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Anthony Albanese under fire over free Qantas upgrades

A journalist's new book has claimed that Anthony Albanese has been scoring free flight upgrades with Qantas for over 15 years. According to AFR journalist Joe Aston's new book The Chairman’s Lounge, the PM and his family received upgrades from Qantas over his time as Transportation Minister and Opposition Leader between the years of 2007 and 2019. Aston's investigation allegedly found that Albanese had used his relationship with former Qantas CEO Alan Joyce to secure free upgrades to business and first-class flights on at least 22 occasions. “According to Qantas insiders, Albanese would liaise with Joyce directly about his personal travel,” Aston wrote. Albanese has defended these upgrades by stating they were all “declared as appropriate”, saying, “From time to time, members of parliament receive upgrades. What’s important is that they are declared. All of mine have been declared." “I note that a range of them go back a long, a long period of time and that they have all been declared as appropriate.” Despite claiming that the upgrades were all above board, Opposition Leader Peter Dutton called the perks “a bit strange.” “I think it is a bit strange that Mr Albanese is contacting the CEO of an airline when he is the shadow minister or minister for transport,” said Dutton. “I very strongly believe in the need for people to declare their interests, and sometimes there are oversight and human error involved, but when you’re talking about having a personal phone call to ask for an upgrade, as the transport minister or shadow transport minister, then I presume the prime minister will answer questions about that.” Image credits: Shutterstock/LUKAS COCH/EPA-EFE/Shutterstock Editorial

Travel Trouble

Millions of Aussies eligible for free holidays

Millions of Australians are set to be eligible for free holidays under a new initiative by the Victorian government in an attempt to ease cost-of-living pressures. From December, any Aussies wishing to embark on a camping trip in Victoria will have all their booking fees waived. Camping will be free at all 131 of Parks Victoria’s paid campgrounds from December 1st 2024, until June 30th 2025, saving families an estimated $7.3 million in booking fees, according to the state government. Those who have already booked a camping trip before the promotion's commencement date will still have the offer honoured, with full refunds available online. Premier Jacinta Allan said in the lead up to the festive season, every family deserves a holiday that won't break the bank. "Busy families deserve a great holiday in our great outdoors – and this summer, they can stay for free," she said. "I grew up camping with my family and those special memories have stayed with me forever." Each year, approximately 50 million people visit Victoria’s iconic state forests and national parks every year for activities including camping, hiking, fishing and hunting and four-wheel driving All bookings and refunds under the scheme can be made at <a href="https://www.parks.vic.gov.au" target="_blank" rel="noopener">parks.vic.gov.au</a>. Image credits: Parks Victoria

Domestic Travel

Helping alleviate the pain of arthritis

One in seven Australians, or 3.6 million people, are living with arthritis, a leading cause of chronic pain and the second most common cause of disability and early retirement due to ill health, according to Arthritis Australia. Mike Whitney is a big fan of Arborvitae after having spent years playing cricket for NSW and Australia resulting in many aches and pains throughout his body. The joys of sport that many people experience as they get older. Arborvitae Health and Wellbeing has spent years formulating a solution to target debilitating pain caused by arthritis and other chronic conditions. “We wanted it to be a natural product as well,” says Arborvitae Director Brendan Howell. Since it was founded in 2014, Arborvitae Health and Wellbeing, has used Pycnogenol (French maritime pine bark extract) as the main ingredient in its range of natural anti-inflammatory and antioxidant supplements. The natural plant extract, which grows on the coast of south-west France, is used alongside aloe vera, papain enzyme and honey. “Arborvitae’s unique formulation of natural ingredients provides a potent supplement and is based on years of research into the impact of inflammation in the human body,” Howell says. The company’s main product, Arborvitae Joint Health, may help provide relief from symptoms of mild-moderate arthritis, joint pain, inflammation, soreness and stiffness. ‘‘Arborvitae does make a difference, and that has been supported by over 160 clinical trials on its main ingredient Pycnogenol across a broad range of conditions and Arborvitae’s own clinical study,” Howell says. The recent clinical study on Arborvitae Joint Health has shown some exceptional results with pain relief (66% decrease in pain test scores), a 50% increase in walking distance, a 56% decrease in inflammation in blood tests (CRP), a 78% reduction in their use of on-demand medications and a 50% improvement in quality-of-life scores. <img class="alignnone size-full wp-image-71490" src="https://oversixtydev.blob.core.windows.net/media/2024/10/Infographic_1280.jpg" alt="" width="1280" height="899" /> “The customer feedback we receive also demonstrates the product's efficacy and enables us to provide real examples of its success when speaking with customers,” Brendan Howell said. As an example, Tracy from All Sort Cakes in Sydney is a regular Arborvitae customer and states: “Arborvitae has been a game changer for me. I’ve suffered with sore hands for years and I probably don’t have to tell all of you fellow cake makers how debilitating it can be. A friend suggested I try Arborvitae. So the first bottle I wasn’t sure but I was told to wait till I finish the second bottle to feel the full effects. And yep! Omg!!! The pain all but disappeared.” <img class="alignnone size-full wp-image-71488" src="https://oversixtydev.blob.core.windows.net/media/2024/10/Tracy-Wilson-May-2023_1280.jpg" alt="" width="1280" height="1477" /> Whilst Gary from Kenthurst, another regular customer, states: “To be told at 50 I may need a knee operation one day was an obvious shock. I run a small Forklift Business and 19 months ago became a grandfather, so I need to be mobile. Not wanting an operation at this point I needed an alternative, and what an alternative I found. In obvious pain I started my Arborvitae Joint Health treatment and after 2 weeks my pain and swelling had reduced. Now my pain is gone. If I am going to have a big day in the yard or in the bobcat I make sure I take my Arborvitae Joint Health first. What a fabulous product this is. No one should go through life in pain and I will tell anyone that will listen - if you have early onset mild Osteo Arthritis start taking Arborvitae Joint Health it has certainly helped me, and I can keep up with my grandson Max.” <img class="alignnone size-full wp-image-71487" src="https://www.readersdigest.com.au/wp-content/uploads/2024/10/Gary-copy-holding-new-blue-bottle_770.jpg" alt="" width="770" height="482" /> Arborvitae’s main product is Arborvitae Joint Health, however the other stars in the range are Arborvitae Health and Wellbeing Supplement for blood glucose, cholesterol and the immune system and Arborvitae Cognitive Function, Memory and Eye Health. Mr Howell said the natural anti-inflammatory comes in an easy to take daily liquid supplement that has been designed to reset the immune system and bring down inflammation in the body quickly and efficiently. The inflammation reduction (of 56%) at the cellular level is confirmed by the CRP results in the recent clinical study. This reduction in inflammation alone is significant. Supplements are sold via Arborvitae’s website and at over 2000 chemists and health food shops Australia wide – including Chemist Warehouse, TerryWhite Chemmart and Blooms The Chemist. To find the closest store near you, visit <a href="http://www.arborvitae.com.au/pages/where-to-buy" target="_blank" rel="noopener">www.arborvitae.com.au/pages/where-to-buy</a> To find out more on the clinical study and Arborvitae’s health supplements you can visit the website: <a href="http://www.arborvitae.com.au" target="_blank" rel="noopener">www.arborvitae.com.au</a> or call 1300 879 863. Always read the label and follow the directions for use. Images: Courtesy of Arborvitae This is a sponsored article produced in partnership with Arborvitae

