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Young homeowners are more likely to use their home as an ‘ATM’ than their Boomer parents. Here’s why

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/rachel-ong-viforj-113482">Rachel Ong ViforJ</a>, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a> and <a href="https://theconversation.com/profiles/christopher-phelps-378137">Christopher Phelps</a>, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a></em></p> <p>For many Australians, the family home is their largest financial asset. With an increasing variety of ways to tap into home equity, the temptation to access this wealth is ever growing.</p> <p>Homeowners increase the debt owed on their home when they borrow against their <a href="https://doi.org/10.1080/02673037.2013.783202">equity</a>. Standard mortgage home loans now provide facilities for relatively cheap or free withdrawals of equity from the home.</p> <p>This turns the <a href="https://theconversation.com/your-home-as-an-atm-home-equity-a-risky-welfare-tool-22000">home into an ATM</a>, which borrowers can access when they choose.</p> <p>Our new <a href="https://doi.org/10.1080/02673037.2024.2400158">study</a> asks what motivates Australians to tap into their home equity, and how does this behaviour change with age?</p> <p>Surprisingly, despite having much lower housing equity levels, younger homeowners borrow often, and borrow more, than their Boomer parents.</p> <h2>How common is equity borrowing?</h2> <p>Using 15 years of data from the government-funded <a href="https://melbourneinstitute.unimelb.edu.au/hilda">Household, Income and Labour Dynamics in Australia </a>(HILDA) survey, we tracked the mortgage debt and repayments of homeowners aged 35 and over.</p> <p>The chart below shows younger owners are far more likely to engage in equity borrowing.</p> <p>In 2006, nearly 39% of the youngest homeowners, aged 35–44, borrowed against their home equity. By 2021, this number had dropped to 29%. Despite the decline, it’s still 24 percentage points more common than those aged 65 and over. The older group has remained steady at about 5% over the years.</p> <hr /> <p><iframe id="Ll9Cw" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/Ll9Cw/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe></p> <hr /> <h2>How much do equity borrowers withdraw from their home?</h2> <p>Among those who use their home like an ATM, younger borrowers now withdraw larger amounts than older borrowers.</p> <p>In 2006–07, equity borrowers aged 35–44 and 45–54 withdrew on average $43,000 and $57,000, respectively (expressed in real values set at 2022 price levels). By 2021, the amount withdrawn by these two age groups had climbed to $70,000 and $100,000.</p> <p>On the other hand, the amount withdrawn by borrowers aged 55 or older fell from more than $50,000 to less than $40,000.</p> <hr /> <p><iframe id="ujq3S" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/ujq3S/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe></p> <hr /> <h2>What motivates equity borrowing?</h2> <p>Young homeowners’ equity borrowing behaviours are sensitive to changes in house prices and debt values, and their financial risk preferences. Among those aged 35–44, a $10,000 increase in the primary home value raises the likelihood of equity borrowing by ten percentage points.</p> <p>Every $10,000 in debt against the primary home reduces the likelihood by 2.8% percentage points. Those willing to take substantial financial risk are eight percentage points more likely to borrow against their home than those who are risk-averse.</p> <p>Those aged 65+ are not inclined to borrow, and exhibit little change in equity borrowing behaviour with variations in asset, debt, income or financial risk preferences.</p> <h2>Why borrowing practices differ between age groups</h2> <p>As well as being more likely than older homeowners to borrow against equity, the younger group also withdraws higher amounts than their Boomer parents.</p> <p>This is despite younger borrowers already carrying much higher debt against their primary home. Among those in our study who engaged in equity borrowing in 2021, the median debt before borrowing was $401,000 for 35-44 year-olds compared to $0 for those aged 65+.</p> <p>As real house prices have risen over decades, the current generation of young homeowners has had to invest more money into purchasing their first home than previous generations.</p> <p>It’s therefore not surprising the primary home is now widely viewed as a financial resource to be <a href="https://theconversation.com/your-home-as-an-atm-home-equity-a-risky-welfare-tool-22000">tapped into to meet spending needs</a>.</p> <p>On the other hand, most Baby Boomers bought their first home at more affordable prices than their children, and at lower levels of debt. Now they don’t appear to be spending their kids’ inheritance by drawing down housing wealth.</p> <p>In fact, older parents may shy away from equity borrowing to <a href="https://www.pc.gov.au/research/completed/wealth-transfers/wealth-transfers.pdf">bequeath wealth to children</a>. Some also <a href="https://doi.org/10.1017/S0047279417000058">dislike passing debt</a> on to their children.</p> <p>Older people may also avoid equity borrowing due to concerns about <a href="https://treasury.gov.au/sites/default/files/2023-08/p2023-435150.pdf">aged care costs</a>. Some may be hampered by <a href="https://doi.org/10.1016/j.jue.2013.08.003">poor financial literacy</a>.</p> <h2>More debt ahead without policy changes</h2> <p>Present trends suggest young homeowners will remain indebted for longer periods, and more and more will <a href="https://theconversation.com/more-of-us-are-retiring-with-mortgage-debts-the-implications-are-huge-115134">retire with mortgage debt</a>.</p> <p>For indebted retirees, there are real prospects of <a href="https://theconversation.com/fall-in-ageing-australians-home-ownership-rates-looms-as-seismic-shock-for-housing-policy-120651">drawing down of superannuation</a> to pay off mortgages in retirement.</p> <p>This may impose extra burdens on the age pension system. Another unwelcome consequence, which may add to health costs, is the prospect of <a href="https://www.ahuri.edu.au/sites/default/files/migration/documents/AHURI-Final-Report-319-Mortgage-stress-and-precarious-home-ownership-implications-for-older-Australians.pdf">debt-related psychological distress</a> among those who can’t pay off their mortgage in old age.</p> <p>If the current trends continue, the <a href="https://www.afr.com/policy/economy/what-happens-when-australia-s-boomers-hand-5-trillion-to-their-heirs-20240515-p5jdvf">great wealth transfer</a> that has already begun looks set to <a href="https://theconversation.com/not-everyone-wins-from-the-bank-of-mum-and-dad-73842">further entrench inequality</a> between those who have access to the bank of mum and dad and those who do not.</p> <p>Encouraging older people to use their housing equity to fund their needs in old age may lighten fiscal burdens on younger generations. But policy reforms will be needed to relieve concerns about the risks of equity borrowing in old age.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/238924/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/rachel-ong-viforj-113482"><em>Rachel Ong ViforJ</em></a><em>, ARC Future Fellow &amp; Professor of Economics, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a> and <a href="https://theconversation.com/profiles/christopher-phelps-378137">Christopher Phelps</a>, Research Fellow, School of Accounting, Economics and Finance, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/young-homeowners-are-more-likely-to-use-their-home-as-an-atm-than-their-boomer-parents-heres-why-238924">original article</a>.</em></p> </div>

Money & Banking

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I’m feeling run down. Why am I more likely to get sick? And how can I boost my immune system?

<div class="theconversation-article-body"> <p><em><a href="https://theconversation.com/profiles/sathana-dushyanthen-1169328">Sathana Dushyanthen</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a></em></p> <p>It has been a long winter, filled with many viruses and cost-of-living pressures, on top of the usual mix of work, study, life admin and caring responsibilities.</p> <p>Stress is an inevitable part of life. In short bursts, our stress response has evolved as a survival mechanism to help us be more alert in <a href="https://theconversation.com/no-you-cant-blame-all-your-health-issues-on-high-cortisol-heres-how-the-hormone-works-203162">fight or flight situations</a>.</p> <p>But when stress is chronic, it weakens the immune system and makes us more vulnerable to illnesses such as the <a href="https://www.healthline.com/health/can-stress-make-you-sick#:%7E:text=The%20common%20cold&amp;text=Inflammation%20has%20been%20linked%20to,to%20the%20cold%2Dcausing%20germs.">common cold</a>, <a href="https://journals.lww.com/psychosomaticmedicine/abstract/1999/03000/psychological_stress,_cytokine_production,_and.9.aspx">flu</a> and <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/smi.3017">COVID</a>.</p> <h2>Stress makes it harder to fight off viruses</h2> <p>When the immune system starts to break down, a virus that would normally have been under control starts to flourish.</p> <p>Once you begin to feel sick, the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4465119/">stress response</a> rises, making it harder for the immune system to fight off the disease. You may be sick more often and for longer periods of time, without enough immune cells primed and ready to <a href="https://link.springer.com/chapter/10.1007/978-3-030-16996-1_6">fight</a>.</p> <p>In the 1990s, American psychology professor Sheldon Cohen and his colleagues conducted a number of <a href="https://www.cmu.edu/common-cold-project/">studies</a> where healthy people were exposed to an upper respiratory infection, through drops of virus placed directly into their <a href="https://www.nejm.org/doi/full/10.1056/NEJM199108293250903">nose</a>.</p> <p>These participants were then quarantined in a hotel and monitored closely to determine who became <a href="https://theconversation.com/stress-less-it-might-protect-you-from-covid-153361">ill</a>.</p> <p>One of the most important factors predicting who got sick was prolonged psychological <a href="https://journals.sagepub.com/doi/full/10.1177/1745691620942516">stress</a>.</p> <h2>Cortisol suppresses immunity</h2> <p>“Short-term stress” is stress that lasts for a period of minutes to hours, while “chronic stress” persists for several hours per day for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5964013/#:%7E:text=Therefore%2C%20a%20major%20distinguishing%20characteristic,weeks%20or%20months%20%5B9%5D.">weeks or months</a>.</p> <p>When faced with a perceived threat, psychological or physical, the hypothalamus region of the brain sets off an alarm system. This signals the release of a surge of hormones, including adrenaline and <a href="https://www.embopress.org/doi/full/10.15252/msb.20209510">cortisol</a>.</p> <figure class="align-center "><img src="https://images.theconversation.com/files/616892/original/file-20240903-18-blrqoz.png?ixlib=rb-4.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/616892/original/file-20240903-18-blrqoz.png?ixlib=rb-4.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=472&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/616892/original/file-20240903-18-blrqoz.png?ixlib=rb-4.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=472&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/616892/original/file-20240903-18-blrqoz.png?ixlib=rb-4.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=472&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/616892/original/file-20240903-18-blrqoz.png?ixlib=rb-4.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=593&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/616892/original/file-20240903-18-blrqoz.png?ixlib=rb-4.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=593&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/616892/original/file-20240903-18-blrqoz.png?ixlib=rb-4.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=593&amp;fit=crop&amp;dpr=3 2262w" alt="Human brain illustration" /><figcaption><span class="caption">The hypothalamus sets off an alarm system in response to a real or perceived threat.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/hypothalamus-causes-vasoconstriction-illustration-medical-brain-435142264">stefan3andrei/Shutterstock</a></span></figcaption></figure> <p>In a typical stress response, <a href="https://www.sciencedirect.com/science/article/abs/pii/S147149060300173X">cortisol levels</a> quickly increase when stress occurs, and then rapidly drop back to normal once the stress has subsided. In the short term, cortisol suppresses inflammation, to ensure the body has enough energy available to respond to an <a href="https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2019.00245/full">immediate threat</a>.</p> <p>But in the longer term, chronic stress can be harmful. A Harvard University study <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2796097">from 2022</a> showed that people suffering from psychological distress in the lead up to their COVID infection had a greater chance of experiencing long COVID. They <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2796097">classified</a> this distress as depression, probable anxiety, perceived stress, worry about COVID and loneliness.</p> <p>Those suffering distress had close to a <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2796097">50% greater risk</a> of long COVID compared to other <a href="https://theconversation.com/being-stressed-out-before-you-get-covid-increases-your-chances-of-long-covid-heres-why-190649">participants</a>. Cortisol has been shown to be high in the most severe cases of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102614/">COVID</a>.</p> <h2>Stress causes inflammation</h2> <p><a href="https://stories.uq.edu.au/imb/the-edge/inflammation/what-is-inflammation/index.html">Inflammation</a> is a short-term reaction to an injury or infection. It is responsible for trafficking immune cells in your body so the right cells are present in the right locations at the right times and at the right <a href="https://link.springer.com/article/10.1007/s12026-014-8517-0">levels</a>.</p> <p>The immune cells also store a memory of that threat to respond faster and more effectively the next <a href="https://theconversation.com/being-stressed-out-before-you-get-covid-increases-your-chances-of-long-covid-heres-why-190649">time</a>.</p> <p>Initially, circulating immune cells detect and flock to the site of <a href="https://www.nature.com/articles/ni1275">infection</a>. Messenger proteins, known as pro-inflammatory cytokines, are released by immune cells, to signal the danger and recruit help, and our immune system responds to neutralise the <a href="https://stories.uq.edu.au/imb/the-edge/inflammation/what-is-inflammation/index.html">threat</a>.</p> <p>During this response to the infection, if the immune system produces too much of these inflammatory chemicals, it can trigger symptoms such as nasal congestion and runny <a href="https://journals.sagepub.com/doi/full/10.1177/1745691620942516">nose</a>.</p> <h2>What about chronic stress?</h2> <p>Chronic stress causes persistently high cortisol secretion, which remains high even in the absence of an immediate <a href="https://theconversation.com/no-you-cant-blame-all-your-health-issues-on-high-cortisol-heres-how-the-hormone-works-203162">stressor</a>.</p> <p>The immune system becomes desensitised and unresponsive to this <a href="https://www.sciencedirect.com/science/article/abs/pii/S1043661816307435">cortisol suppression</a>, increasing low-grade “silent” inflammation and the production of pro-inflammatory cytokines (the messenger proteins).</p> <p>Immune cells become exhausted and start to <a href="https://www.fxmedicine.com.au/blog-post/adrenal-immune-connection">malfunction</a>. The body loses the ability to turn down the inflammatory <a href="https://journals.sagepub.com/doi/full/10.1177/1745691620942516">response</a>.</p> <p>Over time, the immune system changes the way it responds by reprogramming to a “<a href="https://www.unimelb.edu.au/newsroom/news/2021/april/how-stress-can-stop-immune-cells-in-their-tracks">low surveillance mode</a>”. The immune system misses early opportunities to destroy threats, and the process of recovery can take <a href="https://theconversation.com/being-stressed-out-before-you-get-covid-increases-your-chances-of-long-covid-heres-why-190649">longer</a>.</p> <h2>So how can you manage your stress?</h2> <p>We can actively strengthen our immunity and natural defences by managing our <a href="https://theconversation.com/stuck-in-fight-or-flight-mode-5-ways-to-complete-the-stress-cycle-and-avoid-burnout-or-depression-218599">stress levels</a>. Rather than letting stress build up, try to address it early and frequently by:</p> <p><strong>1) Getting enough sleep</strong></p> <p>Getting enough sleep reduces <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3132857/">cortisol levels</a> and inflammation. During sleep, the immune system <a href="https://link.springer.com/chapter/10.1007/978-1-4939-6578-6_12">releases</a> <a href="https://theconversation.com/sleep-wont-cure-the-coronavirus-but-it-can-help-our-bodies-fight-it-134674">cytokines</a>, which help fight infections and inflammation.</p> <p><strong>2) Taking regular exercise</strong></p> <p>Exercising helps the lymphatic system (which balances bodily fluids as part of the immune system) circulate and allows immune cells to monitor for threats, while sweating flushes <a href="https://www.healthline.com/nutrition/does-exercise-boost-immune-system">toxins</a>. Physical activity also lowers stress hormone levels through the release of positive brain <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7387807/">signals</a>.</p> <p><strong>3) Eating a healthy diet</strong></p> <p>Ensuring your diet contains enough nutrients – such as the B vitamins, and the full breadth of minerals like magnesium, iron and zinc – during times of stress has a positive impact on overall stress <a href="https://www.ncbi.nlm.nih.gov/pubmed/22782571">levels</a>. Staying hydrated helps the body to flush out <a href="https://theconversation.com/a-strong-immune-system-helps-ward-off-colds-and-flus-but-its-not-the-only-factor-99512">toxins</a>.</p> <p><strong>4) Socialising and practising meditation or mindfulness</strong></p> <p>These activities increase endorphins and serotonin, which improve mood and have <a href="https://www.sciencedirect.com/science/article/pii/S2949834123000351">anti-inflammatory effects</a>. Breathing exercises and meditation stimulate the parasympathetic nervous system, which calms down our stress responses so we can “reset” and reduce <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940234/">cortisol levels</a>.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/237456/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/sathana-dushyanthen-1169328">Sathana Dushyanthen</a>, Academic Specialist &amp; Lecturer in Cancer Sciences &amp; Digital Health| Superstar of STEM| Science Communicator, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/im-feeling-run-down-why-am-i-more-likely-to-get-sick-and-how-can-i-boost-my-immune-system-237456">original article</a>.</em></p> </div>

