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Breast cancer screening in Australia may change. Here’s what we know so far

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/brooke-nickel-200747">Brooke Nickel</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/katy-bell-134554">Katy Bell</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> The way women are screened for breast cancer in Australia may <a href="https://www.cancer.org.au/about-us/policy-and-advocacy/early-detection/breast-cancer/rosa/key-findings">change</a>. There’s international debate on the <a href="https://www.bmj.com/content/385/bmj.q1353">age</a> women should be invited for screening. But an even larger change being considered worldwide is whether to screen women at <a href="https://www.nature.com/articles/s41416-021-01550-3">high and low risk</a> of breast cancer differently. But what such a “risk-based” approach to screening might look like in Australia is not yet clear. Here’s why researchers and public health officials are floating a change to breast cancer screening in Australia, and what any changes might mean. <h2>Why breast cancer screening may need to change</h2> Mass screening (known as population-based screening) for breast cancer was introduced in Australia and many other developed countries in the 1980s and 90s. This was based on <a href="https://pubmed.ncbi.nlm.nih.gov/26756588/">robust research</a> that found early detection and treatment of cancers before there were symptoms prevented some women from dying from breast cancer. These programs offer regular breast cancer screening to women within a specific age group. For example, <a href="https://www.aihw.gov.au/reports/cancer-screening/national-cancer-screening-programs-participation/contents/breastscreen-australia">in Australia</a>, women aged 40-74 years can have free mammograms (x-rays of the breasts) every two years. The BreastScreen program sends invitations for screening to those aged 50-74. However, evidence has been mounting that mammography screening could be inadvertently causing <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61611-0/abstract">harm</a> for some women. For some, screening causes a false alarm that may cause anxiety, and unnecessary tests and procedures. Even though these tests rule out cancer, these women may remain anxious and perceive something is wrong <a href="https://bmjopen.bmj.com/content/13/4/e072188">for many years</a>. A more insidious harm is <a href="https://theconversation.com/five-warning-signs-of-overdiagnosis-110895">overdiagnosis</a>, where screening detects a non-growing or slow-growing lesion that looks like “cancer” under the microscope, but would not have progressed or caused harm if it had been left alone. This means some women are having unnecessary surgery, radiotherapy and hormone therapy that will not benefit them, but may harm. Although trials have shown screening reduces the risk of dying from breast cancer, questions are being raised about how much it <a href="https://www.bmj.com/content/352/bmj.h6080.abstract">saves lives overall</a>. That is, it’s uncertain how much the reduced risk of dying from breast cancer translates into improvements in a woman’s overall survival. <h2>How about better targeting women?</h2> One idea is to target screening to those most likely to benefit. Under such a “<a href="https://www.nature.com/articles/s41416-021-01550-3">risk-based</a>” approach, a women’s personal risk of breast cancer is estimated. This may be based on her age and many other factors that may include breast density, family history of breast cancer, body-mass index, genetics, age she started and stopped her periods, and the number of children she’s had. Women who are at higher risk would be recommended to start screening at a younger age and to screen more frequently or to use different, more sensitive, imaging tests. Women at lower risk would be recommended to start later and to screen less often. The idea of this more “precise” approach to screening is to direct efforts and resources towards the smaller number of women most likely to benefit from screening via the early detection of cancer. At the same time, this approach would reduce the risk of harm from false positives (detection of an anomaly but no cancer is present) and overdiagnosis (detection of a non-growing or slow-growing cancer) for the larger number of women who are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6230256/">unlikely to benefit</a>. On face value this sounds like a good idea, and could be a favourable change for breast cancer screening. <h2>But there’s much we don’t know</h2> However, it’s uncertain how this would play out in practice. For one thing, someone’s future risk of a cancer diagnosis includes the risk of detecting both <a href="https://www.acpjournals.org/doi/10.7326/m17-2792">overdiagnosed cancers</a> as well as potentially lethal ones. This is proving to be a problem in risk-based screening for <a href="https://www.nature.com/articles/s41698-022-00266-8">prostate cancer</a>, another cancer prone to overdiagnosis. Ideally, we’d want to predict someone’s risk of <a href="https://www.thelancet.com/journals/landig/article/PIIS2589-7500(23)00113-9/fulltext">potentially lethal cancers</a> as these are the ones we want to catch early. It is also still uncertain how many women found to be at <a href="https://pubmed.ncbi.nlm.nih.gov/31701797/">low risk</a> will accept a recommendation for <a href="https://pubmed.ncbi.nlm.nih.gov/23092125/">less screening</a>. These uncertainties mean we need robust evidence the benefits outweigh the harms for Australian women before we make changes to the breast cancer screening program. There are several international <a href="https://www.nature.com/articles/s41416-021-01550-3">randomised controlled trials</a> (the gold standard for research) under way to evaluate the effectiveness of risk-based screening compared to current practice. So it may be prudent to wait for their findings before making changes to policy or practice. Even if such trials did give us robust evidence, there are still a number of issues to address before implementing a risk-based approach. One key issue is having enough staff to run the program, including people with the skills and time to discuss with women any concerns they have about their calculated risk. <h2>How about breast density?</h2> Women with dense breasts are at <a href="https://www.sciencedirect.com/science/article/pii/S0960977622001618#:%7E:text=Mammographic%20density%20is%20a%20well,increased%20risk%20of%20breast%20cancer.">higher risk of breast cancer</a>. So notifying women about their breast density has been proposed as a “first step” on the pathway to risk-based screening. However, this ignores the many other factors that determine a woman’s risk of breast cancer. Legislation in the <a href="https://www.fda.gov/radiation-emitting-products/mammography-quality-standards-act-and-program">United States</a> and changes in some <a href="https://australianbreastcancer.org.au/news-stories/latest-news/breast-density-reporting-at-all-sa-clinics/">Australian states</a> mean some women are already being notified about their breast density. The idea is to enhance their knowledge about their breast cancer risk so they can make informed decisions about future screening. But this has happened before we know what the best options are for such women. An <a href="https://www.mja.com.au/journal/2023/219/9/psychosocial-outcomes-and-health-service-use-after-notifying-women-participating">ongoing Australian trial</a> is investigating the effects that breast density notification has on individual women and the health system. <h2>What next?</h2> Robust evidence and careful planning are needed before risk-based screening or other changes are made to Australia’s breast cancer screening program. Where changes are made, there needs to be early evaluation of both the <a href="https://www.bmj.com/content/350/bmj.h1566.abstract">benefits and harms</a>. Programs also need <a href="https://www.bmj.com/content/374/bmj.n2049.long">independent, regular re-evaluation</a> in the longer term.<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/231917/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/brooke-nickel-200747">Brooke Nickel</a>, NHMRC Emerging Leader Research Fellow, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/katy-bell-134554">Katy Bell</a>, Professor in Clinical Epidemiology, Sydney School of Public Health, <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/breast-cancer-screening-in-australia-may-change-heres-what-we-know-so-far-231917">original article</a>. </div>

Body

"I want her parents to know": Fellow Qantas passenger reveals final moments of young woman

