul> The older fathers were also twice as likely to have used assisted reproductive technology, including IVF, to conceive than their younger counterparts. <h2>Dads are getting older</h2> In this <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2821811#google_vignette">US study</a>, the mean age of all fathers increased from 30.8 years in 2011 to 32.1 years in 2022. In that same period, the proportion of men aged 50 years or older fathering a child increased from 1.1% to 1.3%. We don’t know the proportion of men over 50 years who father children in Australia, but data shows the average age of fathers has increased. In 1975 the <a href="https://www.abs.gov.au/statistics/people/population/births-australia/latest-release">median age of Australian dads</a> was 28.6 years. This jumped to 33.7 years in 2022. <h2>How male age affects getting pregnant</h2> As we know from <a href="https://www.businessinsider.com/celebrities-dads-first-time-over-age-50#when-he-was-54-simon-cowell-and-girlfriend-lauren-silverman-became-parents-to-their-son-eric-7">media reports</a> of celebrity dads, men produce sperm from puberty throughout life and can father children well into old age. However, there is a noticeable decline in <a href="https://www.fertstert.org/article/S0015-0282(18)30269-3/fulltext">sperm quality</a> from about age 40. Female partners of older men take longer to achieve pregnancy than those with younger partners. A study of the effect of male age on <a href="https://www.fertstert.org/article/S0015-0282(03)00366-2/fulltext">time to pregnancy</a> showed women with male partners aged 45 or older were almost five times more likely to take more than a year to conceive compared to those with partners aged 25 or under. More than three quarters (76.8%) of men under the age of 25 years impregnated their female partners within six months, compared with just over half (52.9%) of men over the age of 45. Pooled data from ten studies showed that partners of older men are also more likely to experience miscarriage. Compared to couples where the male was aged 25 to 29 years, <a href="https://pubmed.ncbi.nlm.nih.gov/32358607/">paternal age over 45 years</a> increased the risk of miscarriage by 43%. <h2>Older men are more likely to need IVF</h2> Outcomes of assisted reproductive technology, such as IVF, are also influenced by the age of the male partner. A <a href="https://doi.org/10.1016/j.rbmo.2022.03.031">review of studies</a> in couples using assisted reproductive technologies found paternal age under 40 years reduced the risk of miscarriage by about 25% compared to couples with men aged over 40. Having a male under 40 years also almost doubled the chance of a live birth per treatment cycle. With a man over 40, 17.6% of treatment rounds resulted in a live birth, compared to 28.4% when the male was under 40. <h2>How does male age affect the health outcomes of children?</h2> As a result of age-related changes in sperm DNA, the children of older fathers have increased risk of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9957550/">a number of conditions</a>. Autism, schizophrenia, bipolar disorders and leukaemia have been linked to the father’s advanced years. A <a href="https://www.fertstert.org/article/S0015-0282(22)01979-3/fulltext">review of studies</a> assessing the impact of advanced paternal age reported that children of older fathers have increased rates of psychiatric disease and behavioural impairments. But while the increased risk of adverse health outcomes linked to older paternal age is real, the magnitude of <a href="https://pubmed.ncbi.nlm.nih.gov/29471389/">the effect is modest</a>. It’s important to remember that an increase in a very small risk is still a small risk and most children of older fathers are born healthy and develop well. <h2>Improving your health can improve your fertility</h2> In addition to the effects of older age, some chronic conditions that affect fertility and reproductive outcomes become more common as men get older. They include <a href="https://www.fertstert.org/article/S0015-0282(23)01935-0/fulltext">obesity and diabetes</a> which affect sperm quality by lowering testosterone levels. While we can’t change our age, some lifestyle factors that increase the risk of pregnancy complications and reduce fertility, can be tackled. They include: <ul> <li><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4639396/">smoking</a></li> <li>recreational <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1002/tre.414">drug taking</a></li> <li><a href="https://onlinelibrary.wiley.com/doi/pdf/10.1002/tre.414">anabolic steroid</a> use</li> <li>heavy <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5504800/">alcohol consumption</a>.</li> </ul> <h2>Get the facts about the male biological clock</h2> Research shows <a href="https://academic.oup.com/humupd/article/23/4/458/3065332?login=false">men want children</a> as much as women do. And most men want at least two children. Yet most men <a href="https://academic.oup.com/humupd/article/23/4/458/3065332?login=false">lack knowledge</a> about the limitations of female and male fertility and overestimate the chance of getting pregnant, with and without assisted reproductive technologies. We need better public education, starting at school, to improve awareness of the impact of male and female age on reproductive outcomes and help people have healthy babies. For men wanting to improve their chance of conceiving, the government-funded sites <a href="https://healthymale.org.au/">Healthy Male</a> and <a href="https://www.yourfertility.org.au/">Your Fertility</a> are a good place to start. These offer evidence-based and accessible information about reproductive health, and <a href="https://www.yourfertility.org.au/fertility-week-2022">tips</a> to improve your reproductive health and give your children the best start in life.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/236892/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/karin-hammarberg-113096">Karin Hammarberg</a>, Senior Research Fellow, Global and Women's Health, School of Public Health & Preventive Medicine, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/men-have-a-biological-clock-too-heres-whats-more-likely-when-dads-are-over-50-236892">original article</a>. </div>

Body

5 foods to add to your shopping list to save money – and they’re good for you too

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/clare-collins-7316">Clare Collins</a>, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Food prices are <a href="https://www.abc.net.au/news/2024-06-13/anglicare-cost-living-unemployment-groceries-fuel-rent-prices/103972166?utm_medium=social&utm_content=sf273549397&utm_campaign=abc&utm_source=linkedin.com&sf273549397=1">adding pressure on household budgets</a>, especially for Australians on the lowest incomes. To help save money on the weekly groceries, consider adding these five staples to your shopping trolley: eggs, oats, carrots, UHT milk and apples. These foods rate highly on the <a href="https://pubmed.ncbi.nlm.nih.gov/20181811/">nutrient-rich foods index</a> and on cost, meaning they represent good value for money when it comes to buying nutritious food. Loading up on these items helps push more expensive, less nutritious foods out of your trolley. Keeping a supply at your place will also save extra trips to the shops, which saves petrol and time. <h2>1. Eggs</h2> Eggs are extremely good value at around A$6 a dozen (50 cents an egg). Meat, chicken and fish prices vary from $12 a kilo for mince, $12–$20 a kilo for chicken, to $20–$50 a kilo for steak and fish depending on cut or type. Selecting the cheapest cuts still costs $2–$3 a serve, compared to two eggs at a $1 serve. When you swap a red meat meal for an eggy dish, this can add up to a big saving. Try our egg recipes on the <a href="https://nomoneynotime.com.au/healthy-easy-recipes/filter/meals--dinner,lunch/superfoods--eggs">No Money No Time website</a>, from <a href="https://nomoneynotime.com.au/healthy-easy-recipes/sweetcorn-and-zucchini-fritters">fritters</a>, to <a href="https://nomoneynotime.com.au/healthy-easy-recipes/mushroom-omelette">omelettes</a>, or <a href="https://nomoneynotime.com.au/healthy-easy-recipes/clares-rainbow-rice">fried rice</a>. These recipes also help use up other items you have in the pantry, fridge and veggie crisper. Eggs are a good <a href="https://www.australianeggs.org.au/nutrition/nutrients-and-vitamins">source</a> of protein and also contain choline, lutein and zeaxanthin, vitamins A, B2, B12, D, E and folate, and minerals iron, zinc, iodine and selenium. For people concerned about eggs raising cholesterol, a <a href="https://pubmed.ncbi.nlm.nih.gov/38370115/">recent review of research evidence</a> concluded there wasn’t likely to be any adverse effect on overall disease risk when consuming up to one egg a day. <h2>2. Rolled oats</h2> Rolled oats vary a lot in price from about $2 a kilogram for “own brand”, up to $9 for premium varieties. Oats are really <a href="https://nomoneynotime.com.au/healthy-easy-recipes/filter/keywords--Oats">versatile</a>. For breakfast you can make <a href="https://nomoneynotime.com.au/healthy-easy-recipes/microwave-porridge">porridge</a>, <a href="https://nomoneynotime.com.au/healthy-easy-recipes/easy-overnight-oats">overnight oats,</a> DIY muesli or <a href="https://nomoneynotime.com.au/healthy-easy-recipes/gingerbread-granola">granola</a>. Oats make a pastry substitute for a <a href="https://nomoneynotime.com.au/healthy-easy-recipes/clares-rolled-oats-quiche">quick and easy quiche base</a>. Or blitz them in a food processor and use as a breadcrumb substitute. For dessert, you can use them to top a comforting <a href="https://nomoneynotime.com.au/healthy-easy-recipes/wholegrain-apple-crumble">apple crumble</a>. <a href="https://www.glnc.org.au/resource/oats-2/">Oats are a wholegrain</a>, meaning they retain every part of the original grain – the germ, bran and outer layers – and hence more fibre and nutrients. Oats are a rich in beta-glucan, a soluble fibre that <a href="https://pubmed.ncbi.nlm.nih.gov/34236436/">helps lower blood cholesterol levels</a> by binding with bile acids in the gut, meaning they can’t be converted into LDL (bad) cholesterol. They <a href="https://www.glnc.org.au/resource/oats-2/">also contain</a> B vitamins of thiamin (b1), riboflavin (B2), niacin (B3), pyridoxine (B6), pantothenic acid (B5) and folate (B9), as well as vitamin E and the minerals iron, zinc, magnesium, phosphorus and potassium. <h2>3. Carrots</h2> It’s hard to get better value than a bag of carrots at about $2.50 a kilo. They last for ages in the fridge and can be eaten raw, as carrot sticks or with <a href="https://nomoneynotime.com.au/healthy-easy-recipes/moroccan-carrot-dip">carrot dip</a>, or baked to make carrot veggie “<a href="https://nomoneynotime.com.au/healthy-easy-recipes/vegetable-chips">chips</a>”. Try grating carrot as an extra on a salad roll or <a href="https://nomoneynotime.com.au/healthy-easy-recipes/basic-beef-burgers">burger</a>, or mixed into grated cheese to extend it when topping tacos, pasta or pizza, or even a dish like <a href="https://nomoneynotime.com.au/healthy-easy-recipes/carrot-and-cauliflower-macaroni-cheese">mac and cheese</a>. Other versatile uses include soup, <a href="https://nomoneynotime.com.au/healthy-easy-recipes/carrot-puree">carrot mash</a>, <a href="https://nomoneynotime.com.au/healthy-easy-recipes/baked-carrots-with-honey-thyme">roasted carrots</a> or, for something sweet, carrot muffins or <a href="https://nomoneynotime.com.au/healthy-easy-recipes/easy-carrot-cake-bliss-balls">bliss balls</a>. Carrots are rich in the carotenoids <a href="https://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/">alpha-carotene and beta-carotene</a>, which get converted into vitamin A in the body and used in antibody production and to maintain <a href="https://ods.od.nih.gov/factsheets/VitaminA-Consumer/">healthy functioning</a> of your eyes, skin, lungs and gut. <h2>4. Longlife skim milk</h2> Longlife skim milk costs about $1.60 a litre. While some fresh varieties are around the same price, the value of longlife milk is that you can keep a store of it in the cupboard, meaning you never run out and it has a long shelf life. Milk makes great <a href="https://nomoneynotime.com.au/healthy-easy-recipes/banana-breakfast-smoothie">smoothies</a> and is an essential ingredient in dishes from quiche to <a href="https://nomoneynotime.com.au/healthy-easy-recipes/cauliflower-cheese-bake">cauliflower cheese</a> to <a href="https://nomoneynotime.com.au/healthy-easy-recipes/clares-lemon-orange-delicious">lemon delicious</a> pudding. <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/milk#nutrients-in-milk">Milk contains</a> protein, calcium, magnesium, zinc, potassium and vitamins A, B2 and B12. Research shows regular milk consumption is <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/milk#milk-and-health-conditions">associated with</a> a lower risk of developing osteoporosis, high blood pressure, type 2 diabetes, heart disease and colon cancer. <h2>5. Apples</h2> A bag of apples costs about $4 or 60 cents an apple and $4–$5 for a large can of stewed apple. Apples make a portable snack. Add <a href="https://nomoneynotime.com.au/healthy-easy-recipes/comforting-apple-porridge">them to porridge</a>, serve <a href="https://nomoneynotime.com.au/healthy-easy-recipes/pork-loin-rolls">with pork</a>, <a href="https://nomoneynotime.com.au/healthy-easy-recipes/carrot-and-apple-coleslaw-with-mustard-vinaigrette">in coleslaw</a> or in <a href="https://nomoneynotime.com.au/healthy-easy-recipes/wholegrain-apple-crumble">apple crumble</a>. Apples <a href="https://pubmed.ncbi.nlm.nih.gov/35502671/">contain</a> dietary fibre and pectin, vitamin B6 and C, and the minerals potassium, calcium, nitrogen, magnesium and traces of zinc, iron and copper. In <a href="https://pubmed.ncbi.nlm.nih.gov/31667463/">observational studies</a>, people who ate more apples had a lower risk of heart disease, stroke, type 2 diabetes and death from any cause. For easy, tasty, economical meals that are quick to prepare, without too much effort, along with our food budget tips, visit our team’s <a href="https://nomoneynotime.com.au/">No Money No Time</a> website.<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/229903/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/clare-collins-7316">Clare Collins</a>, Laureate Professor in Nutrition and Dietetics, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/5-foods-to-add-to-your-shopping-list-to-save-money-and-theyre-good-for-you-too-229903">original article</a>. </div>