Body

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What is type 1.5 diabetes? It’s a bit like type 1 and a bit like type 2 – but it’s often misdiagnosed

<div class="theconversation-article-body"> <p><em><a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a> and <a href="https://theconversation.com/profiles/lauren-ball-14718">Lauren Ball</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a></em></p> <p>While you’re likely familiar with type 1 and type 2 diabetes, you’ve probably heard less about type 1.5 diabetes.</p> <p>Also known as latent autoimmune diabetes in adults (LADA), type 1.5 diabetes has features of <a href="https://diabetesjournals.org/diabetes/article/69/10/2037/16062/Management-of-Latent-Autoimmune-Diabetes-in-Adults">both type 1 and type 2 diabetes</a>.</p> <p>More people became aware of this condition after <a href="https://www.imdb.com/name/nm0004726/">Lance Bass</a>, best known for his role in the iconic American pop band NSYNC, <a href="https://www.foxnews.com/health/pop-singer-lance-bass-type-1-5-diabetes-know-disease">recently revealed</a> he has it.</p> <p>So, what is type 1.5 diabetes? And how is it diagnosed and treated?</p> <h2>There are several types of diabetes</h2> <p>Diabetes mellitus is a group of conditions that arise when the levels of glucose (sugar) in our blood are higher than normal. There are actually <a href="https://diabetesjournals.org/care/article/37/Supplement_1/S81/37753/Diagnosis-and-Classification-of-Diabetes-Mellitus">more than ten types</a> of diabetes, but the <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01301-6/fulltext">most common</a> are type 1 and type 2.</p> <p>Type 1 diabetes is an <a href="https://diabetesjournals.org/care/article/44/11/2589/138492/The-Management-of-Type-1-Diabetes-in-Adults-A">autoimmune condition</a> where the body’s immune system attacks and destroys the cells in the pancreas that make the hormone insulin. This leads to very little or no insulin production.</p> <p>Insulin is important for moving glucose from the blood into our cells to be used for energy, which is why people with type 1 diabetes need <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6995794/">insulin medication daily</a>. Type 1 diabetes usually <a href="https://www.nature.com/articles/s41390-024-03107-5">appears</a> in children or young adults.</p> <p>Type 2 diabetes is not an autoimmune condition. Rather, it happens when the body’s cells become resistant to insulin over time, and the pancreas is no longer able to make enough insulin to <a href="https://diabetesjournals.org/care/article/47/Supplement_1/S20/153954/2-Diagnosis-and-Classification-of-Diabetes">overcome this resistance</a>. Unlike type 1 diabetes, people with type 2 diabetes still produce some insulin.</p> <p>Type 2 is more common in adults but is <a href="https://www.sciencedirect.com/science/article/abs/pii/S1871402121002733">increasingly</a> seen in children and young people. Management <a href="https://www.racgp.org.au/getattachment/41fee8dc-7f97-4f87-9d90-b7af337af778/Management-of-type-2-diabetes-A-handbook-for-general-practice.aspx">can include</a> behavioural changes such as nutrition and physical activity, as well as oral medications and insulin therapy.</p> <h2>How does type 1.5 diabetes differ from types 1 and 2?</h2> <p>Like type 1 diabetes, type 1.5 occurs when the immune system attacks the pancreas cells that make insulin. But people with type 1.5 often don’t need insulin <a href="https://diabetesjournals.org/diabetes/article/69/10/2037/16062/Management-of-Latent-Autoimmune-Diabetes-in-Adults">immediately</a> because their condition develops more slowly. Most people with type 1.5 diabetes will need to use insulin within <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5111528/">five years</a> of diagnosis, while those with type 1 typically require it from diagnosis.</p> <p>Type 1.5 diabetes is usually diagnosed in people <a href="https://diabetesjournals.org/diabetes/article/69/10/2037/16062/Management-of-Latent-Autoimmune-Diabetes-in-Adults">over 30</a>, likely due to the slow progressing nature of the condition. This is older than the typical age for type 1 diabetes but younger than the usual diagnosis age for type 2.</p> <p>Type 1.5 diabetes shares <a href="https://www.nature.com/articles/nrendo.2017.99">genetic and autoimmune risk factors</a> with type 1 diabetes such as specific gene variants. However, evidence has also shown it may be influenced by lifestyle factors such as <a href="https://pubmed.ncbi.nlm.nih.gov/29589073/">obesity</a> and <a href="https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2019.00320/full">physical inactivity</a> which are more commonly associated with type 2 diabetes.</p> <h2>What are the symptoms, and how is it treated?</h2> <p>The symptoms of type 1.5 diabetes are highly variable between people. Some have no symptoms at all. But generally, people may experience the following <a href="https://www.ncbi.nlm.nih.gov/books/NBK557897/">symptoms</a>:</p> <ul> <li>increased thirst</li> <li>frequent urination</li> <li>fatigue</li> <li>blurred vision</li> <li>unintentional weight loss.</li> </ul> <p>Typically, type 1.5 diabetes is <a href="https://diabetesjournals.org/diabetes/article/69/10/2037/16062/Management-of-Latent-Autoimmune-Diabetes-in-Adults">initially treated</a> with oral medications to keep blood glucose levels in normal range. Depending on their glucose control and the medication they are using, people with type 1.5 diabetes may need to monitor their blood glucose levels regularly throughout the day.</p> <p>When average blood glucose levels increase beyond normal range even with oral medications, treatment may progress to insulin. However, there are <a href="https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2022.959011/full">no universally accepted</a> management or treatment strategies for type 1.5 diabetes.</p> <h2>Type 1.5 diabetes is often misdiagnosed</h2> <p>Lance Bass said he was initially diagnosed with <a href="https://www.healthline.com/health-news/lance-bass-misdiagnosed-diabetes">type 2 diabetes</a>, but later learned he actually has type 1.5 diabetes. This is <a href="https://journals.lww.com/jaanp/abstract/2009/03000/latent_autoimmune_diabetes_of_adulthood__lada___an.4.aspx">not entirely uncommon</a>. Estimates suggest type 1.5 diabetes is misdiagnosed as type 2 diabetes <a href="https://www.sciencedirect.com/science/article/abs/pii/S1043276018301292">5–10% of the time</a>.</p> <p>There are a few possible reasons for this.</p> <p>First, accurately diagnosing type 1.5 diabetes, and distinguishing it from other types of diabetes, requires special <a href="https://journals.lww.com/jaanp/abstract/2009/03000/latent_autoimmune_diabetes_of_adulthood__lada___an.4.aspx">antibody tests</a> (a type of blood test) to detect autoimmune markers. Not all health-care professionals necessarily order these tests routinely, either due to cost concerns or because they may not consider them.</p> <p>Second, type 1.5 diabetes is commonly found in adults, so doctors might wrongly assume a person has developed type 2 diabetes, which is more common in this age group (whereas type 1 diabetes usually affects children and young adults).</p> <p>Third, people with <a href="https://diabetesjournals.org/diabetes/article/69/10/2037/16062/Management-of-Latent-Autoimmune-Diabetes-in-Adults">type 1.5 diabetes</a> often initially make enough insulin in the body to manage their blood glucose levels without needing to start insulin medication. This can make their condition appear like type 2 diabetes, where people also produce some insulin.</p> <p>Finally, because type 1.5 diabetes has <a href="https://www.ncbi.nlm.nih.gov/books/NBK557897/">symptoms</a> that are similar to type 2 diabetes, it may initially be treated as type 2.</p> <h2>We’re still learning about type 1.5</h2> <p>Compared with type 1 and type 2 diabetes, there has been much less research on how common type 1.5 diabetes is, especially in <a href="https://www.sciencedirect.com/science/article/abs/pii/S1043276018301292">non-European populations</a>. In 2023, it was estimated type 1.5 diabetes represented <a href="https://pubmed.ncbi.nlm.nih.gov/37428296/">8.9%</a> of all diabetes cases, which is similar to type 1. However, we need more research to get accurate numbers.</p> <p>Overall, there has been a limited awareness of type 1.5 diabetes and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10683931/">unclear diagnostic criteria</a> which have slowed down our understanding of this condition.</p> <p>A misdiagnosis can be stressful and confusing. For people with type 1.5 diabetes, being misdiagnosed with type 2 diabetes might mean they don’t get the insulin they need in a timely manner. This can lead to worsening health and a greater likelihood of complications down the road.</p> <p>Getting the right diagnosis helps people receive the most appropriate treatment, save money, and reduce <a href="https://diabetesjournals.org/diabetes/article/73/Supplement_1/55-OR/155112/55-OR-Diabetes-Distress-among-Persons-Living-with">diabetes distress</a>. If you’re experiencing symptoms you think may indicate diabetes, or feel unsure about a diagnosis you’ve already received, monitor your symptoms and chat with your doctor.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/237041/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, Accredited Practising Dietitian and Lecturer, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a> and <a href="https://theconversation.com/profiles/lauren-ball-14718">Lauren Ball</a>, Professor of Community Health and Wellbeing, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-is-type-1-5-diabetes-its-a-bit-like-type-1-and-a-bit-like-type-2-but-its-often-misdiagnosed-237041">original article</a>.</em></p> </div>