The passenger who was seated next to the woman who tragically <a href="https://oversixty.com.au/travel/travel-trouble/young-woman-dies-on-qantas-flight" target="_blank" rel="noopener">died</a> after boarding a Qantas flight has broken his silence on her last moments. Ravinder Singh was seated next to Manpreet Kaur, who passed away shortly after boarding a flight from Melbourne to Delhi on June 20th. The 24-year-old student, who had dreams of becoming a chef, was travelling to see her parents in India for the first time in four years, but did not make it to her destination. Now, Ravinder Singh has shared details on her final moments in the hopes it will bring her grieving parents some comfort. “I was sitting next to her on the Qantas flight from Melbourne to Delhi and was actually the last person to talk to her,” Ravinder Singh exclusively told <a href="https://www.news.com.au/travel/travel-updates/incidents/passenger-speaks-after-woman-dies-next-to-him-on-qantas-flight/news-story/24e8396d8eb3a1d35aea4a4291b847ba" target="_blank" rel="noopener">news.com.au</a>. “When I boarded the plane, she was already seated in the aisle. I was in the window, so I asked if she could please get up so I could occupy my seat. “I noticed that she began scrolling through photos on her mobile phone and stopped at a photograph of an elderly couple. I asked if they were her parents. She smiled and nodded and kept staring at it.” Mr Singh, who had been in Australia to visit family, said that everything seemed fine and the plane eventually began moving towards the runway, ready for take off. He explained that Ms Kaur had then put her phone down and rested her head on the seat in front, when he realised something was not right. “She was wearing her seatbelt and leaned forward to rest her head on the seat in front. As the plane was preparing for takeoff, I wanted to alert her to sit upright,” he shared. “But the plane jerked and I expected her to wake up. But instead, her head just moved towards me." “I got the attention of a flight attention and told her that this woman does not seem very well. She checked her pulse and after that, the reaction of the cabin crew was very commendable." “They tried their best to revive her. She was then evacuated by medical staff.” The retired army officer said the incident still “haunts him” and he wants her parents to know that she “left the world peacefully”. “The incident has been etched in my memory for life,” he said. “It is very difficult to digest that a young girl with whom you were just interacting with has passed away in front of your eyes." “Her innocent face stills haunts me and I want her parents to know she loved them a lot. She left this world peacefully looking at their photograph." “My heart breaks for her family who would have been looking forward to seeing her after a long time.” It is understood that Ms Kaur had been feeling "unwell" when she arrived at the airport and boarded the plane with no issues, with reports suggesting she died of tuberculosis. Image credits: news.com.au

Caring

What you need to know about protecting your children’s inheritance

For many people, ensuring that their children’s inheritance is protected is of paramount importance to them. There are a number of strategies that you can put in place to achieve this objective, you just need to determine which one bests suits you and your family’s circumstances. Put a Will in place By putting a Will in place, you get to decide who your assets go to, allowing you to make provision in your Will for them to pass to your children upon your death. If you do not have a Will in place then it is up to the government where your assets get paid and this may mean that your assets do not pass to your children, or do not pass to them in the manner that you desire. Play it safe and ensure things go the way you want them by taking the time to put a Will in place. Testamentary trust Let me introduce you to Testamentary Trusts. These amazing vehicles allow you to transfer your wealth to your children in the most asset protective and tax effective way possible. With an increasing number of marriages crumbling and divorce rates soaring, the last thing you want is your hard earned wealth passing to your child’s estranged partner in the event of one of your child’s marriage breakdown. By making provision in your Will leaving your children’s inheritance in a Testamentary Trust it protects their inheritance from any divorce or family law risks if your child’s relationship breaks down. Additionally, you may have a child who works in a high-risk occupation – a doctor, financial advisor or perhaps carrying on the role of a director. Alternatively, your child may be an entrepreneur, taking risks in their own business operations. If something adverse happened to your child whilst they were undertaking these roles and they were sued, they could be personally liable for them for any actions brought upon them by the aggrieved party. Creditors and other associated parties could only seek recourse to moneys owed by your child from them in their own personal capacity. If your child had received their inheritance in their own name, and hence the assets were now individual assets, the creditors and other associated parties would have recourse in recovering funds owed to them by your child. However, if your child’s inheritance was paid to a Testamentary Trust for their benefit at the time of your death then these assets would be held on trust for them and are not personal assets, hence the creditors and other associated parties would not have recourse in respect to these assets. Blended marriages If you have children from a previous marriage, it’s imperative that you obtain the appropriate legal advice in respect to how to protect your assets for your children. There are a number of options that you can put in place including a Binding Financial Agreement and a Mutual Wills Agreement. There are also strategies that you can put in place which ensure that your assets pass to your children upon your death. Options are also available where you may wish for your partner to receive some benefit of some of your assets during your lifetime with all assets passing to your children upon your partner’s death. Choose the right executor If you have young children, it will be your executor who looks after your children’s inheritance until your children reach the age that you have stipulated in your Will that you would like them to receive your assets. It is therefore imperative that you have the best person possible to undertake this role as you are effectively giving them the keys to everything that you own and control. That’s big. You need to appoint someone that you trust implicitly to undertake this role. You need to appoint your most trusted ally. Your executor also needs to be financial savvy or receptive to obtaining the appropriate financial advice to enable them to look after and grow your children’s inheritance. It is important that you seek the appropriate advice so that you can put the best strategies in place that protect your children’s inheritance in the best manner possible. There are a number of ways that you can protect your children’s inheritance, you just need to find the best one that works for you and your children. Melisa Sloan, author of Big Moments, expert advice for conquering those moments that define us, is a lawyer, industry leader, author and board director who loves helping people put in place beautiful legacies. For more information visit www.melisasloan.com.au Image credits: Shutterstock

