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John Boland’s battle against prostate cancer and the urgent need for reform

John Boland, a 74-year-old retired Navy Reserve Lieutenant Commander, found himself at a crossroads – a place where hope and despair often meet in the lives of those battling life-threatening illnesses like prostate cancer. Diagnosed five years ago, John’s journey has been a relentless fight against a disease that, despite medical advancements, still claims the lives of 10 men in Australia every day. After undergoing surgery and 37 rounds of radiation therapy, John’s battle was far from over. His PSA (Prostate-Specific Antigen) levels, an indicator of prostate cancer activity, were not dropping sufficiently, signalling that the fight was only getting tougher. It was then that John was introduced to a groundbreaking treatment: Lutetium-177 PSMA therapy (LuPSMA), a targeted radionuclide therapy with pinpoint accuracy to attack cancer cells. This innovative treatment offered a glimmer of hope, a chance to strike at the heart of the disease that had disrupted his life. But there was a catch – the cost. Each round of LuPSMA treatment costs $10,000, and while some patients may require up to eight rounds, John’s doctors recommended two based on his response. Even so, the financial burden was immense, forcing John to dip into his superannuation, ultimately spending $60,000 on the treatment that was not covered by insurance. Despite the financial strain, the results were nothing short of miraculous. After just the first round, John’s PSA levels dropped by a staggering 95%. After the second, they fell to nearly zero. The treatment had not only attacked the cancer but had also restored his quality of life, allowing him to once again enjoy the simple pleasures – time with family, daily activities and even golf. It was a victory that brought renewed hope and confidence for the future, a victory that made the $60,000 investment worth every cent. “My case was remarkably successful after the second treatment, which are eight weeks apart, after the scan had no cancer, and my PSA was effective to zero. So it was a reliable result for me and a huge boost, but unfortunately, they're $10,000 a time, and you can require up to eight treatments,” says John. “Fortunately we were able to fund it from our superannuation pension account, the $20,000, but I imagine that a lot of people, they can’t find that $20,000.” But John’s story, while inspiring, also highlights a grim reality: many Australians are not as fortunate. The LuPSMA treatment that worked so well for John remains out of reach for many others due to its prohibitive cost. And this isn’t just an isolated issue; it’s a systemic problem affecting thousands of men across the country. A new report, the <a href="https://www.pcfa.org.au/media/nbennwom/aus-np-1123-80001-amgen-access-gap-report_april-2024-data-final-approved.pdf" target="_blank" rel="noopener">Australian Patient Access Gap Report</a>, has shed light on the alarming delay in the public availability of new medicines in Australia. The report reveals that Australians with life-threatening illnesses are waiting an average of 591 days – more than 18 months – for access to new, potentially life-saving medicines. For some, the wait can be as long as three years. These delays are not just statistics; they represent real people, real lives hanging in the balance. The Prostate Cancer Foundation of Australia (PCFA), the country’s leading organisation in the fight against prostate cancer, is calling for urgent reform. They argue that the current system, which often requires multiple rounds of review before new treatments are approved for public use, is failing Australians. PCFA CEO Anne Savage points out that while 10 men die from prostate cancer every day, the approval process for new treatments drags on, leaving patients like John Boland to fend for themselves – often at great financial and emotional cost. “In almost every instance, Australians are being denied access to new medicines that can extend and save their lives, simply because our approval systems have not kept up with the pace of change,” she says. “In relation to prostate cancer, applications typically undergo two or three rounds of review before achieving a positive recommendation, while 10 men die a day from the disease. It’s simply not good enough.” John’s story serves as a strong call to action. His successful treatment with LuPSMA is a testament to the power of modern medicine, but it also underscores the urgent need for change. No one should have to choose between their life savings and their life; it’s time for Australia to modernise its pharmaceutical benefits scheme, ensuring that all Australians, regardless of their financial situation, have access to the treatments they need. As we move forward, the PCFA is urging Australians to take part in initiatives like <a href="https://www.thelongrun.org.au/" target="_blank" rel="noopener">The Long Run</a> during Prostate Cancer Awareness Month in September, raising awareness and funds to support the fight against this devastating disease. For John Boland, and for the thousands of others who share his struggle, we must work towards a future where no one is left behind in the fight against cancer. Image: Courtesy of John Boland.

Caring

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

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

Body

Does free-to-air TV really need gambling ads to survive?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/andrew-hughes-2728">Andrew Hughes</a>, <a href="https://theconversation.com/institutions/australian-national-university-877">Australian National University</a> If anything is a sure bet right now, it’s corporate Australia’s willingness to use some variation of the “for society’s good” argument. The most recent example of this is the claim being made, including by federal minister <a href="https://www.theguardian.com/australia-news/article/2024/aug/13/gambling-ad-ban-labor-bill-shorten-tv-media-advertising-revenue">Bill Shorten</a>, that an outright ban on gambling advertising would be disastrous for free-to-air TV. To be clear, Labor still supports new restrictions on gambling advertisements, including hourly caps and bans during kids’ TV and during and around sports broadcasts. But it has rejected the idea of a total ban, prompting a <a href="https://www.smh.com.au/politics/federal/labor-mps-say-total-ban-is-the-only-way-on-gambling-ads-20240812-p5k1q0.html">backlash</a> extending as far as some of its own backbench MPs. Speaking on ABC’s Q&A on Monday night, Shorten said Australia’s free-to-air TV broadcasters were in “diabolical trouble”, with many needing gambling ad revenue “in order just to stay afloat”. “I’m not convinced that complete prohibition works,” he said. So would our commercial TV networks really fall over tomorrow without gambling ad revenue? Or is something else at play? <h2>Who is buying ads in Australia?</h2> Let’s start by building a bigger picture of where advertising spend more broadly comes from in Australia. Global analytics firm Nielsen regularly compiles <a href="https://www.nielsen.com/news-center/2024/top-20-categories-by-ad-spend-for-2023-revealed-in-latest-nielsen-ad-intel-report/#:%7E:text=Retail%20topped%20the%20list%20with,significant%20investment%20of%20%24596m.">top 20</a> lists of both the categories and individual companies spending the most on ads here. In 2023 the top category, retail, accounted for A$2.56 billion in advertising spend. Gambling and gaming, in contrast, represented just $239 million, less than a tenth of this figure. Harvey Norman topped the list of <a href="https://www.nielsen.com/news-center/2024/australias-top-20-highest-spending-advertisers-of-2023-revealed-in-latest-nielsen-ad-intel-report/">individual companies</a> in 2023. The first we see of any gambling brand is Sportsbet, which came in at 16th. For gambling companies, it’s fair to assume the lion’s share of this goes to TV. <a href="https://www.acma.gov.au/publications/2023-10/report/gambling-advertising-australia-placement-and-spending">Research</a> by the Australian Communications and Media Authority (ACMA) found 68% of gambling companies’ ad spend went to free-to-air TV markets. As for the remainder, 9% went to radio, 15% to social media and 8% to other online platforms. <h2>How much is actually getting spent?</h2> But how do we estimate the gambling industry’s total annual advertising spend? There are certainly a lot of numbers getting thrown around. One <a href="https://www.afr.com/companies/media-and-marketing/tv-networks-to-demand-fee-relief-as-40m-wagering-hole-opens-up-20240804-p5jzav">source</a> put it at $300.5 million for 2022. More recently, ACMA published detailed figures for the period between May 2022 and April 2023 which put it at just over <a href="https://www.acma.gov.au/publications/2023-10/report/gambling-advertising-australia-placement-and-spending">$238 million</a>, with $162 million of this going to free-to-air TV networks. But the way advertising is classified – what defines an advertisement – can sometimes differ between agencies. Then there is the <a href="https://www.acma.gov.au/check-if-gambling-operator-legal#register-licensed-gambling">number of brands operating</a>, which is constantly changing. In a market with so many competitors, any new entrant needs to spend big on advertising just to capture enough market share to be viable. This is why I argue that the actual figure for financial year 2023 may be slightly higher than ACMA’s widely quoted figure, accounting for the big ad spend of new entrants that may have fallen outside the time window assessed. Based on average company ad spend as a percentage of revenue and the size of the gambling industry, I estimate it could be higher, in the ballpark of $275 million. <h2>How much is that to the networks?</h2> This exercise is all about putting these figures in context. Channel Seven, for example, brought in <a href="https://www.sevenwestmedia.com.au/assets/Uploads/Final-2023-Annual-Report.pdf">$1.5 billion in revenue in 2023</a>. Even if it had received the gambling industry’s entire ad spend at my higher estimate of $275 million, this would still only account for less than 20% of its annual turnover. If that money all went to TV ads, Channel Seven’s stated 38.5% share of television advertising revenue would put its revenue from the estimated sports betting advertising at about $106 million in this example, around 7% of its total annual revenue. Losing most of that would hurt, but wouldn’t mortally threaten the business. A total ban would most likely be <a href="https://www.abc.net.au/news/2024-08-13/peta-murphy-left-online-gambling-legacy-why-isn-t-labor-adopting/104217328">phased in</a> over a number of years, not enacted overnight. Australia’s free-to-air networks would adapt, restrategise, and find and develop new markets to replace that revenue. Their management teams are far too smart to just shrug their shoulders and take a revenue hit on the corporate chin. <h2>Networks have had plenty of time to adapt</h2> Just a refresher. LinkedIn is now more than 20 years old. Facebook is 20. YouTube is 19. X (formerly known as Twitter) is 18. TikTok is seven. If free-to-air TV’s business model is so glacial it can’t function in the digital age, it probably doesn’t deserve to be operating in the big leagues. Digital is here and has been for a while now. The media industry has borne the brunt of this change, but has also had the most time to adapt to the disruptors, who are now more established oligopolies and duopolies than “cool start-ups” out of Silicon Valley. The argument that we need to protect sports gambling ads to protect the big media brands – has little to no basis. It’s a worn out argument we’ve seen time and time again – <a href="https://theconversation.com/how-the-push-to-end-tobacco-advertising-in-the-1970s-could-be-used-to-curb-gambling-ads-today-200915">big tobacco</a>, I’m looking at you. Protecting the interests of corporate Australia at the cost of society itself is a gamble none of us should be prepared to take.<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/236686/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/andrew-hughes-2728">Andrew Hughes</a>, Lecturer, Research School of Management, <a href="https://theconversation.com/institutions/australian-national-university-877">Australian National University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/does-free-to-air-tv-really-need-gambling-ads-to-survive-236686">original article</a>. </div>