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

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

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What does family look like in Australia? It’s more diverse than you think

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/yuvisthi-naidoo-476322">Yuvisthi Naidoo</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a>; <a href="https://theconversation.com/profiles/ilan-katz-147135">Ilan Katz</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a>, and <a href="https://theconversation.com/profiles/megan-blaxland-128122">Megan Blaxland</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a></em></p> <p>When we think of the concept of the family, a specific version often springs to mind: a mother, a father and children, usually two or three. It’s the version of society our policies and systems are built around.</p> <p>But Australia’s families are far more diverse. Some are multigenerational, some are sole-parent, some are blended. We need to understand how families have evolved over time and what that means for the social fabric of our country.</p> <p>Our <a href="https://www.uniting.org/content/dam/uniting/documents/families-report/uniting-families-report-2024.pdf">new research</a>, released today, charts years of data to map out what families have looked like historically and what they look like now. We also looked at how these families function, including income, wealth, labour division and care responsibilities.</p> <h2>Charting change over time</h2> <p>Families are the primary social environment in which we are cared for. As such, they play a fundamental role in our development and in making a thriving society.</p> <p>Of the <a href="https://www.abs.gov.au/media-centre/media-releases/2021-census-shows-changing-face-australias-6-million-families">six million</a> children and young people, aged 0–19 years, currently growing up in Australia, the majority learn and develop with the care and support of families. More than two and a half million families are raising children under the age of 15.</p> <p>Our understanding of who counts as family has expanded enormously over the past 50 years. But too often, we assume families are nuclear. Research too is guilty of examining “families” without exploring variation. If any different forms of family are explored, they typically divide families into couple-parent and sole-parent families.</p> <p>Shining a spotlight on family diversity is essential to ensuring that policies, systems and society are supportive and inclusive of the many ways children and young people grow up. We need to <a href="https://research-information.bris.ac.uk/ws/files/236470646/socsci_09_00083_v2.pdf">change the way</a> we think about family.</p> <p>Our team, in partnership with <a href="https://www.uniting.org/home">Uniting NSW.ACT</a>, will report annually over the next decade to chart the diversity of families, how this changes over time, and the implications for policy and practice. Our first report analyses the 2022 wave of Housing Income and Dynamics in Australia (HILDA) data and the 2021 Census to examine these issues.</p> <p><a href="https://www.uniting.org/content/dam/uniting/documents/families-report/uniting-families-report-2024.pdf">We found</a> while the majority of children live in couple-parent (69%) and sole-parent (11%) families, 12% of children live in step/blended families, 6% live in multigenerational families, and around 1% live in foster families or families made up of other kin.</p> <p>We also found First Nations families are more likely to live in multigenerational (9%), step and/or blended (27%), sole-parent (23%), or foster and other kin (6%) families.</p> <h2>Care, wealth and labour</h2> <p>Our analysis of ten years of the Census shows this diverse mix of families has been a consistent part of the Australian population over time.</p> <p>As well as nurturing children and supporting young adults as they establish themselves in the world, we found families provide care during times of ill-health and disability. Unsurprisingly, multigenerational families are likely to provide this kind of care, because they are living with older adults with care needs.</p> <p>But this was also the case for sole-parent families, step/blended families and foster and other kin families. All these family types are at least twice as likely to provide care than couple families.</p> <p>We know the cost of living is affecting many families. However, our research suggests that couple families, on the whole, have higher incomes (around 1.5 times more) and higher levels of wealth, and are more likely to be able to cope with rising costs than other families.</p> <p>Sole-parent families, step/blended families, multigenerational families and foster and other kin families have lower incomes and are more likely to experience financial hardship, with close to 20% reaching out to friends, family and community for financial help.</p> <p>Across all family types, we found that old patterns around the gendered division of labour are still in force. Women continue to do more housework and more child-rearing than men. Women have this in common across all family types.</p> <p>What’s more, the majority of women (more than two-thirds) report they believe they are doing more than their fair share. Most men, on the other hand, (again, around two-thirds) feel their contributions are about right. Men heading sole-parent families are the main exception to this pattern.</p> <p>These findings challenge conventional notions of family structure and underscore the importance of inclusive support systems policies that recognise and address the multifaceted needs of families. For example, <a href="https://www.servicesaustralia.gov.au/family-tax-benefit">some family assistance programs</a> base access to supports on household incomes, assuming an increase in resources will benefit all families equally, without considering the number of people in the household or the complexity of caring roles they may hold.</p> <h2>Why does this matter?</h2> <p>Greater understanding of family diversity is important in public debate, policy development and service delivery.</p> <p>By thinking about “children and young people and the people who are raising them”, we have developed a new typology of families, which includes: step/blended, multigenerational, and foster and other kin families – groups that are rarely included in quantitative research.</p> <p>The higher care responsibilities of these family types, combined with access to fewer financial resources, shows the importance of ensuring our policies and programs understand more about the many kinds of families who live in Australia. The findings show there is work to do to ensure that conditions and opportunities are equal for all families.</p> <p>At the same time, old challenges about women’s uneven greater share of work raising children, and caring for the homes in which we live, continue to need our focused attention to redress gender imbalances.</p> <p>Importantly, the research also uncovers areas of hope. Despite the obvious challenges many families face, the resilience and care within families is clear. Satisfaction with relationships with children and between siblings is high across all family types.</p> <p>In the next decade we hope to build a compelling narrative that provides a rich evidence base on how family practices, relationships, needs and circumstances change.</p> <p>A better understanding of the rich of tapestry of families and family life in which children and young people are raised in Australia will compel us to look more closely in the design of our policies and systems to disrupt entrenched disadvantage and secure the futures of the next generation.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/236499/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/yuvisthi-naidoo-476322">Yuvisthi Naidoo</a>, Senior Research Fellow, Social Policy Research Centre, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a>; <a href="https://theconversation.com/profiles/ilan-katz-147135">Ilan Katz</a>, Professor of Social Policy, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a>, and <a href="https://theconversation.com/profiles/megan-blaxland-128122">Megan Blaxland</a>, Senior Research Fellow, Social Policy Research Centre, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-does-family-look-like-in-australia-its-more-diverse-than-you-think-236499">original article</a>.</em></p> </div>

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Australia’s IV fluids shortage will likely last all year. Here’s what that means for surgeries

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/stuart-marshall-1115779">Stuart Marshall</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722"><em>The University of Melbourne</em></a></em></p> <p>The current <a href="https://www.tga.gov.au/about-IV-fluids-shortages">shortage of sterile intravenous (IV) fluids</a> is a serious ongoing concern for doctors across Australia. During surgery, these sterile fluids are essential to administer drugs and hydrate patients intravenously (via the veins).</p> <p>But supplies of two of the most common solutions are critically low.</p> <p>The Australian government has recently moved to <a href="https://www.theguardian.com/australia-news/article/2024/aug/16/australia-iv-fluid-shortage-government-distribution">coordinate supplies</a> of IV fluids to increase manufacturing and ensure distribution. Despite this, supplies are not expected to return to normal levels <a href="https://www.health.gov.au/sites/default/files/2024-08/joint-statement-on-iv-fluids-health-ministers-meeting-16-august-2024.pdf">until the end of the year</a>.</p> <p>So, what will this mean for surgery in Australia? And are there any alternatives?</p> <h2>Why do we need IV fluids for surgery?</h2> <p>IV fluids are used before, during and after surgery to maintain blood volume and the body’s normal functions. They also combat dehydration, which can happen in a number of ways.</p> <p>Before surgery, patients may become dehydrated from illnesses that cause vomiting or diarrhoea. They are also asked to stop eating and drinking for several hours before surgery. This is to minimise the risk of stomach contents being regurgitated and inhaled into the lungs – a <a href="https://my.clevelandclinic.org/health/diseases/21954-aspiration-pneumonia">complication that can cause injury or death</a>. But it can also make them more dehydrated.</p> <p>During surgery, the body continues to lose fluid through normal processes such as sweating and making urine. But some aspects of surgery also exacerbate dehydration, for example, through blood loss or when internal organs are exposed and lose more fluid through evaporation.</p> <p>After the operation, IV fluids may be required for some days. Many patients may still be unable to eat and drink until the function of the gut returns to normal.</p> <p>Multiple research studies, including <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1801601">a trial </a>of 3,000 patients who underwent major abdominal surgery, have demonstrated the importance of adequate fluid therapy throughout all stages of surgery to avoid kidney damage.</p> <p>Apart from hydration, these sterile fluids – prepared under strict conditions so they contain no bacteria or viruses – are used in surgery for other reasons.</p> <p>Anaesthetists commonly use fluid infusions to slowly deliver medications into the bloodstream. There is some evidence this method of maintaining anaesthesia, compared to inhalation, can improve patients’ experience of “waking up” after the procedure, <a href="https://medcast.com.au/blog/total-intravenous-anaesthesia-tiva">such as being clearer headed and having less nausea and vomiting</a>.</p> <p>Surgeons also use sterile fluids to flush out wounds and surgical sites to prevent infection.</p> <h2>Are there workarounds?</h2> <p>Fluid given intravenously needs to closely resemble the salts in the blood to prevent additional problems. The safest and cheapest options are:</p> <ul> <li>isotonic saline, a solution of water with 0.9% table salt</li> <li>Hartmann’s solution (compound sodium lactate), which combines a range of salts such as potassium and calcium.</li> </ul> <p>Both are <a href="https://www.tga.gov.au/about-IV-fluids-shortages">in short supply</a>.</p> <p>One way to work around the shortage is to minimise how much IV fluid is used during the procedure. This can be achieved by ensuring those admitted to surgery are as well hydrated as possible.</p> <p>Many people presenting for minor surgery can safely drink water up until an hour or so before their operation. A recent initiative termed “<a href="https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.15855">sip ‘til send</a>” has shown it is safe for patients to drink small amounts of fluid until the operating theatre team “sends” for them from the waiting room or hospital ward.</p> <p>However, this may not be appropriate for those at higher risk of inhaling stomach contents, or patients who take medications including <a href="https://www.journal.acorn.org.au/cgi/viewcontent.cgi?article=1291&amp;context=jpn">Ozempic</a>, which delay the stomach emptying. Patients should follow their anaesthetist’s advice about how to prepare for surgery and when to stop eating and drinking.</p> <p>Large research trials have also helped establish protocols called “<a href="https://www.bjanaesthesia.org/article/S0007-0912(17)53976-8/fulltext">enhanced recovery after surgery</a>”. They show that using special hydrating, carbohydrate-rich drinks before surgery can improve patients’ comfort and speed up healing.</p> <p>These protocols are common in <a href="https://aci.health.nsw.gov.au/__data/assets/pdf_file/0003/736617/ERAS-Key-principles-for-colorectal-surgery.pdf">major bowel surgery</a> in Australia but not used universally. Widespread adoption of these processes may reduce the amount of IV fluids needed during and after large operations, and help patients return to normal eating and drinking earlier. Medications reducing nausea and vomiting are now also routinely administered after surgery to help with this.</p> <h2>What will the shortage mean for surgeries?</h2> <p>The Australian and New Zealand College of Anaesthetists <a href="https://www.anzca.edu.au/news/guidance-on-sparing-of-intravenous-fluid-use">has advised anaesthetists</a> to reduce the consumption of fluid during operations where there might be limited or minimal benefit. This means that the fluid will only be used for people who need it, without a change to the quality and safety of anaesthetic care for any patient.</p> <p>Even with these actions, there is still a chance that some planned surgeries may <a href="https://www.abc.net.au/news/2024-08-15/iv-fluid-shortage-elective-urgery-delays/104225280">need to be postponed</a> in the coming months.</p> <p>If needed, these cancelled operations will likely be ones requiring large volumes of fluid and ones that would not cause unacceptable risks if delayed. Similar to cancellations during the height of the COVID pandemic, emergency operations and surgery for cancers are unlikely to be affected.</p> <p>Monitoring of the supplies and ongoing honest and open dialogue between senior health managers and clinicians will be crucial in minimising the disruption to surgical services.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/237009/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/stuart-marshall-1115779">Stuart Marshall</a>, Associate Professor, Department of Critical Care, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/australias-iv-fluids-shortage-will-likely-last-all-year-heres-what-that-means-for-surgeries-237009">original article</a>.</em></p> </div>

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Readers response: What are you starting to like more as you get older?