Body

Readers response: What's a pain you can't truly explain until you've endured it?

When it comes to experiencing pain, many of us are used to hearing people say "I know how you feel" while they're empathising with your suffering. However, there are some kinds of pain - either physical or emotional - that cannot be understood until you experience them yourself. We asked our readers what pain you can't truly explain until you've endured it yourself, and the response was overwhelming. Here's what they said. Anne Hare - Shingles! Absolutely excruciating. I seriously considered topping myself until I was finally prescribed Lyrica. Took five months to recover as misdiagnosed twice so antivirals prescribed too late. Have the shot! Karen Ambrose - Childbirth. 15.5 hours of agony. Annette Maree - Pain from a dying nerve in a tooth. Royce Jowett - The worst pain is always the one you are currently experiencing, especially as you get older and forgetful. Julia Santos - Hip pain is hard to explain how it affects your whole day. Even trying to sleep is an adventure. And sneezing while your hips are inflamed is always fun. Betty Weller Edwards - Gallbladder stones. I would rather go through labor for 12 hours than have 4 hours off gallbladder pain. Sandra Morris - The loss of your child. Kevin Chapman - Chronic arthritis. The pain is 24/7, it never goes away. Danny Bennett - Divorce. Patricia White - Dislocated shoulder. Jill Harker - A couple of bulging discs in my back! Linda Charlton - Clot in the lungs, couldn't breathe thought I was having a heart attack in my 30's. Other than that, definitely childbirth. George Dworcowyi - Back spasms after a 7 hour operation on my broken spine. Maxine Cuevas - Losing two adult children at separate times. Josephine Broughton - White tail spider bite. Shelley Woolley - Ruptured ovarian cysts. Image credits: Shutterstock