Money & Banking

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

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/christopher-rudge-108366">Christopher Rudge</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> A growing number of complaints against older doctors has prompted the Medical Board of Australia to <a href="https://www.medicalboard.gov.au/News/2024-08-07-Medical-Board-consults-on-new-approach-to-keep-late-career-doctors-in-safe-practice.aspx">announce</a> today that it’s reviewing how doctors aged 70 or older are regulated. Two new options are on the table. The first would require doctors over 70 to undergo a detailed health assessment to determine their current and future “fitness to practise” in their particular area of medicine. The second would require only general health checks for doctors over 70. A third option acknowledges existing rules requiring doctors to maintain their health and competence. As part of their <a href="https://www.medicalboard.gov.au/Codes-Guidelines-Policies/Code-of-conduct.aspx">professional code of conduct</a>, doctors must seek independent medical and psychological care to prevent harming themselves and their patients. So, this third option would maintain the status quo. <h2>Haven’t we moved on from set retirement ages?</h2> It might be surprising that stricter oversight of older doctors’ performance is proposed now. Critics of mandatory retirement ages in other fields – for judges, for instance – have long questioned whether these rules are “<a href="https://law.unimelb.edu.au/__data/assets/pdf_file/0019/2061019/02-Blackham.pdf">still valid in a modern society</a>”. However, unlike judges, doctors are already <a href="https://www.medicalboard.gov.au/Registration/Registration-Renewal.aspx">required to renew their registration</a> annually to practise. This allows the Medical Board of Australia not only to access sound data about the prevalence and activity of older practitioners, but to assess their eligibility regularly and to conduct <a href="https://www.ahpra.gov.au/Notifications/Further-information/Guides-and-fact-sheets/Performance-assessments.aspx">performance assessments</a> if and when they are needed. <h2>What has prompted these proposals?</h2> This latest <a href="https://www.ahpra.gov.au/documents/default.aspx?record=WD24%2f33840&dbid=AP&chksum=vCEdxXaBs0%2bMeMZFxSb7SQ%3d%3d&_gl=1*3ol06k*_ga*MzU1NjAzMTc1LjE3MjMwMDA1Nzc.*_ga_F1G6LRCHZB*MTcyMzAwMDU3Ny4xLjEuMTcyMzAwMDU4My4wLjAuMA..">proposal</a> identifies several emerging concerns about older doctors. These are grounded in external research about the effect of age on doctors’ competence as well as the regulator’s internal data showing surges of complaints about older doctors in recent years. Studies of medical competence in ageing doctors show <a href="https://qualitysafety.bmj.com/content/29/2/113">variable results</a>. However, the Medical Board of Australia’s consultation document emphasises studies of neurocognitive loss. It explains how physical and cognitive impairment can lead to poor record-keeping, improper prescribing, as well as disruptive behaviour. The other issue is the number of patient complaints against older doctors. These “notifications” have surged in recent years, as have the number of disciplinary actions against older doctors. In 2022–2023, the Medical Board of Australia took disciplinary action against older doctors about 1.7 times more often than for doctors under 70. In 2023, notifications against doctors over 70 were 81% higher than for the under 70s. In that year, patients sent 485 notifications to the Medical Board of Australia about older doctors – up from 189 in 2015. While older doctors make up only about 5.3% of the doctor workforce in Australia (less than 1% over 80), this only makes the high numbers of complaints more starkly disproportionate. It’s for these reasons that the Medical Board of Australia has determined it should take further regulatory action to safeguard the health of patients. <h2>So what distinguishes the two new proposed options?</h2> The “fitness to practise” assessment option would entail a rigorous assessment of doctors over 70 based on their specialisation. It would be required every three years after the age of 70 and every year after 80. Surgeons, for example, would be assessed by an independent occupational physician for dexterity, sight and the ability to give clinical instructions. Importantly, the results of these assessments would usually be confidential between the assessor and the doctor. Only doctors who were found to pose a substantial risk to the public, which was not being managed, would be obliged to report their health condition to the Medical Board of Australia. The second option would be a more general health check not linked to the doctor’s specific role. It would occur at the same intervals as the “fitness to practise” assessment. However, its purpose would be merely to promote good health-care decision-making among health practitioners. There would be no general obligation on a doctor to report the results to the Medical Board of Australia. In practice, both of these proposals appear to allow doctors to manage their own general health confidentially. <h2>The law tends to prioritise patient safety</h2> All state versions of the legal regime regulating doctors, known as the National Accreditation and Registration Scheme, include a “paramountcy” provision. <a href="https://www8.austlii.edu.au/cgi-bin/viewdoc/au/legis/act/consol_act/hprnl428/s3a.html">That provision</a> basically says patient safety is paramount and trumps all other considerations. <figure class="align-center zoomable"><figcaption></figcaption></figure> As with legal <a href="https://legislation.nsw.gov.au/view/html/inforce/current/act-2010-104a#sec.3">regimes regulating childcare</a>, health practitioner regulation prioritises the health and safety of the person receiving the care over the rights of the licensed professional. Complicating this further, is the fact that a longstanding principle of health practitioner regulation has been that doctors should not be “<a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3383892">punished</a>” for errors in practice. All of this means that reforms of this nature can be difficult to introduce and that the balance between patient safety and professional entitlements must be handled with care. <h2>Could these proposals amount to age discrimination?</h2> It is premature to analyse the legal implications of these proposals. So it’s difficult to say how these proposals interact with Commonwealth age- and other anti-discrimination laws. For instance, one complication is that the federal age discrimination statute includes an exemption to allow “qualifying bodies” such as the Medical Board of Australia to discriminate against older professionals <a href="https://www8.austlii.edu.au/cgi-bin/viewdoc/au/legis/cth/consol_act/ada2004174/s22.html?context=1;query=inherent;mask_path=au/legis/cth/consol_act/ada2004174">who are</a> “unable to carry out the inherent requirements of the profession, trade or occupation because of his or her age”. In broader terms, a licence to practise medicine is often compared to a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6797044/">licence to drive</a> or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10236877/">pilot an aircraft</a>. Despite <a href="https://www.smh.com.au/national/nsw/mandatory-test-older-drivers-facing-discrimination-says-pensioner-group-20170607-gwm45u.html">claims of discrimination</a>, New South Wales law requires older drivers to undergo a medical assessment <a href="https://www.nsw.gov.au/driving-boating-and-transport/driver-and-rider-licences/older-drivers-and-riders/assessments">every year</a>; and similar requirements affect older <a href="https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.casa.gov.au/guidelines-medical-assessment-aviation&ved=2ahUKEwil-9GXlOKHAxUdslYBHdN_EboQFnoECBkQAQ&usg=AOvVaw0SgpoCCKjNriMN20fs16rq">pilots and air traffic controllers</a>. <h2>Where to from here?</h2> When changes are proposed to health practitioner regulation, there is typically much media attention followed by a consultation and behind-the-scenes negotiation process. This issue is no different. How will doctors respond to the proposed changes? It’s too soon to say. If the proposals are implemented, it’s possible some older doctors might retire rather than undergo these mandatory health assessments. Some may argue that encouraging more older doctors to retire is precisely the point of these proposals. However, <a href="https://www1.racgp.org.au/newsgp/professional/ahpra-eyes-mandatory-health-checks-for-older-gps">others have suggested</a> this would only exacerbate shortages in the health-care workforce. The proposals are open for <a href="https://www.medicalboard.gov.au/News/Current-Consultations.aspx">public comment</a> until October 4.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/236305/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/christopher-rudge-108366">Christopher Rudge</a>, Law lecturer, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-olds-too-old-to-be-a-doctor-why-gps-and-surgeons-over-70-may-need-a-health-check-to-practise-236305">original article</a>. </div>

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Sorting a loved one’s finances after their death – what you need to know