Money & Banking

We finally know why some people got COVID while others didn’t

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/marko-nikolic-1543289">Marko Nikolic</a>, <a href="https://theconversation.com/institutions/ucl-1885">UCL</a> and <a href="https://theconversation.com/profiles/kaylee-worlock-1543639">Kaylee Worlock</a>, <a href="https://theconversation.com/institutions/ucl-1885">UCL</a> Throughout the pandemic, one of the key questions on everyone’s mind was why some people avoided getting COVID, while others caught the virus multiple times. Through a collaboration between University College London, the Wellcome Sanger Institute and Imperial College London in the UK, we set out to answer this question using the world’s first controlled <a href="https://www.nature.com/articles/s41591-022-01780-9">“challenge trial” for COVID</a> – where volunteers were deliberately exposed to SARS-CoV-2, the virus that causes COVID, so that it could be studied in great detail. Unvaccinated healthy volunteers with no prior history of COVID were exposed – via a nasal spray – to an extremely low dose of the original strain of SARS-CoV-2. The volunteers were then closely monitored in a quarantine unit, with regular tests and samples taken to study their response to the virus in a highly controlled and safe environment. For our <a href="https://www.nature.com/articles/s41586-024-07575-x">recent study</a>, published in Nature, we collected samples from tissue located midway between the nose and the throat as well as blood samples from 16 volunteers. These samples were taken before the participants were exposed to the virus, to give us a baseline measurement, and afterwards at regular intervals. The samples were then processed and analysed using single-cell sequencing technology, which allowed us to extract and sequence the genetic material of individual cells. Using this cutting-edge technology, we could track the evolution of the disease in unprecedented detail, from pre-infection to recovery. To our surprise, we found that, despite all the volunteers being carefully exposed to the exact same dose of the virus in the same manner, not everyone ended up testing positive for COVID. In fact, we were able to divide the volunteers into three distinct infection groups (see illustration). Six out of the 16 volunteers developed typical mild COVID, testing positive for several days with cold-like symptoms. We referred to this group as the “sustained infection group”. Out of the ten volunteers who did not develop a sustained infection, suggesting that they were able to fight off the virus early on, three went on to develop an “intermediate” infection with intermittent single positive viral tests and limited symptoms. We called them the “transient infection group”. The final seven volunteers remained negative on testing and did not develop any symptoms. This was the “abortive infection group”. This is the first confirmation of abortive infections, which were previously <a href="https://www.nature.com/articles/s41586-021-04186-8">unproven</a>. Despite differences in infection outcomes, participants in all groups shared some specific novel immune responses, including in those whose immune systems prevented the infection. When we compared the timings of the cellular response between the three infection groups, we saw distinct patterns. For example, in the transiently infected volunteers where the virus was only briefly detected, we saw a strong and immediate accumulation of immune cells in the nose one day after infection. This contrasted with the sustained infection group, where a more delayed response was seen, starting five days after infection and potentially enabling the virus to take hold in these volunteers. In these people, we were able to identify cells stimulated by a key antiviral defence response in both the nose and the blood. This response, called the “interferon” response, is one of the ways our bodies signal to our immune system to help fight off viruses and other infections. We were surprised to find that this response was detected in the blood before it was detected in the nose, suggesting that the immune response spreads from the nose very quickly. <h2>Protective gene</h2> Lastly, we identified a specific gene called HLA-DQA2, which was expressed (activated to produce a protein) at a much higher level in the volunteers who did not go on to develop a sustained infection and could hence be used as a marker of protection. Therefore, we might be able to use this information and identify those who are probably going to be protected from severe COVID. These findings help us fill in some gaps in our knowledge, painting a much more detailed picture regarding how our bodies react to a new virus, particularly in the first couple of days of an infection, which is crucial. We can use this information to compare our data to other data we are currently generating, specifically where we are “challenging” volunteers to other viruses and more recent strains of COVID. In contrast to our current study, these will mostly include volunteers who have been vaccinated or naturally infected – that is, people who already have immunity. Our study has significant implications for future treatments and vaccine development. By comparing our data to volunteers who have never been exposed to the virus with those who already have immunity, we may be able to identify new ways of inducing protection, while also helping the development of more effective vaccines for future pandemics. In essence, our research is a step towards better preparedness for the next pandemic.<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/233063/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/marko-nikolic-1543289">Marko Nikolic</a>, Principal Research Fellow/Honorary consultant Respiratory Medicine, <a href="https://theconversation.com/institutions/ucl-1885">UCL</a> and <a href="https://theconversation.com/profiles/kaylee-worlock-1543639">Kaylee Worlock</a>, Postdoc Research Fellow, Molecular and Cellular Biology, <a href="https://theconversation.com/institutions/ucl-1885">UCL</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-finally-know-why-some-people-got-covid-while-others-didnt-233063">original article</a>. </div>

Body

I’ve been given opioids after surgery to take at home. What do I need to know?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/katelyn-jauregui-1527878">Katelyn Jauregui</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/asad-patanwala-1529611">Asad Patanwala</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/jonathan-penm-404921">Jonathan Penm</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/shania-liu-1433659">Shania Liu</a>, <a href="https://theconversation.com/institutions/university-of-alberta-1232">University of Alberta</a> Opioids are commonly prescribed when you’re discharged from hospital after surgery to help manage pain at home. These strong painkillers may have unwanted side effects or harms, such as constipation, drowsiness or the risk of dependence. However, there are steps you can take to minimise those harms and use opioids more safely as you recover from surgery. <h2>Which types of opioids are most common?