Body

Why is pain so exhausting?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/michael-henry-1321395">Michael Henry</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/lorimer-moseley-1552">Lorimer Moseley</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> One of the most common feelings associated with persisting pain is fatigue and this fatigue can become overwhelming. People with chronic pain can report being drained of energy and motivation to engage with others or the world around them. In fact, a study from the United Kingdom on people with long-term health conditions found pain and fatigue are the <a href="https://weareundefeatable.co.uk/campaign-hub/latest-from-us/the-bridging-the-gap-report/">two biggest barriers</a> to an active and meaningful life. But why is long-term pain so exhausting? One clue is the nature of pain and its powerful effect on our thoughts and behaviours. <h2>Short-term pain can protect you</h2> Modern ways of thinking about pain emphasise its protective effect – the way it grabs your attention and compels you to change your behaviour to keep a body part safe. Try this. Slowly pinch your skin. As you increase the pressure, you’ll notice the feeling changes until, at some point, it becomes painful. It is the pain that stops you squeezing harder, right? In this way, pain protects us. When we are injured, tissue damage or inflammation makes our pain system become more sensitive. This pain stops us from mechanically loading the damaged tissue while it heals. For instance, the pain of a broken leg or a cut under our foot means we avoid walking on it. The concept that “pain protects us and promotes healing” is one of the most important things people who were in chronic pain tell us <a href="https://pubmed.ncbi.nlm.nih.gov/35934276/">they learned</a> that helped them recover. <h2>But long-term pain can overprotect you</h2> In the short term, pain does a terrific job of protecting us and the longer our pain system is active, the more protective it becomes. But persistent pain can overprotect us and <a href="https://onlinelibrary.wiley.com/doi/10.1111/jabr.12124">prevent recovery</a>. People in pain have called this “<a href="https://www.jpain.org/article/S1526-5900(22)00379-0/fulltext">pain system hypersensitivity</a>”. Think of this as your pain system being on red alert. And this is where exhaustion comes in. When pain becomes a daily experience, triggered or amplified by a widening range of activities, contexts and cues, it becomes a constant drain on one’s resources. Going about life with pain requires substantial and constant effort, and this makes us fatigued. <a href="https://www.aihw.gov.au/reports/chronic-disease/chronic-pain-in-australia/summary">About 80%</a> of us are lucky enough to not know what it is like to have pain, day in day out, for months or years. But take a moment to imagine what it would be like. Imagine having to concentrate hard, to muster energy and use distraction techniques, just to go about your everyday tasks, let alone to complete work, caring or other duties. Whenever you are in pain, you are faced with a choice of whether, and how, to act on it. Constantly making this choice requires thought, effort and strategy. Mentioning your pain, or explaining its impact on each moment, task or activity, is also tiring and difficult to get across when no-one else can see or feel your pain. For those who do listen, it can become tedious, draining or worrying. <h2>No wonder pain is exhausting</h2> In chronic pain, it’s not just the pain system on red alert. Increased inflammation throughout the body (the immune system on red alert), disrupted output of the hormone cortisol (the endocrine system on red alert), and stiff and guarded movements (the motor system on red alert) also go <a href="https://www.noigroup.com/product/explain-pain-supercharged/">hand in hand</a> with chronic pain. Each of these adds to fatigue and exhaustion. So learning how to manage and resolve chronic pain often includes learning how to best manage the over-activation of these systems. Loss of sleep is also a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9289983/">factor</a> in both fatigue and pain. Pain causes disruptions to sleep, and loss of sleep contributes to pain. In other words, chronic pain is seldom “just” pain. No wonder being in long-term pain can become all-consuming and exhausting. <h2>What actually works?</h2> People with chronic pain are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9633893/">stigmatised, dismissed</a> and <a href="https://www.jpain.org/article/S1526-5900(13)01367-9/fulltext">misunderstood</a>, which can lead to them not getting the care they need. Ongoing pain may prevent people working, limit their socialising and impact their relationships. This can lead to a descending spiral of social, personal and economic disadvantage. So we need better access to evidence-based care, with high-quality education for people with chronic pain. There is good news here though. Modern care for chronic pain, which is grounded in first gaining a modern understanding of the underlying biology of chronic pain, <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00441-5/abstract">helps</a>. The key seems to be recognising, and accepting, that a hypersensitive pain system is a key player in chronic pain. This makes a quick fix highly unlikely but a program of gradual change – perhaps over months or even years – promising. Understanding how pain works, how persisting pain becomes overprotective, how our brains and bodies adapt to training, and then learning new skills and strategies to gradually retrain both brain and body, offers scientifically based hope; there’s strong <a href="https://jamanetwork.com/journals/jama/article-abstract/2794765">supportive evidence</a> from <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00441-5/abstract">clinical trials</a>. <h2>Every bit of support helps</h2> The best treatments we have for chronic pain take effort, patience, persistence, courage and often a good coach. All that is a pretty overwhelming proposition for someone already exhausted. So, if you are in the 80% of the population without chronic pain, spare a thought for what’s required and support your colleague, friend, partner, child or parent as they take on the journey. <hr /> More information about chronic pain is available from <a href="https://www.painrevolution.org/painfacts">Pain Revolution</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/238417/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/michael-henry-1321395">Michael Henry</a>, Physiotherapist and PhD candidate, Body in Mind Research Group, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/lorimer-moseley-1552">Lorimer Moseley</a>, Professor of Clinical Neurosciences and Foundation Chair in Physiotherapy, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</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/why-is-pain-so-exhausting-238417">original article</a>. </div>