Food & Wine

How old’s too old to be a doctor? Why GPs and surgeons over 70 may need a health check to practise

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/christopher-rudge-108366">Christopher Rudge</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> A growing number of complaints against older doctors has prompted the Medical Board of Australia to <a href="https://www.medicalboard.gov.au/News/2024-08-07-Medical-Board-consults-on-new-approach-to-keep-late-career-doctors-in-safe-practice.aspx">announce</a> today that it’s reviewing how doctors aged 70 or older are regulated. Two new options are on the table. The first would require doctors over 70 to undergo a detailed health assessment to determine their current and future “fitness to practise” in their particular area of medicine. The second would require only general health checks for doctors over 70. A third option acknowledges existing rules requiring doctors to maintain their health and competence. As part of their <a href="https://www.medicalboard.gov.au/Codes-Guidelines-Policies/Code-of-conduct.aspx">professional code of conduct</a>, doctors must seek independent medical and psychological care to prevent harming themselves and their patients. So, this third option would maintain the status quo. <h2>Haven’t we moved on from set retirement ages?</h2> It might be surprising that stricter oversight of older doctors’ performance is proposed now. Critics of mandatory retirement ages in other fields – for judges, for instance – have long questioned whether these rules are “<a href="https://law.unimelb.edu.au/__data/assets/pdf_file/0019/2061019/02-Blackham.pdf">still valid in a modern society</a>”. However, unlike judges, doctors are already <a href="https://www.medicalboard.gov.au/Registration/Registration-Renewal.aspx">required to renew their registration</a> annually to practise. This allows the Medical Board of Australia not only to access sound data about the prevalence and activity of older practitioners, but to assess their eligibility regularly and to conduct <a href="https://www.ahpra.gov.au/Notifications/Further-information/Guides-and-fact-sheets/Performance-assessments.aspx">performance assessments</a> if and when they are needed. <h2>What has prompted these proposals?</h2> This latest <a href="https://www.ahpra.gov.au/documents/default.aspx?record=WD24%2f33840&dbid=AP&chksum=vCEdxXaBs0%2bMeMZFxSb7SQ%3d%3d&_gl=1*3ol06k*_ga*MzU1NjAzMTc1LjE3MjMwMDA1Nzc.*_ga_F1G6LRCHZB*MTcyMzAwMDU3Ny4xLjEuMTcyMzAwMDU4My4wLjAuMA..">proposal</a> identifies several emerging concerns about older doctors. These are grounded in external research about the effect of age on doctors’ competence as well as the regulator’s internal data showing surges of complaints about older doctors in recent years. Studies of medical competence in ageing doctors show <a href="https://qualitysafety.bmj.com/content/29/2/113">variable results</a>. However, the Medical Board of Australia’s consultation document emphasises studies of neurocognitive loss. It explains how physical and cognitive impairment can lead to poor record-keeping, improper prescribing, as well as disruptive behaviour. The other issue is the number of patient complaints against older doctors. These “notifications” have surged in recent years, as have the number of disciplinary actions against older doctors. In 2022–2023, the Medical Board of Australia took disciplinary action against older doctors about 1.7 times more often than for doctors under 70. In 2023, notifications against doctors over 70 were 81% higher than for the under 70s. In that year, patients sent 485 notifications to the Medical Board of Australia about older doctors – up from 189 in 2015. While older doctors make up only about 5.3% of the doctor workforce in Australia (less than 1% over 80), this only makes the high numbers of complaints more starkly disproportionate. It’s for these reasons that the Medical Board of Australia has determined it should take further regulatory action to safeguard the health of patients. <h2>So what distinguishes the two new proposed options?</h2> The “fitness to practise” assessment option would entail a rigorous assessment of doctors over 70 based on their specialisation. It would be required every three years after the age of 70 and every year after 80. Surgeons, for example, would be assessed by an independent occupational physician for dexterity, sight and the ability to give clinical instructions. Importantly, the results of these assessments would usually be confidential between the assessor and the doctor. Only doctors who were found to pose a substantial risk to the public, which was not being managed, would be obliged to report their health condition to the Medical Board of Australia. The second option would be a more general health check not linked to the doctor’s specific role. It would occur at the same intervals as the “fitness to practise” assessment. However, its purpose would be merely to promote good health-care decision-making among health practitioners. There would be no general obligation on a doctor to report the results to the Medical Board of Australia. In practice, both of these proposals appear to allow doctors to manage their own general health confidentially. <h2>The law tends to prioritise patient safety</h2> All state versions of the legal regime regulating doctors, known as the National Accreditation and Registration Scheme, include a “paramountcy” provision. <a href="https://www8.austlii.edu.au/cgi-bin/viewdoc/au/legis/act/consol_act/hprnl428/s3a.html">That provision</a> basically says patient safety is paramount and trumps all other considerations. <figure class="align-center zoomable"><figcaption></figcaption></figure> As with legal <a href="https://legislation.nsw.gov.au/view/html/inforce/current/act-2010-104a#sec.3">regimes regulating childcare</a>, health practitioner regulation prioritises the health and safety of the person receiving the care over the rights of the licensed professional. Complicating this further, is the fact that a longstanding principle of health practitioner regulation has been that doctors should not be “<a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3383892">punished</a>” for errors in practice. All of this means that reforms of this nature can be difficult to introduce and that the balance between patient safety and professional entitlements must be handled with care. <h2>Could these proposals amount to age discrimination?</h2> It is premature to analyse the legal implications of these proposals. So it’s difficult to say how these proposals interact with Commonwealth age- and other anti-discrimination laws. For instance, one complication is that the federal age discrimination statute includes an exemption to allow “qualifying bodies” such as the Medical Board of Australia to discriminate against older professionals <a href="https://www8.austlii.edu.au/cgi-bin/viewdoc/au/legis/cth/consol_act/ada2004174/s22.html?context=1;query=inherent;mask_path=au/legis/cth/consol_act/ada2004174">who are</a> “unable to carry out the inherent requirements of the profession, trade or occupation because of his or her age”. In broader terms, a licence to practise medicine is often compared to a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6797044/">licence to drive</a> or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10236877/">pilot an aircraft</a>. Despite <a href="https://www.smh.com.au/national/nsw/mandatory-test-older-drivers-facing-discrimination-says-pensioner-group-20170607-gwm45u.html">claims of discrimination</a>, New South Wales law requires older drivers to undergo a medical assessment <a href="https://www.nsw.gov.au/driving-boating-and-transport/driver-and-rider-licences/older-drivers-and-riders/assessments">every year</a>; and similar requirements affect older <a href="https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.casa.gov.au/guidelines-medical-assessment-aviation&ved=2ahUKEwil-9GXlOKHAxUdslYBHdN_EboQFnoECBkQAQ&usg=AOvVaw0SgpoCCKjNriMN20fs16rq">pilots and air traffic controllers</a>. <h2>Where to from here?</h2> When changes are proposed to health practitioner regulation, there is typically much media attention followed by a consultation and behind-the-scenes negotiation process. This issue is no different. How will doctors respond to the proposed changes? It’s too soon to say. If the proposals are implemented, it’s possible some older doctors might retire rather than undergo these mandatory health assessments. Some may argue that encouraging more older doctors to retire is precisely the point of these proposals. However, <a href="https://www1.racgp.org.au/newsgp/professional/ahpra-eyes-mandatory-health-checks-for-older-gps">others have suggested</a> this would only exacerbate shortages in the health-care workforce. The proposals are open for <a href="https://www.medicalboard.gov.au/News/Current-Consultations.aspx">public comment</a> until October 4.<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/236305/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/christopher-rudge-108366">Christopher Rudge</a>, Law lecturer, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-olds-too-old-to-be-a-doctor-why-gps-and-surgeons-over-70-may-need-a-health-check-to-practise-236305">original article</a>. </div>