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/kate-reed-1548385">Kate Reed</a>, <a href="https://theconversation.com/institutions/university-of-sheffield-1147">University of Sheffield</a> Financial anxiety is often talked about, but rarely in the context of bereavement. Following the death of a loved one, relatives usually have to complete a range of financial “death administration” tasks. These can be anything from closing bank accounts and settling utility bills to managing probate (things like property sales, asset management and inheritance distribution). The <a href="https://bereavementcommission.org.uk/media/xube5elb/ukbc_summary_report_low-res.pdf">UK Commission on Bereavement</a> has estimated that 61% of adults struggle to deal with such time consuming and time sensitive administrative responsibilities. While research has begun to shed light on some of the financial difficulties bereaved people can face after the death of a <a href="https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-015-0194-1">spouse</a> or a <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/1468-4446.12190">family member</a>, the emotional toll of navigating financial admin after bereavement remains <a href="https://www.bereavementjournal.org/index.php/bcj/article/view/1114">largely invisible</a>. But the good news is there are several resources that can help bereaved people to navigate these processes, including the UK government’s own <a href="https://www.gov.uk/when-someone-dies">step-by-step guide</a>. We conducted <a href="https://thenbs.org/partnerships/death-admin-research-report">research</a> on death admin in collaboration with the <a href="https://thenbs.org/">National Bereavement Service</a>, an organisation that provides free practical and emotional support for anyone who has lost a loved-one. The study showed how government services provide a gateway to sorting out a range of financial issues. Financial organisations require proof of the death through a death certificate. This is provided when you <a href="https://www.gov.uk/when-someone-dies">register</a> a death with the local registrar of births, marriages and deaths. Where there is an inquest, an interim death certificate will be issued. Often, multiple copies of the death certificate are needed. And, at £12.50 for <a href="https://www.gov.uk/order-copy-birth-death-marriage-certificate">each copy</a> (£12 in <a href="https://www.mygov.scot/birth-death-marriage-certificate#:%7E:text=You%20can%20order%20a%20certificate,orders%20made%20in%20another%20way.">Scotland</a>), the financial burden falling on bereaved people can quickly grow. In terms of tax, pensions and benefits, the registrar provides a unique reference number that bereaved people can use to inform the government through a service called <a href="https://www.gov.uk/after-a-death/organisations-you-need-to-contact-and-tell-us-once">Tell Us Once</a>. This is an initiative that notifies national and local government bodies including HM Revenue and Customs (to deal with personal tax and to cancel certain benefits and tax credits) and the Department for Work and Pensions (to cancel benefits and entitlements like universal credit or the state pension). The <a href="https://www.gov.uk/valuing-estate-of-someone-who-died?step-by-step-nav=4f1fe77d-f43b-4581-baf9-e2600e2a2b7a">government website</a> also provides help on how to value the person’s estate and work out inheritance tax. <h2>Avoiding family fall-outs</h2> But other financial aspects of death administration can be more challenging to navigate. Probate, for example, is the legal right to deal with someone’s property, money and possessions (their “estate”) when they die. You can <a href="https://www.gov.uk/applying-for-probate?step-by-step-nav=4f1fe77d-f43b-4581-baf9-e2600e2a2b7a">check</a> on the UK government website whether you require probate. It remains one of the most challenging aspects of death administration. Our <a href="https://thenbs.org/partnerships/death-admin-research-report">research</a> shows that people often seek legal advice to manage probate because they are scared to get things wrong, or because they want to avoid future disputes with family members. The process of closing bank accounts and managing assets can be straightforward when the deceased person had made clear arrangements and had few bank accounts. But financial concerns often arise in situations where there are multiple or complicated banking systems. As one of the participants in our research stated: “It’s been a real mess … my dad had quite a few properties, and it’s been quite difficult winding those down.” Worse still, bereaved people can face threatening letters from companies like utilities providers in relation to bills and closing accounts. We found organisations often lack compassion in this context. We encountered cases of companies continuing to write directly to the deceased person, causing further distress to their loved-ones. One of our participants told us that their stepmother was “still getting the bill with my father’s name on, which distresses her”. It is also worth noting that certain types of death present particular administrative and financial challenges. For example, in 2022 17% of deaths in England and Wales were subject to a <a href="https://www.gov.uk/government/statistics/coroners-statistics-2022/coroners-statistics-2022-england-and-wales#inquests-opened">coroner’s inquest</a>. These deaths can be more difficult to administer on the Tell Us Once initiative due to the time-lag and extra bureaucracy involved. In addition, many people die without a will, which usually makes navigating financial issues much harder. The location of the death can also have financial implications. For example, our <a href="https://www.bereavementjournal.org/index.php/bcj/article/view/1114">research</a> shows how financing a care home stay is usually interconnected with inheritance or selling the person’s house, which places extra pressure on those trying to release the funds. Many organisations could make their administrative processes clearer and train their staff to be more compassionate towards people who have recently been bereaved. There are, however, glimmers of hope that things are improving. My own father died last year and while my experiences of helping my mum deal with the financial aspects of death administration have been mixed, we did experience many acts of kindness and compassion along the way. There is also excellent practical guidance out there from organisations like the <a href="https://thenbs.org/">National Bereavement Service</a>, which along with emotional support from charities like <a href="https://www.cruse.org.uk/">Cruse Bereavement Support</a> are vital to helping people navigate complex administrative systems. The COVID pandemic and death of the queen in 2022 have likely meant that, as a society, we are talking more about death and grief both publicly and privately. Death and bereavement happen to us all, and it is crucial that we talk more openly, not just about our emotional concerns, but about the practical and financial implications too.<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/231967/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/kate-reed-1548385">Kate Reed</a>, Professor of Sociology and Director of the Sheffield Methods Institute, <a href="https://theconversation.com/institutions/university-of-sheffield-1147">University of Sheffield</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/sorting-a-loved-ones-finances-after-their-death-what-you-need-to-know-231967">original article</a>. </div>

Money & Banking

Castor oil is all the rage among health influencers – what you need to know about this alternative remedy

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/veronique-seidel-1542416">Veronique Seidel</a>, <a href="https://theconversation.com/institutions/university-of-strathclyde-1287">University of Strathclyde </a> Castor oil, which was once used by fascists in Italy as <a href="https://www.rcpe.ac.uk/remoteandruralremedies/activities/exhibitions/medicines.html#:%7E:text=Due%20to%20its%20use%20as,the%20bludgeon%20and%20castor%20oil'.">punishment</a> because of its quick-acting laxative effect, is now a weight-loss trend on TikTok. Not drinking it, but rubbing it on your belly. Influencers are also pouring it in their belly buttons and wrapping towels soaked in it around their midriff. They claim it can <a href="https://www.tiktok.com/@karinawaldron/video/7333667470756072709?lang=en">melt belly fat</a> and <a href="https://www.tiktok.com/@sarahjmce/video/7322670147473362207?lang=en&q=castor%20oil&t=1716463274921">help with bloating</a>. Castor oil – made from the beans of the castor plant – is an ancient medicine. References to it appear in an ancient Egyptian medical text called the <a href="https://www.nationalgeographic.com/premium/article/castor-oil-real-health-benefits">Ebers Papyrus</a> (1550BC). It was used as a laxative and to treat various skin conditions. Cleopatra is said to have <a href="https://www.washingtonpost.com/lifestyle/wellness/cleopatra-used-it-as-a-beauty-aid-now-castor-oil-is-staging-a-cosmetics-comeback/2019/07/05/2d457584-92c5-11e9-aadb-74e6b2b46f6a_story.html?itid=sr_1_4c3daa8b-2b15-41d9-9b45-f1b2af1d7cf7">used it</a> in her hair and to brighten the whites of her eyes. The odourless oil is rich in a fatty substance called ricinoleic acid that strongly stimulates bowel movements. Today, it is an approved <a href="https://dps.fda.gov/omuf/monographsearch/monograph_m007">over-the-counter remedy</a> in some countries for short-term constipation and is used for cleansing the bowel before medical examinations. However, there’s not much scientific evidence to indicate that this laxative effect is better than other commonly used laxatives, such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3862068/">senna</a> – which has also been used for centuries. Other reported traditional uses for the oil include as a cure for sore and itchy eyes, to relieve joint and period pain, and as a means to induce labour. But, again, the evidence for these things is scant. Castor oil isn’t just imbibed, it is also widely used in skin creams, hair conditioners and other cosmetic products, such as lipsticks. It is used to moisturise, soothe irritated skin and reduce the appearance of wrinkles. Its moisturising properties have been attributed to ricinoleic acid. As part of haircare products, it is said to help with hair loss and dandruff. But taking castor oil as a standalone product is not risk free. The main side-effects of imbibing the oil are abdominal cramps, vomiting, bloating and dizziness. Vulnerable people, such as the elderly, babies, pregnant or breastfeeding women, and those with liver or kidney failure should avoid taking castor oil. As should anyone with inflammatory bowel disease, appendicitis or gastrointestinal obstruction or perforation. The side-effects of castor oil can also be exacerbated in people with <a href="https://www.degruyter.com/document/doi/10.1515/jom-1988-880520/html">eating disorders</a> who may choose to use the oil to lose weight by speeding up the passage of food through the gut. However, if you want to apply the oil to your skin or scalp, proceed with caution. In some people, it can trigger an allergic reaction. It is always advised to apply a small amount of pure castor oil or a castor oil-containing cosmetic product onto a small patch of skin. If there is no allergic reaction after 24 hours, then it can be assumed that the product can be applied safely to a larger area of the body. Ultimately, though, there are generally safer and better remedies out there. And rubbing it on your belly – sadly – won’t melt the fat.<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/232782/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/veronique-seidel-1542416">Veronique Seidel</a>, Senior Lecturer, Pharmacy and Biomedical Sciences, <a href="https://theconversation.com/institutions/university-of-strathclyde-1287">University of Strathclyde</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/castor-oil-is-all-the-rage-among-health-influencers-what-you-need-to-know-about-this-alternative-remedy-232782">original article</a>. </div>

Body

You don’t need a doctor to get more physically active – here are 10 simple steps you can take by yourself