</h2> The <a href="https://journals.sagepub.com/doi/full/10.1177/0310057X231163890">most commonly prescribed</a> opioids after surgery in Australia are oxycodone (brand names include Endone, OxyNorm) and tapentadol (Palexia). In fact, <a href="https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/bcp.16063">about half</a> of new oxycodone prescriptions in Australia occur after a recent hospital visit. <a href="https://journals.sagepub.com/doi/full/10.1177/0310057X231163890">Most commonly</a>, people will be given immediate-release opioids for their pain. These are quick-acting and are used to manage short-term pain. Because they work quickly, their dose can be easily adjusted to manage current pain levels. Your doctor will provide instructions on how to adjust the dosage based on your pain levels. Then there are slow-release opioids, which are specially formulated to slowly release the dose over about half to a full day. These may have “sustained-release”, “controlled-release” or “extended-release” on the box. Slow-release formulations are primarily used for chronic or long-term pain. The slow-release form means the medicine does not have to be taken as often. However, it takes longer to have an effect compared with immediate-release, so it is not commonly used after surgery. Controlling your pain after surgery is <a href="https://www.nps.org.au/assets/4811a27845042173-00a4ff09097b-postoperative-pain-management_36-202.pdf">important</a>. This allows you get up and start moving sooner, and recover faster. Moving around sooner after surgery prevents muscle wasting and harms associated with immobility, such as bed sores and blood clots. Everyone’s pain levels and needs for pain medicines are different. Pain levels also decrease as your surgical wound heals, so you may need to take less of your medicine as you recover. <h2>But there are also risks</h2> As mentioned above, side effects of opioids include constipation and feeling drowsy or nauseous. The drowsiness can also make you more likely to fall over. Opioids prescribed to manage pain at home after surgery are usually prescribed for short-term use. But up to <a href="https://pubmed.ncbi.nlm.nih.gov/35545810/">one in ten</a> Australians still take them up to four months after surgery. <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/msc.1837">One study</a> found people didn’t know how to safely stop taking opioids. Such long-term opioid use may lead to dependence and overdose. It can also reduce the medicine’s effectiveness. That’s because your body becomes used to the opioid and needs more of it to have the same effect. Dependency and side effects are also more common with <a href="https://www.anzca.edu.au/getattachment/535097e6-9f50-4d09-bd7f-ffa8faf02cdd/Prescribing-slow-release-opioids-4-april-2018#:%7E:text=%E2%80%9CSlow%2Drelease%20opioids%20are%20not,its%20Faculty%20of%20Pain%20Medicine.">slow-release opioids</a> than immediate-release opioids. This is because people are usually on slow-release opioids for longer. Then there are concerns about “leftover” opioids. One study found 40% of participants were prescribed <a href="https://journals.sagepub.com/doi/full/10.1177/0310057X231163890">more than twice</a> the amount they needed. This results in unused opioids at home, which <a href="https://www.anzca.edu.au/getattachment/558316c5-ea93-457c-b51f-d57556b0ffa7/PS41-Guideline-on-acute-pain-management">can be dangerous</a> to the person and their family. Storing leftover opioids at home increases the risk of taking too much, sharing with others inappropriately, and using without doctor supervision. <h2>How to mimimise the risks</h2> Before using opioids, speak to your doctor or pharmacist about using over-the-counter pain medicines such as paracetamol or anti-inflammatories such as ibuprofen (for example, Nurofen, Brufen) or diclofenac (for example, Voltaren, Fenac). These can be quite effective at controlling pain and will lessen your need for opioids. They can often be used instead of opioids, but in some cases a combination of both is needed. Other techniques to manage pain include physiotherapy, exercise, <a href="https://theconversation.com/hot-pack-or-cold-pack-which-one-to-reach-for-when-youre-injured-or-in-pain-161086">heat packs or ice packs</a>. Speak to your doctor or pharmacist to discuss which techniques would benefit you the most. However, if you do need opioids, there are some ways to make sure you use them <a href="https://www.safetyandquality.gov.au/sites/default/files/2022-04/opioid-analgesic-stewardship-in-acute-pain-clinical-care-standard.pdf">safely and effectively</a>: <ul> <li> ask for <a href="https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/full/10.1111/anae.16085">immediate-release</a> rather than slow-release opioids to lower your risk of side effects </li> <li> do not drink alcohol or take sleeping tablets while on opioids. This can increase any drowsiness, and lead to reduced alertness and slower breathing </li> <li> as you may be at higher risk of falls, remove trip hazards from your home and make sure you can safely get up off the sofa or bed and to the bathroom or kitchen </li> <li> before starting opioids, have a plan in place with your doctor or pharmacist about how and when to stop taking them. Opioids after surgery are ideally taken at the lowest possible dose for the shortest length of time. </li> </ul> <h2>If you’re concerned about side effects</h2> If you are concerned about side effects while taking opioids, speak to your pharmacist or doctor. Side effects include: <ul> <li> <a href="https://theconversation.com/health-check-what-causes-constipation-114290">constipation</a> – your pharmacist will be able to give you lifestyle advice and recommend laxatives </li> <li> drowsiness – do not drive or operate heavy machinery. If you’re trying to stay awake during the day, but keep falling asleep, your dose may be too high and you should contact your doctor </li> <li> weakness and slowed breathing – this may be a sign of a more serious side effect such as respiratory depression which requires medical attention. Contact your doctor immediately. </li> </ul> <h2>If you’re having trouble stopping opioids</h2> Talk to your doctor or pharmacist if you’re having trouble stopping opioids. They can give you alternatives to manage the pain and provide advice on gradually lowering your dose. You may experience withdrawal effects, such as agitation, anxiety and insomnia, but your doctor and pharmacist can help you manage these. <h2>How about leftover opioids?</h2> After you have finished using opioids, take any leftovers to your local pharmacy to <a href="https://theconversation.com/health-check-what-should-you-do-with-your-unused-medicine-81406">dispose of them safely</a>, free of charge. Do not share opioids with others and keep them away from others in the house who do not need them, as opioids can cause unintended harms if not used under the supervision of a medical professional. This could include accidental ingestion by children. <hr /> For more information, speak to your pharmacist or doctor. Choosing Wisely Australia also has <a href="https://www.choosingwisely.org.au/resources/consumers-and-carers/patient-guide-to-managing-pain-and-opioid-medicines">free online information</a> about managing pain and opioid medicines.<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/228615/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/katelyn-jauregui-1527878">Katelyn Jauregui</a>, PhD Candidate and Clinical Pharmacist, School of Pharmacy, Faculty of Medicine and Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/asad-patanwala-1529611">Asad Patanwala</a>, Professor, Sydney School of Pharmacy, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/jonathan-penm-404921">Jonathan Penm</a>, Senior lecturer, School of Pharmacy, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/shania-liu-1433659">Shania Liu</a>, Postdoctoral Research Fellow, Faculty of Medicine and Dentistry, <a href="https://theconversation.com/institutions/university-of-alberta-1232">University of Alberta</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/ive-been-given-opioids-after-surgery-to-take-at-home-what-do-i-need-to-know-228615">original article</a>. </div>