<p>As we age, we start to have a whole new appreciation for things we previously overlooked in our younger years. </p> <p>We asked our reader what of life's simple pleasures they are starting to enjoy more as they get older, and the response was overwhelming. Here's what you said. </p> <p><span dir="auto"><strong>Wendy Turner</strong> - The beauty and companionship of dogs, the wildness of a garden, the treasured times between physical pain, and the love of family and treasured friends.</span></p> <p><span dir="auto"><span dir="auto"><strong>SE Rosenberg</strong> - Being on my own away from people but hanging out with my cats.</span></span></p> <p><span dir="auto"><span dir="auto"><span dir="auto"><strong>Lynette Miller</strong> - Taking time to enjoy sunrise and sunsets, smelling the roses and just little things that sometimes pass you by because you're too busy to enjoy them.</span></span></span></p> <p><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><strong>Antoinette Devlin</strong> - Peace and quiet.</span></span></span></span></p> <p><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><strong>Robert Edward Fleming</strong> - Not having to work for the man anymore.</span></span></span></span></p> <p><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><strong>Janine Sarai George</strong> - Putting my feet up, a good book and my wildlife.</span></span></span></span></span></p> <p><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><strong>Maureen Brown Montgomery</strong> - Finally starting not to mind living a solo life and enjoying my own company </span></span></span></span></span></span><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto">without drama.</span></span></span></span></span></span></p> <p><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><strong>Liz Lewis</strong> - Not having to set the alarm but being able to wake up naturally and usually not having to be anywhere in a hurry.</span></span></span></span></span></span></span></p> <p><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><strong>Roselyn Reincastle</strong> - Appreciating life more now that I have had the experience.</span></span></span></span></span></span></span></span></p> <p><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><strong>Frances Bradshaw</strong> - Peace and hearing the birds sing.</span></span></span></span></span></span></span></span></span></p> <p><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><strong>Margie Buckingham</strong> - Serenity, that my opinions matter, travelling, spare time &amp; being a grandparent.</span></span></span></span></span></span></span></span></span></span></p> <p><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><strong>Rob Anderson</strong> - Time with the grandchildren, and reflection.</span></span></span></span></span></span></span></span></span></span></span></p> <p><span dir="auto"><strong>Wendy Hope</strong> - Travel and wonder at the diversity of people.</span></p> <p><span dir="auto"><span dir="auto"><strong>Maya Richardson</strong> - Staying as far away from people as possible.</span></span></p> <p><span dir="auto"><span dir="auto"><span dir="auto"><strong>Christine Tully</strong> - Not having to commit to anything if I don’t want to.</span></span></span></p> <p><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto"><strong>Margaret Inglis</strong> - Doing what I want to do, although my 4 legged mate still wants to get me out of the house each morning.</span></span></span></span></p> <p><em><span dir="auto"><span dir="auto"><span dir="auto"><span dir="auto">Image credits: Shutterstock </span></span></span></span></em></p>

Retirement Life

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What is ‘slot hoarding’ – and is it locking out regional airlines like Rex?

<div class="theconversation-article-body"> <p><em><a href="https://theconversation.com/profiles/doug-drury-1277871">Doug Drury</a>, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a></em></p> <p>It’s been a depressing year for regional aviation. Rex Airlines has just become the second Australian airline to go into voluntary administration this year, after Bonza’s collapse in April.</p> <p>Is Qantas’ chief executive Vanessa Hudson right – that there simply <a href="https://www.smh.com.au/business/companies/australia-can-t-sustain-more-than-three-airlines-says-qantas-boss-20240714-p5jtlo.html">aren’t enough passengers</a> in Australia to support more than three airlines?</p> <p>That’s certainly a convenient narrative for the members of our domestic airline duopoly, Qantas and Virgin Australia, who now face even less competition.</p> <p>Or did Rex fall victim to other airlines’ strategic management to limit the number of airport slots available to them to successfully fly between the capital cities? This practice is known as “slot hoarding”.</p> <p>On Thursday, the former chair of the the Australian Competition and Consumer Commission (ACCC), Rod Sims, seemed to think so, <a href="https://www.theguardian.com/australia-news/article/2024/aug/01/rex-airlines-administration-qantas-virgin">telling ABC radio</a>:</p> <blockquote> <p>The government outsources the management of the slots at Sydney airport to a company that’s majority-owned by Qantas and Virgin, it is just unbelievable.</p> </blockquote> <p>It’s certainly not a new allegation. <a href="https://www.theguardian.com/business/2023/jun/06/rex-and-bonza-call-for-immediate-overhaul-of-sydney-airport-laws-to-increase-competition">Rex</a>, <a href="https://www.theguardian.com/business/2023/jun/06/rex-and-bonza-call-for-immediate-overhaul-of-sydney-airport-laws-to-increase-competition">Bonza</a>, and the <a href="https://www.afr.com/companies/transport/accc-warns-sydney-airport-slots-manager-has-conflicts-of-interest-20231220-p5espy">ACCC</a> have all previously raised concerns.</p> <p>So how exactly do airline slots work, and does the system need reform?</p> <h2>What are slots?</h2> <p>Back in the 1970s, the International Air Transport Association (IATA) developed the airline slot system to reduce airport congestion. The aim was to improve the traffic flow during peak travel times at “level 3” high traffic density airports – a category that includes Sydney and Melbourne.</p> <p>Under the system, airlines are allocated a daily number of slots they can use. Importantly, there is a set amount of slots available, as they represent specific time windows for aircraft to take off or land.</p> <p>Airlines <a href="https://doi.org/10.1016/j.trb.2018.04.005">schedule</a> their slots ahead of time as part of a yield management program. This plan looks across the whole calendar year, taking into account projected peak and off-peak travel times for business and leisure travellers.</p> <p>An airline owns the time slot it is designated by the <a href="https://doi.org/10.1016/j.trb.2018.04.005">airport infrastructure</a> capacity, whether it gets used or not.</p> <p>The IATA system relies on what’s called the “<a href="https://australianaviation.com.au/2024/02/80-20-rule-looks-to-survive-government-overhaul-of-sydney-slots/#:%7E:text=Currently%2C%20an%20airline%20can%20keep,calls%20it%20%E2%80%9Ctoo%20generous%E2%80%9D.">80/20 rule</a>”, which states an airline must use 80% of its allocated slots or it will loose its unused slots. The 20% is a buffer. But it has been <a href="https://australianaviation.com.au/2024/02/80-20-rule-looks-to-survive-government-overhaul-of-sydney-slots/">criticised</a> as overly generous.</p> <p>Airlines can also <a href="https://www.sciencedirect.com/science/article/pii/S1000936123002340">buy sell or lease</a>, slots they are not using due to slow demand or the need for financial gain. These can sell for <a href="https://simpleflying.com/biggest-airport-slot-deals-list/">huge sums</a>.</p> <h2>Can slots be hoarded?</h2> <p>Broadly speaking, slot hoarding is the practice of booking slots for use only to cancel them in bad faith, preventing other airlines from getting access to premium travel times.</p> <p>In June last year, Rex’s then-deputy-chairman John Sharp <a href="https://www.theguardian.com/business/2023/jun/06/rex-and-bonza-call-for-immediate-overhaul-of-sydney-airport-laws-to-increase-competition">accused Qantas</a> of engaging in the practice:</p> <blockquote> <p>It’s as plain as the nose on your face that Qantas is hoarding slots by cancelling sufficient flights to remain within the 80/20 rule.</p> </blockquote> <p>Slot availability is a particular <a href="https://www.afr.com/companies/transport/accc-warns-sydney-airport-slots-manager-has-conflicts-of-interest-20231220-p5espy">issue for Sydney Airport</a>, because takeoffs and landings are capped at 80 per hour.</p> <p>Sydney Airport Corporation’s executive general manager of aviation, Robert Wood, as well as the airport’s then-chief-executive Geoff Culbert also both expressed <a href="https://www.abc.net.au/news/2023-11-21/airlines-qantas-virgin-slot-hoarding-solving-problems/103110390">serious concerns</a> about slot use last year.</p> <p>In February this year, the federal government unveiled a <a href="https://minister.infrastructure.gov.au/c-king/media-release/reforming-sydney-airport-slots-boost-efficiency-competition-and-consumers-outcomes">range of reforms</a> for Sydney airport’s slot system. These included requirements for increased transparency on how slots are used, and new independent audits.</p> <p>Notably though, the government made <a href="https://australianaviation.com.au/2024/02/80-20-rule-looks-to-survive-government-overhaul-of-sydney-slots/">no change</a> to the 80/20 rule.</p> <h2>What needs to change?</h2> <p>A number of further reforms could help make the airport system friendlier to new entrants and more equitable.</p> <p>One possibility is to <em>sell</em> a predefined number of slots to the major participating airlines. Airlines would have to make a business case outlining their proposed needs over the next calendar year.</p> <p>Currently, airlines request slots from the airport slot management team at no cost to the airline, a system which favours established airlines that have met the 80/20 rule.</p> <p>But a key criticism of this proposal is that the cost of purchasing slots <a href="https://www.abc.net.au/news/2023-11-21/airlines-qantas-virgin-slot-hoarding-solving-problems/103110390">would be passed down</a> to the flying public, likely resulting in higher airfares. Bidding for slots would also add new cost barriers to entry for would-be startup challengers.</p> <p>Another possibility is to look at <a href="https://doi.org/10.1287/trsc.2019.0926">slot allocation based on fairness</a>, measuring an airline’s needs against airport infrastructure.</p> <p>Airlines that had historically used 80% of their allocated slots would be given priority bidding on <em>up to 50%</em> of the following year’s total airport slot allocation.</p> <p>The remaining 50% of slots could be prioritised for new airlines without an established history, with the goal of awarding them take off and landing times that aren’t necessarily premium, but close enough.</p> <p>Airlines that didn’t achieve this 80% target or were found to be abusing the slot hoarding rules would be removed from the top-tier fairness status and placed in a slot allocation “sin bin” until their performance measures were brought up to standards.</p> <p>Australia has challenges ahead for domestic flights that are already at capacity. Government reforms that provide better oversight of airport usage of the 80/20 rule could help mitigate the risk of anti-competitive behaviour.</p> <p>Australian airlines have the right to compete without feeling unfairly held back, and we as consumers have the right to reasonable airfares. <!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/235960/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/doug-drury-1277871">Doug Drury</a>, Professor/Head of Aviation, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-is-slot-hoarding-and-is-it-locking-out-regional-airlines-like-rex-235960">original article</a>.</em></p> </div>

Travel Trouble

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What it's like to play the baddest opera villain in the world