Body

The Princess of Wales wants to stay cancer-free. What does this mean?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/amali-cooray-1482458">Amali Cooray</a>, <a href="https://theconversation.com/institutions/wehi-walter-and-eliza-hall-institute-of-medical-research-822">WEHI (Walter and Eliza Hall Institute of Medical Research) </a>; <a href="https://theconversation.com/profiles/john-eddie-la-marca-1503690">John (Eddie) La Marca</a>, <a href="https://theconversation.com/institutions/wehi-walter-and-eliza-hall-institute-of-medical-research-822">WEHI (Walter and Eliza Hall Institute of Medical Research) </a>, and <a href="https://theconversation.com/profiles/sarah-diepstraten-1495268">Sarah Diepstraten</a>, <a href="https://theconversation.com/institutions/wehi-walter-and-eliza-hall-institute-of-medical-research-822">WEHI (Walter and Eliza Hall Institute of Medical Research) </a> Catherine, Princess of Wales, <a href="https://www.theguardian.com/uk-news/article/2024/sep/09/princess-of-wales-cancer-free-after-completing-chemotherapy">has announced</a> she has now completed a course of preventive chemotherapy. The news comes nine months after the princess first <a href="https://www.bbc.com/news/uk-68641441">revealed</a> she was being treated for an unspecified form of cancer. In the new <a href="https://www.youtube.com/watch?v=QSrDEq8QFkc">video message</a> released by Kensington Palace, Princess Catherine says she’s focused on doing what she can to stay “cancer-free”. She acknowledges her cancer journey is not over and the “path to recovery and healing is long”. While we don’t know the details of the princess’s cancer or treatment, it raises some questions about how we declare someone fully clear of the disease. So what does being – and staying – “cancer-free” mean? <h2>What’s the difference between being cancer-free and in remission?</h2> Medically, “cancer-free” <a href="https://www.mdanderson.org/cancerwise/remission--cancer-free--no-evidence-of-disease--what-is-the-difference-when-talking-about-cancer-treatment-effectiveness-and-results.h00-159460845.html">means</a> two things. First, it means no cancer cells are able to be detected in a patient’s body using the available testing methods. Second, there is no cancer left in the patient. These might sound basically the same. But this second aspect of “cancer-free” can be complicated, as it’s essentially impossible to be sure no cancer cells have survived a treatment. It only takes a few surviving cells for the cancer to <a href="https://theconversation.com/how-does-cancer-spread-to-other-parts-of-the-body-219616">grow back</a>. But these cells may not be detectable via testing, and can lie dormant for some time. The possibility of some cells still surviving means it is more accurate to say a patient is “in remission”, rather than “cancer-free”. Remission means there is no detectable cancer left. Once a patient has been in remission for a certain period of time, they are often considered to be fully “cancer-free”. Princess Catherine was not necessarily speaking in the strict medical sense. Nonetheless, she is clearly signalling a promising step in her recovery. <h2>What happens during remission?</h2> During remission, patients will usually undergo surveillance testing to make sure their cancer hasn’t returned. Detection tests can vary greatly depending on both the patient and their cancer type. Many <a href="https://www.cancer.gov/about-cancer/screening/screening-tests">tests</a> involve simply looking at different organs to see if there are cancer cells present, but at varying levels of complexity. Some cancers can be detected with the naked eye, such as skin cancers. In other cases, technology is needed: colonoscopies for colorectal cancers, X-ray mammograms for breast cancers, or CT scans for lung cancers. There are also molecular tests, which test for the presence of cancer cells using protein or DNA from blood or tissue samples. For most patients, testing will continue for years at regular intervals. Surveillance testing ensures any returning cancer is caught early, giving patients the best chance of successful treatment. Remaining in remission for five years can be a huge milestone in a patient’s cancer journey. For most types of cancer, the <a href="https://pubmed.ncbi.nlm.nih.gov/31231898/">chances of cancer returning</a> drop significantly after five years of remission. After this point, surveillance testing may be performed less frequently, as the patients might be deemed to be at a lower risk of their cancer returning. <h2>Measuring survival rates</h2> Because it is very difficult to tell when a cancer is “cured”, clinicians may instead refer to a “five-year survival rate”. This measures how likely a cancer patient is to be alive five years after their diagnosis. For example, data shows the <a href="https://ncci.canceraustralia.gov.au/outcomes/relative-survival-rate/5-year-relative-survival-diagnosis">five-year survival rate</a> for <a href="https://cancer.org.au/cancer-information/types-of-cancer/bowel-cancer">bowel cancer</a> among Australian women (of all ages) is around 70%. That means if you had 100 patients with bowel cancer, after five years you would expect 70 to still be alive and 30 to have succumbed to the disease. These statistics can’t tell us much about individual cases. But comparing five-year survival rates between large groups of patients after different cancer treatments can help clinicians make the often complex decisions about how best to treat their patients. The likelihood of cancer coming back, or recurring, is influenced by many factors which can vary over time. For instance, approximately 30% of people with lung cancer <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7061059/">develop a recurrent disease</a>, even after treatment. On the other hand, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4933127/">breast cancer recurrence</a> within two years of the initial diagnosis is approximately 15%. Within five years it drops to 10%. After ten, it falls below 2%. These are generalisations though – recurrence rates can vary greatly depending on things such as what kind of cancer the patient has, how advanced it is, and whether it has spread. <h2>Staying cancer-free</h2> Princess Catherine <a href="https://www.theguardian.com/uk-news/article/2024/sep/09/princess-of-wales-cancer-free-after-completing-chemotherapy">says</a> her focus now is to “stay cancer-free”. What might this involve? How a cancer develops and whether it recurs can be <a href="https://nature.com/articles/s41467-018-05467-z">influenced</a> by things we can’t control, such as age, ethnicity, gender, genetics and hormones. However, there are sometimes <a href="https://www.cancer.gov/about-cancer/causes-prevention/risk/substances">environmental factors</a> we can control. That includes things like exposure to UV radiation from the sun, or inhaling carcinogens like tobacco. Lifestyle factors also play a role. Poor diet and nutrition, a lack of exercise and excessive alcohol consumption can all <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10925935">contribute to cancer development</a>. Research estimates more than half of all cancers could <a href="https://www.canceraustralia.gov.au/resources/position-statements/lifestyle-risk-factors-and-primary-prevention-cancer/recommendations">potentially be prevented</a> through <a href="https://www.health.gov.au/topics/cancer/screening-for-cancer">regular screening</a> and maintaining a healthy lifestyle (not to mention preventing other chronic conditions such as heart disease and diabetes). Recommendations to reduce cancer risk are the same for everyone, not just those who’ve had treatment like Princess Catherine. They include not smoking, eating a nutritious and balanced diet, exercising regularly, cutting down on alcohol and staying sun smart.<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/238681/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/amali-cooray-1482458">Amali Cooray</a>, PhD Candidate in Genetic Engineering and Cancer, <a href="https://theconversation.com/institutions/wehi-walter-and-eliza-hall-institute-of-medical-research-822">WEHI (Walter and Eliza Hall Institute of Medical Research) </a>; <a href="https://theconversation.com/profiles/john-eddie-la-marca-1503690">John (Eddie) La Marca</a>, Senior Research Officer, Blood Cells and Blood Cancer, <a href="https://theconversation.com/institutions/wehi-walter-and-eliza-hall-institute-of-medical-research-822">WEHI (Walter and Eliza Hall Institute of Medical Research) </a>, and <a href="https://theconversation.com/profiles/sarah-diepstraten-1495268">Sarah Diepstraten</a>, Senior Research Officer, Blood Cells and Blood Cancer Division, <a href="https://theconversation.com/institutions/wehi-walter-and-eliza-hall-institute-of-medical-research-822">WEHI (Walter and Eliza Hall Institute of Medical Research)</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-princess-of-wales-wants-to-stay-cancer-free-what-does-this-mean-238681">original article</a>. </div>

Caring

Why is it so hard to cancel subscriptions or end ‘free’ trials? Report shows how companies trap you into paying