Body

What you should know before you start chasing bargains at the EOFY sales

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/park-thaichon-175182">Park Thaichon</a>, <a href="https://theconversation.com/institutions/university-of-southern-queensland-1069">University of Southern Queensland</a> What cost-of-living crisis? Millions of Australians are expected to spend <a href="https://www.roymorgan.com/findings/9592-ara-roy-morgan-media-release-eofy-mid-year-sales-2024">A$10.1 billion</a> during the end of financial year (EOFY) sales. Many products, from cars and holiday packages to clothing and white goods will be available at marked down prices over the next few weeks. Clothing and accessories will attract the biggest spend, followed by electronics and technology, household items and decorations and then appliances and white goods. To put the estimated $10.1 billion EOFY spend in perspective, in 2023 Australians spent <a href="https://ecommerce-report.auspost.com.au/">$361 billion on retail goods</a>, with $63.6 billion of that spent online. With such high spending, consumers need to make informed decisions to maximise their savings and avoid pitfalls. <h2>Buyer beware</h2> It is important to understand the return and exchange policies of the different retail stores. Most retailers allow shoppers who change their mind up to 30 days to return and receive a refund or exchange the product. Some may have shorter return periods or may not accept returns on sale items. These items are sometimes referred to as final sales, non-refundable purchases, last-chance deals, no-return sales and clearance items. This means if a customer bought something on sale and later doesn’t want it, they can’t return or exchange it. Some retailers have specific conditions about where items can be returned. For example, in Melbourne <a href="https://www.davidjones.com/return-options">David Jones</a> requires boutique brands to be returned to specific branch locations. For example, items purchased instore from Chanel can only be returned at Elizabeth Street and Bourke Street Mall branches. Other conditions might include <a href="https://www.myer.com.au/content/returns-exchanges">no refunds/no exchanges</a> on large electrical items, furniture or mattresses unless faulty or damaged. Or retailers may only offer instore credit or charge a <a href="https://www.davidjones.com/return-options">25% restocking fee</a> when a customer cancels an order for a large or bulky item. Many retailers, such as streetwear brand <a href="https://www.culturekings.com.au/pages/shipping-returns">Culture Kings</a>, also require a payment if the return process involves shipping. As well as these conditions, retailers require any returned items to be in their original condition and sometimes, their original packaging. Being aware of these policies can help customers make more informed decisions and avoid being stuck with items they don’t want. <h2>What to buy and where to get it</h2> Certain items, such as off-season clothing, electronics and furniture are often discounted during EOFY sales, making it a good time to get them at reduced cost. However, some items, like the latest Playstation or newest smart phone, may not be as heavily discounted and might be better bought at other times of the year. Shoppers should also avoid buying items they are unlikely to use or consume before they expire including perishable goods like food, cosmetics and vitamins. <hr /> <iframe id="dnC1Y" class="tc-infographic-datawrapper" style="border: none;" src="https://datawrapper.dwcdn.net/dnC1Y/" width="100%" height="400px" frameborder="0"></iframe> <hr /> It’s also important to consider the value of the item and whether the discount offered during sales justifies the purchase, especially for big-ticket items that may require significant storage space or maintenance. Customers should also consider where to buy their items. Online retailers often have competitive prices and a wide selection, but some customers may prefer to see the item before they purchase instore. <a href="https://journals.sagepub.com/doi/full/10.1177/14413582231167664">Multi-channel shopping</a> is a combination of both instore and online shopping. It gives customers the flexibility to choose how and where they want to browse and purchase. For example, some customers prefer to touch, feel and try a product instore but then make the purchase online for convenience, taking advantage of any free shipping offers and online discount. <h2>Pressure tactics</h2> It is important to be wary any deceptive tactics to persuade you to buy unwanted products. For example, some stores might use misleading advertising or pressure tactics to convince customers to make purchases with the feeling of fear of missing out (FOMO). <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/ijcs.12649?casa_token=271MN72XdP8AAAAA%3AfhYF_2yUJtM7KGv5jvFdXn5UsXQLkMcIM_F6hffYa30QaSdRivjf2mhFX-cr5C7ttCuLl1-e2OFYXBA">Our research found</a> FOMO played a role in panic buying. During the EOFY sales, businesses may try to create a sense of urgency by claiming that items are selling out quickly or prices will increase soon. For example, online sites might state a product is “low in stock”, “151 items have been sold today” or “25 people are watching this item”. By being aware these tactics are intended to lock them into buying, customers can take their time to consider purchases carefully and avoid being swayed into buying things they do not really want or need. Ultimately, the best approach for customers is to plan ahead, research prices and shop around to find the best deals for their needs. <h2>Why we have EOFY sales</h2> The original purpose of the EOFY is to mark the end of a 12-month accounting period for businesses and individuals. EOFY sales help businesses clear out last year’s stock and make way for new. Moving stock also helps to improve the bottom line by converting unsold goods into revenue. If consumers are savvy, they can find ways to make savings while also putting money back into the economy.<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/232568/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/park-thaichon-175182">Park Thaichon</a>, Associate Professor of Marketing, <a href="https://theconversation.com/institutions/university-of-southern-queensland-1069">University of Southern Queensland</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/what-you-should-know-before-you-start-chasing-bargains-at-the-eofy-sales-232568">original article</a>. </div>