<p>As we mark the 100th anniversary of Giacomo Puccini’s passing, Opera Australia is pulling out all the stops to celebrate the legendary Italian composer with two of his most celebrated works at the iconic Sydney Opera House this winter. Kicking off the season is Edward Dick’s five-star production of <em>Tosca</em>, which had its opening night on June 25.</p> <p>This electrifying new take on Puccini’s action-packed thriller is captivating audiences with its compelling narrative and intense emotional depth. <em>Tosca</em> unfolds over a swift 24-hour period, weaving a tale of passion and power, jealousy and betrayal, love and tragedy. It's a perfect introduction to opera for newcomers and a beloved classic for seasoned fans, promising an edge-of-your-seat experience.</p> <p>Renowned for his ability to breathe fresh life into classic works, Director Edward Dick has assembled an award-winning creative team to deliver a visually stunning production. Tom Scutt's set design brilliantly juxtaposes Renaissance grandeur with contemporary elegance, featuring a suspended gilded dome revealing a breathtaking Renaissance fresco. BAFTA-winning costume designer Fotini Dimou dresses the performers in chic, modern attire, while Lee Curran's stadium-style lighting adds a dramatic flair.</p> <p>The cast is equally stellar. Making her Opera Australia debut, Northern Irish soprano Giselle Allen has taken on the titular role of Tosca, sharing the stage with OA favourite Karah Son, who received critical acclaim for her performance in Melbourne.</p> <p>Joining them is Korean tenor Young Woo Kim, debuting at the Sydney Opera House as the love-struck painter Cavaradossi. The role of the villainous Scarpia will be portrayed for the first half of the show's run by Armenian dramatic baritone Gevorg Hakobyan, also making his OA debut, until award-winning local baritone Warwick Fyfe takes over the role for the second half of the run, beginning on July 31 until the run's conclusion on August 16.</p> <p>Over60 was thrilled to be given the chance to interview Fyfe in the lead-up to his Sydney performance. </p> <p><em><strong>O60: Firstly, by way of an introduction to Warwick Fyfe the Australian Helden bass baritone – can you summarise your career?</strong></em></p> <p><strong>Fyfe: </strong>“In <em>Yes, Minister</em>, Sir Humphrey once – referring to Bernard – used the expression “a low flyer supported by occasional gusts of hot air”. I suppose I’m a bit like that. But I have a single major achievement, to wit: I’m still here! Over several decades I’ve seen hot shots come and go and change careers but I’m still earning a living at singing. Moreover, I think I might at last be getting the hang of it.” </p> <p><strong><em>O60: What is your history with this opera Tosca by Puccini?</em></strong></p> <p><strong>Fyfe: </strong>“I sang the Sacristan in the 1995 Victoria State Opera production. That was the start. The director John Copley was very supportive and taught me a lot. Also, I got to know the great John Wegner, having previously only seen him from the auditorium. He was a great influence even though he and I were very different. I’d watch him every night from the wings during Act 2. Then years later, having done countless Sacristans, I did a Scarpia of my own, taking over from John at the tail end of a season. Then in 2022 I was to sing Scarpia for West Australian Opera. Alas, the season was severely damaged when I caught Covid. I only did the first and last shows and not very well. This current production allows me at last to put my stamp on the role and do it properly. It went well in the Melbourne run.” </p> <p><em><strong>O60: How do you approach learning the role of Scarpia and connecting with a villainous character?</strong></em></p> <p><strong>Fyfe: </strong>“Tosca is very standard repertoire and additionally I was the Sacristan early in my career so that I had an osmotically acquired sense of the thing from early on. Also, the donkey work of learning and memorising the notes and words is a task of only moderate proportions with this role. So one just sits down at the piano and starts hacking away at it. </p> <p>“The other two bits of the equation (which can’t actually be separated) are the singing of the role and the inhabiting of the character. Vocally, it requires that I be at peak form. I can sing it much better than when I was young but it requires much more conscious effort to sustain it. My teacher Christina Henson Hayes has helped me enormously on that front. </p> <p>“Dramatically, it’s almost always possible to find in some dark recess of oneself something which is reflected in the character. Having found this way in, one can push it and stretch it and eventually pop out like a newborn into the new fictional world where that person lives. But equally important, especially for the in-the-round, creaturely and not at all stylised characters of verismo, one needs to have lived and absorbed that which is around one. Read good books, watch great actors – not in an ad hoc sense but generally. Be a cultural sponge. Make reading good books and watching great actors as constant and inevitable a part of life as eating. Read everything, listen to everything, observe everything. If the singer has no cultural hinterland, it is to be hoped that the director is a magician!” </p> <p><em><strong>O6O: You recently performed in this production in Melbourne’s Margaret Court Arena – the first opera to be staged on the tennis court. How did you find that experience and will anything about your performance be different for the Sydney season?</strong></em></p> <p>“Well, it was lovely because all my colleagues were lovely. As well as all my Opera Australia chums, there were people new to me such as Nadine Benjamin and Young Woo Kim – people so warm and friendly, not to mention talented, that one feels almost abashed and instinctively tries in response to be the best colleague one knows how to be. </p> <p>“Nevertheless, I’m a traditionalist who believes that opera will always be better for all concerned in a conventional, properly appointed theatre. Opera singers do not like being miked. For me, however good the technicians, the sense of one’s sound being only partially in one’s own control is uncomfortable. On the other hand, feeling one’s voice commanding a huge space as if one were a Rabelaisian giant is quite thrilling and of course it opens up possibilities for the company commercially.” </p> <p><em><strong>O60: Opera Australia is presenting several Puccini works this year in celebration of the legendary composer as 2024 marks the 100th anniversary of Puccini’s death, so let’s chat about Puccini’s contribution to the world of opera. He was a champion of verismo; can you explain what that means? What should audiences expect from the performance?</strong></em></p> <p>“Verismo is simply realism. Characters presented in the round rather than as two-dimensional types or figures of heightened allegory. In place of a stylised, artificial or high-flown approach, the composers wished to present real people in plausible dramatic settings. Of course this presents an apparent contradiction because in real life we don’t sing at each other. However, in practice you can have your cake and eat it because the genius of Puccini, from a starting point of a verisimilitudinous situation and story, can take it to another plane of intensity and power. But the roots in reality are unbroken. That reality is in the DNA of every cell of the artwork which rises majestically from those roots. Hence the opera feels real despite the built-in artificiality of the art form. By contrast, a composer of another era and school might take his subject away from reality to a more rarefied place. Audiences should expect an intense, purely human drama.” </p> <p><em><strong>O60: Puccini is known for his innovative use of the orchestra and an expansive use of instruments; what should audiences be listening for when they come to Tosca?</strong></em></p> <p>“Different composers have their preferred palettes. This also varies on national as well as individual lines. As Puccini is the supreme figure in verismo, he IS the archetype so that I can answer the question in a circular way by saying that it will sound very Italian, very verismo. Lush, yes, but a Puccinian version thereof rather than a Straussian one. </p> <p>“There are also exquisite touches, sort of musical special effects used judiciously and sparingly enough so as not to seem gimmicky. For example, the bells and spoken Latin of the Te Deum or the distanced effect of the oratorio in Act 2. The arias are of course high points but much of the interest lies in the meat connecting those moments.” </p> <p><em><strong>O60: Which of Puccini’s works is your preferred or do you find one most revolutionary?</strong></em></p> <p>“For brutal intensity, <em>Tosca</em> represents the high-water mark, especially Act 2. I love the kaleidoscopic richness of <em>Turandot</em>. The story is horrible but this is not a negative if one accepts it as a fable which has different rules from those applying to a pungently realistic tale. Also, <em>Turandot</em> is structurally flawed because he didn’t finish it. It is, however, musically astonishingly good. If you said I had to see a Puccini opera tonight but I could choose which one, I’d definitely choose <em>La Fanciulla del West</em>. Not only is it a masterpiece, it doesn’t get done nearly enough.”</p> <p>---</p> <p>Don't miss this extraordinary celebration of Puccini's legacy. Whether you're an opera aficionado or a first-time attendee, this production of <em>Tosca</em> is set to be an unforgettable highlight of the cultural calendar. Get ready to be swept off your feet by the sheer drama, passion, and beauty of Puccini’s masterpiece. Visit <a href="https://opera.org.au/" target="_blank" rel="noopener">https://opera.org.au/</a> for more info.</p> <p><em>Images: Opera Australia</em></p>

Music

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"Felt like a criminal": Mother and disabled son "kicked out" of Pink concert

<p>A distraught mother has taken to social media to recall the moment her and her seven-year-old son, who has Down syndrome, were asked to leave a concert venue. </p> <p>Vanessa Vasey, 48, spent over $1,000 to take her son Jesse to see Pink in London during her UK stadium tour, but when the pair arrived at the venue, things took a turn. </p> <p>Jesse struggled to stay still in his seat and was soon surrounded by "six security guards" who ordered the disabled boy to sit down, otherwise they would have to leave.</p> <p>She said she tried to explain her son’s condition to the guards but they ended up being “escorted from the premises” just as Pink took to the stage.</p> <p>On Facebook, Vasey wrote in detail about what happened, saying her son had been “robbed” of a special experience.</p> <p>“Music is his life and Pink is one of his absolute favourites,” she wrote.</p> <p>“We successfully saw her perform at BST Hyde Park last year and were thrilled to learn of her return again this year.”</p> <p>Vasey said she purchased more expensive “hospitality tickets” allowing people to move between bars and food outlets during the night “so that Jesse wouldn’t be pressured into remaining in one seat all night, as he gets overwhelmed in busy environments and finds it hard to sit still.”</p> <p>“We spent some time in the bar leading up to the main act, and Jesse was having a wonderful time, until about 45 minutes before Pink was due to come on, they suddenly shut all the blinds, obstructing us from seeing anything,” she wrote.</p> <p>“I tried to consult with the hospitality managers over this, and explained Jesse’s needs, but they wouldn’t budge on it. So not wanting Jesse to stare at a blind all night, we attempted to go into the seating zone."</p> <p>“We couldn’t get him to sit in his seat, but he was happy dancing and singing at the front railings, and even interacting with some of the other guests."</p> <p>“Doing no harm to anyone, or obstructing anyone’s view. This seemed OK for about half an hour or so. Then ... just as Pink dropped from the sky in her opening number, we had six security guards come into the zone and ask us to leave or sit in our seats.”</p> <p>Vasey said the security guards were “abrupt, intimidating and unpleasant”, as they "tried to force us to take Jesse to a sensory room which was soundproof, and watch Pink on a screen.” </p> <div> </div> <p>“Something we could do at home, robbing us of the whole experience, as if my son was some sort of inconvenience, and better off shut in a room out of sight.”</p> <p>When Vasey complained to venue staff, she claims that more security guards appeared and they had no choice but to leave. </p> <p>“We were escorted out of the building like criminals and saw no more of the Pink show. Jesse was utterly devastated, and they showed absolutely zero care or understanding."</p> <p>“Shame on you Tottenham Stadium,” she concluded. “My poor boy deserved so much better than this!”</p> <p>After UK media picked up Vasey's story, Tottenham Stadium released a statement explaining their actions. </p> <p>“Following further investigation, we can confirm that Ms Vasey was offered assistance by our Safeguarding and Welfare teams throughout the night to provide Jesse with a comfortable viewing experience, including access to our dedicated Sensory Room,” the statement read.</p> <p>“The offers of assistance were declined by Ms Vasey and the party chose to leave the event.”</p> <p>Vasey was soon set upon by online trolls who condemned her choice to take Jesse to the concert in the first place, to which she issues a lengthy statement about inclusivity and not singling people out for their disabilities. </p> <p>“Why do we take them [to events]? Because, as parents, we have the same dreams and aspirations for our children as any other parent,” she wrote.</p> <p>“We have the same desires to see our children’s faces light up, as any other parent would. Our children are exposed to the same world as other children, and they enjoy the same things."</p> <p>“They have the same likes and desires. The only thing that’s different is their needs, their abilities and their way of accessing their dreams."</p> <p>“Why should these things deny them of fulfilling these dreams and passions? This is meant to be a world of inclusion. So let’s start including!"</p> <p>“That means adapting, understanding, supporting and most importantly; changing the way we deliver these privileges so that they are privileges for all of us, and not just some of us.”</p> <p><em>Image credits: Facebook/Richard Isaac/Shutterstock Editorial </em></p> <div class="hide-print ad-no-notice css-qyun7f-StyledAdUnitWrapper ezkyf1c0" style="box-sizing: border-box; caret-color: #292a33; color: #292a33; font-family: HeyWow, Montserrat, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px;"> </div>

Caring

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How to buy a home: 7 tips for negotiating like a pro