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/nerys-m-astbury-410114">Nerys M Astbury</a>, <a href="https://theconversation.com/institutions/university-of-oxford-1260">University of Oxford</a> We all know physical activity has many <a href="https://www.nhs.uk/live-well/exercise/exercise-health-benefits/">health benefits</a>, including for mental health. It helps <a href="https://theconversation.com/exercise-can-reduce-stress-and-improve-sleep-particularly-for-women-with-breast-cancer-186144">manage stress</a>, ease joint or back pain, and boost energy levels. Exercise can also improve <a href="https://theconversation.com/exercise-and-the-brain-three-ways-physical-activity-changes-its-very-structure-150203">brain function</a> and <a href="https://theconversation.com/exercise-really-can-help-you-sleep-better-at-night-heres-why-that-may-be-192427">sleep</a>, and lift mood. In contrast, inactivity or spending too much time <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6308180/">sedentary</a> is a leading factor in developing a range of diseases. The <a href="https://www.who.int/publications/i/item/9789240015128">World Health Organization</a> recommends we should do a weekly minimum of 150-300 minutes of moderate intensity physical activity, such as walking, or 75 minutes of vigorous physical activity, such as swimming, jogging or an exercise class – as well as <a href="https://theconversation.com/strength-training-could-be-the-answer-to-one-of-the-worlds-worst-killers-228665">regular strength training</a>. However, many people <a href="https://www.who.int/teams/health-promotion/physical-activity/global-status-report-on-physical-activity-2022">fail to meet these guidelines</a>. So what to do about this <a href="https://www.weforum.org/agenda/2022/12/lack-exercise-inactivity-preventable-diseases/">health crisis</a>? There is already <a href="https://www.bmj.com/content/376/bmj-2021-068465">evidence</a> that when GPs give patients guidance and continued support to increase physical activity, this encourages them to be more physically active – at least in the short term. However, we don’t yet know the best way for doctors to communicate with patients to help them sustain these increased activity levels so the current guidance and support on offer to patients isn’t as effective as it could be. <figure><iframe src="https://www.youtube.com/embed/vCCD1xHKpZc?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> For example, my <a href="https://www.bmj.com/content/386/bmj-2023-078713">latest research</a> examines the <a href="https://www.bmj.com/content/340/bmj.c1900">“motivational interviewing” (MI)</a> method GPs currently use to encourage patients to change their lifestyle. MI is a patient-centred, non-confrontational communication style that helps patients address any problem behaviour by exploring their ambivalence towards changing it. MI has been shown to help patients with a host of health problems, including <a href="https://pubmed.ncbi.nlm.nih.gov/25577724/">addiction issues</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/23001832/">eating disorders</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/25726920/">smokers</a> and those with <a href="https://pubmed.ncbi.nlm.nih.gov/33637368/">diabetes</a> to change their behaviour. However, I found that while MI programmes can help patients increase their total amount of physical activity – the benefits are only short term. <h2>Ten simple ways to be more physically active</h2> If you want more physical activity in your life, then, there are many self-directed things you can do to help yourself, without joining a programme or seeing your GP. Here are ten simple and effective ways to help you become – and stay – more physically active: 1) Don’t sit, stand We <a href="https://theconversation.com/sitting-is-bad-for-your-health-and-exercise-doesnt-seem-to-offset-the-harmful-effects-225056">sit a lot</a>. In fact, it’s likely you’re sitting right now – and you needn’t be. Sitting for long periods has been <a href="https://doi.org/10.1016/j.amepre.2010.05.024">linked</a> with many adverse health outcomes, so try to stand more. <figure><iframe src="https://www.youtube.com/embed/wUEl8KrMz14?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> 2) Take the stairs Being physically active needn’t mean expensive gym memberships. Try building physical activity into your daily routine. One easy way to do this is by swapping the lift or escalator for the stairs. 3) Make it fun If you like doing something, you’re <a href="https://theconversation.com/why-you-shouldnt-let-guilt-motivate-you-to-exercise-220342">more likely</a> to continue doing it. Why not try an activity you liked doing as a child, or even something new? Who knows, you might enjoy it. 4) Phone a friend Exercising <a href="https://theconversation.com/exercise-can-be-punishing-but-heres-how-to-stop-thinking-of-it-as-a-punishment-76167">with a friend</a> or loved one is a great way to stay motivated, and it can make physical activity more fun too. 5) Do less, more often <a href="https://pilotfeasibilitystudies.biomedcentral.com/articles/10.1186/s40814-023-01272-8">“Snacktivity”</a> – a term for breaking up your activity into shorter <a href="https://theconversation.com/forget-the-gym-in-january-exercise-snacking-is-the-way-forward-69702">activity “snacks”</a> – can help you increase activity in convenient, manageable bursts while reaping the health benefits. 6) Track your progress Activity trackers aren’t a fad. There is <a href="https://doi.org/10.1016/S2589-7500(22)00111-X">evidence</a> that just using an activity tracker such as a pedometer to count steps or a smart watch that logs activity can help increase your activity levels, reduce body fat and increase muscle mass – and increase your overall physical fitness. 7) Get into a habit We know it takes about ten weeks to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505409/">form a habit</a>. Repetition is key – so stick with it and keep going. Once you’ve formed a physical activity habit, it will be <a href="https://www.psychologytoday.com/gb/basics/habit-formation#:%7E:text=Building%20healthy%20habits%20can%20involve,listening%20to%20music%20while%20exercising">hard to shake it off</a>.). 8) Hold still Try to incorporate <a href="https://en.wikipedia.org/wiki/Isometric_exercise">isometric exercises</a> like the plank or wall squats into your routine. These exercises, which need no equipment, require you to tighten muscles and hold still – and have been shown to <a href="https://bjsm.bmj.com/content/57/20/1317">lower your blood pressure</a>. 9) Set a goal Give yourself an achievable target to work towards – it will <a href="https://theconversation.com/three-tips-to-help-you-stay-motivated-to-keep-exercising-all-year-long-175868">motivate you</a> to reach your goal. 10) Reward yourself And don’t forget to reward yourself when you meet that goal. You can also build in rewards to mark your progress along the way. After all, who doesn’t like to treat themselves when they’ve done well?<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/231991/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/nerys-m-astbury-410114">Nerys M Astbury</a>, Associate professor, <a href="https://theconversation.com/institutions/university-of-oxford-1260">University of Oxford</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/you-dont-need-a-doctor-to-get-more-physically-active-here-are-10-simple-steps-you-can-take-by-yourself-231991">original article</a>. </div>

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Second marriage asset protection: What you need to know

Of paramount importance for many people in a second marriage is how to protect their assets if their relationship breaks down, or in the event of their death. Although second marriages bring a level of complexity, there are a number of strategies that you can implement to ensure that your assets are protected. Let’s explore some of the options available to you and what you need to know to protect your assets. Binding Financial Agreement A Binding Financial Agreement, often referred to as a pre-nup, allows you and your spouse to put in place a legal agreement which outlines how your assets will be dealt with in the event that your relationship breaks down. Should you wish, it can also extend to the provision of financial support for either party. The intention is for each party to protect their own assets, and such agreements can be put in place prior to a marriage or during a marriage if both parties consent. Like any legal document, a Binding Financial Agreement needs to be well drafted to ensure that it encompasses all relevant information, and it is important that you seek the advice of a family lawyer to assist you with putting this important document in place. Joint Assets v Individual Assets The manner in which you hold your assets is of paramount importance. All joint assets pass to the surviving party. If you and your spouse own a property as joint proprietors upon your death this property will automatically pass to your spouse. By changing the manner in which you hold the property from joint proprietors to tenants in common allows you and your spouse to deal with your individual interest in the property in your respective Wills. Additionally, you need to be mindful of any bank accounts or other investments that you hold jointly with your spouse as these are not individual assets that you can make provision for and will pass to your spouse upon your death. Your Will It is imperative that you put a Will in place that is reflective of your current circumstances and adequately provides for both your spouse and your children from a previous relationship in the manner that you desire. For many parents in second marriages with children from a previous relationship, protecting their children’s inheritance is of paramount importance. Discretionary Testamentary Trusts which are created in accordance with the provisions of your Will, can make provision for your spouse during their lifetime, whilst also ensuring that most of your assets go to your children. If you are the sole registered proprietor of your residence in which you and your spouse reside you may make provision in your Will providing a life interest in your residence to your spouse subject to some conditions being adhered to. This will allow your spouse to reside in your residence for the duration of their life then subsequent to their death the property may then pass to your children. Dying without a valid Will in place deems that you died intestate, and your assets will be distributed in accordance with a government formula and may not end up with the people who you would like to receive them. Your spouse would be entitled to a share of your assets, however this may not have been your intention, or the share that they would receive may be significantly more than you would like them to receive. It is therefore crucial that you take the time to put a well drafted Will in place so that your assets pass to those who you would like to receive them upon your death. Mutual Wills Agreement A Mutual Wills Agreement is a separate document to your Will and essentially is an agreement between you and your spouse that both of you will not change your Will without the consent of the your spouse or their legal personal representative upon their death. This document is intended to prevent the remaining spouse from altering their Will and disinheriting step-children or making other adverse changes to their Will. The Right People in Key Roles The roles of executor of your Will and your attorney in respect to your Power of Attorney documents are important roles and it is paramount that you appoint trusted people to undertake these roles as essentially you are handing control of your assets to those who assume these roles. Your attorney is entrusted to look after your finances and provide the best care for you in the event that you become incapacitated so you need to choose wisely. Communication is Crucial It is important that there is transparency for you and your family. By having important conversations with your spouse and children you can openly discuss your intentions and expectations so that all parties are relevantly informed and fully understand what your wishes are and what you have put in place. In order to evaluate the best options for you it is important that you obtain the appropriate professional advice to determine which is the best strategy for your own individual circumstances so that the relevant documents are put in place which offer you the best asset protection possible. Melisa Sloan is principal of Madison Sloan Lawyers and author of Big Moments: Expert Advice for Conquering those moments that define us. www.melisasloan.com.au Image credits: Shutterstock

Money & Banking

Heading to Bali or somewhere tropical these holidays? Here’s what you need to know about dengue fever