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/katharine-kemp-402096">Katharine Kemp</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Many businesses are trapping Australian consumers in paid subscriptions by making them hard to cancel, hiding important details and offering “free” trials that auto-renew with hefty charges. We need law reform to tackle this continuing problem. <a href="https://cprc.org.au/report/let-me-out">A new report</a> shows 75% of Australian consumers have had negative experiences when trying to cancel a subscription, according to the Consumer Policy Research Centre (CPRC). It shows businesses use “<a href="https://www.wired.com/story/how-to-spot-avoid-dark-patterns/">dark patterns</a>”, which are designs that hinder consumers who try to act in their own best interests. Subscription traps are often called “<a href="https://www.ftc.gov/business-guidance/blog/2022/11/checking-out-ftcs-100-million-settlement-vonage">Hotel California</a>” techniques, referring to The Eagles’ famous lyric: “you can check out any time you want, but you can never leave”. In some of these cases, consumers may have remedies under our existing consumer law, including for misleading conduct. But we need law reform to capture other <a href="https://treasury.gov.au/consultation/c2023-430458">unfair practices</a>. In the meantime, the CPRC’s research also gives examples of businesses with fair, consumer-friendly subscription practices. These also benefit the business. <h2>Examples of unfair subscription traps</h2> <a href="https://www.forbes.com/councils/forbesbusinessdevelopmentcouncil/2022/09/12/the-evolution-of-the-subscription-model-and-whats-on-the-horizon/">Subscription business models</a> have become common – many products are now provided in the form of software, an app or access to a website. Some of these would once have been a physical book, newspaper, CD or exercise class. Most people who use online services have experienced the frustration of finding a credit card charge for an unwanted, unused subscription or spending excessive time trying to cancel a subscription. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/615486/original/file-20240826-16-fp57es.png?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/615486/original/file-20240826-16-fp57es.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/615486/original/file-20240826-16-fp57es.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=643&fit=crop&dpr=1 600w, https://images.theconversation.com/files/615486/original/file-20240826-16-fp57es.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=643&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/615486/original/file-20240826-16-fp57es.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=643&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/615486/original/file-20240826-16-fp57es.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=808&fit=crop&dpr=1 754w, https://images.theconversation.com/files/615486/original/file-20240826-16-fp57es.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=808&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/615486/original/file-20240826-16-fp57es.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=808&fit=crop&dpr=3 2262w" alt="Infographic with a few statistics from the report." /></a><figcaption><a class="source" href="https://cprc.org.au/wp-content/uploads/2024/08/CPRC_LetMeOut_SubsTraps_Report_FINAL.pdf">CPRC, Let me out – Subscription trap practices in Australia, August 2024</a></figcaption></figure> Businesses can make it difficult for consumers to stop paying for unwanted subscriptions. Some do this by allowing consumers to start a subscription with a single click, but creating multiple obstacles if you want to end the subscription. This can include obscuring cancellation options in the app, requiring consumers to phone during business hours or making them navigate through multiple steps and offers before terminating. The report points out many of the last-ditch discounts offered in this process are only short term. One survey respondent said: <blockquote> I wasn’t able to cancel without having to call up and speak to someone. Their business hours meant I had to call up during my work day and it took some time to action. </blockquote> Other businesses badger consumers with frequent emails or messages after they cancel. One respondent said a business made “the cancellation process impossible by making you call and then judging your reason for cancellation”. <h2>What does consumer law say?</h2> Some subscription traps already fall foul of the Australian Consumer Law and warrant investigation by the <a href="https://www.accc.gov.au/media-release/accc-warns-consumers-to-beware-of-subscription-traps">Australian Competition & Consumer Commission</a> (ACCC). Consumers may have remedies where the business has engaged in misleading conduct or imposes an unfair contract term. For example, the ACCC is <a href="https://www.accc.gov.au/media-release/accc-court-action-against-eharmony-for-alleged-misleading-online-dating-membership-statements#:%7E:text=The%20ACCC%20has%20today%20commenced%20proceedings%20in%20the,the%20pricing%2C%20renewal%20and%20duration%20of%20its%20memberships.">suing dating site eHarmony</a> for its allegedly misleading subscription practices. In the United States, the Federal Trade Commission <a href="https://www.ftc.gov/news-events/news/press-releases/2024/06/ftc-takes-action-against-adobe-executives-hiding-fees-preventing-consumers-easily-cancelling">has filed a complaint against software company Adobe</a> for allegedly using dark patterns in its subscription practices. The Federal Trade Commission has alleged that “Adobe pushed consumers toward the ‘annual paid monthly’ subscription without adequately disclosing that cancelling the plan in the first year could cost hundreds of dollars”. Adobe <a href="https://news.adobe.com/news/news-details/2024/Adobes-Recent-Statement-Regarding-Updated-Federal-Trade-Commission-Complaint-/default.aspx">issued a statement</a> arguing the commission’s complaint “mischaracterises” its business. The litigation is ongoing. <h2>We need an unfair practices prohibition</h2> Some subscription traps would fall outside the existing consumer law. This is because they don’t meet the test for misleading conduct or unfair contract terms, but make it practically very difficult to cancel. The <a href="https://www.accc.gov.au/media-release/accc-welcomes-consultation-on-possible-unfair-trading-practices-regulatory-reforms">ACCC has advocated</a> for Australia to follow other countries such as the United Kingdom and the United States to enact an unfair practices prohibition to capture conduct like this. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/615487/original/file-20240826-16-2j23h7.png?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/615487/original/file-20240826-16-2j23h7.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/615487/original/file-20240826-16-2j23h7.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=769&fit=crop&dpr=1 600w, https://images.theconversation.com/files/615487/original/file-20240826-16-2j23h7.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=769&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/615487/original/file-20240826-16-2j23h7.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=769&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/615487/original/file-20240826-16-2j23h7.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=966&fit=crop&dpr=1 754w, https://images.theconversation.com/files/615487/original/file-20240826-16-2j23h7.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=966&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/615487/original/file-20240826-16-2j23h7.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=966&fit=crop&dpr=3 2262w" alt="" /></a><figcaption>The shift businesses can make today. <a class="source" href="https://cprc.org.au/wp-content/uploads/2024/08/CPRC_LetMeOut_SubsTraps_Report_FINAL.pdf">CPRC, Let me out – Subscription trap practices in Australia, August 2024</a></figcaption></figure> <h2>Better practices benefit businesses too</h2> The CPRC report also revealed that 90% of Australians would likely purchase from the same organisation if cancelling a subscription process was quick and simple. Businesses focused on a short-sighted cash grab fail to realise that consumers might cancel but later return if treated well. The CPRC highlights businesses that are doing a good job. For instance, the habit change app Atoms (based on James Clear’s book Atomic Habits) has a genuinely free trial. It doesn’t require credit card details, doesn’t auto-renew, and lets consumers know how many trial days remain. The CPRC says the charity World Vision doesn’t auto-renew annual sponsorships, but reminds supporters about when the sponsorship will lapse. Importantly, some businesses – such as Netflix – use their data for good in this context. They notice when users are paying for the service without using it and help them unsubscribe. These practices should be applauded. But we need an unfair practices prohibition for businesses who don’t follow suit and recognise the long-term benefits of treating customers fairly.<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/237236/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/katharine-kemp-402096">Katharine Kemp</a>, Associate Professor, Faculty of Law & Justice; Lead, UNSW Public Interest Law & Tech Initiative, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/why-is-it-so-hard-to-cancel-subscriptions-or-end-free-trials-report-shows-how-companies-trap-you-into-paying-237236">original article</a>. </div>