Body

We have too few aged care workers to care for older Australians. Why? And what can we do about it?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/hal-swerissen-9722">Hal Swerissen</a>, <a href="https://theconversation.com/institutions/la-trobe-university-842">La Trobe University</a> In a country like Australia, we all expect that when we get old, we’ll be able to rely on a robust aged care system. But aged care providers can’t find staff and a crisis is brewing. If the problem isn’t fixed, there are serious risks to quality and access to services for older people who need support. There are also broader social, economic and political consequences for undervaluing the rapidly expanding health and social assistance workforce. Aged care <a href="https://www.health.gov.au/sites/default/files/documents/2021/10/2020-aged-care-workforce-census.pdf">employs</a> around 420,000 people. Around 80% of those are front line staff providing care and demand for them is increasing rapidly. <h2>Australians are ageing</h2> The number of people aged 80 and over is <a href="https://treasury.gov.au/sites/default/files/2019-03/IGR_2010_Overview.pdf">projected to double</a> by 2050. At the same time, informal family care is becoming less available. In the next 25 years, <a href="https://www.australianageingagenda.com.au/executive/shortfall-of-400000-aged-care-workers-predicted-by-2050/">twice as many</a> aged care staff will be needed. Currently, about 1.4 million older people <a href="https://www.aihw.gov.au/reports/older-people/older-australians/contents/aged-care">receive</a> aged care services, including basic and more intensive home care and residential care. Health care and social support job vacancies and ads are the highest of any industry. Between 30,000 and 35,000 additional direct aged care workers a year are already needed. By 2030 the <a href="https://cedakenticomedia.blob.core.windows.net/cedamediacontainer/kentico/media/attachments/ceda-duty-of-care-3.pdf">shortfall</a> is likely to be 110,000 full time equivalent workers. <h2>Why don’t enough people want to work in aged care?</h2> Despite recent <a href="https://www.health.gov.au/topics/aged-care-workforce/what-were-doing/better-and-fairer-wages">pay increases</a>, it is difficult to attract and retain aged care workers because the work is under-valued. The Australian workforce is undergoing profound change. A generation ago, manufacturing made up 17% of the workforce. Today it has fallen to 6%. By contrast, the health care and social assistance workforce has doubled from 8% to 16%. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/607090/original/file-20240716-17-hup1e8.png?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/607090/original/file-20240716-17-hup1e8.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/607090/original/file-20240716-17-hup1e8.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/607090/original/file-20240716-17-hup1e8.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/607090/original/file-20240716-17-hup1e8.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/607090/original/file-20240716-17-hup1e8.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=423&fit=crop&dpr=1 754w, https://images.theconversation.com/files/607090/original/file-20240716-17-hup1e8.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=423&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/607090/original/file-20240716-17-hup1e8.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=423&fit=crop&dpr=3 2262w" alt="" /></a><figcaption>The manufacturing workforce has declined, while health, aged care and social assistance has risen. ABS 6291.0.55.001 Labour Force, Australia.</figcaption></figure> Manufacturing jobs were <a href="https://australiainstitute.org.au/wp-content/uploads/2020/12/Manufacturing-Briefing-Paper-FINAL.pdf">mainly</a> secure, full-time, reasonably paid jobs dominated by male workers. By contrast, jobs in aged care are often insecure, part-time and poorly paid, dominated by women, with many workers coming from non-English speaking backgrounds. Since moving to take over aged care in the 1980s, the federal government has over-emphasised <a href="https://arena.org.au/a-genealogy-of-aged-care/">cost constraint</a> through service privatisation, activity-based funding and competition, often under the cover of consumer choice. The result is a highly fragmented and poorly coordinated aged care sector with almost 3,200, often small and under-resourced providers centrally funded and regulated from Canberra. This has <a href="https://www.health.gov.au/sites/default/files/a-matter-of-care-australia-s-aged-care-workforce-strategy.pdf">led to</a> high levels of casualisation, low investment in training and professional development, and inadequate supervision, particularly in the home care sector. Aged care is facing a perfect storm. Demand for care and support staff is increasing dramatically. The sector is poorly coordinated and difficult to navigate. Pay and conditions remain poor and the workforce is relatively untrained. There are no minimum standards or registration requirements for many front-line aged care staff. <h2>What are the consequences?</h2> An understaffed and under-trained aged care workforce reduces access to services and the quality of care and support. Aged care providers <a href="https://www.agedhealth.com.au/content/compliance-and-governance/news/troubled-outlook-for-aged-care-reforms-1224428737#:%7E:text=Its%20report%20found%20that%2053.8,was%20%22impossible%20to%20achieve%22.">routinely report</a> it is difficult to attract staff and they can’t meet the growing demand for services from older people. Staff shortages are already having an impact on residential care occupancy rates falling, with some regional areas now down to only 50% occupancy. That means older people either don’t get care or they are at increased risk of neglect, malnutrition, avoidable hospital admissions and a poorer quality of life. Inevitably, lack of aged care workers puts pressure on hospital services when older people have nowhere else to go. <h2>What needs to be done?</h2> Addressing these challenges requires a multifaceted approach. Australia will need a massive increase in the number of aged care workers and the quality of the care they provide. Wages have to be competitive to attract and retain staff. But better pay and conditions is only part of the story. Unless aged care becomes a career the community recognises, values and supports, it will continue to be difficult to train, attract and retain staff. The recent <a href="https://www.royalcommission.gov.au/aged-care">Royal Commission on Aged Care Quality and Safety</a> highlighted the need for a more skilled workforce, emphasising the importance of ongoing professional development for all staff. To date the federal government’s aged care workforce initiatives have been underwhelming. They are a limited and piecemeal rather than a coherent workforce strategy. In the short term, skilled migration may be part of the solution. But progress to bring in skilled aged care workers has been glacial. Currently only about 1% of providers <a href="https://theconversation.com/overseas-recruitment-wont-solve-australias-aged-care-worker-crisis-189126">have agreements</a> to bring in staff from overseas. At best, overseas migration will meet only 10% of the workforce shortfall. Registration, qualifications and training for direct care work have to become mandatory to make sure care standards are met. Much more significant and systematic incentives and support for training will be needed. Supervision, career progression and staff development will also have to be dramatically improved if we are to attract and retain the workforce that is needed. “Learn and earn” incentives, including scholarships and traineeships for aged care, are needed to attract the future workforce. At the same time, a much broader investment in upskilling the entire workforce through continuing professional development and good quality supervision is necessary. Like manufacturing a generation ago, aged care needs to become valued, skilled, secure and well-paid employment if it is going to attract the staff that are needed to avoid a looming crisis.<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/232707/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/hal-swerissen-9722">Hal Swerissen</a>, Emeritus Professor of Public Health, <a href="https://theconversation.com/institutions/la-trobe-university-842">La Trobe University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/we-have-too-few-aged-care-workers-to-care-for-older-australians-why-and-what-can-we-do-about-it-232707">original article</a>. </div>

Caring

3 signs your diet is causing too much muscle loss – and what to do about it

<div class="theconversation-article-body"><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> When trying to lose weight, it’s natural to want to see quick results. So when the number on the scales drops rapidly, it seems like we’re on the right track. But as with many things related to weight loss, there’s a flip side: rapid weight loss can result in a significant loss of muscle mass, as well as fat. So how you can tell if you’re losing too much muscle and what can you do to prevent it? <h2>Why does muscle mass matter?</h2> Muscle is an important factor in determining our metabolic rate: how much energy we burn at rest. This is determined by how much muscle and fat we have. Muscle is more metabolically active than fat, meaning it burns more calories. When we diet to lose weight, we create a calorie deficit, where our bodies don’t get enough energy from the food we eat to meet our energy needs. Our bodies start breaking down our fat and muscle tissue for fuel. A decrease in calorie-burning muscle mass slows our metabolism. This quickly slows the rate at which we lose weight and impacts our ability to maintain our weight long term. <h2>How to tell you’re losing too much muscle</h2> Unfortunately, measuring changes in muscle mass is not easy. The most accurate tool is an enhanced form of X-ray called a dual-energy X-ray absorptiometry (DXA) scan. The scan is primarily used in medicine and research to capture data on weight, body fat, muscle mass and bone density. But while DEXA is becoming more readily available at weight-loss clinics and gyms, it’s not cheap. There are also many “smart” scales available for at home use that promise to provide an accurate reading of muscle mass percentage. However, the accuracy of these scales is questionable. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8122302/">Researchers found</a> the scales tested massively over- or under-estimated fat and muscle mass. Fortunately, there are three free but scientifically backed signs you may be losing too much muscle mass when you’re dieting. <h2>1. You’re losing much more weight than expected each week</h2> Losing a lot of weight rapidly is one of the early signs that your diet is too extreme and you’re losing too much muscle. Rapid weight loss (of more than 1 kilogram per week) results in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5702468/">greater muscle mass loss</a> than slow weight loss. Slow weight loss better preserves muscle mass and often has the added benefit of <a href="https://www.sciencedirect.com/science/article/pii/S0195666312000153">greater fat mass loss</a>. One study compared people in the obese weight category who followed either a very low-calorie diet (500 calories per day) for five weeks or a low-calorie diet (1,250 calories per day) for 12 weeks. While both groups lost similar amounts of weight, participants following the very low-calorie diet (500 calories per day) for five weeks lost <a href="https://pubmed.ncbi.nlm.nih.gov/26813524/">significantly more muscle mass</a>. <h2>2. You’re feeling tired and things feel more difficult</h2> It sounds obvious, but feeling tired, sluggish and finding it hard to complete physical activities, such as working out or doing jobs around the house, is another strong signal you’re losing muscle. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3648712/">Research</a> shows a decrease in muscle mass may negatively impact your body’s physical performance. <h2>3. You’re feeling moody</h2> Mood swings and feeling anxious, stressed or depressed may also be signs you’re losing muscle mass. <a href="https://pubmed.ncbi.nlm.nih.gov/26228522/">Research</a> on muscle loss due to ageing suggests low levels of muscle mass can negatively impact mental health and mood. This seems to stem from the relationship between low muscle mass and proteins called neurotrophins, which help regulate mood and feelings of wellbeing. <h2>So how you can do to maintain muscle during weight loss?</h2> Fortunately, there are also three actions you can take to maintain muscle mass when you’re following a calorie-restricted diet to lose weight. <h2>1. Incorporate strength training into your exercise plan</h2> While a broad exercise program is important to support overall weight loss, strength-building exercises are a surefire way to help prevent the loss of muscle mass. A <a href="https://pubmed.ncbi.nlm.nih.gov/29596307/">meta-analysis of studies</a> of older people with obesity found resistance training was able to prevent almost 100% of muscle loss from calorie restriction. Relying on diet alone to lose weight will reduce muscle along with body fat, slowing your metabolism. So it’s essential to make sure you’ve incorporated sufficient and appropriate exercise into your weight-loss plan to hold onto your muscle mass stores. But you don’t need to hit the gym. Exercises using body weight – such as push-ups, pull-ups, planks and air squats – are just as effective as lifting weights and using strength-building equipment. Encouragingly, moderate-volume resistance training (three sets of ten repetitions for eight exercises) <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/sms.14237">can be as effective</a> as high-volume training (five sets of ten repetitions for eight exercises) for maintaining muscle when you’re following a calorie-restricted diet. <h2>2. Eat more protein</h2> Foods high in protein play an essential role in building and maintaining muscle mass, but <a href="https://europepmc.org/article/MED/19927027">research</a> also shows these foods help prevent muscle loss when you’re following a calorie-restricted diet. But this doesn’t mean just eating foods with protein. Meals need to be balanced and include a source of protein, wholegrain carb and healthy fat to meet our dietary needs. For example, eggs on wholegrain toast with avocado. <h2>3. Slow your weight loss plan down</h2> When we change our diet to lose weight, we take our body out of its comfort zone and trigger its survival response. It then counteracts weight loss, triggering <a href="https://pubmed.ncbi.nlm.nih.gov/25896063/">several physiological responses</a> to defend our body weight and “survive” starvation. Our body’s survival mechanisms want us to regain lost weight to ensure we survive the next period of famine (dieting). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/">Research</a> shows that more than half of the weight lost by participants is regained within two years, and more than 80% of lost weight is regained within five years. However, a slow and steady, stepped approach to weight loss, prevents our bodies <a href="https://pubmed.ncbi.nlm.nih.gov/38193357/">from activating defence mechanisms</a> to defend our weight when we try to lose weight. Ultimately, losing weight long-term comes down to making gradual changes to your lifestyle to ensure you form habits that last a lifetime. <hr /> At the Boden Group, Charles Perkins Centre, we are studying the science of obesity and running clinical trials for weight loss. You can <a href="https://redcap.sydney.edu.au/surveys/?s=RKTXPPPHKY">register here</a> to express your interest.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/223865/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/nick-fuller-219993">Nick Fuller</a>, Charles Perkins Centre Research Program Leader, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/3-signs-your-diet-is-causing-too-much-muscle-loss-and-what-to-do-about-it-223865">original article</a>. </div>