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/cameron-webb-6736">Cameron Webb</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> If you’re looking to escape the Australian winter for your next holiday, don’t forget where there’s warmth, there will also be mosquitoes. In turn, tropical destinations can be hot spots of mosquito-borne diseases such as dengue. In fact, Australian health authorities have warned travellers to Bali <a href="https://www.health.wa.gov.au/Media-releases/2024/May/Dengue-fever-warning-for-Western-Australian-travellers">to be aware</a> of the risk of dengue, with cases surging in the region. So here’s how to protect yourself and your family on holidays. <h2>What is dengue?</h2> <a href="https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue">Dengue virus infection</a> (commonly known as dengue fever, or just dengue) is caused by viruses spread by the bite of a mosquito. The mosquito species that typically transmit dengue are Aedes aegypti and Aedes albopictus. There are four strains of dengue virus. Each has the potential to cause illness that can range from <a href="https://www.cdc.gov/dengue/signs-symptoms/index.html">mild to severe and potentially life threatening</a>. Symptoms <a href="https://www.health.nsw.gov.au/Infectious/factsheets/Pages/dengue.aspx">typically include</a> rash, fever, chills, headache, muscle and joint pain, and fatigue. People also often report abdominal pain, nausea and vomiting. While infection with just one of these viruses can make you sick, subsequent exposure to other strains can have more <a href="https://theconversation.com/explainer-what-are-antibodies-and-why-are-viruses-like-dengue-worse-the-second-time-68227">serious health implications</a>. In these cases, symptoms can also include the presence of blood in vomit, bleeding gums and breathing difficulties. Dengue infection must be confirmed via a blood test, but there are <a href="https://www.healthdirect.gov.au/dengue-fever">no specific treatments</a>. Most people will recover on their own however <a href="https://www.cdc.gov/dengue/treatment/index.html">staying hydrated is crucial</a> and pain relief can help with symptoms. If more severe illness occurs, seek urgent medical care. <h2>Are travellers at risk?</h2> The disease is now endemic in around 100 countries and <a href="https://www.cdc.gov/dengue/areas-with-risk/index.html">an estimated 4 billion people</a> are considered at risk. Asian countries represent <a href="https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue">around 70%</a> of the global disease burden. Even <a href="https://theconversation.com/how-the-paris-olympics-could-become-a-super-spreader-event-for-dengue-231853">Europe is at risk</a>. <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON498">One of the worst years</a> on record was 2023, but the burden of dengue continues to grow. In the first four months of 2024, Indonesia reported <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON518">three times as many cases</a> of dengue compared to the same period in 2023. Dengue is not a new risk to Australian travellers. Before COVID disrupted international travel, the number of Australians returning from tropical destinations with dengue <a href="https://europepmc.org/article/med/23692160">was steadily increasing</a>. For example, between 2010 and 2016, there was an average <a href="https://www.mdpi.com/2414-6366/3/1/9">annual increase of 22%</a> of travellers returning to Victoria with dengue. Almost half of these people contracted the illness in Indonesia. Bali is well documented as posing <a href="https://academic.oup.com/jtm/article/25/1/tay061/5065180?login=false">a risk of dengue</a> to travellers. International travel restrictions due to COVID <a href="https://academic.oup.com/jtm/article/31/2/taae014/7577676">abruptly stopped this trend</a>. But now Australians are again embracing international travel, <a href="https://www.dailymail.co.uk/news/article-13303747/Worrying-reason-Aussie-travellers-Bali-coming-sick.html">cases are rising once more</a>. Bali isn’t the only destination with <a href="https://www.washingtonpost.com/health/2024/06/30/dengue-puerto-rico-mosquito-climate-change/">a surge in dengue</a>, but we know it’s a popular holiday destination for Australian travellers. There’s little doubt plenty of families will be heading to Bali these school holidays. <h2>How about the risk in Australia?</h2> Not all mosquitoes can spread dengue viruses. This is why the risk is different in Bali and other tropical regions compared to Australia. Although there are more than 40 Australian mosquito species known or suspected to be transmitting local pathogens, such as <a href="https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1005070">Ross River virus</a>, Australia is generally free of local dengue risk due to the limited spread of Aedes aegypti and Aedes albopictus. While Aedes aegypti is found in <a href="https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/diseases-infection/diseases/mosquito-borne/dengue/virus-fever">parts of Queensland</a>, thanks to interventions by the <a href="https://www.worldmosquitoprogram.org/en/global-progress/australia/cairns-and-surrounds">World Mosquito Program</a> and local authorities dengue risk is low. These interventions include the release of laboratory-bred mosquitoes that prevent mosquitoes in the environment <a href="https://www.worldmosquitoprogram.org/en/work/wolbachia-method">spreading viruses</a>, as well as <a href="https://www.sciencedirect.com/science/article/pii/S2221169115309096">community education</a>. But <a href="https://theconversation.com/after-decades-away-dengue-returns-to-central-queensland-117821">local cases</a> occasionally occur. Aedes albopictus is not currently found <a href="https://theconversation.com/how-we-kept-disease-spreading-asian-tiger-mozzies-away-from-the-australian-mainland-72873">on the Australian mainland</a> but is present in the islands of the Torres Strait. A dengue outbreak <a href="https://www.torres-cape.health.qld.gov.au/about-us/news/further-cases-of-dengue-fever-on-mer">has occurred</a> there this year. <h2>Keep mozzies away during the day, not just at night</h2> While there is a vaccine available, it’s not recommended for <a href="https://onlinelibrary.wiley.com/doi/full/10.5694/mja2.50471">short-term travellers</a>. There are <a href="https://www.health.gov.au/resources/publications/atagi-advice-on-the-use-of-dengvaxiar-for-australians">strict eligibility criteria</a> for its use, so speak to a health professional for advice. For the majority of travellers, preventing mosquito bites is the only way to prevent disease. But there are differences in the behaviour of dengue mosquitoes that mean the normal measures to avoid mosquito bites may not be as effective. During the Australian summer, mosquitoes found in local wetlands can be <a href="https://theconversation.com/the-worst-year-for-mosquitoes-ever-heres-how-we-find-out-68433">incredibly abundant</a>. We tend to need to reach for the repellent and cover up to stop bites as soon as the sun starts going down. Aedes aegypti and Aedes albopictus <a href="https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0010818">can aggressively bite people</a> but they’re not as abundant as the swarms of summer mosquitoes back home. They also bite during the day, not just at night. So for those travelling to Bali or other areas at risk of dengue, putting insect repellent on <a href="https://www.smartraveller.gov.au/news-and-updates/global-dengue-fever-outbreaks">throughout the day</a> is recommended. <h2>What to pack for protection</h2> If you’re staying in a major resort, there’s likely to be a mosquito control program in place. This may include minimising available water for mosquito breeding in combination with insecticide use. Mosquitoes are also less likely to be an issue in air-conditioned accommodation. But if you’re planning to spend time out and about visiting local villages, markets, or in nature, it’s best to protect against bites. Light coloured and <a href="https://www.health.wa.gov.au/Media-releases/2024/May/Dengue-fever-warning-for-Western-Australian-travellers">loose fitting clothing</a> will help stop mosquito bites (and help keep you cool). Covered shoes can help too – dengue mosquitoes <a href="https://www.npr.org/sections/goatsandsoda/2016/02/22/465594861/why-zika-spreading-mosquitoes-love-ankles">love smelly feet</a>. Finally, it’s best to take some insect repellent with you. There may not be any available at your destination, and formulations on sale might not have been through the same thorough testing as products <a href="https://www.apvma.gov.au/">approved in Australia</a>.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/233670/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/cameron-webb-6736">Cameron Webb</a>, Clinical Associate Professor and Principal Hospital Scientist, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/heading-to-bali-or-somewhere-tropical-these-holidays-heres-what-you-need-to-know-about-dengue-fever-233670">original article</a>. </div>

Travel Tips

How much do you need to know about how your spouse spends money? Maybe less than you think

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/scott-rick-1534612">Scott Rick</a>, <a href="https://theconversation.com/institutions/university-of-michigan-1290">University of Michigan</a> Love is in the air, and wedding season is upon us. Like many elder millennials, I grew up watching sitcoms in the 1980s and ‘90s. Whenever those series needed a ratings boost, they would feature a wedding. Those special episodes taught me that weddings usually involve young lovebirds: think Elvin and Sondra from “The Cosby Show,” Cory and Topanga from “Boy Meets World,” or David and Darlene from “Roseanne.” But those were different times. People are getting married later in life than they used to: In the United States, <a href="https://www.census.gov/content/dam/Census/library/visualizations/time-series/demo/families-and-households/ms-2.pdf">the median age of newlyweds</a> has grown to 28 for women and 30 for men. This trend means that many Americans now enter marriage after being self-reliant for several years, including managing their own money. Will they be eager to change that once they get married? Don’t count on it. A 2017 <a href="https://bettermoneyhabits.bankofamerica.com/content/dam/bmh/pdf/ar6vnln9-boa-bmh-millennial-report-winter-2018-final2.pdf">Bank of America survey</a> suggests that millennial married couples are around 15 percentage points more likely than their predecessors to keep their finances separate. This is not necessarily a good development. As a behavioral scientist <a href="https://michiganross.umich.edu/faculty-research/faculty/scott-rick">who studies money and relationships</a>, I find that joint accounts <a href="https://doi.org/10.1093/jcr/ucad020">can bring partners closer</a>. There are some risks, however. Joint accounts create transparency, and intuitively, transparency feels like a good thing in relationships. But I argue that some privacy is important even for highly committed couples – <a href="https://us.macmillan.com/books/9781250280077/tightwadsandspendthrifts">and money is no exception</a>. <h2>The newlywed game</h2> Behavioral scientists <a href="https://kelley.iu.edu/faculty-research/faculty-directory/profile.html?id=jgolson">Jenny Olson</a>, <a href="https://som.yale.edu/faculty-research/faculty-directory/deborah-small">Deb Small</a>, <a href="https://www.kellogg.northwestern.edu/faculty/directory/finkel_eli.aspx">Eli Finkel</a> and I recently conducted <a href="https://academic.oup.com/jcr/article-abstract/50/4/704/7077142">an experiment with engaged and newlywed couples</a>. Each of the pairs had entirely separate accounts, but they were undecided about how they wanted to manage their money moving forward. We randomly assigned each of the 230 couples to one of three groups. One group kept their money in separate accounts; one merged their cash into a joint account and stopped using separate accounts; and one managed their money however they liked. We followed couples for two years, periodically asking them to complete surveys assessing their relationship dynamics and satisfaction. Our relationship quality measure included items such as “I cannot imagine another person making me as happy as my partner does” and “Within the last three months, I shouted or yelled at my partner.” Among the couples who could do whatever they wanted, most kept things separate. They and the couples assigned to keep separate accounts experienced a steady decline in relationship quality over time. This is a fairly typical pattern. For instance, in <a href="https://academic.oup.com/sf/article-abstract/79/4/1313/2234046">a large study that tracked U.S. couples’ marital happiness for 17 years</a>, <a href="https://www.unk.edu/academics/social-work/faculty_staff/van_laningham.php">sociologist Jody Van Laningham</a> and colleagues found that “marital happiness either declines continuously or flattens after a long period of decline.” Declines during the first two years of marriage are particularly important. Social scientist <a href="https://liberalarts.utexas.edu/prc/faculty/hustontl">Ted Huston</a> and colleagues call those first two years <a href="https://doi.org/10.1037/0022-3514.80.2.237">the “connubial crucible</a>.” They find that relationship dynamics that develop during that crucial period can foreshadow relationship quality for many years to come. Couples in our study who were prompted to take the plunge into a joint account, however, maintained their initial level of relationship satisfaction over the course of the two-year experiment. <h2>Tit-for-tat</h2> Our survey results suggest that, by turning “my money” and “your money” into “our money,” a joint account can help to reduce scorekeeping within a relationship. For example, we found that couples with joint accounts were more likely to agree with statements such as “When one person does something for the other, the other should not owe the giver anything.” Relationships usually don’t start with a scorekeeping orientation. In the 1980s and ‘90s, psychologist <a href="https://psychology.yale.edu/people/margaret-clark">Margaret Clark</a> and colleagues conducted experiments where partners had the option of keeping track of each other’s contributions to a shared task. <a href="https://clarkrelationshiplab.yale.edu/sites/default/files/files/Resource%20allocation%20in%20intimate%20relationships.pdf">They observed</a> that intimate relationships often begin with a “communal” orientation, where partners help one another without keeping careful track of who’s doing what. Eventually, however, they take on more of an “exchange” orientation – where inputs are tracked and timely reciprocity is expected. Couples that manage to stave off a tit-for-tat mindset <a href="https://doi.org/10.1177/0956797610373882">tend to be happier</a>. <h2>Too much of a good thing?</h2> The data from our experiment with young couples clearly suggests that using only a joint account is better than using only separate accounts. However, I argue in my new book, “<a href="https://us.macmillan.com/books/9781250280077/">Tightwads and Spendthrifts</a>,” that just a joint account is probably not optimal. When partners use only a joint account, they get an up-close-and-personal view of how the other person is spending money. This kind of transparency is <a href="https://www.businessinsider.com/money-habits-successful-married-couples-avoid-2016-11">normally viewed</a> as a good thing. Some commentators argue that a healthy marriage should have no secrets whatsoever. For example, Willard Harley, Jr., a clinical psychologist who primarily writes for Christian audiences, argues that you should “reveal to your spouse <a href="https://www.marriagebuilders.com/the-policy-of-radical-honesty.htm">as much information about yourself as you know</a>: your thoughts, feelings, habits, likes, dislikes, personal history, daily activities, and plans for the future.” In addition, if your goal is to minimize optional spending, <a href="https://doi.org/10.1002/jcpy.1083">research suggests</a> that the transparency that comes with a joint account can be helpful. We spend less when someone is looking over our shoulder. Still, there are reasons to believe that <a href="https://doi.org/10.1177/0265407500172005">complete transparency can be harmful for couples</a>. Many people have become convinced that if they could just stop buying lattes and avocado toast, they could invest that money and become rich. Unfortunately, the underlying math is highly dubious, as journalist Helaine Olen points out in <a href="https://www.penguinrandomhouse.com/books/308568/pound-foolish-by-helaine-olen/">her book “Pound Foolish</a>.” Still, many people view small indulgences as their primary obstacle to wealth. Complete transparency around these financially inconsequential “treats” <a href="https://slate.com/business/2021/09/partner-hates-retail-therapy-money-advice.html">can lead to unnecessary arguments</a>. Also, spouses may have different passions that their partner does not fully understand. Expenses that seem perfectly reasonable to another hobbyist may seem outrageous <a href="https://academic.oup.com/jcr/article-abstract/19/2/256/1929895">to someone without the proper context</a> – another source of <a href="https://www.sciencedirect.com/science/article/abs/pii/S2352250X21000750">avoidable disagreements</a>. <h2>'Translucent,’ not transparent</h2> I propose that many couples may benefit from a combination of joint and separate accounts. A joint account is essential for ensuring that both partners have immediate and equal access to “our money.” Ideally, all income would be direct-deposited into the joint account, which would help to blur the gap between partners’ earnings. Conspicuous income differences <a href="https://doi.org/10.1086/432228">can jeopardize relationship quality</a>. Separate accounts attached to the joint account can allow some privacy for individual purchases and help partners maintain a sense of autonomy and individuality. Each person gets to spend some of “our money” without their partner looking over their shoulder. Spouses would have a high-level understanding of how much their partner is spending per week or per month, but avoid the occasionally irritating details. This kind of partial financial transparency – <a href="https://us.macmillan.com/books/9781250280077/tightwadsandspendthrifts">what I call “financial translucency</a>” – could help couples strike the right balance between financial and psychological well-being. Of course, this approach requires a lot of trust. If the relationship is already on thin ice, complete financial transparency may be necessary. However, if the relationship is generally in the “good, but could be even better” category, I would argue that financial translucency is worth considering.<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/230070/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/scott-rick-1534612">Scott Rick</a>, Associate Professor of Marketing, <a href="https://theconversation.com/institutions/university-of-michigan-1290">University of Michigan</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-much-do-you-need-to-know-about-how-your-spouse-spends-money-maybe-less-than-you-think-230070">original article</a>. </div>