Money & Banking

How long does back pain last? And how can learning about pain increase the chance of recovery?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/sarah-wallwork-1361569">Sarah Wallwork</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/lorimer-moseley-1552">Lorimer Moseley</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> Back pain is common. One in thirteen people have it right now and worldwide a staggering 619 million people will <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186678/">have it this year</a>. Chronic pain, of which back pain is the most common, is the world’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186678/">most disabling</a> health problem. Its economic impact <a href="https://www.ncbi.nlm.nih.gov/books/NBK92510/">dwarfs other health conditions</a>. If you get back pain, how long will it take to go away? We scoured the scientific literature to <a href="https://www.cmaj.ca/content/cmaj/196/2/E29.full.pdf">find out</a>. We found data on almost 20,000 people, from 95 different studies and split them into three groups: <ul> <li>acute – those with back pain that started less than six weeks ago</li> <li>subacute – where it started between six and 12 weeks ago</li> <li>chronic – where it started between three months and one year ago.</li> </ul> We found 70%–95% of people with acute back pain were likely to recover within six months. This dropped to 40%–70% for subacute back pain and to 12%–16% for chronic back pain. Clinical guidelines point to graded return to activity and pain education under the guidance of a health professional as the best ways to promote recovery. Yet these effective interventions are underfunded and hard to access. <h2>More pain doesn’t mean a more serious injury</h2> Most acute back pain episodes are <a href="https://www.racgp.org.au/getattachment/75af0cfd-6182-4328-ad23-04ad8618920f/attachment.aspx">not caused</a> by serious injury or disease. There are rare exceptions, which is why it’s wise to see your doctor or physio, who can check for signs and symptoms that warrant further investigation. But unless you have been in a significant accident or sustained a large blow, you are unlikely to have caused much damage to your spine. Even very minor back injuries can be brutally painful. This is, in part, because of how we are made. If you think of your spinal cord as a very precious asset (which it is), worthy of great protection (which it is), a bit like the crown jewels, then what would be the best way to keep it safe? Lots of protection and a highly sensitive alarm system. The spinal cord is protected by strong bones, thick ligaments, powerful muscles and a highly effective alarm system (your nervous system). This alarm system can trigger pain that is so unpleasant that you cannot possibly think of, let alone do, anything other than seek care or avoid movement. The messy truth is that when pain persists, the pain system becomes more sensitive, so a widening array of things contribute to pain. This pain system hypersensitivity is a result of neuroplasticity – your nervous system is becoming better at making pain. <h2>Reduce your chance of lasting pain</h2> Whether or not your pain resolves is not determined by the extent of injury to your back. We don’t know all the factors involved, but we do know there are things that you can do to reduce chronic back pain: <ul> <li> understand how pain really works. This will involve intentionally learning about modern pain science and care. It will be difficult but rewarding. It will help you work out what you can do to change your pain </li> <li> reduce your pain system sensitivity. With guidance, patience and persistence, you can learn how to gradually retrain your pain system back towards normal. </li> </ul> <h2>How to reduce your pain sensitivity and learn about pain</h2> Learning about “how pain works” provides the most sustainable <a href="https://www.bmj.com/content/376/bmj-2021-067718">improvements in chronic back pain</a>. Programs that combine pain education with graded brain and body exercises (gradual increases in movement) can reduce pain system sensitivity and help you return to the life you want. These programs have been in development for years, but high-quality clinical trials <a href="https://jamanetwork.com/journals/jama/fullarticle/2794765">are now emerging</a> and it’s good news: they show most people with chronic back pain improve and many completely recover. But most clinicians aren’t equipped to deliver these effective programs – <a href="https://www.jpain.org/article/S1526-5900(23)00618-1/fulltext">good pain education</a> is not taught in most medical and health training degrees. Many patients still receive ineffective and often risky and expensive treatments, or keep seeking temporary pain relief, hoping for a cure. When health professionals don’t have adequate pain education training, they can deliver bad pain education, which leaves patients feeling like they’ve just <a href="https://www.jpain.org/article/S1526-5900(23)00618-1/fulltext">been told it’s all in their head</a>. Community-driven not-for-profit organisations such as <a href="https://www.painrevolution.org/">Pain Revolution</a> are training health professionals to be good pain educators and raising awareness among the general public about the modern science of pain and the best treatments. Pain Revolution has partnered with dozens of health services and community agencies to train more than <a href="https://www.painrevolution.org/find-a-lpe">80 local pain educators</a> and supported them to bring greater understanding and improved care to their colleagues and community. But a broader system-wide approach, with government, industry and philanthropic support, is needed to expand these programs and fund good pain education. To solve the massive problem of chronic back pain, effective interventions need to be part of standard care, not as a last resort after years of increasing pain, suffering and disability.<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/222513/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/sarah-wallwork-1361569">Sarah Wallwork</a>, Post-doctoral Researcher, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/lorimer-moseley-1552">Lorimer Moseley</a>, Professor of Clinical Neurosciences and Foundation Chair in Physiotherapy, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</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-long-does-back-pain-last-and-how-can-learning-about-pain-increase-the-chance-of-recovery-222513">original article</a>. </div>