Body

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

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/caroline-sirois-1524891">Caroline Sirois</a>, <a href="https://theconversation.com/institutions/universite-laval-1407">Université Laval</a> When we see an older family member handling a bulky box of medications sorted by day of the week, we might stop and wonder, is it too much? How do all those pills interact? The fact is, as we get older we are more likely to develop different chronic illnesses that require us to take several different medications. This is known as polypharmacy. The concept applies to people taking five or more medications, but there are all sorts of <a href="https://doi.org/10.3390/pharmacy7030126">definitions with different thresholds</a> (for example, four, 10 or 15 medicines). I’m a pharmacist and pharmacoepidemiologist interested in polypharmacy and its impact on the population. The research I carry out with my team at the Faculty of Pharmacy at Université Laval focuses on the appropriate use of medication by older family members. We have published this <a href="https://doi.org/10.1093/ageing/afac244">study</a> on the perceptions of older adults, family carers and clinicians on the use of medication among persons over 65. <h2>Polypharmacy among older adults</h2> Polypharmacy is very common among older adults. In 2021, a quarter of persons over 65 in Canada were prescribed <a href="https://www.cihi.ca/en/drug-use-among-seniors-in-canada">more than ten different classes of medication</a>. In Québec, persons over 65 used an average of <a href="https://www.inspq.qc.ca/sites/default/files/publications/2679_portrait_polypharmacie_aines_quebecois.pdf">8.7 different drugs in 2016</a>, the latest year available for statistics. Is it a good idea to take so many drugs? According to <a href="https://journals.sagepub.com/doi/10.1177/07334648211069553">our study</a>, the vast majority of seniors and family caregivers would be willing to stop taking one or more medications if the doctor said it was possible, even though most are satisfied with their treatments, <a href="https://doi.org/10.1093/ageing/afac244">have confidence in their doctors</a> and feel that their doctors are taking care of them to the best of their ability. In the majority of cases, medicine prescribers are helping the person they are treating. Medications have a positive impact on health and are essential in many cases. But while the treatment of individual illnesses is often adequate, the whole package can sometimes become problematic. <h2>The risks of polypharmacy: 5 points to consider</h2> When we evaluate cases of polypharmacy, we find that the quality of treatment is often compromised when many medications are being taken. <ol> <li> Drug interactions: polypharmacy increases the risk of drugs interacting, which can lead to undesirable effects or reduce the effectiveness of treatments. </li> <li> A drug that has a positive effect on one illness may have a negative effect on another: what should you do if someone has both illnesses? </li> <li> The greater the number of drugs taken, the greater the risk of undesirable effects: for adults over 65, for example, there is an increased risk of confusion or falls, which have significant consequences. </li> <li> The more medications a person takes, the more likely they are to take a <a href="https://www.doi.org/10.1093/fampra/cmz060">potentially inappropriate medication</a>. For seniors, these drugs generally carry more risks than benefits. For example, benzodiazepines, medicine for anxiety or sleep, are the <a href="https://www.inspq.qc.ca/sites/default/files/publications/2575_utilisation_medicaments_potentiellement_inappropries_aines.pdf">most frequently used class</a> of medications. We want to reduce their use as much as possible <a href="https://www.canada.ca/en/health-canada/services/substance-use/controlled-illegal-drugs/benzodiazepines.html">to avoid negative impacts</a> such as confusion and increased risk of falls and car accidents, not to mention the risk of dependence and death. </li> <li> Finally, polypharmacy is associated with various adverse health effects, such as an <a href="https://www.doi.org/10.1007/s41999-021-00479-3">increase in frailty, hospital admissions and emergency room visits</a>. However, studies conducted to date have not always succeeded in isolating the effects specific to polypharmacy. As polypharmacy is more common among people with multiple illnesses, these illnesses may also contribute to the observed risks. </li> </ol> Polypharmacy is also a combination of medicines. There are almost as many as there are people. The risks of these different combinations can vary. For example, the risks associated with a combination of five potentially inappropriate drugs would certainly be different from those associated with blood pressure medication and vitamin supplements. Polypharmacy is therefore complex. <a href="https://doi.org/10.1186/s12911-021-01583-x">Our studies attempt to use artificial intelligence</a> to manage this complexity and identify combinations associated with negative impacts. There is still a lot to learn about polypharmacy and its impact on health. <h2>3 tips to avoid the risks associated with polypharmacy</h2> What can we do as a patient, or as a caregiver? <ol> <li> Ask questions: when you or someone close to you is prescribed a new treatment, be curious. What are the benefits of the medication? What are the possible side effects? Does this fit in with my treatment goals and values? How long should this treatment last? Are there any circumstances in which discontinuing it should be considered ? </li> <li> Keep your medicines up to date: make sure they are all still useful. Are there still any benefits to taking them? Are there any side effects? Are there any drug interactions? Would another treatment be better? Should the dose be reduced? </li> <li> Think about de-prescribing: this is an increasingly common clinical practice that involves stopping or reducing the dose of an inappropriate drug after consulting a health-care professional. It is a shared decision-making process that involves the patient, their family and health-care professionals. The <a href="https://www.deprescribingnetwork.ca">Canadian Medication Appropriateness and Deprescribing Network</a> is a world leader in this practice. It has compiled a number of tools for patients and clinicians. You can find them on their website and subscribe to the newsletter. </li> </ol> <h2>Benefits should outweigh the risks</h2> Medications are very useful for staying healthy. It’s not uncommon for us to have to take more medications as we age, but this shouldn’t be seen as a foregone conclusion. Every medication we take must have direct or future benefits that outweigh the risks associated with them. As with many other issues, when it comes to polypharmacy, the saying, “everything in moderation,” frequently applies.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/230612/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/caroline-sirois-1524891">Caroline Sirois</a>, Professor in Pharmacy, <a href="https://theconversation.com/institutions/universite-laval-1407">Université Laval</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/taking-too-many-medications-can-pose-health-risks-heres-how-to-avoid-them-230612">original article</a>. </div>

Body

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

<div class="theconversation-article-body"><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> 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. 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>. 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. 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”. <h2>What are FOMO, problematic social media use and doomscrolling?</h2> 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>. 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. 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. 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. <h2>What we tried to find out</h2> 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. 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>. 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. 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. In our analyses, we sought to uncover how both intrapersonal emotion regulation (ability to self-manage our own emotional states) and interpersonal 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. <h2>What we found – and what it might mean for the future of internet use</h2> 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). 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. 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. While links between FOMO and doomscrolling have been observed before, our study is among the first to try and account for this theoretically. We suspect the link between FOMO and doomscrolling may be more about having more of an online presence while things are happening. This would account for intrapersonal emotion regulation failing to help manage our reactions to “bad news” stories as they unfold, leading to doomscrolling. 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. <h2>Getting the balance right</h2> 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. 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. 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). 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. 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. <hr /> 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.<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" /> <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> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/spending-too-much-time-on-social-media-and-doomscrolling-the-problem-might-be-fomo-230980">original article</a>. </div>

Technology

"Taken way too soon": TV star's brother breaks silence after shocking death

The grieving brother of slain TV star Johnny Wactor has broken his silence over his brother's untimely death. Johnny Wactor, 37, was <a href="https://oversixty.com.au/health/caring/soap-star-killed-in-robbery-gone-wrong" target="_blank" rel="noopener">killed</a> in Los Angeles in the early hours of Saturday morning when he intercepted a group of men trying to steal the catalytic converter from his vehicle, and was shot dead at the scene. Now, Wactor's brother Grant has shared more details on the events surrounding his Johnny's death, telling <a href="https://people.com/general-hospital-actor-johnny-wactors-brother-speaks-out-on-killing-taken-way-too-early-8654340" target="_blank" rel="noopener">People</a> magazine that he had finished a shift working as a bartender at the time he was shot. After his shift finished at about 3:25am local time, he walked to his car with a female co-worker when he noticed that his car had been “jacked up or lifted in some way”. Initially, the actor thought his car was being towed away, but quickly realised the people surrounding his car were not tow-truck drivers. Grant said his brother physically shielded his female colleague to prevent her from being hurt and had his hands up in the air when he was shot. “He did not confront them,” he told the publication. “He did not try to stop them. He was just trying to diffuse the situation by stepping back.” After the shooting the men fled the scene in a different car, and LAPD officer Jeff Lee said the suspects were “still outstanding”. Grant Wactor said his family were “hoping and praying” that the killers were found and brought to justice. “We just want (them to be found) as quickly as possible and correctly,” he said, describing his brother as “a good person”. “He was taken way too early, and no one should be taken like this at all,” he said. “He touched a lot of people. He believed in his core values to the end, and he lived life to the fullest the way he wanted to. And he was happy doing that.” Image credits: Instagram / Ouzounova / Shutterstock Editorial

Family & Pets

“Too chaotic for me”: Bride and groom slammed for “unreasonable” wedding rules

A bride and groom has been slammed online for giving their wedding guests an extensive list of rules they must abide by on their big day. The list of 15 demands was shared on Reddit, where social media users tore the newlyweds to shreds with their “unreasonable” rules. The post racked up thousands of comments on the Wedding Shamers subreddit, with one person writing, 'If someone sent this to me, I would simply just not go.' The rules included that guests needed to remember their opinions on the wedding are “irrelevant” while also banning attendees from “sitting down all night” or making their own big announcements. The first rule urged guests to remember that this was the bride and groom's big day, “not yours”, while also telling guests, “Do not get in the photographer's way.” They also made a strict dress code, writing, “the attire is BLACK and/or GOLD not red, blue, green and definitely NO WHITE!” “Do not rearrange the seats, we have a seating chart for a reason.” The rules continued, “If you didn't put out any money for the wedding, keep your "should've, could've, would've" to yourself. Your opinion is irrelevant.” But the couple did not stop there as they also urged guests to pace themselves when drinking and banned “big announcements or proposals.” Next up, it read, “If you can't handle or dislike the music being played, simply go home. This is a celebration, not a funeral.” The lovebirds then instructed their friends and family to use their own personalised hashtag when posting photos on social media. Rounding out the demands, the final five read, “Do not sit down all night. No outside liquor. If caught, you will be escorted out.” “Refer back to rule number one. The bride and groom said what they said! Turn ALL the way up!” The post was soon flooded with comments with many insisting that the couple had taken it too far. One person wrote, “What kind of list is this? Too chaotic for me.” Another person added, “Yeah, I would not be going to that wedding. Sounds like too much drama.” On the other hand, there were a few commenters who understood the need for issuing such strict guidelines and defended the couple. One person wrote, “They're not asking for anything out of order. They're just stating what should be obvious, but they probably have seen from their family and friends past behaviour, that it NEEDS to be addressed.” “Is it a little tacky? Yes, but the only people that will be bothered by any of it are the ones that would have been an issue.” Image credits: Reddit / Shutterstock