<div class="theconversation-article-body"><em><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></em></p> <p>The main purpose of negotiation is to find a mutually acceptable solution for buyers and sellers. Good negotiations greatly improve relationships between buyers, sellers and agents. They also help avoid future problems and conflicts.</p> <p>Negotiating skills become even more important for home buyers in a “seller’s market”, where demand from buyers exceeds supply from sellers. That’s <a href="https://propertyupdate.com.au/australian-property-market-predictions/">currently the case</a> in all Australian capital cities and major regional cities such as Gold Coast, Sunshine Coast and others.</p> <p>Many home buyers mistakenly believe negotiation only occurs during the signing of the sale contract. However, it involves distinct stages: <em>pre-negotiation</em> and <em>during negotiation</em>.</p> <p>So how can people maximise their chances of successfully negotiating a purchase in a seller’s market? I offer the following tips.</p> <h2>Be someone the seller’s agent wants to do business with</h2> <p>Buyers often communicate solely with the seller’s agent, rather than directly with the seller. It’s crucial to ensure the agent views the buyer positively. Ultimately, it’s the agent who presents offers to the seller for their decision.</p> <p>It’s important, then, to understand what might motivate the seller’s agent to choose your offer. The key performance indicator for the agent often revolves around closing a property sale at a reasonable price within a certain time.</p> <p>This means price is a crucial factor. However, other factors can influence the seller’s agent and seller.</p> <p>For example, having pre-approved finance can increase the agent’s confidence in the buyer. If the buyer appears serious, can make quick decisions and makes a good impression, the agent may be more motivated to push for them, even if their offer is slightly lower than others without pre-approved finance.</p> <h2>Be a big fish (for the seller’s agent)</h2> <p>The next strategy is to give the seller’s agent extra incentive to favour you and your offer. <a href="https://www.emerald.com/insight/content/doi/10.1108/MIP-09-2019-0489/full/html">Our research</a> in customer behaviour suggests businesses value customers who make frequent purchases or engage them for long-term services.</p> <p>For example, the agent would be pleased to learn that the buyer might be interested in buying another property in the near future or in using their rental service for the new property. You have an advantage if you can position yourself as someone who could provide them with extra business.</p> <h2>Point to competing options</h2> <p>In a positive manner, let the seller’s agent know you are considering two or three properties, and this specific property is among those you are inclined to make an offer on.</p> <p>In certain situations, it may stimulate competitive pricing when multiple properties of similar quality are available in the same area. Make it clear to the agent you will choose the property that offers you the best overall value.</p> <p>While this strategy might not necessarily lower the price in a seller’s market, it can prompt the agent to have a fuller discussion with you.</p> <h2>Think beyond price</h2> <p>The next set of tips focuses on the <em>during negotiation</em> stages. It can be challenging for buyers to negotiate a lower price in a market with low supply and high demand. You might have to “think outside the price box”.</p> <p>Buyers often have a specific price range or fixed budget in mind when they start discussions with a seller. However, other factors besides price can influence a property’s overall value.</p> <p>So if a seller won’t adjust the price, consider negotiating for other concessions that could reduce your expenses.</p> <p>These may include:</p> <p><strong>Settlement period</strong></p> <p>Consider the expenses associated with the settlement period. A shorter settlement period could enable buyers to move into the property sooner and save on rent. For example, if a buyer is paying $600 per week in rent, an early settlement could save them around $2,400 per month.</p> <p><strong>Insurance costs after contract signing</strong></p> <p>In many states, buyers’ <a href="https://www.finder.com.au/home-insurance/home-insurance-cost">home insurance cover</a> is required to begin from the date of contract signing. It’s reasonable for buyers to include a special condition requesting the seller to bear the insurance costs until settlement. On average, home insurance may amount to about $140 per month.</p> <p><strong>Cleaning expenses</strong></p> <p>Consider negotiating a condition stipulating that the seller must ensure the property is professionally cleaned by settlement. Failure to do so could result in a $500 adjustment in the buyer’s favour at settlement.</p> <p>In some states, like Queensland, sellers are not obligated to deliver a clean property. Based on typical end-of-lease cleaning charges, internal cleaning of a four-bedroom property could cost <a href="https://firstcallhomeservices.com.au/service-menu/bond-exit-end-lease-cleaning/">$455 to $590</a>.</p> <p><strong>Building and pest inspection costs</strong></p> <p>Buyers should always include a 14-day pre-purchase inspection clause for <a href="https://www.topdogpestcontrol.com.au/building-pest-inspections-gold-coast/">building and pest inspections</a> in their offer. Although they may cost $300 to $600, these inspections provide a clear report that could lead to negotiations after contract signing if they find any issues with the property.</p> <h2>Be careful with your first offer</h2> <p>Don’t present the first offer in writing. It can be challenging to negotiate down the price once it has been written in an offer document.</p> <p>Instead, the buyer should begin by testing the expected price of the property. As well as obtaining property reports from multiple banks, the buyer could talk with the seller’s agent in person about a price range that would be agreeable to the seller.</p> <p>You could include phrases like “a price that will make the seller happy” or “a price that will make the seller accept the offer”. While the agent might not provide a specific price, this talk can provide a guideline for the buyer. All properties up for auction or private sale should have an expected price set, which may or may not be discussed with potential buyers.</p> <p>It’s also advisable to consult a solicitor before submitting an offer or signing a contract. They can offer valuable suggestions to smooth the purchase process and identify any issues.</p> <h2>Use the power of 900</h2> <p>Buyers often submit offers with round numbers, such as $700,000 or $750,000. In a competitive seller’s market, aim to submit an offer with a number that stands out from the rest, yet remains within your budget.</p> <p>An example of such a number is $900. For instance, comparing $700,000 to $700,900, the extra $900 makes the offer feel closer to $710,000.</p> <h2>Write a personalised letter</h2> <p>It’s true the most important point of selling a house for many sellers is price. But they are human and have emotions. Finishing a purchasing offer with a personal letter to the seller can make a difference.</p> <p>Often that $3,000 to $20,000 could be a lot of money for a buyer, but it may not be as much for someone selling a house for $700,000 or $1,000,000. Write the letter to express your feelings about the property in a way that makes it clear you will care for it. Most people selling their home would prefer to have someone look after it well.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/226237/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/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></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-to-buy-a-home-7-tips-for-negotiating-like-a-pro-226237">original article</a>.</em></p> </div>

Money & Banking

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4 things you’re likely doing that are damaging your hearing

<p>Your hearing is a precious gift, so it’s important to take good care of your ears. We’ve got some advice on the things to avoid, and what you can do to protect your hearing.</p> <p><strong>Using cotton tips</strong></p> <p>Though they’re commonly used for the job, cotton tips should never be used to clean out your ears. In fact, no solid object should be put inside your ears. Cotton tips account for around four per cent of all ruptured eardrums.</p> <p>These innocuous-looking objects can also cause bleeding, scratch your ear canal, or trigger an infection. So put them down and step away. Instead, use a commercial ear cleaner, or even just a few drops of mineral oil, baby oil, or glycerine to soften the earwax.</p> <p><strong>Don’t wait and see</strong></p> <p>If your hearing in one or both ears suddenly disappears without cause, you need to go and see your doctor as soon as you can. It could be inflammation, infection, or a decrease in blood supply to the area.</p> <p>If you need treatment, you’ll likely need it immediately to have any hope of restoring your hearing.</p> <p><strong>Using eardrops without advice</strong></p> <p>There are many over-the-counter eardrops available to help with things like swimmer’s ear. But in extreme cases, these products can cause deafness. Before you use anything, including a home remedy, get your doctor to check that you don’t have a ruptured eardrum.</p> <p>Some people may be born that way, or have had surgery as a child, or suffered an injury. If the ingredients in these drops make their way inside your eardrum, it can cause a lot of pain, and permanent deafness.</p> <p><strong>Always protect your ears</strong></p> <p>It’s incredibly important to protect your ears from permanent damage. Tiny hairs inside your ears act as hearing receptors, and these can be broken by extremely loud noises. Once they’re gone, they don’t come back.</p> <p>So things like loud music, fireworks, machinery, and artillery are all risky to be around. The best thing you can do is cover up with earmuffs whenever you’re around these things – especially if it’s on a regular basis. For extra safety, use earplugs as well.</p> <p><em>Image credits: Shutterstock </em></p>

Body

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Drinking lots of water may seem like a healthy habit – here’s when and why it can prove toxic

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/adam-taylor-283950">Adam Taylor</a>, <a href="https://theconversation.com/institutions/lancaster-university-1176">Lancaster University</a></em></p> <p>In late 2023, actor <a href="https://www.glamour.com/story/brooke-shields-recently-experienced-a-full-blown-seizure-and-bradley-cooper-came-running?utm_source=instagram&amp;utm_medium=social&amp;utm_content=instagram-bio-link&amp;client_service_id=31196&amp;client_service_name=glamour&amp;service_user_id=1.78e+16&amp;supported_service_name=instagram_publishing&amp;utm_brand=glm&amp;utm_social_type=owned">Brooke Shields</a> suffered a seizure after “flooding” her body with water. Shields became dangerously low on sodium while preparing for her show by drinking loads of water. “I flooded my system and I drowned myself,” she would later explain. “And if you don’t have enough sodium in your blood or urine or your body, you can have a seizure.”</p> <p>Shields said she found herself walking around outside for “no reason at all”, wondering: “Why am I out here?”</p> <blockquote> <p>Then I walk into the restaurant and go to the sommelier who had just taken an hour to watch my run through. That’s when everything went black. Then my hands drop to my side and I go headfirst into the wall.</p> </blockquote> <p>Shields added that she was “frothing at the mouth, totally blue, trying to swallow my tongue”.</p> <p>Like Shields, many people may be unaware of the dangers of drinking excessive amounts of water – especially because hydration is so often associated with health benefits. Models and celebrities <a href="https://www.teenvogue.com/story/drinking-water-flawless-skin#:%7E:text=If%20you're%20reading%20a,long%20hours%20at%20a%20time.">often advocate</a> drinking lots of water to help maintain clear, smooth skin. Some <a href="https://www.independent.co.uk/life-style/75-hard-challenge-before-and-after-tiktok-b2382706.html">social media influencers</a> have promoted drinking a gallon of water daily for weight loss.</p> <p>But excessive water consumption can cause <a href="https://patient.info/treatment-medication/hyponatraemia-leaflet">hyponatraemia</a> – a potentially fatal condition of low sodium in the blood.</p> <h2>Worried about hydration levels? Check your urine</h2> <p>The body strictly regulates its water content to maintain the optimum level of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2323003/">total body water</a> and “osmolality” – the concentration of dissolved particles in your blood. Osmolality increases when you are dehydrated and decreases when you have too much fluid in your blood.</p> <p>Osmolality is monitored by <a href="https://pubmed.ncbi.nlm.nih.gov/9074779/">osmoreceptors</a> that regulate sodium and water balance in the hypothalamus – the part of the brain that controls numerous hormones. These osmoreceptors signal the release of antidiuretic hormone (ADH), which acts on blood vessels and the kidneys to control the amount of water and salt in the body.</p> <figure><iframe src="https://www.youtube.com/embed/Qghf7Y9ILAs?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p>In healthy people, the body releases ADH when osmolality becomes high. ADH tells the kidneys to reabsorb water, which makes urine more concentrated. The reabsorbed water dilutes the blood, bringing osmolality back to normal levels.</p> <p>Low blood osmolality suppresses the release of ADH, reducing how much water the kidneys reabsorb. This dilutes your urine, which the body then passes to rid itself of the excess water.</p> <p>Healthy urine should be clear and odourless. Darker, yellower urine with a noticeable odour can indicate dehydration – although medications and certain foods, including <a href="https://pubmed.ncbi.nlm.nih.gov/3433805/">asparagus</a>, can affect urine colour and odour, too.</p> <h2>How much is too much?</h2> <p>Adults should consume <a href="https://www.nhs.uk/live-well/eat-well/food-guidelines-and-food-labels/water-drinks-nutrition/">two-to-three litres per day</a>, of which around 20% comes from food. However, we can lose <a href="https://www.ncbi.nlm.nih.gov/books/NBK236237/">up to ten litres</a> of water through perspiration – so sweating during exercise or in hot weather increases the amount of water we need to replace through drinking.</p> <p>Some medical conditions can cause overhydration. Approximately <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616165/">one in five</a> schizophrenia patients drink water compulsively, a dangerous condition known as <a href="https://www.theguardian.com/uk-news/2024/apr/15/woman-died-mental-hospital-excessive-water-drinking-inquest#:%7E:text=Woman%20died%20at%20mental%20hospital%20after%20excessive%20water%20drinking%2C%20inquest%20told,-Parents%20of%20Lillian&amp;text=A%20woman%20collapsed%20and%20died,water%2C%20an%20inquest%20has%20heard.">psychogenic polydipsia</a>. One long-term study found that patients with psychogenic polydipsia have a <a href="https://pubmed.ncbi.nlm.nih.gov/18984069/">“74% greater chance</a> of dying before a non-polydipsic patient”.</p> <p>In <a href="https://pubmed.ncbi.nlm.nih.gov/22306188/">some cases</a>, people with <a href="https://psychiatry-psychopharmacology.com/en/childhood-and-adolescence-disorders-psychogenic-polydipsia-in-an-adolescent-with-eating-disorder-a-case-report-132438">anorexia nervosa</a> can also suffer from compulsive water drinking.</p> <figure><iframe src="https://www.youtube.com/embed/ReQew2zcN7c?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p>For those suffering from polydipsia, treatment is focused on medication to reduce the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10675986/">urge to drink</a>, as well as <a href="https://www.uptodate.com/contents/overview-of-the-treatment-of-hyponatremia-in-adults/print">increasing sodium levels</a>. This should be done gradually to avoid causing <a href="https://www.ncbi.nlm.nih.gov/books/NBK562251/">myelinolysis</a> – <a href="https://www.ncbi.nlm.nih.gov/books/NBK551697/">neurological damage</a> caused by rapid changes in sodium levels in nerve cells.</p> <p>In rare but often highly publicised cases such as that of <a href="http://news.bbc.co.uk/onthisday/hi/dates/stories/november/13/newsid_2516000/2516593.stm">Leah Betts</a> in 1995, some users of the illegal drug MDMA (also known as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6119400/">ecstasy)</a> have <a href="https://pubmed.ncbi.nlm.nih.gov/11265566/">died</a> after drinking copious amounts of water to rehydrate after dancing and sweating.</p> <p>The drug <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008716/">increases body temperature</a>, so users drink water to avoid overheating. Unfortunately, MDMA also triggers the <a href="https://pubmed.ncbi.nlm.nih.gov/12105115/">unnecessary release of ADH</a>, causing water retention. The body becomes unable to rid itself of excess water, which affects its electrolyte levels – causing cells to swell with water.</p> <p>Symptoms of water intoxication start with nausea, vomiting, blurred vision and dizziness. As the condition progresses, sufferers can often display symptoms of <a href="https://www.nhs.uk/mental-health/conditions/psychosis/symptoms/">psychosis</a>, such as inappropriate behaviour, confusion, delusions, disorientation and hallucinations.</p> <p>These symptoms are caused by <a href="https://www.ncbi.nlm.nih.gov/books/NBK470386/">hyponatraemia</a>, where sodium levels are diluted or depleted in blood and the subsequent imbalance of electrolytes affects the nervous system. Water begins to move into the brain causing <a href="https://www.sciencedirect.com/science/article/pii/S1572349604000149">a cerebral oedema</a> – brain swelling because of excessive fluid buildup, which is usually fatal if not treated.</p> <p>A healthy body will tell you when it needs water. If you’re thirsty and your urine is dark with a noticeable odour, then you need to drink more. If you aren’t thirsty and your urine is clear or the colour of light straw, then you’re already doing a good job of hydrating yourself.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/228715/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/adam-taylor-283950"><em>Adam Taylor</em></a><em>, Professor and Director of the Clinical Anatomy Learning Centre, <a href="https://theconversation.com/institutions/lancaster-university-1176">Lancaster University</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/drinking-lots-of-water-may-seem-like-a-healthy-habit-heres-when-and-why-it-can-prove-toxic-228715">original article</a>.</em></p> </div>