Body

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

Thinking about trying physiotherapy for endometriosis pain? Here’s what to expect

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/peter-stubbs-1531259">Peter Stubbs</a>, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a> and <a href="https://theconversation.com/profiles/caroline-wanderley-souto-ferreira-1563754">Caroline Wanderley Souto Ferreira</a>, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a> Endometriosis is a condition that affects women and girls. It occurs when tissue similar to the lining of the uterus ends up in other areas of the body. These areas <a href="https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656">include</a> the ovaries, bladder, bowel and digestive tract. Endometriosis will <a href="https://endometriosisaustralia.org/understanding-endometriosis/">affect</a> nearly one million Australian women and girls in their lifetime. Many high-profile Australians are affected by endometriosis including <a href="https://www.endofound.org/bindi-irwin-shares-her-endometriosis-story-in-detail-as-she-prepares-to-receive-endofounds-blossom-a">Bindi Irwin</a>, <a href="https://www.endofound.org/actress-sophie-monk-reveals-endometriosis-diagnosis">Sophie Monk</a> and former Yellow Wiggle, <a href="https://endometriosisaustralia.org/emma-watkins-ambassador/">Emma Watkins</a>. <a href="https://www.sciencedirect.com/science/article/pii/S0092867421005766">Symptoms</a> of endometriosis include intense pelvic, abdominal or low back pain (that is often worse during menstruation), bladder and bowel problems, pain during sex and infertility. But women and girls wait an average of <a href="https://www.epworth.org.au/newsroom/reducing-time-to-an-endometriosis-diagnosis">seven years to receive a diagnosis</a>. Many are living with the burden of endometriosis and not receiving treatments that could improve their quality of life. This includes physiotherapy. <h2>How is endometriosis treated?</h2> No treatments cure endometriosis. Symptoms can be reduced by taking <a href="https://www.nichd.nih.gov/health/topics/endometri/conditioninfo/treatment">medications</a> such as non-steriodal anti-inflammatories (ibuprofen, aspirin or naproxen) and hormonal medicines. Surgery is sometimes used to diagnose endometriosis, remove endometrial lesions, reduce pain and improve fertility. But these lesions can <a href="https://pubmed.ncbi.nlm.nih.gov/39098538/">grow back</a>. Whether they take medication or have surgery, many women and girls continue to experience pain and other symptoms. Pelvic health physiotherapy is <a href="https://australian.physio/inmotion/physiotherapists-can-help-endometriosis">often recommended</a> as a non-drug management technique to manage endometriosis pain, <a href="https://www1.racgp.org.au/ajgp/2024/january-february/endometriosis">in consultation</a> with a gynaecologist or general practitioner. The goal of physiotherapy treatment depends on the symptoms but is usually to reduce and manage pain, improve ability to do activities, and ultimately improve quality of life. <h2>What could you expect from your first appointment?</h2> Physiotherapy management can differ based on the severity and location of symptoms. Prior to physical tests and treatments, your physiotherapist will comprehensively explain what is going to happen and seek your permission. They will ask questions to better understand your case and specific needs. These will include your age, weight, height as well as the presence, location and intensity of symptoms. You will also be asked about the history of your period pain, your first period, the length of your menstrual cycle, urinary and bowel symptoms, sexual function and details of any previous treatments and tests. They may also assess your posture and movement to see how your muscles have changed because of the related symptoms. They will press on your lower back and pelvic muscles to spot painful areas (trigger points) and muscle tightness. If you consent to a vaginal examination, the physiotherapist will use one to two gloved fingers to assess the area inside and around your vagina. They will also test your ability to coordinate, contract and relax your pelvic muscles. <h2>What type of treatments could you receive?</h2> Depending on your symptoms, your physiotherapist may use the following treatments: General education Your physiotherapist will give your details about the disease, pelvic floor anatomy, the types of treatment and how these can improve pain and other symptoms. They might <a href="https://pubmed.ncbi.nlm.nih.gov/38452219/">teach you about</a> the changes to the brain and nerves as a result of being in long-term pain. They will provide guidance to improve your ability to perform daily activities, including getting quality sleep. If you experience pain during sex or difficulty using tampons, they may teach you how to use vaginal dilators to improve flexibility of those muscles. Pelvic muscle exercises Pelvic muscles often contract too hard as a result of pain. <a href="https://www.physio-pedia.com/Pelvic_Floor_Exercises">Pelvic floor exercises</a> will help you contract and relax muscles appropriately and provide an awareness of how hard muscles are contracting. This can be combined with machines that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7843943/">monitor muscle activity or vaginal pressure</a> to provide detailed information on how the muscles are working. Yoga, stretching and low-impact exercises <a href="https://pubmed.ncbi.nlm.nih.gov/27869485/">Yoga</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/37467936/">stretching and low impact aerobic exercise</a> can improve fitness, flexibility, pain and blood circulation. These have <a href="https://pubmed.ncbi.nlm.nih.gov/28369946/">general pain-relieving properties</a> and can be a great way to contract and relax bigger muscles affected by long-term endometriosis. These exercises can help you regain function and control with a gradual progression to perform daily activities with reduced pain. Hydrotherapy (physiotherapy in warm water) Performing exercises in water improves blood circulation and muscle relaxation due to the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4049052/">pressure and warmth of the water</a>. Hydrotherapy allows you to perform aerobic exercise with low impact, which will reduce pain while exercising. However, while hydrotherapy shows positive results clinically, scientific studies to show its effectiveness studies <a href="https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619001611112">are ongoing</a>. Manual therapy Women frequently have small areas of muscle that are tight and painful (trigger points) inside and outside the vagina. Pain can be temporarily reduced by <a href="https://pubmed.ncbi.nlm.nih.gov/37176750/">pressing, massaging or putting heat on</a> the muscles. Physiotherapists can teach patients how to do these techniques by themselves at home. <h2>What does the evidence say?</h2> Overall, patients report <a href="https://www.wmhp.com.au/blog/endo-story">positive experiences</a> pelvic health physiotherapists treatments. In a <a href="https://pubmed.ncbi.nlm.nih.gov/37176750/">study of 42 women</a>, 80% of those who received manual therapy had “much improved pain”. In studies investigating yoga, one study <a href="https://pubmed.ncbi.nlm.nih.gov/27869485/">showed</a> pain was reduced in 28 patients by an average of 30 points on a 100-point pain scale. Another study showed yoga was beneficial for pain in <a href="https://pubmed.ncbi.nlm.nih.gov/27552065/">all 15 patients</a>. But while some studies show this treatment <a href="https://pubmed.ncbi.nlm.nih.gov/36571475/">is effective</a>, a review <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9740037/">concluded</a> more studies were needed and the use of physiotherapy was “underestimated and underpublicised”. <h2>What else do you need to know?</h2> If you have or suspect you have endometriosis, consult your gynaecologist or GP. They may be able to suggest a pelvic health physiotherapist to help you manage your symptoms and improve quality of life. As endometriosis is a chronic condition you <a href="https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=10960">may be entitled</a> to five subsidised or free sessions per calendar year in clinics that accept Medicare. If you go to a private pelvic health physiotherapist, you won’t need a referral from a gynaecologist or GP. Physiotherapy rebates can be available to those with private health insurance. The Australian Physiotherapy Association has a <a href="https://choose.physio/find-a-physio">Find a Physio</a> section where you can search for women’s and pelvic physiotherapists. <a href="https://endometriosisaustralia.org/">Endometriosis Australia</a> also provides assistance and advice to women with Endometriosis. Thanks to UTS Masters students Phoebe Walker and Kasey Collins, who are researching physiotherapy treatments for endometriosis, for their contribution to this article.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/236328/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/peter-stubbs-1531259">Peter Stubbs</a>, Senior Lecturer in Physiotherapy, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a> and <a href="https://theconversation.com/profiles/caroline-wanderley-souto-ferreira-1563754">Caroline Wanderley Souto Ferreira</a>, Visiting Professor of Physiotherapy, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology 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/thinking-about-trying-physiotherapy-for-endometriosis-pain-heres-what-to-expect-236328">original article</a>. </div>