Relationships

Too many Australians aren’t getting a flu vaccine. Why, and what can we do about it?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/holly-seale-94294">Holly Seale</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Australia’s childhood immunisation program gets very good uptake every year – <a href="https://www.health.gov.au/topics/immunisation/immunisation-data/childhood-immunisation-coverage">almost 94% of five-year-olds</a> have had all their routine vaccinations. But our influenza vaccine coverage doesn’t get such a good report card. Looking back over <a href="https://ncirs.org.au/influenza-vaccination-coverage-data/historical-national-influenza-vaccination-coverage-end-year-age">recent years</a>, for kids aged six months to five years, we saw a peak in flu vaccine coverage at the beginning of the COVID pandemic at 46%, which then declined to 30% by the 2023 season. While we’re still relatively early in the 2024 flu season, only <a href="https://ncirs.org.au/influenza-vaccination-coverage-data">7% of children</a> under five have received their flu shot this year so far. Although young children are a particular concern, flu vaccination rates appear to be lagging for the population as a whole. Reports indicate that <a href="https://www.abc.net.au/news/2024-05-07/calls-to-vaccinate-young-children-against-flu-as-season-begins/103783508">from March 1 to April 28</a>, 16% fewer people were vaccinated against the flu compared with the same period last year. So what’s going on, and what can we do to boost uptake? <h2>Why do we vaccinate kids against the flu?</h2> Last year, <a href="https://www.health.gov.au/sites/default/files/2023-12/aisr-2023-national-influenza-season-summary.pdf">reported cases of flu</a> were highest in children aged five to nine, followed by those aged zero to four. This is not a new trend – we record a high number of flu cases and hospital admissions in kids every year. So far <a href="https://nindss.health.gov.au/pbi-dashboard/">this year</a> children aged zero to four have had the highest number of infections, marginally ahead of five- to nine-year-olds. While kids are more likely to catch and spread the flu, they’re also <a href="https://theconversation.com/kids-are-more-vulnerable-to-the-flu-heres-what-to-look-out-for-this-winter-117748">at greater risk</a> of getting very sick from it. This particularly applies to children under five, and the flu vaccine is available for free for this age group. The flu vaccine isn’t perfect – it may not prevent infections entirely – but it’s definitely our best chance of protection. Research has shown influenza-related visits to the GP were <a href="https://pubmed.ncbi.nlm.nih.gov/27577556/">more than halved</a> in vaccinated children compared with unvaccinated children. <h2>So why are kids not receiving the vaccine?</h2> Often, it comes down to misunderstandings about who is eligible for the vaccine or whom it’s recommended for. But we can address this issue by nudging people via <a href="https://www.annfammed.org/content/15/6/507?sf174332549=1">a text message reminder</a>. Some parents <a href="https://www.sciencedirect.com/science/article/pii/S0264410X17318285">report concerns</a> about the vaccine, including the old dogma that it can cause the flu. The flu vaccine <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/flu-influenza-immunisation">can’t give you the flu</a> because it doesn’t contain live virus. Unfortunately, that myth is really sticky. For <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jpc.15235">some parents</a>, the challenge can be forgetting to book or accessing an appointment. <h2>It’s not just kids at higher risk</h2> Adults aged 65 and over are also <a href="https://theconversation.com/im-over-65-and-worried-about-the-flu-which-vaccine-should-i-have-204810">more vulnerable</a> to the flu, and can receive a <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">free vaccine</a>. For this group, we usually get around <a href="https://ncirs.org.au/influenza-vaccination-coverage-data/historical-national-influenza-vaccination-coverage-end-year-age">65% vaccinated</a>. So far this year, <a href="https://ncirs.org.au/influenza-vaccination-coverage-data/national-influenza-vaccination-coverage-all-people-age-group">around 35%</a> of over-65s have received their flu vaccine. Aboriginal and Torres Strait Islander people are likewise eligible for a free flu vaccine. While previously coverage rates were higher among Aboriginal and Torres Strait Islander peoples compared to the overall population, this gap has narrowed. There’s even some movement backwards, especially <a href="https://ncirs.org.au/influenza-vaccination-coverage-data/historical-national-influenza-vaccination-coverage-end-year-age">in younger age groups</a>. The flu vaccine is also free for pregnant women and anyone who has <a href="https://www.health.gov.au/topics/immunisation/when-to-get-vaccinated/immunisation-for-people-with-medical-risk-conditions">a medical condition</a> such as heart disease, chronic lung disease, diabetes or kidney disease. Past studies have found flu vaccine coverage <a href="https://www.phrp.com.au/wp-content/uploads/2022/06/PHRP31232111.pdf">for pregnant women</a> varies around the country from 39% to 76% (meaning in some jurisdictions up to 60% of pregnant women are not getting vaccinated). When it comes to adults with chronic health conditions, we don’t have a good sense of how many people receive the vaccine. The reasons adults don’t always get the flu vaccine overlap with the reasons for children. Often <a href="https://www.tandfonline.com/doi/full/10.1080/08870446.2021.1957104">concerns about side effects</a> are cited as the reason for not getting vaccinated, followed by time constraints. We also know <a href="https://www.aihw.gov.au/reports/primary-health-care/coordination-of-health-care-experiences-barriers/summary">accessing medical services</a> can be difficult for some people, such as those living in rural areas or experiencing financial hardship. <h2>Filling the gaps</h2> In Australia, GPs offer flu vaccines for all ages, while flu vaccination is also available at pharmacies, generally from age five and up. While some people make a conscious decision not to get themselves or their children vaccinated, for many people, the barriers are related to access. Programs offering vaccination outside the doctor’s office are increasing globally, and may assist in <a href="https://www.tandfonline.com/doi/full/10.1080/14760584.2019.1698955">filling gaps</a>, especially among those who don’t have regular access to a GP. For some people, their only point of contact with the <a href="https://pubmed.ncbi.nlm.nih.gov/34272104/">medical system</a> may be during emergency department visits. Others may have more regular contact with a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7046372/">specialist</a> who coordinates their medical care, rather than a GP. Offering vaccine education and programs <a href="https://journals.sagepub.com/doi/10.1177/0009922810374353">in these settings</a> has been shown to improve immunisation rates and may play a pivotal role in filling access gaps. Outside medical and pharmacy settings, the workplace is the most common place for Australian adults to receive their flu vaccine. A <a href="https://www.sciencedirect.com/science/article/pii/S1326020023004272">survey</a> showed Australian adults find workplace vaccination convenient and cost-effective, especially where free or subsidised vaccines are offered. Expanding vaccination settings, such as with <a href="https://journals.sagepub.com/doi/10.1177/19375867221087360?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">drive-through</a> and mobile clinics, can benefit groups who have unique access barriers or are under-served. Meanwhile, offering vaccination through faith-based organisations has been shown to improve uptake among <a href="https://pubmed.ncbi.nlm.nih.gov/37013523/">racial and ethnic minority groups</a>. Eleftheria Lentakis, a masters student at the School of Population Health at UNSW Sydney, contributed to this article.<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/229477/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/holly-seale-94294">Holly Seale</a>, Associate Professor, School of Population Health, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/too-many-australians-arent-getting-a-flu-vaccine-why-and-what-can-we-do-about-it-229477">original article</a>. </div>

Body

"A step too far": Grandparents barred from school event for bizarre reason

A Melbourne school has come under fire for refusing to let a group of grandparents into the classroom for a special event because they did not have a Working With Children Check (WWCC). Furious grandparents have slammed St Joseph’s Primary School in Yarra Junction for taking it "a step too far" when they asked them to provide the WWCC after being invited to attend the “Inquiry Afternoon”. The event was held for year one and two students to speak about “technology and the world has changed over time”, according to The Herald Sun. Grandparents were asked to provide a WWCC on the back of the invitation, which some of them missed. “The Working With Children Check isn’t set up for the one-off visit — it is a step too far,” founder of the National Grandparent Movement Ian Barnett told Sunrise. “I understand we’re living in a time when we want more checks and balances, but it is unrealistic to think that grandparents attending such a day would actually need to go and provide a Working With Children Check." The grandparents without a WWCC were forced to sit in the principal's office and do their show-and-tell via a video call. “I’m sure they had very good intentions — no one set out for this to happen,” Herald Sun education editor Susie O’Brien said. “But imagine turning up, arranging your entire week, your day to come to your grandchild’s event … and the child’s school refuses entry.” She added that although schools did have some discretion over such requirements, when a group of people are invited for a specific event, it is usually not required. Barnett also said that "for such visits you don’t need a Working With Children Check,” in most states. “I haven’t heard of this in NSW. I have to admit, I’m from NSW. So it is really going a bit extreme. Schools do have the right to decide who comes onsite. But it just seems it’s not required. “To actually drag the child out from the classroom to sit with nana or grandad, it’s a step too far and embarrassing, I think, for the school as well.” A spokesperson for the primary school acknowledged that although there was some confusion, the school had to comply with the child safe standards. “There was advance notice to all St Joseph’s families on this requirement, with 29 grandparents signing in on Friday with a working with children clearance," they told the Herald Sun. “We acknowledge the disappointing experience of the four grandparents who couldn’t attend the grandparents’ day and are attempting to call these families this morning.” Images: Sunrise/ The Herald Sun

Legal

New studies suggest millions with mild cognitive impairment go undiagnosed, often until it’s too late