Money & Banking

The hidden risks of buy now, pay later: What shoppers need to know

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/vivek-astvansh-1318943">Vivek Astvansh</a>, <a href="https://theconversation.com/institutions/mcgill-university-827">McGill University</a> and <a href="https://theconversation.com/profiles/chandan-kumar-behera-1479139">Chandan Kumar Behera</a>, <a href="https://theconversation.com/institutions/indian-institute-of-management-lucknow-6023">Indian Institute of Management Lucknow</a> <iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" src="https://narrations.ad-auris.com/widget/the-conversation-canada/the-hidden-risks-of-buy-now-pay-later-what-shoppers-need-to-know" width="100%" height="400"></iframe> <a href="https://www.canada.ca/en/financial-consumer-agency/services/loans/buy-now-pay-later.html">Buy now, pay later</a> is a relatively new form of financial technology that allows consumers to purchase an item immediately and repay the balance at a later time in instalments. Unlike applying for a credit card, buy now, pay later <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4591446">doesn’t require a credit check</a>. Instead, <a href="https://doi.org/10.1108/EJM-11-2021-0923">these programs use algorithms</a> to perform <a href="https://www.investopedia.com/terms/s/soft-inquiry.asp">“soft” credit checks</a> to determine <a href="https://theconversation.com/if-it-looks-like-debt-lets-treat-it-like-debt-buy-now-pay-later-schemes-need-firmer-regulation-in-nz-211820">a shopper’s eligibility</a>. This means buy now, pay later loans target <a href="https://www.theguardian.com/money/2022/jan/27/buy-now-pay-later-schemes-entice-consumers-spend-more">low-income, tech-savvy</a> <a href="https://www.cnbc.com/2022/10/27/gen-z-and-millennials-prefer-buy-now-pay-later-services.html">millennials and Gen Z shoppers</a> in an effort to <a href="https://libertystreeteconomics.newyorkfed.org/2023/09/who-uses-buy-now-pay-later/">supposedly improve financial inclusion</a> for these groups. However, the newness of buy now, pay later programs means existing <a href="https://doi.org/10.1111/acfi.13100">consumer credit laws don’t cover it</a>. This lack of regulation puts shoppers at financial risk of accumulating higher levels of debt. <h2>Credit cards versus buy now, pay later</h2> There are three key differences between credit cards and buy now, pay later loans. First, while buy now, pay later loans are a line of credit like credit cards are, <a href="https://www.cnbc.com/2022/05/04/klarna-to-report-buy-now-pay-later-data-to-uk-credit-bureaus.html">they don’t impact credit reports</a>. Because of this, shoppers might be less cautious when using buy now, pay later services. Credit cards typically have annual interest rates ranging from <a href="https://www.bankrate.com/finance/credit-cards/what-is-credit-card-apr/#credit-card-apr-vs-credit-card-interest">15 to 26 per cent</a>. While most buy now, pay later loans have no interest, longer term loans have <a href="https://www.cbsnews.com/news/buy-now-pay-later-loans-interest-rate-fees-tips-what-to-know/">annual interest rates of about 37 per cent</a>. Shoppers are <a href="https://hbswk.hbs.edu/item/buy-now-pay-later-how-retails-hot-feature-hurts-lower-income-shoppers">at risk of overusing buy now, pay later programs</a> and accumulating more debt than they can manage. In addition, formal lenders, such as banks, currently have no way of knowing what buy now, pay later debt a person is carrying. The lender, therefore, likely incurs more risk than they are aware of. Second, credit cards typically provide <a href="https://doi.org/10.1080/1369118X.2022.2161830">an interest-free period</a>, after which <a href="https://doi.org/10.1177/03128962211032448">borrowers must pay interest</a>. In contrast, buy now, pay later users typically don’t have interest fees, but can incur <a href="https://doi.org/10.1108/IJBM-07-2022-0324">late fees for missed or late payments</a>. Falling behind on payment terms <a href="https://www.forbes.com/sites/andriacheng/2020/12/16/why-retailers-are-embracing-buy-now-pay-later-service-this-holiday-season/">can result in charges</a> that exceed <a href="https://stateline.org/2022/02/02/regulators-scrutinize-buy-now-pay-later-plans/">typical credit card interest rates</a>, causing more harm than interest payments. Low-income buy now, pay later users are <a href="https://hbswk.hbs.edu/item/buy-now-pay-later-how-retails-hot-feature-hurts-lower-income-shoppers">particularly vulnerable</a> to <a href="https://www.consumerfinance.gov/data-research/research-reports/consumer-use-of-buy-now-pay-later-insights-from-the-cfpb-making-ends-meet-survey/">using overdrafts to cover their buy now, pay later payments</a>. Third, people typically have just a few credit cards, making it easier to keep track of payments. Buy now, pay later users, on the other hand, usually engage with multiple buy now, pay later lenders through retailers. As a result, it’s difficult for them to keep track of all the buy now, pay later lenders and retailers they made purchases from. <h2>What are the Canadian governments doing?</h2> Canada classifies buy now, pay later as an unsecured instalment loan, which means lenders are subject to laws at the federal and provincial levels. Under federal law, there is an <a href="https://www.sec.gov/Archives/edgar/data/1711291/000171129122000011/curo-20211231.htm">annual interest rate cap of 60 per cent</a>. Provincial laws require buy now, pay later lenders to disclose the cost of credit and extend consumer protection rights to buy now, pay later shoppers. At the provincial level, <a href="https://www.canada.ca/en/financial-consumer-agency/services/loans/buy-now-pay-later.html">specific laws come into play</a>. Manitoba, Alberta, Québec, and Ontario have passed laws that require lenders to be licensed before they offer these products and be subject to regulatory oversight. These laws regulate high-cost credit products that have annual rates of 32 per cent or higher. This means buy now, pay later services should fall under this category. However, I found no evidence of buy now, pay later lenders being licensed in Canada. This means either lenders are not aware they fall under these laws, or no one is enforcing them. This ambiguity over whether or not buy now, pay later lenders are subject to regulatory oversight could be a hindrance for banks like the <a href="https://financialpost.com/fp-finance/fintech/why-higher-interest-rates-threaten-the-buy-now-pay-later-bubble">Bank of Nova Scotia and the Canadian Imperial Bank of Commerce</a>, as it deters them from entering the buy now, pay later market despite its profitability. <h2>Questions to ask before using buy now, pay later</h2> Before signing up for a buy now, pay later loan, shoppers should consider the following six questions. 1. Payment structure. How much of the invoice amount needs to be paid upfront? The norm is typically 25 per cent. What is the number of remaining instalments? The answer to this is usually four. Lastly, what is the frequency of instalments? The norm is biweekly. 2. Sensitive information. Does the lender require you to provide information about your chequing account? This is sensitive information to give away and puts you at risk of data breaches. Most buy now, pay later lenders withdraw instalment amounts from chequing accounts or debit cards, potentially exposing shoppers to greater risks than credit cards. 3. Interest charges Does the buy now, pay later lender charge interest on instalment payments? The norm is no. 4. Late fees How much is the late fee, when does it apply and what is the maximum amount of the late fee? Typically, late fees don’t exceed $8 or one-quarter of the invoice amount. Late fees usually kick in if your scheduled payment remains unpaid after 10 days. 5. Data responsibility. Who is responsible for your data? Whether it’s the retailer, the buy now, pay later lender or a company whose cloud storage the provider may be using, you should know. In general, the buy now, pay later lender holds this responsibility. 6. Licensing. Is the buy now, pay later lender licensed to sell the loan? Usually, the <a href="https://dfpi.ca.gov/wp-content/uploads/sites/337/2020/03/afterpay-settlement.pdf">answer to this question is no</a>. <h2>Buy now, pay later regulation</h2> Two sets of laws and regulations should be implemented to address some of these issues. The first set of regulations focuses on how buy now, pay later lenders interact with consumers. These lenders should clearly communicate <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4359956">all terms and conditions of their loans</a>, including late charges, interest charges and payment schedules, on their platforms to ensure shoppers are fully informed of their financial obligations. The Financial Conduct Authority in the United Kingdom recently issued guidelines allowing buy now, pay later lenders to <a href="https://www.ft.com/content/ca428bc8-65c3-49ed-8ba6-0d6f206098aa">terminate, suspend or restrict access to shopper accounts</a> for any reason without notice. Effective September 2024, New Zealand will require buy now, pay later lenders to <a href="https://theconversation.com/if-it-looks-like-debt-lets-treat-it-like-debt-buy-now-pay-later-schemes-need-firmer-regulation-in-nz-211820">check a shopper’s credit</a> before providing them a buy now, pay later loan. The second set of regulations defines the scope and boundaries of buy now, pay later lenders. On Dec. 9, 2022, California became the first American state to <a href="https://dfpi.ca.gov/2022/12/09/buy-now-pay-later-protect-yourself-before-you-check-out/">classify buy now, pay later as a loan</a>. Such classifications allowed California regulators to <a href="https://stateline.org/2022/02/02/regulators-scrutinize-buy-now-pay-later-plans/">question lenders about their transparency in disclosing the terms of their offerings</a>. The hope is that these laws and regulations will facilitate microlending and not impede the existence of buy now, pay later services, but rather make it safer and more secure for both lenders and users.<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/215421/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/vivek-astvansh-1318943">Vivek Astvansh</a>, Associate Professor of Quantitative Marketing and Analytics, <a href="https://theconversation.com/institutions/mcgill-university-827">McGill University</a> and <a href="https://theconversation.com/profiles/chandan-kumar-behera-1479139">Chandan Kumar Behera</a>, PhD Student in Marketing, <a href="https://theconversation.com/institutions/indian-institute-of-management-lucknow-6023">Indian Institute of Management Lucknow</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/the-hidden-risks-of-buy-now-pay-later-what-shoppers-need-to-know-215421">original article</a>. </div>