Money & Banking

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

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

Money & Banking

What is ‘breathwork’? And do I need to do it?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/theresa-larkin-952095">Theresa Larkin</a>, <a href="https://theconversation.com/institutions/university-of-wollongong-711">University of Wollongong</a> and <a href="https://theconversation.com/profiles/judy-pickard-831093">Judy Pickard</a>, <a href="https://theconversation.com/institutions/university-of-wollongong-711">University of Wollongong</a> From “breathwork recipes” to breathing techniques, many <a href="https://www.instagram.com/p/C5WpkWxNrDI/">social media</a> and <a href="https://www.healthline.com/health/breathing-exercise">health websites</a> are recommending breathwork to reduce stress. But breathwork is not new. Rather it is the latest in a long history of breathing techniques such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7336946/">Pranayama</a> from India and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9312231/#:%7E:text=Qigong%2C%20on%20the%20other%20hand,one%20or%20two%20balancing%20poses.">qigong</a> from China. Such practices have been used for thousands of years to promote a healthy mind and body. The benefits can be immediate and obvious. Try taking a deep breath in through your nose and exhaling slowly. Do you feel a little calmer? So, what’s the difference between the breathing we do to keep us alive and breathwork? <h2>Breathwork is about control</h2> Breathwork is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9873947/#bib3">not the same</a> as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6189422/">other mindfulness practices</a>. While the latter focus on observing the breath, breathwork is about <a href="https://www.nature.com/articles/s41598-022-27247-y">controlling inhalation and exhalation</a>. Normally, breathing happens automatically via messages from the brain, outside our conscious control. But we can control our breath, by directing the movement of our diaphragm and mouth. <a href="https://www.medicalnewstoday.com/articles/diaphragmatic-breathing">The diaphragm</a> is a large muscle that separates our thoracic (chest) and abdominal (belly) cavities. When the diaphragm contracts, it expands the thoracic cavity and pulls air into the lungs. Controlling how deep, how often, how fast and through what (nose or mouth) we inhale is the crux of breathwork, from <a href="https://www.healthline.com/health/breath-of-fire-yoga">fire breathing</a> to the <a href="https://www.headspace.com/content/meditation/humming-bee-breath/9422">humming bee breath</a>. <h2>Breathwork can calm or excite</h2> Even small bits of breathwork can have physical and mental health benefits and <a href="https://theconversation.com/stuck-in-fight-or-flight-mode-5-ways-to-complete-the-stress-cycle-and-avoid-burnout-or-depression-218599">complete the stress cycle</a> to avoid burnout. Calming breathwork includes diaphragmatic (belly) breathing, slow breathing, pausing between breaths, and specifically slowing down the exhale. In diaphragmatic breathing, you consciously contract your diaphragm down into your abdomen to inhale. This pushes your belly outwards and makes your breathing deeper and slower. You can also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3681046/">slow the breath</a> by doing: <ul> <li> <a href="https://www.medicalnewstoday.com/articles/321805">box breathing</a> (count to four for each of four steps: breathe in, hold, breathe out, hold), or </li> <li> <a href="https://pubmed.ncbi.nlm.nih.gov/38092805/">coherent breathing</a> (controlled slow breathing of five or six breaths per minute), or </li> <li> <a href="https://www.healthline.com/health/alternate-nostril-breathing#benefits">alternate nostril breathing</a> (close the left nostril and breathe in slowly through the right nostril, then close the right nostril and breathe out slowly through the left nostril, then repeat the opposite way). </li> </ul> You can slow down the exhalation specifically by counting, humming or pursing your lips as you breathe out. In contrast to these calming breathing practices, energising fast-paced breathwork increases arousal. For example, <a href="https://www.webmd.com/balance/what-is-breath-of-fire-yoga">fire breathing</a> (breathe in and out quickly, but not deeply, through your nose in a consistent rhythm) and <a href="https://www.healthline.com/health/breathing-exercise#breath-focus">Lion’s breath</a> (breathe out through your mouth, stick your tongue out and make a strong “haa” sound). <h2>What is happening in the body?</h2> Deep and slow breathing, especially with a long exhale, is the best way to <a href="https://theconversation.com/our-vagus-nerves-help-us-rest-digest-and-restore-can-you-really-reset-them-to-feel-better-210469">stimulate the vagus nerves</a>. The vagus nerves pass through the diaphragm and are the main nerves of the parasympathetic nervous system. Simulating the vagus nerves calms our sympathetic nervous system (fight or flight) stress response. This improves mood, lowers the stress hormone <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5455070/">cortisol</a> and helps to regulate emotions and responses. It also promotes more <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6137615/">coordinated brain activity</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6189422/">improves immune function and reduces inflammation</a>. Taking deep, diaphragmatic breaths also has <a href="https://my.clevelandclinic.org/health/articles/9445-diaphragmatic-breathing">physical benefits</a>. This improves blood flow, lung function and exercise performance, increases oxygen in the body, and strengthens the diaphragm. <a href="https://link.springer.com/article/10.1007/s12671-023-02294-2#:%7E:text=Accumulating%20evidence%20supports%20the%20efficacy,et%20al.%2C%202001">Slow breathing</a> reduces heart rate and blood pressure and increases heart rate variability (normal variation in <a href="https://www.health.harvard.edu/blog/heart-rate-variability-new-way-track-well-2017112212789">time between heart beats</a>). These are linked to better heart health. Taking shallow, quick, rhythmic breaths in and out through your nose stimulates the sympathetic nervous system. Short-term, controlled activation of the stress response is healthy and <a href="https://pubmed.ncbi.nlm.nih.gov/36624160/">develops resilience to stress</a>. <h2>Breathing in through the nose</h2> We are designed to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6986941/">inhale through our nose</a>, not our mouth. Inside our nose are lots of <a href="https://www.ncbi.nlm.nih.gov/books/NBK544232/">blood vessels, mucous glands and tiny hairs called cilia</a>. These warm and humidify the air we breathe and filter out germs and toxins. We want the air that reaches our airways and lungs to be clean and moist. Cold and dry air is irritating to our nose and throat, and we don’t want germs to get into the body. <a href="https://journals.physiology.org/doi/full/10.1152/ajpregu.00148.2023?utm_source=AJPRegu&utm_medium=PressRelease&utm_campaign=1.17.2024">Nasal breathing</a> increases parasympathetic activity and releases nitric oxide, which improves airway dilation and lowers blood pressure. Consistently breathing through our mouth <a href="https://www.sciencefocus.com/the-human-body/mouth-breathing">is not healthy</a>. It can lead to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7455204/">pollutants</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8967998/#:%7E:text=Hence%2C%20we%20sought%20to%20synthesize,barriers%20to%20long%2Dterm%20enjoyment.">infections</a> reaching the lungs, snoring, sleep apnoea, and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6986941/">dental issues</a> including cavities and jaw joint problems. <h2>A free workout</h2> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5709795/">Slow breathing</a> – even short sessions at home – can reduce stress, anxiety and depression in the general population and among those with clinical depression or anxiety. Research on breathwork in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4309518/">helping post-traumatic stress disorder</a> (PTSD) is also promising. Diaphragmatic breathing to improve lung function and strengthen the diaphragm can improve breathing and exercise intolerance in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9690833/">chronic heart failure</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/33076360/">chronic obstructive pulmonary disease</a> and <a href="https://www.medicalnewstoday.com/articles/diaphragmatic-breathing#conditions-it-can-help-with">asthma</a>. It can also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8967998/#:%7E:text=Hence%2C%20we%20sought%20to%20synthesize,barriers%20to%20long%2Dterm%20enjoyment.">improve exercise performance</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/19875429/">reduce oxidative stress</a> (an imbalance of more free radicals and/or less antioxidants, which can damage cells) after exercise. <h2>A mind-body connection you can access any time</h2> If you feel stressed or anxious, you might subconsciously <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/breathing-to-reduce-stress">take shallow, quick breaths</a>, but this can make you feel more anxious. Deep diaphragmatic breaths through your nose and focusing on strong exhalations can help break this cycle and bring calm and mental clarity. Just <a href="https://www.nature.com/articles/s41598-022-27247-y">a few minutes a day</a> of breathwork can improve your physical and mental health and wellbeing. Daily deep breathing exercises <a href="https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2023.1040091/full">in the workplace</a> reduce blood pressure and stress, which is important since <a href="https://theconversation.com/what-is-burnout-and-how-to-prevent-it-in-the-workplace-insights-from-a-clinical-psychologist-196578">burnout rates are high</a>. Bottom line: any conscious control of your breath throughout the day is positive. So, next time you are waiting in a line, at traffic lights or for the kettle to boil, take a moment to focus on your breath. Breathe deeply into your belly through your nose, exhale slowly, and enjoy the benefits.<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/231192/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/theresa-larkin-952095">Theresa Larkin</a>, Associate professor of Medical Sciences, <a href="https://theconversation.com/institutions/university-of-wollongong-711">University of Wollongong</a> and <a href="https://theconversation.com/profiles/judy-pickard-831093">Judy Pickard</a>, Senior Lecturer, Clinical Psychology, <a href="https://theconversation.com/institutions/university-of-wollongong-711">University of Wollongong</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-is-breathwork-and-do-i-need-to-do-it-231192">original article</a>. </div>