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/soeren-mattke-1484707">Soeren Mattke</a>, <a href="https://theconversation.com/institutions/university-of-southern-california-1265">University of Southern California</a> and <a href="https://theconversation.com/profiles/ying-liu-1221170">Ying Liu</a>, <a href="https://theconversation.com/institutions/usc-dornsife-college-of-letters-arts-and-sciences-2669">USC Dornsife College of Letters, Arts and Sciences</a> Mild cognitive impairment – an early stage of dementia – is widely underdiagnosed in people 65 and older. That is the key takeaway of two recent studies from our team. In the first study, we used Medicare data for about 40 million beneficiaries age 65 and older from 2015 to 2019 to estimate the prevalence of mild cognitive impairment in that population and to identify what proportion of them had actually been diagnosed. Our <a href="https://doi.org/10.1186/s13195-023-01272-z">finding was sobering</a>: A mere 8% of the number of cases with mild cognitive impairment that we expected based on a statistical model had actually been diagnosed. Scaled up to the general population 65 and older, this means that approximately 7.4 million cases across the country remain undiagnosed. In the second study, we analyzed data for 226,756 primary care clinicians and found that <a href="https://doi.org/10.14283/jpad.2023.131">over 99% of them underdiagnosed mild cognitive impairment</a> in this population. <h2>Why it matters</h2> Mild cognitive impairment is an early symptom of Alzheimer’s disease in <a href="https://doi.org/10.1001/jama.2019.2000">about half of cases</a> and progresses to dementia <a href="https://www.alz.org/alzheimers-dementia/what-is-dementia/related_conditions/mild-cognitive-impairment">at a rate of 10% to 15% per year</a>. It includes symptoms such as losing the ability to remember recent events and appointments, make sound decisions and master complex tasks. Failure to detect it might deprive patients of an opportunity to get treated and to slow down disease progression. Mild cognitive impairment can sometimes be caused by easily addressable factors, such as medication side effects, thyroid dysfunction or <a href="https://theconversation.com/vitamin-b12-deficiency-is-a-common-health-problem-that-can-have-serious-consequences-but-doctors-often-overlook-it-192714">vitamin B12 deficiency</a>. Since mild cognitive impairment has <a href="https://doi.org/10.1016/j.amjopharm.2008.06.004">the same risk factors as cardiovascular disease</a>, such as high blood pressure and cholesterol, medication management of these risks combined with diet and exercise <a href="https://doi.org/10.1016/S0140-6736(15)60461-5">can reduce the risk of progression</a>. In 2023, the Food and Drug Administration <a href="https://www.fda.gov/news-events/press-announcements/fda-converts-novel-alzheimers-disease-treatment-traditional-approval">approved the drug lecanemab</a> as the <a href="https://theconversation.com/what-the-fdas-accelerated-approval-of-a-new-alzheimers-drug-could-mean-for-those-with-the-disease-5-questions-answered-about-lecanemab-197460">first disease-modifying treatment</a> <a href="https://www.nia.nih.gov/health/alzheimers-causes-and-risk-factors/what-happens-brain-alzheimers-disease">for Alzheimer’s disease</a>, the most common cause of mild cognitive impairment. In contrast to previous drugs, which can temporarily improve symptoms of the disease, such as memory loss and agitation, this new treatment addresses the underlying cause of the disease. Lecanemab, a monoclonal antibody, <a href="https://www.news-medical.net/health/What-are-Amyloid-Plaques.aspx">reduces amyloid plaques</a> in the brain, which are toxic protein clumps that are believed to contribute to the progression of the disease. In a large clinical trial, lecanemab was able to <a href="https://doi.org/10.1056/NEJMoa2212948">reduce the progression</a> of early-stage Alzheimer’s disease. A similar drug, donanemab, also <a href="https://doi.org/10.1001/jama.2023.13239">succeeded in a clinical trial</a> and is expected to be <a href="https://www.medicalnewstoday.com/articles/fda-delays-approval-of-alzheimers-drug-donanemab-what-experts-think">approved sometime in 2024</a>. However, these drugs must be used in the early stages of Alzheimer’s disease, ideally when a patient has only mild cognitive impairment, as there is <a href="https://www.alz.org/alzheimers-dementia/treatments/lecanemab-leqembi">no evidence that they are effective in advanced stages</a>. <figure><iframe src="https://www.youtube.com/embed/w3IbAscNjsQ?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>An earlier diagnosis leads to early treatment and better outcomes.</figcaption></figure> <h2>What still isn’t known</h2> Many factors contribute to the <a href="https://doi.org/10.1002/alz.13051">lack of timely detection</a>. But researchers don’t have a good understanding of the relative importance of those individual factors or how to reduce the high rate of underdiagnosis. While distinct, symptoms are subtle and their slow progression means that they can be overlooked or misinterpreted as normal aging. A neurologist in China told our research team that diagnosis rates spike in China after the New Year’s holiday, when children who haven’t seen their parents for a year notice changes that are harder to pick up when interacting with someone daily. Doctors also commonly discount memory concerns as normal aging and doubt that much can be done about it. While cognitive tests to distinguish mild cognitive impairment from pathologic decline do exist, they take about 15 minutes, which can be hard to come by during the limited time of a doctor’s visit and may require a follow-up appointment. <h2>What’s next</h2> People, particularly those in their 60s and beyond, as well as their families and friends need to be vigilant about cognitive decline, bring it up during doctor’s appointments and insist on a formal assessment. The <a href="https://www.medicare.gov/coverage/yearly-wellness-visits">Medicare yearly “wellness” visit</a> is an opportunity to explore such concerns, but only about half of beneficiaries <a href="https://doi.org/10.1377/hlthaff.2019.01795">take advantage of it</a>. Just as physicians ask patients about unexplained weight loss and take those concerns seriously, we believe questions that explore a patient’s cognitive state need to become the norm. The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take on interesting academic work.<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/216892/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/soeren-mattke-1484707">Soeren Mattke</a>, Director of the USC Dornsife Brain Health Observatory, <a href="https://theconversation.com/institutions/university-of-southern-california-1265">University of Southern California</a> and <a href="https://theconversation.com/profiles/ying-liu-1221170">Ying Liu</a>, Research Scientist, Center for Economic and Social Research, <a href="https://theconversation.com/institutions/usc-dornsife-college-of-letters-arts-and-sciences-2669">USC Dornsife College of Letters, Arts and Sciences</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/new-studies-suggest-millions-with-mild-cognitive-impairment-go-undiagnosed-often-until-its-too-late-216892">original article</a>. </div>

Mind

Think $5.50 is too much for a flat white? Actually it’s too cheap, and our world-famous cafes are paying the price

<a href="https://theconversation.com/profiles/emma-felton-143029">Emma Felton</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> Even in a stubborn cost-of-living crisis, it seems there’s one luxury most Australians <a href="https://www.comparethemarket.com.au/news/what-australians-wont-give-up-cost-of-living-crisis-report/">won’t sacrifice</a> – their daily cup of coffee. Coffee sales have largely <a href="https://www.statista.com/statistics/866543/australia-domestic-consumption-of-coffee/">remained stable</a>, even as financial pressures have bitten over the past few years. So too have prices. Though many of us became upset when prices began to creep up last year, they’ve since largely settled in the range between $4.00 and $5.50 for a basic drink. But this could soon have to change. By international standards, Australian coffee prices are low. No one wants to pay more for essentials, least of all right now. But our independent cafes are struggling. By not valuing coffee properly, we risk losing the <a href="https://bizcup.com.au/australian-coffee-culture/">internationally renowned</a> coffee culture we’ve worked so hard to create, and the phenomenal quality of cup we enjoy. <h2>Coffee is relatively cheap in Australia</h2> Our recent survey of Australian capital cities found the average price of a small takeaway flat white at speciality venues is A$4.78. But in <a href="https://pabloandrustys.com.au/blogs/drinkbettercoffee/global-coffee-prices">some international capitals</a>, it’s almost double this, even after adjusting for local <a href="https://www.investopedia.com/updates/purchasing-power-parity-ppp/">purchasing power parity</a>. <iframe id="gaplH" class="tc-infographic-datawrapper" style="border: none;" src="https://datawrapper.dwcdn.net/gaplH/" width="100%" height="400px" frameborder="0"></iframe> In London, a small flat white costs about A$6.96. Singapore, A$8.42. In Athens, as much as A$9.95. <h2>The cafe business is getting harder</h2> Over the past few decades, coffee prices haven’t kept pace with input costs. In the early 2000s, after wages, food costs, utilities and rent, many cafes <a href="https://www.coffeecommune.com.au/blog-why-are-cafes-so-expensive/">earned healthy profit margins</a> as high as 20%. The <a href="https://www.ibisworld.com/au/industry/cafes-coffee-shops/2015/">most recent data from IBISWorld</a> show that while Australian cafe net profits have recovered from a drop in 2020, at 7.6%, they remain much lower than the Australian <a href="https://www.money.com.au/research/australian-business-statistics">average business profit margin of 13.3%</a>. For an independent owner operating a cafe with the <a href="https://www.ibisworld.com/au/industry/cafes-coffee-shops/2015/">average turnover of A$300,000</a>, this would amount to a meagre A$22,800 annual net profit after all the bills are paid. <h2>What goes into a cup?</h2> Just looking at the cost of raw inputs – milk, beans, a cup and a lid – might make the margin seem lucrative. But they don’t paint the whole picture. <figure class="align-center "><img src="https://images.theconversation.com/files/584949/original/file-20240328-24-rlngpk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/584949/original/file-20240328-24-rlngpk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/584949/original/file-20240328-24-rlngpk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/584949/original/file-20240328-24-rlngpk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/584949/original/file-20240328-24-rlngpk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/584949/original/file-20240328-24-rlngpk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/584949/original/file-20240328-24-rlngpk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" alt="A takeaway coffee cup showing the price inputs, with wages and operation costs making up over 65% of the cost of a coffee" /><figcaption>Chart: The Conversation. <a class="source" href="https://pabloandrustys.com.au/blogs/drinkbettercoffee/whats-in-the-cost-of-coffee">Data: Pablo and Rusty's Coffee Roasters</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></figcaption></figure> Over the past few years, renting the building, keeping the lights on and paying staff have all become <a href="https://www.reuters.com/business/ground-down-australia-coffee-shops-an-early-inflation-casualty-2023-07-10/">much bigger factors</a> in the equation for coffee shop owners, and many of these pressures aren’t easing. 1. Green coffee price Increasingly <a href="https://www.aa.com.tr/en/environment/brewing-crisis-how-climate-change-is-reshaping-coffee-production/3113886">subject to the effects</a> of climate change, the baseline commodity price of green (unroasted) coffee is <a href="https://perfectdailygrind.com/2024/02/demand-for-robusta-prices-record-high/">going up</a>. Arabica – the higher quality bean you’re most likely drinking at specialty cafes – is a more expensive raw product. Despite levelling off from post-pandemic highs, its price is still trending up. In 2018, it <a href="https://www.statista.com/statistics/675807/average-prices-arabica-and-robusta-coffee-worldwide/">sold</a> for US$2.93 per kilogram, which is projected to increase to US$4.38 dollars in 2025. Robusta coffee is cheaper, and is the type <a href="https://www.lavazza.com.au/en/coffee-secrets/difference-type-arabica-robusta-coffee">typically used to make instant coffee</a>. But serious drought in Vietnam has just pushed the price of robusta to an <a href="https://www.barchart.com/story/news/25094367/coffee-rallies-with-robusta-at-a-record-high-on-shrinking-coffee-output-in-vietnam">all-time high</a>, putting pressure on the cost of coffee more broadly. 2. Milk prices The price of fresh milk has risen by <a href="https://cdn-prod.dairyaustralia.com.au/-/media/project/dairy-australia-sites/national-home/resources/reports/situation-and-outlook/situation-and-outlook-report-march-2024.pdf?rev=b0222df4b01b40d0ae36cf8ac7b01bc0">more than 20%</a> over the past two years, and remains at a peak. This has put sustained cost pressure on the production of our <a href="https://gitnux.org/australian-coffee-consumption-statistics/#:%7E:text=Coffee%20is%20a%20beloved%20beverage,approximately%206%20billion%20cups%20annually.">most popular drink orders</a>: cappuccinos and flat whites. 3. Wages and utilities Over the past year, Australian wages have grown at their <a href="https://ministers.treasury.gov.au/ministers/jim-chalmers-2022/media-releases/real-wages-growth-back">fastest rate</a> since 2009, which is welcome news for cafe staff, but tough on operators in a sector with low margins. Electricity prices remain elevated after significant inflation, but could <a href="https://www.sbs.com.au/news/article/heres-how-much-your-energy-bills-might-go-down-by-and-when/k8g00jheg">begin to fall mid-year</a>. <h2>Specialty vs. commodity coffee: why price expectations create an industry divide</h2> One of the key factors keeping prices low in Australia is consumer expectation. For many people coffee is a fundamental part of everyday life, a marker of livability. Unlike wine or other alcohol, coffee is not considered a luxury or even a treat, where one might expect to pay a little more, or reduce consumption when times are economically tough. We anchor on familiar prices. <iframe id="oDbah" class="tc-infographic-datawrapper" style="border: none;" src="https://datawrapper.dwcdn.net/oDbah/" width="100%" height="400px" frameborder="0"></iframe> Because of this, it really hurts cafe owners to put their prices up. In touch with their customer base almost every day, they’re acutely aware of how much inflation can hurt. But in Australia, a huge proportion of coffee companies are also passionate about creating a world-class product by only using “<a href="https://medium.com/@samandsunrise/why-is-specialty-coffee-so-expensive-6cf298935e4b#:%7E:text=Specialty%20Shops%20Feature%20High%20Grade%20Coffees&text=Their%20coffees%20are%20hand%2Dpicked,even%20on%20the%20same%20tree.">specialty coffee</a>”. Ranked at least 80 on a quality scale, specialty beans cost significant more than commodity grade, but their production offers better working conditions for farmers and encourages more sustainable growing practices. Although not commensurate with the wine industry, there are similarities. Single origin, high quality beans are often sourced from one farm and demand higher prices than commodity grade coffee, where cheaper sourced beans are often combined in a blend. Running a specialty cafe can also mean roasting your own beans, which requires a big investment in expertise and equipment. It’s an obvious example of doing the right thing by your suppliers and customers. But specialty cafes face much higher operating costs, and when they’re next to a commodity-grade competitor, customers are typically unwillingly to pay the difference. <h2>Approach price rises with curiosity, not defensiveness</h2> When cafe owners put up their prices, we often rush to accuse them of selfishness or profiteering. But they’re often just trying to survive. Given the quality of our coffee and its global reputation, it shouldn’t surprise us if we’re soon asked to pay a little bit more for our daily brew. If we are, we should afford the people who create one of our most important “<a href="https://theconversation.com/how-cafes-bars-gyms-barbershops-and-other-third-places-create-our-social-fabric-135530">third spaces</a>” kindness and curiosity as to why. <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/226015/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/emma-felton-143029">Emma Felton</a>, Adjunct Senior Researcher, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/think-5-50-is-too-much-for-a-flat-white-actually-its-too-cheap-and-our-world-famous-cafes-are-paying-the-price-226015">original article</a>.