Money & Banking

Everything you need to know about tipping in the US

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

International Travel

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

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

Body

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

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

Body

7 things you need to know about fear

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

Mind

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

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/ylva-baeckstrom-1463175">Ylva Baeckstrom</a>, <a href="https://theconversation.com/institutions/kings-college-london-1196">King's College London</a> The number of people struggling with money in Britain is at a <a href="https://www.theguardian.com/money/2024/mar/18/record-numbers-of-uk-people-in-debt-warns-charity">record high</a>. Financial charities say that people are contacting them for help with debt, paying bills and insolvency. The campaign group Debt Justice found in a <a href="https://debtjustice.org.uk/wp-content/uploads/2024/03/WalnutOmnibus-Debt-Justice-Policy-Development-Weighted.xlsx">survey</a> that 29% of 18- to 24-year-olds and 25% of 25- to 34-year-olds had missed three or more bill payments in the last six months. A majority (65%) of people don’t think they can survive on their savings for three months without <a href="https://www.money.co.uk/savings-accounts/savings-statistics">borrowing money</a>. Statistics from the UK’s financial markets regulator show that more than one-third of UK adults have less than £1,000 in savings. And a survey by Money.co.uk found that 30% of Brits aged 25-64 do not save at all <a href="https://www.pensionsage.com/pa/Nearly-one-third-of-Brits-are-not-saving-for-retirement.php">for retirement</a>. With figures like that, is it any wonder that 75% of people in the UK feel <a href="https://www.mentalhealth.org.uk/about-us/news/financial-strain-driving-uks-anxiety#:%7E:text=Almost%20three%2Dquarters%20of%20the,cited%20job%20insecurity%20or%20unemployment">anxious about money</a>? The current state of the economy is particularly scary for young people. Unless you were born with a trust fund (not most people), you are likely part of the first generation to be financially worse off than <a href="https://edition.cnn.com/2020/01/11/politics/millennials-income-stalled-upward-mobility-us/index.html">your parents</a>. Retirement seems like an impossibility, and you’re unlikely to own your own home. Eighty percent of people in their early 20s worry about <a href="https://www.youngminds.org.uk/parent/parents-a-z-mental-health-guide/money-and-mental-health/#Thelinksbetweenmoneyandmentalhealth">not earning enough</a>. It is important to start planning for your financial future early in your career, but you may find it overwhelming. The good news is, there are ways to overcome this. <h2>Finding your financial attachment style</h2> As a psychotherapist and finance researcher, I work with people to help them to increase their financial confidence and find the motivation to start planning. This often starts with understanding what influences their relationship with money. <a href="https://www.cambridge.org/core/journals/behavioral-and-brain-sciences/article/bowlbyainsworth-attachment-theory/6D35C7A344107195D97FD7ADAE06C807">Attachment theory</a> is a psychological concept introduced in the late 1950s. Your attachment style – which can be, for example, secure, anxious or avoidant – explains how you approach creating emotionally intimate relationships with other people. Some people feel secure building relationships, while others are extremely anxious. Some avoid close relationships altogether. Attachment style can also apply to your finances. If you feel confident and safe when it comes to money, you are secure in your relationship to saving and spending. But if the thought of opening an ISA or filling out a tax return, let alone planning for retirement, fills you with dread and panic, you may be anxiously attached. And if you if you push money worries to the back of your mind, you are likely avoidant. Attachment theorists and psychotherapists like me think that attachment styles are shaped by childhood experiences – for example, how well you were looked after by your parents or carers, and how safe and loved you felt. The way money was handled in your family growing up is likely to have set the blueprint for your <a href="https://www.sciencedaily.com/releases/2020/02/200225114410.htm">financial attachment style</a>. Outside influences like education or work experiences may shape this too. Although financial education is part of the <a href="https://maps.org.uk/en/work-with-us/financial-education-in-schools">school curriculum</a> in the UK, 76% of children leave school without sufficient <a href="https://maps.org.uk/en/media-centre/press-releases/2024/hundreds-of-thousands-leaving-school-without-money-skills#:%7E:text=In%20its%20poll%20of%201%2C012,knowledge%20they%20need%20for%20adulthood">financial knowledge</a> to manage their lives. Similarly, financial services like banks have done a poor job helping people establish secure financial relationships. Complex and <a href="https://www.pwmnet.com/private-view-blog-time-for-the-financial-industry-to-jettison-the-jargon">off-putting language</a> has placed a barrier between those who know about money and those who need to learn. If you feel unable to keep up with financial terms, or that you don’t understand money, this is likely to hurt your confidence in your financial planning abilities and fuel a more avoidant attachment style. Identifying your attachment style can help you nurture a better relationship with money. You will be able to understand and predict how and why you react to finances in certain ways. And, it can provide confidence by reminding you that money struggles are not necessarily your fault. <h2>Getting over financial anxiety</h2> Some of the recent financial trends spreading on social media may give an insight into your attachment style. Are you <a href="https://www.cnbc.com/select/what-is-loud-budgeting-trend-can-it-work/">“loud budgeting”</a> (being vocal about why you aren’t spending money)? This could be a sign of financial confidence and that you have secure financial attachment. Or are you “doom spending” (spending money you don’t have instead of creating a <a href="https://www.theguardian.com/lifeandstyle/2024/jan/31/are-you-loud-budgeting-or-doom-spending-finance-according-to-gen-z">nest egg</a> for the future)? You may be avoidant. Healthy relationships with <a href="https://www.nhs.uk/every-mind-matters/lifes-challenges/maintaining-healthy-relationships-and-mental-wellbeing/#:%7E:text=People%20with%20healthy%2C%20positive%20and,such%20as%20stress%20and%20anxiety">people</a> and <a href="https://www.nhs.uk/every-mind-matters/lifes-challenges/money-worries-mental-health/#:%7E:text=Our%20mental%20health%20might%20be,earning%20enough%20or%20currently%20unemployed">money</a> are both critical for our survival and mental health. As an adult, you have the power to improve these relationships. But because attachment patterns were formed early on, they are difficult to change. Therapy and other support can help you adopt healthier habits, as can increasing your financial knowledge. If you want to change your relationship with money, you should try to be mindful of what may be influencing you. While financial advice on social media may be useful and help young people feel more empowered to <a href="https://www.forbes.com/advisor/investing/financial-advisor/adults-financial-advice-social-media/">talk about money</a>, it can also <a href="https://www.mcleanhospital.org/essential/it-or-not-social-medias-affecting-your-mental-health">increase anxiety further</a> and be <a href="https://theconversation.com/if-you-get-your-financial-advice-on-social-media-watch-out-for-misinformation-222196">full of misinformation</a>. A good place to start for accurate and helpful information is the government’s <a href="https://www.moneyhelper.org.uk/en">Money Helper website</a>.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/225243/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/ylva-baeckstrom-1463175">Ylva Baeckstrom</a>, Senior Lecturer in Finance, <a href="https://theconversation.com/institutions/kings-college-london-1196">King's College London</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/if-you-have-money-anxiety-knowing-your-financial-attachment-style-can-help-225243">original article</a>. </div>

Money & Banking

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

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

Home & Garden

Everything you need to know before you travel to Vietnam

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

International Travel

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

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

Body

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

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

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Everything we know about Samantha Murphy's accused killer

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

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Six surprising things about placebos everyone should know