Body

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

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/katelyn-jauregui-1527878">Katelyn Jauregui</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/asad-patanwala-1529611">Asad Patanwala</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/jonathan-penm-404921">Jonathan Penm</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/shania-liu-1433659">Shania Liu</a>, <a href="https://theconversation.com/institutions/university-of-alberta-1232">University of Alberta</a> Opioids are commonly prescribed when you’re discharged from hospital after surgery to help manage pain at home. These strong painkillers may have unwanted side effects or harms, such as constipation, drowsiness or the risk of dependence. However, there are steps you can take to minimise those harms and use opioids more safely as you recover from surgery. <h2>Which types of opioids are most common?</h2> The <a href="https://journals.sagepub.com/doi/full/10.1177/0310057X231163890">most commonly prescribed</a> opioids after surgery in Australia are oxycodone (brand names include Endone, OxyNorm) and tapentadol (Palexia). In fact, <a href="https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/bcp.16063">about half</a> of new oxycodone prescriptions in Australia occur after a recent hospital visit. <a href="https://journals.sagepub.com/doi/full/10.1177/0310057X231163890">Most commonly</a>, people will be given immediate-release opioids for their pain. These are quick-acting and are used to manage short-term pain. Because they work quickly, their dose can be easily adjusted to manage current pain levels. Your doctor will provide instructions on how to adjust the dosage based on your pain levels. Then there are slow-release opioids, which are specially formulated to slowly release the dose over about half to a full day. These may have “sustained-release”, “controlled-release” or “extended-release” on the box. Slow-release formulations are primarily used for chronic or long-term pain. The slow-release form means the medicine does not have to be taken as often. However, it takes longer to have an effect compared with immediate-release, so it is not commonly used after surgery. Controlling your pain after surgery is <a href="https://www.nps.org.au/assets/4811a27845042173-00a4ff09097b-postoperative-pain-management_36-202.pdf">important</a>. This allows you get up and start moving sooner, and recover faster. Moving around sooner after surgery prevents muscle wasting and harms associated with immobility, such as bed sores and blood clots. Everyone’s pain levels and needs for pain medicines are different. Pain levels also decrease as your surgical wound heals, so you may need to take less of your medicine as you recover. <h2>But there are also risks</h2> As mentioned above, side effects of opioids include constipation and feeling drowsy or nauseous. The drowsiness can also make you more likely to fall over. Opioids prescribed to manage pain at home after surgery are usually prescribed for short-term use. But up to <a href="https://pubmed.ncbi.nlm.nih.gov/35545810/">one in ten</a> Australians still take them up to four months after surgery. <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/msc.1837">One study</a> found people didn’t know how to safely stop taking opioids. Such long-term opioid use may lead to dependence and overdose. It can also reduce the medicine’s effectiveness. That’s because your body becomes used to the opioid and needs more of it to have the same effect. Dependency and side effects are also more common with <a href="https://www.anzca.edu.au/getattachment/535097e6-9f50-4d09-bd7f-ffa8faf02cdd/Prescribing-slow-release-opioids-4-april-2018#:%7E:text=%E2%80%9CSlow%2Drelease%20opioids%20are%20not,its%20Faculty%20of%20Pain%20Medicine.">slow-release opioids</a> than immediate-release opioids. This is because people are usually on slow-release opioids for longer. Then there are concerns about “leftover” opioids. One study found 40% of participants were prescribed <a href="https://journals.sagepub.com/doi/full/10.1177/0310057X231163890">more than twice</a> the amount they needed. This results in unused opioids at home, which <a href="https://www.anzca.edu.au/getattachment/558316c5-ea93-457c-b51f-d57556b0ffa7/PS41-Guideline-on-acute-pain-management">can be dangerous</a> to the person and their family. Storing leftover opioids at home increases the risk of taking too much, sharing with others inappropriately, and using without doctor supervision. <h2>How to mimimise the risks</h2> Before using opioids, speak to your doctor or pharmacist about using over-the-counter pain medicines such as paracetamol or anti-inflammatories such as ibuprofen (for example, Nurofen, Brufen) or diclofenac (for example, Voltaren, Fenac). These can be quite effective at controlling pain and will lessen your need for opioids. They can often be used instead of opioids, but in some cases a combination of both is needed. Other techniques to manage pain include physiotherapy, exercise, <a href="https://theconversation.com/hot-pack-or-cold-pack-which-one-to-reach-for-when-youre-injured-or-in-pain-161086">heat packs or ice packs</a>. Speak to your doctor or pharmacist to discuss which techniques would benefit you the most. However, if you do need opioids, there are some ways to make sure you use them <a href="https://www.safetyandquality.gov.au/sites/default/files/2022-04/opioid-analgesic-stewardship-in-acute-pain-clinical-care-standard.pdf">safely and effectively</a>: <ul> <li> ask for <a href="https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/full/10.1111/anae.16085">immediate-release</a> rather than slow-release opioids to lower your risk of side effects </li> <li> do not drink alcohol or take sleeping tablets while on opioids. This can increase any drowsiness, and lead to reduced alertness and slower breathing </li> <li> as you may be at higher risk of falls, remove trip hazards from your home and make sure you can safely get up off the sofa or bed and to the bathroom or kitchen </li> <li> before starting opioids, have a plan in place with your doctor or pharmacist about how and when to stop taking them. Opioids after surgery are ideally taken at the lowest possible dose for the shortest length of time. </li> </ul> <h2>If you’re concerned about side effects</h2> If you are concerned about side effects while taking opioids, speak to your pharmacist or doctor. Side effects include: <ul> <li> <a href="https://theconversation.com/health-check-what-causes-constipation-114290">constipation</a> – your pharmacist will be able to give you lifestyle advice and recommend laxatives </li> <li> drowsiness – do not drive or operate heavy machinery. If you’re trying to stay awake during the day, but keep falling asleep, your dose may be too high and you should contact your doctor </li> <li> weakness and slowed breathing – this may be a sign of a more serious side effect such as respiratory depression which requires medical attention. Contact your doctor immediately. </li> </ul> <h2>If you’re having trouble stopping opioids</h2> Talk to your doctor or pharmacist if you’re having trouble stopping opioids. They can give you alternatives to manage the pain and provide advice on gradually lowering your dose. You may experience withdrawal effects, such as agitation, anxiety and insomnia, but your doctor and pharmacist can help you manage these. <h2>How about leftover opioids?</h2> After you have finished using opioids, take any leftovers to your local pharmacy to <a href="https://theconversation.com/health-check-what-should-you-do-with-your-unused-medicine-81406">dispose of them safely</a>, free of charge. Do not share opioids with others and keep them away from others in the house who do not need them, as opioids can cause unintended harms if not used under the supervision of a medical professional. This could include accidental ingestion by children. <hr /> For more information, speak to your pharmacist or doctor. Choosing Wisely Australia also has <a href="https://www.choosingwisely.org.au/resources/consumers-and-carers/patient-guide-to-managing-pain-and-opioid-medicines">free online information</a> about managing pain and opioid medicines.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/228615/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/katelyn-jauregui-1527878">Katelyn Jauregui</a>, PhD Candidate and Clinical Pharmacist, School of Pharmacy, Faculty of Medicine and Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/asad-patanwala-1529611">Asad Patanwala</a>, Professor, Sydney School of Pharmacy, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/jonathan-penm-404921">Jonathan Penm</a>, Senior lecturer, School of Pharmacy, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/shania-liu-1433659">Shania Liu</a>, Postdoctoral Research Fellow, Faculty of Medicine and Dentistry, <a href="https://theconversation.com/institutions/university-of-alberta-1232">University of Alberta</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/ive-been-given-opioids-after-surgery-to-take-at-home-what-do-i-need-to-know-228615">original article</a>. </div>