Money & Banking

How much stress is too much? A psychiatrist explains the links between toxic stress and poor health − and how to get help

<a href="https://theconversation.com/profiles/lawson-r-wulsin-1493655">Lawson R. Wulsin</a>, <a href="https://theconversation.com/institutions/university-of-cincinnati-1717">University of Cincinnati </a> COVID-19 taught most people that the line between tolerable and toxic stress – defined as persistent demands that lead to disease – varies widely. But some people will age faster and die younger from toxic stressors than others. So how much stress is too much, and what can you do about it? I’m a <a href="https://researchdirectory.uc.edu/p/wulsinlr">psychiatrist specializing in psychosomatic medicine</a>, which is the study and treatment of people who have physical and mental illnesses. My research is focused on people who have psychological conditions and medical illnesses as well as those whose stress exacerbates their health issues. I’ve spent my career studying mind-body questions and training physicians to treat mental illness in primary care settings. My <a href="https://www.cambridge.org/core/books/toxic-stress/677FA62B741540DBDB53E2F0A52A74B1">forthcoming book</a> is titled “Toxic Stress: How Stress is Killing Us and What We Can Do About It.” A 2023 study of stress and aging over the life span – one of the first studies to confirm this piece of common wisdom – found that four measures of stress all speed up the pace of biological aging in midlife. It also found that persistent high stress ages people in a comparable way to the <a href="https://doi.org/10.1097/PSY.0000000000001197">effects of smoking and low socioeconomic status</a>, two well-established risk factors for accelerated aging. <figure><iframe src="https://www.youtube.com/embed/yiglpsqv5ik?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>Children with alcoholic or drug-addicted parents have a greater risk of developing toxic stress.</figcaption></figure> <h2>The difference between good stress and the toxic kind</h2> Good stress – a demand or challenge you readily cope with – is good for your health. In fact, the rhythm of these daily challenges, including feeding yourself, cleaning up messes, communicating with one another and carrying out your job, helps to regulate your stress response system and keep you fit. Toxic stress, on the other hand, wears down your stress response system in ways that have lasting effects, as psychiatrist and trauma expert Bessel van der Kolk explains in his bestselling book “<a href="https://www.penguinrandomhouse.com/books/313183/the-body-%20keeps-the-score-by-bessel-van-der-kolk-md/">The Body Keeps the Score</a>.” The earliest effects of toxic stress are often persistent symptoms such as headache, fatigue or abdominal pain that interfere with overall functioning. After months of initial symptoms, a full-blown illness with a life of its own – such as migraine headaches, asthma, diabetes or ulcerative colitis – may surface. When we are healthy, our stress response systems are like an orchestra of organs that miraculously tune themselves and play in unison without our conscious effort – a process called self-regulation. But when we are sick, some parts of this orchestra struggle to regulate themselves, which causes a cascade of stress-related dysregulation that contributes to other conditions. For instance, in the case of diabetes, the hormonal system struggles to regulate sugar. With obesity, the metabolic system has a difficult time regulating energy intake and consumption. With depression, the central nervous system develops an imbalance in its circuits and neurotransmitters that makes it difficult to regulate mood, thoughts and behaviors. <h2>‘Treating’ stress</h2> Though stress neuroscience in recent years has given researchers like me <a href="https://doi.org/10.1097/PSY.0000000000001051">new ways to measure and understand stress</a>, you may have noticed that in your doctor’s office, the management of stress isn’t typically part of your treatment plan. Most doctors don’t assess the contribution of stress to a patient’s common chronic diseases such as diabetes, heart disease and obesity, partly because stress is complicated to measure and partly because it is difficult to treat. In general, doctors don’t treat what they can’t measure. Stress neuroscience and epidemiology have also taught researchers recently that the chances of developing serious mental and physical illnesses in midlife rise dramatically when people are exposed to trauma or adverse events, especially during <a href="https://www.cdc.gov/violenceprevention/aces/ace-brfss.html">vulnerable periods such as childhood</a>. Over the past 40 years in the U.S., the alarming rise in <a href="https://www.cdc.gov/diabetes/health-equity/diabetes-by-the-numbers.html">rates of diabetes</a>, <a href="https://www.cdc.gov/nchs/data/hestat/obesity-child-17-18/overweight-obesity-child-H.pdf">obesity</a>, depression, PTSD, <a href="https://www.cdc.gov/nchs/products/databriefs/db433.htm">suicide</a> and addictions points to one contributing factor that these different illnesses share: toxic stress. Toxic stress increases the risk for the onset, progression, complications or early death from these illnesses. <h2>Suffering from toxic stress</h2> Because the definition of toxic stress varies from one person to another, it’s hard to know how many people struggle with it. One starting point is the fact that about 16% of adults report having been exposed to <a href="https://www.cdc.gov/violenceprevention/aces/fastfact.html">four or more adverse events in childhood</a>. This is the threshold for higher risk for illnesses in adulthood. Research dating back to before the COVID-19 pandemic also shows that about 19% of adults in the U.S. have <a href="https://doi.org/10.7249/TL221">four or more chronic illnesses</a>. If you have even one chronic illness, you can imagine how stressful four must be. And about 12% of the U.S. population <a href="https://blogs.worldbank.org/opendata/introducing-second-edition-world-banks-global-subnational-atlas-poverty">lives in poverty</a>, the epitome of a life in which demands exceed resources every day. For instance, if a person doesn’t know how they will get to work each day, or doesn’t have a way to fix a leaking water pipe or resolve a conflict with their partner, their stress response system can never rest. One or any combination of threats may keep them on high alert or shut them down in a way that prevents them from trying to cope at all. Add to these overlapping groups all those who struggle with harassing relationships, homelessness, captivity, severe loneliness, living in high-crime neighborhoods or working in or around noise or air pollution. It seems conservative to estimate that about 20% of people in the U.S. live with the effects of toxic stress. <figure><iframe src="https://www.youtube.com/embed/WuyPuH9ojCE?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>Exercise, meditation and a healthy diet help fight toxic stress.</figcaption></figure> <h2>Recognizing and managing stress and its associated conditions</h2> The first step to managing stress is to recognize it and talk to your primary care clinician about it. The clinician may do an assessment involving a <a href="https://doi.org/10.1097/PSY.0000000000001051">self-reported measure of stress</a>. The next step is treatment. Research shows that it is possible to retrain a dysregulated stress response system. This approach, <a href="https://lifestylemedicine.org/">called “lifestyle medicine</a>,” focuses on improving health outcomes through changing high-risk health behaviors and adopting daily habits that help the stress response system self-regulate. Adopting these lifestyle changes is not quick or easy, but it works. The <a href="https://www.cdc.gov/diabetes/prevention/index.html">National Diabetes Prevention Program</a>, the <a href="https://www.ornish.com/">Ornish “UnDo” heart disease program</a> and the <a href="https://www.ptsd.va.gov/understand_tx/tx_basics.asp">U.S. Department of Veterans Affairs PTSD program</a>, for example, all achieve a slowing or reversal of stress-related chronic conditions through weekly support groups and guided daily practice over six to nine months. These programs help teach people how to practice personal regimens of stress management, diet and exercise in ways that build and sustain their new habits. There is now strong evidence that it is possible to treat toxic stress in ways that improve health outcomes for people with stress-related conditions. The next steps include finding ways to expand the recognition of toxic stress and, for those affected, to expand access to these new and effective approaches to treatment.<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/222245/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/lawson-r-wulsin-1493655">Lawson R. Wulsin</a>, Professor of Psychiatry and Family Medicine, <a href="https://theconversation.com/institutions/university-of-cincinnati-1717">University of Cincinnati</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-much-stress-is-too-much-a-psychiatrist-explains-the-links-between-toxic-stress-and-poor-health-and-how-to-get-help-222245">original article</a>.