<a href="https://theconversation.com/profiles/jeremy-howick-250620">Jeremy Howick</a>, <a href="https://theconversation.com/institutions/university-of-leicester-1053">University of Leicester</a> Placebos have been studied more than any treatment in the history of medicine, yet they remain mysterious. I’ve been studying placebos for 20 years and I’ve done some of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6288933/">key studies</a> that have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3655171/">advanced the scientific knowledge</a> in this area. Here are six facts about this strange effect that still fascinate me. <h2>1. Placebos have a dark cousin: nocebos</h2> A 29-year-old builder went to the hospital after having jumped onto a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5471339/">15cm nail</a> that pierced his boot. Moving the nail was so painful he had to be sedated with powerful drugs (fentanyl and midazolam) to remove it. But when he took off his boot, the medics discovered that the nail had gone between his toes. The builder’s pain was caused by the wrong belief that the nail had penetrated his foot. The detrimental effects of negative expectations are called nocebo effects. For evolutionary reasons (survival depends on avoiding danger), nocebo effects are larger than placebo effects. Unfortunately, patients are often told more about the bad things that might happen than the good things, which can result in a self-fulfilling prophecy. For example, learning that a drug has a possible side-effect of nausea or pain can actually <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7368797/">cause nausea or pain</a>. <h2>2. Placebos work even if people know they are placebos</h2> Linda Buonanno suffered so badly from irritable bowel syndrome that she often couldn’t <a href="https://www.theguardian.com/lifeandstyle/2017/may/22/knew-they-were-sugar-pills-felt-fantastic-rise-open-label-placebos">leave the house</a> for weeks. She signed up for a trial of “honest” (open-label) placebos, which is a placebo that patients know is a placebo. The Harvard doctors in the trial <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3008733/">told her</a> the pills were “placebo pills made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in [irritable bowel] symptoms through mind-body self-healing processes”. The honest placebos worked so well that she was able to resume a normal life. Honest placebos have <a href="https://pubmed.ncbi.nlm.nih.gov/28452193/">worked in other trials</a> for treating depression, back pain and attention deficit hyperactivity disorder (ADHD). Honest placebos work because of our subconscious expectations. Our past experiences of doctors and hospitals can generate subconscious expectations that activate our body’s inner pharmacy, which produces morphine (endorphins) and other beneficial drugs. <h2>3. Honest placebos are ethically acceptable</h2> It is often considered unethical for doctors to give placebos to patients because this supposedly <a href="https://link.springer.com/article/10.1007/s11724-014-0400-1">involves lying</a> (telling patients that a sugar pill is a powerful medication). But honest placebos do not involve lying, so there is no ethical barrier. In one <a href="https://pubmed.ncbi.nlm.nih.gov/34805194/#:%7E:text=Introduction%3A%20Open%2Dlabel%20placebos%20have,label%20placebos%20in%20acute%20pain.">ongoing trial</a>, doctors asked patients whether they would be willing to try a mix of real painkillers and honest placebos. Patients in this trial have the same level of pain relief following surgery, but are less likely to become dependent on painkillers. <h2>4. Placebo effects are part of most treatment effects</h2> When a doctor prescribes ibuprofen for back pain, the effects are due to the ibuprofen and the patient’s beliefs and expectations, which can be influenced by the doctor’s communication. Doctors who offer positive messages in a warm, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6047264/">empathic manner</a> will increase the effect of the drugs. The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2359128/">size and colour</a> of the pill can also influence the effect. A large, orange pill can reduce pain more than a small, red one. By contrast, blue pills generally have a sedative effect – except for Italian men, for whom blue pills have an <a href="https://www.amherst.edu/system/files/media/1601/moerman_explanatory%20mechanisms%20for%20placebo%20effects.pdf">excitative effect</a>), probably because their revered football team wears blue. Doctors’ ethical duty to benefit patients suggests it is an ethical duty to maximise the placebo effects of all treatments they provide. <h2>5. You don’t need placebos to have placebo effects</h2> In one trial, patients were given morphine <a href="https://pubmed.ncbi.nlm.nih.gov/15488461/">via an intravenous line</a> following surgery. However, only half of the patients were told they were receiving morphine. The patients who were told this had 50% more pain relief than those who were not told they were receiving morphine. This is an example of a placebo effect without a placebo. <h2>6. You can generate placebo (and nocebo) effects in yourself</h2> All communication can have a beneficial or harmful effect. One study found that teaching communication skills to families <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4915212/">reduced anxiety and depression</a>. On the other hand, couples who dwell on problems and negative aspects of their relationships were shown in a study to have <a href="https://www.sciencedirect.com/science/article/abs/pii/S0306453022003304?via%3Dihub">weaker immune systems</a>. Acts of altruism, focusing on a brighter future, or gratitude are proven ways to reduce the effect of negative communication. An easy way to generate positive placebo effects for yourself is by performing a <a href="https://www.mentalhealth.org.uk/explore-mental-health/kindness-and-mental-health/random-acts-kindness">random act of kindness</a>, such as making a colleague a cup of tea, or simply smiling and saying hello. You can learn more about the amazing effects of placebos and nocebos in my <a href="https://www.press.jhu.edu/books/title/12830/power-placebos">latest book</a>, The Power of Placebos: How the Science of Placebos and Nocebos can Improve Health Care.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/220829/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/jeremy-howick-250620">Jeremy Howick</a>, Professor and Director of the Stoneygate Centre for Excellence in Empathic Healthcare, <a href="https://theconversation.com/institutions/university-of-leicester-1053">University of Leicester</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/six-surprising-things-about-placebos-everyone-should-know-220829">original article</a>.

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

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

Money & Banking

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

<a href="https://theconversation.com/profiles/kate-irving-1493654">Kate Irving</a>, <a href="https://theconversation.com/institutions/dublin-city-university-1528">Dublin City University</a> Around <a href="https://www.bbc.co.uk/news/uk-england-67613465">36% of people</a> in England with dementia are unaware they have the condition, according to a new report from the Dementia Commission. <a href="https://chamberuk.com/wp-content/uploads/2023/12/231127-Dementia-Commission-Report-Embargoed.pdf">The report</a> suggests things health and care professionals can do to improve spotting early signs of dementia. But what can you do if you think your partner has the condition? And how can you broach the topic with them? If you are worried about your partner having dementia, here are some useful things to know. Dementia is a term for a range of diseases (for example, Alzheimer’s) which develop over time (months and years) and cause problems with memory and reasoning, communication, changes in personality and a reduction in a person’s ability to carry out daily activities, such as shopping, washing, paying bills or cooking. Dementia can present very differently in each person, so it’s about knowing what’s normal for your loved one. A person who has always been conscientious and organised starting to unravel is very different from a scatterbrained person just being slightly more scatterbrained. Grief and stress can affect memory yet not be the start of dementia. But they can also mask the start of dementia: we call this “diagnostic over-shadowing”. There are also age-related changes to cognition. For example, we take longer to learn when we get older. But a one-off event – no matter how dramatic – is not necessarily dementia. It’s about looking for a pattern of decline. If you see these changes happen in a short space of time (weeks or days) it is unlikely to be dementia and could be something more serious. This requires urgent investigation by a doctor. <h2>Greatest fear</h2> Dementia is one of the greatest fears of our age. The horror of perceived loss of self can cause people to avoid discussing the issue, discussing it in an unhelpful way (such as criticising or inadvertently humiliating) or discussing it with other relatives, but not the person they are noticing changes in. Over time, this can cause a lack of trust to develop. Discussing memory problems openly with the person at the point of a memory failure or if they raise the concern is best. Of course, it takes courage and makes us face our own vulnerability. Sometimes the person will be in denial or lack insight into the memory problems (this can be a symptom of dementia, but isn’t always). If someone raises a concern about their memory issues, I would urge you not to minimise this, as it probably took courage to admit their concerns. I heard a relative say to my mother: “Oh, you left the pot on the stove. I lost the car in the multistory the other day.” My mother had dementia – the relative did not. If they are adamant that they do not have concerns, this is harder to deal with. One approach is to say: “I know you are not concerned, but I am concerned and I wonder if you would see a doctor to ease my worries?” Also explaining that memory problems can at least to some extent have reversible causes means a visit to the doctor to at least rule these out is an important step. It may also be encouraging to say to the person: “If there is something with your memory that will get worse over time, would you want to know?” (Most people <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2408568/">answer yes</a> to this). <h2>Seeing a GP</h2> If your partner agrees to visit a GP, it is helpful to prepare by filling in a diary for a week with the kind of memory (or other) problems experienced, what was happening at the time and the effect of the memory failure. This can be shared with a GP to help them to understand the issues. When people hear even the suggestion of the word dementia, they are faced with the uncertainties of what will become of them, of what they will lose, what they can keep up and where they will end up. These uncertainties are often shared with family members. But research shows that positive aspects of timely diagnosis <a href="https://www.scie.org.uk/dementia/symptoms/diagnosis/early-diagnosis.asp">outweigh fears</a> over time. At the same time, there are often ongoing stresses to do with memory impairments or confusion. With these stresses, everyday life can be troublesome, family relationships can suffer, and people can find it difficult to be supportive of each other. Being honest and open is the best policy. Stating that we are in this together, I want to help, let’s meet whatever happens head on, can help. If a person becomes resistant, it may be there is another family member who might better assist the person.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/219172/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/kate-irving-1493654">Kate Irving</a>, Professor of Clinical Nursing, <a href="https://theconversation.com/institutions/dublin-city-university-1528">Dublin City University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/more-than-a-third-of-people-with-dementia-dont-know-they-have-it-what-to-do-if-you-suspect-your-partner-has-the-condition-219172">original article</a>.

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Breast cancer screening in Australia may change. Here’s what we know so far

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