Body

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

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

Money & Banking

“We need a donor”: Parents' desperate plea to save young daughter

The heartbroken parents of five-year-old Addison Kemp have made a desperate plea to save their young daughter. Addison suffers from a rare health condition called severe Aplastic anaemia, which means that her body’s bone marrow does not produce enough new blood cells to carry out vital tasks like carry oxygen, control infections or heal after an injury. This means that even a simple nosebleed can be catastrophic for the young girl, as she's forced to spend days in hospital getting blood transfusions to stay alive. Her parents Bianca and Daniel have spoken about her condition in an interview with A Current Affair and explained how without a bone-marrow transplant, the condition could mean death for their young daughter. “She wouldn’t live,” Ms Kemp said. “We need a donor.” The couple first found out about their daughter's condition after she returned home from school with bruises all over her body. Addison was taken to the doctor for a blood test, and they found out about the devastating condition a day later and were told to immediately take her to Queensland Children’s Hospital. “I was gutted, I was devastated. Getting a phone call from the doctor saying you need to rush your little girl to the hospital. That wasn’t a phone call that I wanted,” Mr Kemp said. Addison now has to stay in hospital until she can be matched with a donor. Her little sister Crimson, misses her every day that they are apart. “She gets a bit upset every day that they are not home,” Mr Kemp said. The family said that their bone-marrow did not match up with Addison, and no registered Australian donors had matched up with her either. However, not all hope is lost as any regular Australian could help save a life. Lisa Smith, from bone marrow donation charity Strength to Give, said that the donation process is similar to donating blood which involves a short course of injections before the operation. “The vast majority of time, it is you sitting in a chair, having your blood filtered, while you are watching Netflix," Smith said. Ms Kemp begged Australians to sign up as donors. “I really want to put the message out there that if you can, do,” she said. “You could be saving a life, that’s the biggest thing you could do in the world.” Image: A Current Affair

Caring

Everything you need to know about tipping in the US

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

International Travel

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

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

Body

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

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

Body

To tackle gendered violence, we also need to look at drugs, trauma and mental health

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/siobhan-odean-1356613">Siobhan O'Dean</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/lucinda-grummitt-1531503">Lucinda Grummitt</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/steph-kershaw-1466426">Steph Kershaw</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> After several highly publicised alleged murders of women in Australia, the Albanese government this week pledged <a href="https://ministers.pmc.gov.au/gallagher/2024/helping-women-leave-violent-partner-payment">more than A$925 million</a> over five years to address men’s violence towards women. This includes up to $5,000 to support those escaping violent relationships. However, to reduce and prevent gender-based and intimate partner violence we also need to address the root causes and contributors. These include alcohol and other drugs, trauma and mental health issues. <h2>Why is this crucial?</h2> The World Health Organization estimates <a href="https://iris.who.int/bitstream/handle/10665/341604/WHO-SRH-21.6-eng.pdf?sequence=1">30% of women</a> globally have experienced intimate partner violence, gender-based violence or both. In Australia, <a href="https://www.abs.gov.au/statistics/people/crime-and-justice/partner-violence/latest-release#key-statistics">27% of women</a> have experienced intimate partner violence by a co-habiting partner; <a href="https://pubmed.ncbi.nlm.nih.gov/37004184/">almost 40%</a> of Australian children are exposed to domestic violence. By gender-based violence we mean violence or intentionally harmful behaviour directed at someone due to their gender. But intimate partner violence specifically refers to violence and abuse occurring between current (or former) romantic partners. Domestic violence can extend beyond intimate partners, to include other family members. These statistics highlight the urgent need to address not just the aftermath of such violence, but also its roots, including the experiences and behaviours of perpetrators. <h2>What’s the link with mental health, trauma and drugs?</h2> The relationships between mental illness, drug use, traumatic experiences and violence are complex. When we look specifically at the link between mental illness and violence, most people with mental illness will not become violent. But there <a href="https://theconversation.com/bondi-attacker-had-mental-health-issues-but-most-people-with-mental-illness-arent-violent-227868">is evidence</a> people with serious mental illness can be more likely to become violent. The use of alcohol and other drugs also <a href="https://theconversation.com/alcohol-and-drug-use-exacerbate-family-violence-and-can-be-dealt-with-69986">increases the risk</a> of domestic violence, including intimate partner violence. About <a href="https://www.aihw.gov.au/family-domestic-and-sexual-violence/understanding-fdsv/factors-associated-with-fdsv">one in three</a> intimate partner violence incidents involve alcohol. These are more likely to result in physical injury and hospitalisation. The risk of perpetrating violence is even higher for people with mental ill health who are also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525086/">using alcohol or other drugs</a>. It’s also important to consider traumatic experiences. Most people who experience trauma do not commit violent acts, but there are <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(23)00075-0/fulltext">high rates</a> of trauma among people who become violent. For example, experiences of childhood trauma (such as witnessing physical abuse) <a href="https://www.sciencedirect.com/science/article/pii/S1359178915000828?via%3Dihub">can increase the risk</a> of perpetrating domestic violence as an adult. Early traumatic experiences can affect the brain and body’s <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0895-4">stress response</a>, leading to heightened fear and perception of threat, and difficulty regulating emotions. This can result in aggressive responses when faced with conflict or stress. This response to stress increases the risk of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9675346/">alcohol and drug problems</a>, developing <a href="https://pubmed.ncbi.nlm.nih.gov/30798897/">PTSD</a> (post-traumatic stress disorder), and <a href="https://psycnet.apa.org/record/2015-17349-001">increases the risk</a> of perpetrating intimate partner violence. <h2>How can we address these overlapping issues?</h2> We can reduce intimate partner violence by addressing these overlapping issues and tackling the root causes and contributors. The early intervention and treatment of <a href="https://doi.org/10.1186/s12905-019-0728-z">mental illness</a>, <a href="https://doi.org/10.1177/1541204020939645">trauma</a> (including PTSD), and <a href="https://doi.org/10.1016/j.avb.2015.06.001">alcohol and other drug use</a>, could help reduce violence. So extra investment for these are needed. We also need more investment to <a href="https://www.sciencedirect.com/science/article/pii/S2212657023000508">prevent mental health issues</a>, and preventing alcohol and drug use disorders from developing in the first place. <a href="https://www.sciencedirect.com/science/article/pii/S074937972200023X?via%3Dihub">Preventing trauma</a> from occuring and supporting those exposed is crucial to end what can often become a vicious cycle of intergenerational trauma and violence. <a href="https://journals.sagepub.com/doi/10.1177/070674371105600505">Safe and supportive</a> environments and relationships can protect children against mental health problems or further violence as they grow up and engage in their own intimate relationships. We also need to acknowledge the widespread <a href="https://store.samhsa.gov/product/practical-guide-implementing-trauma-informed-approach/pep23-06-05-005">impact of trauma</a> and its effects on mental health, drug use and violence. This needs to be integrated into policies and practices to reduce re-traumatising individuals. <h2>How about programs for perpetrators?</h2> Most existing standard intervention programs for perpetrators <a href="https://journals.sagepub.com/doi/10.1177/1524838018791268">do not consider</a> the links between trauma, mental health and perpetrating intimate partner violence. Such programs tend to have <a href="https://psycnet.apa.org/doi/10.1037/a0012718">little</a> or <a href="https://doi.org/10.1016/j.cpr.2021.101974">mixed effects</a> on the behaviour of perpetrators. But we could improve these programs with a <a href="http://rcfv.archive.royalcommission.vic.gov.au/MediaLibraries/RCFamilyViolence/Reports/RCFV_Full_Report_Interactive.pdf">coordinated approach</a> including treating mental illness, drug use and trauma at the same time. Such “<a href="https://www.sciencedirect.com/science/article/pii/S014976341930449X?via%3Dihub">multicomponent</a>” programs show promise in meaningfully reducing violent behaviour. However, we need more rigorous and large-scale evaluations of how well they work. <h2>What needs to happen next?</h2> Supporting victim-survivors and improving interventions for perpetrators are both needed. However, intervening once violence has occurred is arguably too late. We need to direct our efforts towards broader, holistic approaches to prevent and reduce intimate partner violence, including addressing the underlying contributors to violence we’ve outlined. We also need to look more widely at preventing intimate partner violence and gendered violence. We need developmentally appropriate <a href="https://theconversation.com/4-things-our-schools-should-do-now-to-help-prevent-gender-based-violence-228993">education and skills-based programs</a> for adolescents to prevent the emergence of unhealthy relationship patterns before they become established. We also need to address the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7278040/">social determinants of health</a> that contribute to violence. This includes improving access to affordable housing, employment opportunities and accessible health-care support and treatment options. All these will be critical if we are to break the cycle of intimate partner violence and improve outcomes for victim-survivors. <hr /> The National Sexual Assault, Family and Domestic Violence Counselling Line – 1800 RESPECT (1800 737 732) – is available 24 hours a day, seven days a week for any Australian who has experienced, or is at risk of, family and domestic violence and/or sexual assault. If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14. In an emergency, call 000.<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/229182/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/siobhan-odean-1356613">Siobhan O'Dean</a>, Postdoctoral Research Associate, The Matilda Centre for Research in Mental Health and Substance Use, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/lucinda-grummitt-1531503">Lucinda Grummitt</a>, Postdoctoral Research Fellow, The Matilda Centre for Research in Mental Health and Substance Use, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/steph-kershaw-1466426">Steph Kershaw</a>, Research Fellow, The Matilda Centre for Research in Mental Health and Substance Use, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/to-tackle-gendered-violence-we-also-need-to-look-at-drugs-trauma-and-mental-health-229182">original article</a>. </div>

Caring

7 things you need to know about fear

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

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