Mind

Attempts to access Kate Middleton’s medical records are no surprise. Such breaches are all too common

<a href="https://theconversation.com/profiles/bruce-baer-arnold-1408">Bruce Baer Arnold</a>, <a href="https://theconversation.com/institutions/university-of-canberra-865">University of Canberra</a> The <a href="https://www.abc.net.au/news/2024-03-20/claim-hospital-staff-tried-to-access-kate-middleton-health-info/103608066">alleged</a> data breach involving Catherine, Princess of Wales tells us something about health privacy. If hospital staff can apparently access a future queen’s medical records without authorisation, it can happen to you. Indeed it may have already happened to you, given many breaches of health data go under the radar. Here’s why breaches of health data keep on happening. <h2>What did we learn this week?</h2> Details of the alleged data breaches, by <a href="https://www.mirror.co.uk/news/royals/breaking-kate-middleton-three-london-32401247">up to three staff</a> at The London Clinic, emerged in the UK media this week. These breaches are alleged to have occurred after the princess had abdominal surgery at the private hospital earlier this year. The UK Information Commissioner’s Office <a href="https://ico.org.uk/about-the-ico/media-centre/news-and-blogs/2024/03/ico-statement-in-response-to-reports-of-data-breach-at-the-london-clinic/">is investigating</a>. Its report should provide some clarity about what medical data was improperly accessed, in what form and by whom. But it is unlikely to identify whether this data was given to a third party, such as a media organisation. <h2>Health data isn’t always as secure as we’d hope</h2> Medical records are inherently sensitive, providing insights about individuals and often about biological relatives. In an ideal world, only the “right people” would have access to these records. These are people who “need to know” that information and are aware of the responsibility of accessing it. Best practice digital health systems typically try to restrict overall access to databases through hack-resistant firewalls. They also try to limit access to specific types of data through grades of access. This means a hospital accountant, nurse or cleaner does not get to see everything. Such systems also incorporate blocks or alarms where there is potential abuse, such as unauthorised copying. But in practice each health records ecosystem – in GP and specialist suites, pathology labs, research labs, hospitals – is less robust, often with fewer safeguards and weaker supervision. <h2>This has happened before</h2> Large health-care providers and insurers, including major hospitals or chains of hospitals, have a <a href="https://www.theguardian.com/australia-news/2023/dec/22/st-vincents-health-australia-hack-cyberattack-data-stolen-hospital-aged-care-what-to-do">worrying</a> <a href="https://www.afr.com/technology/medical-information-leaked-in-nsw-health-hack-20210608-p57z7k">history</a> of <a href="https://www.innovationaus.com/oaic-takes-pathology-company-to-court-over-data-breach/">digital breaches</a>. Those breaches include hackers accessing the records of millions of people. The <a href="https://www.theguardian.com/world/2022/nov/11/medical-data-hacked-from-10m-australians-begins-to-appear-on-dark-web">Medibank</a> data breach involved more than ten million people. The <a href="https://www.hipaajournal.com/healthcare-data-breach-statistics/">Anthem</a> data breach in the United States involved more than 78 million people. Hospitals and clinics have also had breaches specific to a particular individual. Many of those breaches involved unauthorised sighting (and often copying) of hardcopy or digital files, for example by nurses, clinicians and administrative staff. For instance, this has happened to public figures such as <a href="https://www.latimes.com/archives/la-xpm-2008-mar-15-me-britney15-story.html">singer</a> <a href="https://journals.lww.com/healthcaremanagerjournal/abstract/2009/01000/health_information_privacy__why_trust_matters.11.aspx">Britney Spears</a>, actor <a href="https://www.nytimes.com/2007/10/10/nyregion/10clooney.html">George Clooney</a> and former United Kingdom prime minister <a href="https://www.theguardian.com/uk-news/2024/mar/20/when-fame-and-medical-privacy-clash-kate-and-other-crises-of-confidentiality">Gordon Brown</a>. Indeed, the Princess of Wales has had her medical privacy breached before, in 2012, while in hospital pregnant with her first child. This was no high-tech hacking of health data. Hoax callers from an Australian radio station <a href="https://theconversation.com/did-2day-fm-break-the-law-and-does-it-matter-11250">tricked</a> hospital staff into divulging details over the phone of the then Duchess of Cambridge’s health care. <h2>Tip of the iceberg</h2> Some unauthorised access to medical information goes undetected or is indeed undetectable unless there is an employment dispute or media involvement. Some is identified by colleagues. Records about your health might have been improperly sighted by someone in the health system. But you are rarely in a position to evaluate the data management of a clinic, hospital, health department or pathology lab. So we have to trust people do the right thing. <h2>How could we improve things?</h2> Health professions have long emphasised the need to protect these records. For instance, medical ethics bodies <a href="https://www.bmj.com/content/350/bmj.h2255">condemn</a> medical students who <a href="https://www.abc.net.au/news/2014-04-14/picture-sharing-app-for-doctors-raises-privacy-concerns/5389226">share</a> intimate or otherwise inappropriate images of patients. Different countries have various approaches to protecting who has access to medical records and under what circumstances. In Australia, for instance, we have a mix of complex and inconsistent laws that vary across jurisdictions, some covering privacy in general, others specific to health data. There isn’t one comprehensive law and set of standards <a href="https://theconversation.com/governments-privacy-review-has-some-strong-recommendations-now-we-really-need-action-200079">vigorously administered</a> by one well-resourced watchdog. In Australia, it’s mandatory to report <a href="https://www.oaic.gov.au/privacy/notifiable-data-breaches">data breaches</a>, including breaches of health data. This reporting system is currently <a href="https://theconversation.com/governments-privacy-review-has-some-strong-recommendations-now-we-really-need-action-200079">being updated</a>. But this won’t necessarily prevent data breaches. Instead, we need to incentivise Australian organisations to improve how they handle sensitive health data. The best policy <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1475-4932.12693">nudges</a> involve increasing penalties for breaches. This is so organisations act as responsible custodians rather than negligent owners of health data. We also need to step-up enforcement of data breaches and make it easier for victims to sue for breaches of privacy – princesses and tradies alike.<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/226303/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/bruce-baer-arnold-1408">Bruce Baer Arnold</a>, Associate Professor, School of Law, <a href="https://theconversation.com/institutions/university-of-canberra-865">University of Canberra</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/attempts-to-access-kate-middletons-medical-records-are-no-surprise-such-breaches-are-all-too-common-226303">original article</a>. Images: Getty

Legal

"Am I being too sensitive?": Woman's dilemma after partner forgets 60th birthday

A woman has shared her dilemma on how to approach her partner of 30 years, after he forgot her 60th birthday. "It's my 60th birthday today, and my partner of 30 years has not acknowledged it. Should I tell him?" she titled her post on Reddit. "It's my actual birthday today, and whilst we have planned a big party for next weekend, when I woke up this morning I expected a 'Happy Birthday!' and a smile," she continued. "I didn't get anything. He started my coffee but he does that almost every morning. "At first I thought maybe he forgot but now I am thinking that he thinks he doesn't have to say anything because we are having a big party this weekend. "Am I being too sensitive? Should I tell him? If so, how?" she asked in her post. Hundreds of Reddit users took to the comments to share their thoughts on how to approach the situation, with a few sharing crafty solutions of their own. "I'd make a joke of it. 'I can't believe they moved my birthday!' Or 'I saw on the TV we should ask easy questions to check for dementia- I'll ask you first, when's my birthday?'" one user playfully suggested. "I'm going to say the absolute minimum I'd expect for ANY birthday is my wife wishing me a Happy Birthday. Don't let it fester and ruin your day - just ask him about it" another added. One user saw the bright side of things and said: "He's handed you the best birthday present of all - the opportunity to use this against him for the next twenty years. "I'd be rubbing my hands with glee. Happy Birthday!" "Happy Birthday. Go out and buy a large cake. Eat it all yourself. Nobody need ever know" to which she responded: "there is a Costco not that far away. Go big or go home." Another Redditor came up with an elaborate plan on how she could get her partner's attention. "Purchase this 'Acknowledge Me' t-shirt of WWE wrestle Roman Reigns. Then write 'Birthday' on a piece of card and use some tape to stick on the t-shirt. 'Acknowledge Me Birthday.' Then just wear it around the house," they said. The woman was onboard with the plan, but luckily she didn't need to apply any of their crafty solutions and shared an update. "He just came up to my home office and gave me a big hug, admitting he had forgotten because he was so focussed on both work and next weekend's party," she wrote. "He apologised sheepishly, which was exactly the best outcome possible. Now I have both my birthday acknowledged as well as a fine story and/or bit of ammo to be saved for another day. "So there you go. I've cancelled the 'acknowledge me' t-shirt order, and shall now share my Costco cake with him instead of eating it from across the table, glaring. "Thank you everyone for the very fine passive aggressive suggestions which made me smile. Much appreciated!" Image: Getty

Relationships

“The system is too soft”: Ally Langdon fires up over stabbing death of Vyleen White

Ally Langdon has called for an overhaul of the youth crime system in the wake of the violent death of Queensland grandmother Vyleen White. The A Current Affair host was discussing the death of the 70-year-old, as she became visibly frustrated while talking about the rising rates of youth crime. Langdon hinted at a nationwide issue, citing the recent stabbing death of young doctor Ash Gordon in Melbourne, who was also allegedly murdered by a teenager less than a month ago. “Whatever we’re doing to deal with youth crime, it’s failing,” she said. “The police do everything they can, but the system is too soft on serious crime, and we have lost faith in it and our politicians.” <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-permalink="https://www.instagram.com/reel/C29TB0HvWGj/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/reel/C29TB0HvWGj/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by A Current Affair (@acurrentaffair9)</a> </div> </blockquote> Ms White’s daughter and widowed husband echoed Ally's sentiment thoughts on the program, saying, “Justice has to be done, not for my sake, for the memory of Vyleen.” “People want action and harsher laws for crimes they are committing,” her husband Victor said. “For several years (politicians) have been promising a lot, a lot of rubbish talk to the public out there, and nothing happens." “All you hear is increase of violence, car stealing … This is due to slackness in the law." “The law is weak as water.” Ms White’s daughter, Cindy Micallef said harsher penalties for youth crimes are needed. “Youth crime, I hate to say it, it’s like having a koala, it’s a protected species, there’s no action,” she said. “They do heinous crimes and it’s getting worse, I don’t care what nationality or race. “If we let people get away with this, it’s going to increase.” A 16-year-old boy was <a href="https://oversixty.com.au/finance/legal/update-on-tragic-stabbing-of-queensland-grandmother" target="_blank" rel="noopener">charged</a> with Ms White’s murder on Tuesday morning, and is also facing charges of unlawful use of a motor vehicle and stealing. Vyleen was <a href="https://www.oversixty.com.au/health/caring/grandmother-fatally-stabbed-in-front-of-granddaughter" target="_blank" rel="noopener">fatally stabbed</a> in the chest in Town Square Redbank Plains Shopping Centre’s underground carpark around 6pm on Saturday, while she was shopping with her granddaughter. Image credits: Facebook / A Current Affair

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