Body

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"Looks nothing like her": Kate Middleton portrait ridiculed

<p>A painted portrait of Kate Middleton has gone viral for all the wrong reasons, after royal fans everywhere claimed the artwork "looks nothing like" the Princess of Wales. </p> <p>The image, created by artist Hannah Uzor, appeared on the front cover of UK magazine <em>Tatler</em>, as the artist recreated Middleton's appearance at a banquet held in South Africa in 2022. </p> <p>The Princess wore a white beaded Jenny Packham gown, and also donned her famous tiara, the Lover’s Knot, which was previously worn by Princess Diana.</p> <p>Uzor explained that in creating the artwork, she was inspired by the composure and bravery demonstrated by the royal mum-of-three in her emotional cancer diagnosis video in March.</p> <p>“A moment of dealing with something difficult, speaking from the heart, having the courage to tackle it head-on,” she explained in awe.</p> <p>However, many royal fans slated the artist on social media, simply asking, “are you kidding me?”.</p> <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-permalink="https://www.instagram.com/p/C7Qy93EtBeT/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/C7Qy93EtBeT/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Tatler (@tatlermagazine)</a></p> </div> </blockquote> <p>“This is just plain weird, looks nothing like her,” one person commented.</p> <p>“What have they done to her face,” asked another.</p> <p>A third agreed: “Doesn’t look like Catherine at all. If she wasn’t wearing that dress I’d have no clue as to who it’s meant to be.”</p> <p>“Are you kidding me? … You must be joking,” scorned someone else.</p> <p>Others slated the artwork by saying they believed it looked “like it was created by a child”.</p> <p>“It’s absolutely dreadful and should never have seen the light of day, let alone appear on the cover,” agreed another.</p> <p>Hannah Uzor defended her artwork, saying she had to draw on other sources as she was not able to meet the Princess directly to create her portrait. </p> <p>She said, “When you can’t meet the sitter in person, you have to look at everything you can find and piece together the subtle human moments revealed in different photographs: do they have a particular way of standing or holding their head or hands? Do they have a recurrent gesture?"</p> <p>“[Kate] has really risen up to her role – she was born for this. She carries herself with such dignity, elegance and grace."</p> <p><em>Image credits: Tatler Magazine / Chris Jackson/WPA Pool/Shutterstock Editorial </em></p>

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If I’m diagnosed with one cancer, am I likely to get another?

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/sarah-diepstraten-1495268">Sarah Diepstraten</a>, <a href="https://theconversation.com/institutions/walter-and-eliza-hall-institute-822">Walter and Eliza Hall Institute</a> and <a href="https://theconversation.com/profiles/terry-boyle-1521638">Terry Boyle</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a></em></p> <p>Receiving a cancer diagnosis is life-changing and can cause a range of concerns about ongoing health.</p> <p>Fear of cancer returning is one of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9321869/">top health concerns</a>. And <a href="https://www.cancercouncil.com.au/cancer-information/living-well/after-cancer-treatment/fear-of-the-cancer-returning/managing-fear-of-recurrence/">managing this fear</a> is an important part of cancer treatment.</p> <p>But how likely is it to get cancer for a second time?</p> <h2>Why can cancer return?</h2> <p>While initial cancer treatment may seem successful, sometimes a few cancer cells remain dormant. Over time, these cancer cells can grow again and may start to cause symptoms.</p> <p>This is known as cancer recurrence: when a cancer returns after a period of remission. This period could be days, months or even years. The new cancer is the same type as the original cancer, but can sometimes grow in a new location through a process called <a href="https://theconversation.com/how-does-cancer-spread-to-other-parts-of-the-body-219616">metastasis</a>.</p> <p>Actor Hugh Jackman has gone public about his <a href="https://www.skincancer.org/blog/is-basal-cell-carcinoma-serious/">multiple diagnoses</a> of basal cell carcinoma (a type of skin cancer) over the <a href="https://www.bbc.com/news/world-australia-65158945">past decade</a>.</p> <p>The exact reason why cancer returns differs depending on the cancer type and the treatment received. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8486871/">Research</a> is <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.3408">ongoing</a> to identify genes associated with cancers returning. This may eventually allow doctors to tailor treatments for high-risk people.</p> <h2>What are the chances of cancer returning?</h2> <p>The risk of cancer returning differs between cancers, and between <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019423/">sub-types</a> of the same cancer.</p> <p>New screening and treatment options have seen reductions in recurrence rates for many types of cancer. For example, between 2004 and 2019, the risk of colon cancer recurring dropped by <a href="https://jamanetwork.com/journals/jamaoncology/fullarticle/2812113">31-68%</a>. It is important to remember that only someone’s treatment team can assess an individual’s personal risk of cancer returning.</p> <p>For most types of cancer, the highest risk of cancer returning is within the <a href="https://pubmed.ncbi.nlm.nih.gov/31231898/">first three years</a> after entering remission. This is because any leftover cancer cells not killed by treatment are likely to start growing again sooner rather than later. Three years after entering remission, recurrence rates for most cancers decrease, meaning that every day that passes lowers the risk of the cancer returning.</p> <p>Every day that passes also increases the numbers of new discoveries, and cancer drugs being developed.</p> <h2>What about second, unrelated cancers?</h2> <p>Earlier this year, we learned Sarah Ferguson, Duchess of York, had been diagnosed with malignant melanoma (a type of skin cancer) <a href="https://www.bbc.com/news/uk-68047608">shortly after</a> being treated for breast cancer.</p> <p>Although details have not been confirmed, this is likely a new cancer that isn’t a recurrence or metastasis of the first one.</p> <p>Australian research from <a href="https://bmccancer.biomedcentral.com/articles/10.1186/1471-2407-11-83">Queensland</a> and <a href="https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.31247">Tasmania</a> shows adults who have had cancer have around a 6-36% higher risk of developing a second primary cancer compared to the risk of cancer in the general population.</p> <h2>Who’s at risk of another, unrelated cancer?</h2> <p>With improvements in cancer diagnosis and treatment, people diagnosed with cancer are living longer than ever. This means they need to consider their long-term health, including their risk of developing another unrelated cancer.</p> <p>Reasons for such cancers <a href="https://www.cancer.net/survivorship/what-second-cancer">include</a> different types of cancers sharing the same kind of lifestyle, environmental and genetic risk factors.</p> <p>The increased risk is also likely partly due to the effects that some cancer treatments and imaging procedures have on the body. However, this increased risk is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6435077/">relatively small</a> when compared with the (sometimes lifesaving) benefits of these treatment and procedures.</p> <p>While a 6-36% greater chance of getting a second, unrelated cancer may seem large, only around 10-12% of participants developed a second cancer in the Australian studies we mentioned. Both had a median follow-up time of around five years.</p> <p>Similarly, in a <a href="https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.30164">large US study</a> only about one in 12 adult cancer patients developed a second type of cancer in the follow-up period (an average of seven years).</p> <p>The kind of first cancer you had also affects your risk of a second, unrelated cancer, as well as the type of second cancer you are at risk of. For example, in the two Australian studies we mentioned, the risk of a second cancer was greater for people with an initial diagnosis of head and neck cancer, or a haematological (blood) cancer.</p> <p>People diagnosed with cancer as a <a href="https://www.mja.com.au/journal/2020/212/3/second-primary-cancers-people-who-had-cancer-children-australian-childhood">child</a>, <a href="https://www.liebertpub.com/doi/10.1089/jayao.2022.0074">adolescent or young adult</a> also have a greater risk of a second, unrelated cancer.</p> <h2>What can I do to lower my risk?</h2> <p>Regular follow-up examinations can give peace of mind, and ensure any subsequent cancer is caught early, when there’s the best chance of successful treatment.</p> <p><a href="https://www.lymphoma.org.au/lymphoma/treatments/maintenance-therapy/">Maintenance therapy</a> may be used to reduce the risk of some types of cancer returning. However, despite ongoing <a href="https://febs.onlinelibrary.wiley.com/doi/10.1111/febs.15626">research</a>, there are no <em>specific</em> treatments against cancer recurrence or developing a second, unrelated cancer.</p> <p>But there are things you can do to help lower your general risk of cancer – not smoking, being physically active, eating well, maintaining a healthy body weight, limiting alcohol intake and being sun safe. These all reduce the chance of <a href="https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21719">cancer returning</a> and <a href="https://www.cancer.net/survivorship/what-second-cancer">getting a second cancer</a>.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/226386/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/sarah-diepstraten-1495268">Sarah Diepstraten</a>, Senior Research Officer, Blood Cells and Blood Cancer Division, <a href="https://theconversation.com/institutions/walter-and-eliza-hall-institute-822">Walter and Eliza Hall Institute</a> and <a href="https://theconversation.com/profiles/terry-boyle-1521638">Terry Boyle</a>, Senior Lecturer in Cancer Epidemiology, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/if-im-diagnosed-with-one-cancer-am-i-likely-to-get-another-226386">original article</a>.</em></p> </div>

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

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a></em></p> <p>Drugs like Ozempic are very <a href="https://dom-pubs.pericles-prod.literatumonline.com/doi/10.1111/dom.12932">effective</a> at helping most people who take them lose weight. Semaglutide (sold as Wegovy and Ozempic) and tirzepatide (sold as Zepbound and Mounjaro) are the most well known in the class of drugs that mimic hormones to reduce feelings of hunger.</p> <p>But does weight come back when you stop using it?</p> <p>The short answer is yes. Stopping <a href="https://jamanetwork.com/journals/jama/fullarticle/2812936">tirzepatide</a> and <a href="https://doi.org/10.1111/dom.14725">semaglutide</a> will result in weight regain in most people.</p> <p>So are these medications simply another (expensive) form of yo-yo dieting? Let’s look at what the evidence shows so far.</p> <h2>It’s a long-term treatment, not a short course</h2> <p>If you have a bacterial infection, antibiotics will help your body fight off the germs causing your illness. You take the full course of medication, and the infection is gone.</p> <p>For obesity, taking tirzepatide or semaglutide can help your body get rid of fat. However it doesn’t fix the reasons you gained weight in the first place because obesity is a chronic, complex condition. When you stop the medications, the weight returns.</p> <p>Perhaps a more useful comparison is with high blood pressure, also known as hypertension. Treatment for hypertension is lifelong. It’s the same with obesity. Medications work, but only while you are taking them. (Though obesity is more complicated than hypertension, as many different factors both cause and perpetuate it.)</p> <p>Therefore, several concurrent approaches are needed; taking medication can be an important part of effective management but on its own, it’s often insufficient. And in an unwanted knock-on effect, stopping medication can undermine other strategies to lose weight, like eating less.</p> <h2>Why do people stop?</h2> <p>Research trials show anywhere from <a href="https://asean-endocrinejournal.org/index.php/JAFES/article/view/1771">6%</a> to <a href="https://pubmed.ncbi.nlm.nih.gov/35015037/">13.5%</a> of participants stop taking these drugs, primarily because of <a href="https://www.health.harvard.edu/staying-healthy/glp-1-diabetes-and-weight-loss-drug-side-effects-ozempic-face-and-more">side effects</a>.</p> <p>But these studies don’t account for those forced to stop because of cost or <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023">widespread supply issues</a>. We don’t know how many people have needed to stop this medication over the past few years for these reasons.</p> <p>Understanding what stopping does to the body is therefore important.</p> <h2>So what happens when you stop?</h2> <p>When you stop using tirzepatide or semaglutide, it takes several days (or even a couple of weeks) to <a href="https://pubmed.ncbi.nlm.nih.gov/30565096/">move out of your system</a>. As it does, a number of things happen:</p> <ul> <li>you start feeling hungry again, because both <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4119845/">your brain and your gut</a> no longer have the medication working to make you feel full</li> </ul> <ul> <li> <p>blood sugars increase, because the medication is no longer acting on the pancreas to help control this. If you have diabetes as well as obesity you may need to take other medications to keep these in an acceptable range. Whether you have diabetes or not, you may need to eat foods with a <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/carbohydrates-and-the-glycaemic-index">low glycemic index</a> to stabilise your blood sugars</p> </li> <li> <p>over the longer term, most people experience a return to their <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10092593/">previous blood pressure and cholesterol levels</a>, as the weight comes back</p> </li> <li> <p>weight regain will mostly be in the form of fat, because it will be gained faster than skeletal muscle.</p> </li> </ul> <p>While you were on the medication, you will have lost <a href="https://academic.oup.com/jes/article/5/Supplement_1/A16/6240360">proportionally less skeletal muscle than fat</a>, muscle loss is inevitable when you lose weight, no matter whether you use medications or not. The problem is, when you stop the medication, your body preferentially puts on fat.</p> <h2>Is stopping and starting the medications a problem?</h2> <p>People whose weight fluctuates with tirzepatide or semaglutide may experience some of the downsides of <a href="https://pubmed.ncbi.nlm.nih.gov/21829159/">yo-yo dieting</a>.</p> <p>When you keep going on and off diets, it’s like a rollercoaster ride for your body. Each time you regain weight, your body has to <a href="https://www.jomes.org/journal/view.html?doi=10.7570/jomes.2017.26.4.237">deal with</a> spikes in blood pressure, heart rate, and how your body handles sugars and fats. This can <a href="https://cardiab.biomedcentral.com/articles/10.1186/s12933-022-01735-x">stress</a> your heart and overall cardiovascular system, as it has to respond to greater fluctuations than usual.</p> <p>Interestingly, the risk to the body from weight fluctuations is greater for people who are <a href="https://jech.bmj.com/content/74/8/662">not obese</a>. This should be a caution to those who are not obese but still using tirzepatide or semaglutide to try to lose unwanted weight.</p> <h2>How can you avoid gaining weight when you stop?</h2> <p>Fear of regaining weight when stopping these medications is valid, and needs to be addressed directly. As obesity has many causes and perpetuating factors, many evidence-based approaches are needed to reduce weight regain. This might include:</p> <ul> <li> <p>getting quality <a href="https://www.hindawi.com/journals/ije/2010/270832/">sleep</a></p> </li> <li> <p>exercising in a way that builds and maintains muscle. While on the medication, you will <a href="https://pubmed.ncbi.nlm.nih.gov/32628589/">likely have lost muscle</a> as well as fat, although this is not inevitable, especially if you <a href="https://www.europeanreview.org/article/34169">exercise regularly</a> while taking it</p> </li> </ul> <ul> <li> <p>addressing emotional and cultural aspects of life that contribute to over-eating and/or eating unhealthy foods, and how you view your body. Stigma and shame around body shape and size is not cured by taking this medication. Even if you have a healthy relationship with food, we live in a culture that is <a href="https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2009.159491">fat-phobic and discriminates</a> against people in larger bodies</p> </li> <li> <p>eating in a healthy way, hopefully continuing with habits that were formed while on the medication. Eating meals that have high nutrition and fibre, for example, and lower overall portion sizes.</p> </li> </ul> <p>Many people will stop taking tirzepatide or semaglutide at some point, given it is expensive and in short supply. When you do, it is important to understand what will happen and what you can do to help avoid the consequences. Regular reviews with your GP are also important.</p> <hr /> <p><em>Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-series-154673">Ozempic series</a> here.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/224972/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></em></p> <p><em><a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, General Practitioner, PhD Candidate, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-happens-when-i-stop-taking-a-drug-like-ozempic-or-mounjaro-224972">original article</a>.</em></p> </div>

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

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

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No, taking drugs like Ozempic isn’t ‘cheating’ at weight loss or the ‘easy way out’

<p><em><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></em></p> <p>Obesity medication that is effective has been a long time coming. Enter semaglutide (sold as Ozempic and Wegovy), which is helping people improve weight-related health, including <a href="https://pubmed.ncbi.nlm.nih.gov/37952131/">lowering the risk</a> of a having a heart attack or stroke, while also silencing “<a href="https://theconversation.com/some-ozempic-users-say-it-silences-food-noise-but-there-are-drug-free-ways-to-stop-thinking-about-food-so-much-208467">food noise</a>”.</p> <p>As demand for semaglutide increases, so are <a href="https://www.smh.com.au/lifestyle/health-and-wellness/in-a-fat-phobic-world-ozempic-is-hardly-the-easy-way-out-20240401-p5fgjd.html">claims</a> that taking it is “cheating” at weight loss or the “easy way out”.</p> <p>We don’t tell people who need statin medication to treat high cholesterol or drugs to manage high blood pressure they’re cheating or taking the easy way out.</p> <p>Nor should we shame people taking semaglutide. It’s a drug used to treat diabetes and obesity which needs to be taken long term and comes with risks and side effects, as well as benefits. When prescribed for obesity, it’s given alongside advice about diet and exercise.</p> <h2>How does it work?</h2> <p>Semaglutide is a <a href="https://en.wikipedia.org/wiki/GLP-1_receptor_agonist">glucagon-like peptide-1</a> receptor agonist (GLP-1RA). This means it makes your body’s own glucagon-like peptide-1 hormone, called <a href="https://en.wikipedia.org/wiki/Glucagon-like_peptide-1">GLP-1</a> for short, work better.</p> <p>GLP-1 gets secreted by cells in your gut when it <a href="https://pubmed.ncbi.nlm.nih.gov/38218319/">detects increased nutrient levels</a> after eating. This stimulates insulin production, which lowers blood sugars.</p> <p>GLP-1 also slows gastric emptying, which makes you feel full, and reduces hunger and feelings of reward after eating.</p> <p><iframe id="tc-infographic-1031" class="tc-infographic" style="border: none;" src="https://cdn.theconversation.com/infographics/1031/c11b606581d4bc58a71f066492d7f740b52c04e1/site/index.html" width="100%" height="400px" frameborder="0"></iframe></p> <p>GLP-1 receptor agonist (GLP-1RA) medications like Ozempic help the body’s own GLP-1 work better by mimicking and extending its action.</p> <p>Some studies have found less GLP-1 gets released after meals in <a href="https://pubmed.ncbi.nlm.nih.gov/38218319/">adults with obesity or type 2 diabetes mellitus</a> compared to adults with normal glucose tolerance. So having less GLP-1 circulating in your blood means you don’t feel as full after eating and get hungry again sooner compared to people who produce more.</p> <p>GLP-1 has a very short half-life of about <a href="https://pubmed.ncbi.nlm.nih.gov/28443255/">two minutes</a>. So GLP-1RA medications were designed to have a very long half-life of about <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">seven days</a>. That’s why semaglutide is given as a weekly injection.</p> <h2>What can users expect? What does the research say?</h2> <p>Higher doses of semaglutide are prescribed to treat obesity compared to type 2 diabetes management (up to 2.4mg versus 2.0mg weekly).</p> <p>A large group of <a href="https://pubmed.ncbi.nlm.nih.gov/36691309/">randomised controlled trials</a>, called STEP trials, all tested weekly 2.4mg semaglutide injections versus different interventions or placebo drugs.</p> <p>Trials lasting 1.3–2 years consistently found weekly 2.4 mg semaglutide injections <a href="https://pubmed.ncbi.nlm.nih.gov/36691309/">led to 6–12% greater weight loss</a> compared to placebo or alternative interventions. The average weight change depended on how long medication treatment lasted and length of follow-up.</p> <p>Weight reduction due to semaglutide also leads to a <a href="https://pubmed.ncbi.nlm.nih.gov/36769420/">reduction in systolic and diastolic blood pressure</a> of about 4.8 mmHg and 2.5 mmHg respectively, a reduction in <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/triglycerides">triglyceride levels</a> (a type of blood fat) and <a href="https://pubmed.ncbi.nlm.nih.gov/38041774/">improved physical function</a>.</p> <p>Another recent trial in adults with pre-existing heart disease and obesity, but without type 2 diabetes, found adults receiving weekly 2.4mg semaglutide injections had a <a href="https://pubmed.ncbi.nlm.nih.gov/37952131/">20% lower risk</a> of specific cardiovascular events, including having a non-fatal heart attack, a stroke or dying from cardiovascular disease, after three years follow-up.</p> <h2>Who is eligible for semaglutide?</h2> <p>Australia’s regulator, the Therapeutic Goods Administration (TGA), has <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023">approved</a> semaglutide, sold as Ozempic, for treating type 2 diabetes.</p> <p>However, due to shortages, the TGA had advised doctors not to start new Ozempic prescriptions for “off-label use” such as obesity treatment and the Pharmaceutical Benefits Scheme doesn’t currently subsidise off-label use.</p> <p>The TGA has <a href="https://www.tga.gov.au/resources/prescription-medicines-registrations/wegovy-novo-nordisk-pharmaceuticals-pty-ltd">approved Wegovy to treat obesity</a> but it’s not currently available in Australia.</p> <p>When it’s available, doctors will be able to prescribe <a href="https://pubmed.ncbi.nlm.nih.gov/36934408/">semaglutide to treat obesity</a> in conjunction with lifestyle interventions (including diet, physical activity and psychological support) in adults with obesity (a BMI of 30 or above) or those with a BMI of 27 or above who also have weight-related medical complications.</p> <h2>What else do you need to do during Ozempic treatment?</h2> <p>Checking details of the <a href="https://pubmed.ncbi.nlm.nih.gov/36691309/">STEP trial intervention components</a>, it’s clear participants invested a lot of time and effort. In addition to taking medication, people had brief lifestyle counselling sessions with dietitians or other health professionals every four weeks as a minimum in most trials.</p> <p>Support sessions were designed to help people stick with consuming 2,000 kilojoules (500 calories) less daily compared to their energy needs, and performing 150 minutes of <a href="https://www.healthdirect.gov.au/tips-for-getting-active">moderate-to-vigorous physical activity</a>, like brisk walking, dancing and gardening each week.</p> <p>STEP trials varied in other components, with follow-up time periods varying from 68 to 104 weeks. The aim of these trials was to show the effect of adding the medication on top of other lifestyle counselling.</p> <p>A <a href="https://pubmed.ncbi.nlm.nih.gov/38041774/">review of obesity medication trials</a> found people reported they needed less <a href="https://pubmed.ncbi.nlm.nih.gov/28652832/">cognitive behaviour training</a> to help them stick with the reduced energy intake. This is one aspect where drug treatment may make adherence a little easier. Not feeling as hungry and having environmental food cues “switched off” may mean less support is required for goal-setting, self-monitoring food intake and <a href="https://theconversation.com/9-ways-wont-power-is-better-than-willpower-for-resisting-temptation-and-helping-you-eat-better-71267">avoiding things that trigger eating</a>.</p> <h2>But what are the side effects?</h2> <p>Semaglutide’s side-effects <a href="https://pubmed.ncbi.nlm.nih.gov/38041774/">include</a> nausea, diarrhoea, vomiting, constipation, indigestion and abdominal pain.</p> <p>In one study these <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">led to</a> discontinuation of medication in 6% of people, but interestingly also in 3% of people taking placebos.</p> <p>More severe side-effects included gallbladder disease, acute pancreatitis, hypoglycaemia, acute kidney disease and injection site reactions.</p> <p>To reduce risk or severity of side-effects, <a href="https://pubmed.ncbi.nlm.nih.gov/36934408/">medication doses are increased very slowly</a> over months. Once the full dose and response are achieved, research indicates you need to take it long term.</p> <p>Given this long-term commitment, and associated <a href="https://www.health.gov.au/topics/private-health-insurance/what-private-health-insurance-covers/out-of-pocket-costs#:%7E:text=An%20out%20of%20pocket%20cost,called%20gap%20or%20patient%20payments">high out-of-pocket cost of medication</a>, when it comes to taking semaglutide to treat obesity, there is no way it can be considered “cheating”.</p> <hr /> <p><em>Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-series-154673">Ozempic series</a> here.</em><!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/219116/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/clare-collins-7316"><em>Clare Collins</em></a><em>, Laureate Professor in Nutrition and Dietetics, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a></em></p> <p><em>Image credits: </em><em>Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/no-taking-drugs-like-ozempic-isnt-cheating-at-weight-loss-or-the-easy-way-out-219116">original article</a>.</em></p>

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

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

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