Body

No, your aches and pains don’t get worse in the cold. So why do we think they do?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/manuela-ferreira-161420">Manuela Ferreira</a>, <a href="https://theconversation.com/institutions/george-institute-for-global-health-874">George Institute for Global Health</a> and <a href="https://theconversation.com/profiles/leticia-deveza-1550633">Leticia Deveza</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> It’s cold and wet outside. As you get out of bed, you can feel it in your bones. Your right knee is flaring up again. That’ll make it harder for you to walk the dog or go to the gym. You think it must be because of the weather. It’s a common idea, but a myth. When we looked at the evidence, <a href="https://www.sciencedirect.com/science/article/pii/S0049017224000337">we found</a> no direct link between most common aches and pains and the weather. In the first study of its kind, we found no direct link between the temperature or humidity with most joint or muscle aches and pains. So why are so many of us convinced the weather’s to blame? Here’s what we think is really going on. <h2>Weather can be linked to your health</h2> The weather is often associated with the risk of new and ongoing health conditions. For example, cold temperatures <a href="https://pubmed.ncbi.nlm.nih.gov/27021573/">may worsen</a> asthma symptoms. Hot temperatures <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(22)00117-6/fulltext">increase the risk</a> of heart problems, such as arrhythmia (irregular heartbeat), cardiac arrest and coronary heart disease. Many people are also convinced the weather is linked to their aches and pains. For example, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1479-8077.2004.00099.x?casa_token=jvpSbA4szqoAAAAA%3ATyHyGaqXmfevWyuJe6LW_3Pap3IPHC8HSMTl3RN63mFzNO0X7ozQjBb6Bi3yVFuPjqkrf-WlB-J5A1q1">two in every three</a> people with knee, hip or hand osteoarthritis <a href="https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-15-66">say</a> cold temperatures trigger their symptoms. Musculoskeletal conditions affect more than <a href="https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/musculoskeletal-conditions-comorbidity-australia/summary">seven million Australians</a>. So we set out to find out whether weather is really the culprit behind winter flare-ups. <h2>What we did</h2> Very few studies have been specifically and appropriately designed to look for any direct link between weather changes and joint or muscle pain. And ours is the first to evaluate data from these particular studies. We looked at data from more than 15,000 people from around the world. Together, these people reported more than 28,000 episodes of pain, mostly back pain, knee or hip osteoarthritis. People with rheumatoid arthritis and gout were also included. We then compared the frequency of those pain reports between different types of weather: hot or cold, humid or dry, rainy, windy, as well as some combinations (for example, hot and humid versus cold and dry). <h2>What we found</h2> We found changes in air temperature, humidity, air pressure and rainfall do not increase the risk of knee, hip or lower back pain symptoms and are not associated with people seeking care for a new episode of arthritis. The results of this study suggest we do not experience joint or muscle pain flare-ups as a result of changes in the weather, and a cold day will not increase our risk of having knee or back pain. In order words, there is no direct link between the weather and back, knee or hip pain, nor will it give you arthritis. It is important to note, though, that very cold air temperatures (under 10°C) were rarely studied so we cannot make conclusions about worsening symptoms in more extreme changes in the weather. The only exception to our findings was for gout, an inflammatory type of arthritis that can come and go. Here, pain increased in warmer, dry conditions. Gout has a very different underlying biological mechanism to back pain or knee and hip osteoarthritis, which may explain our results. The combination of warm and dry weather may lead to increased dehydration and consequently increased concentration of uric acid in the blood, and deposition of uric acid crystals in the joint in people with gout, resulting in a flare-up. <h2>Why do people blame the weather?</h2> The weather can influence other factors and behaviours that consequently shape how we perceive and manage pain. For example, some people may change their physical activity routine during winter, choosing the couch over the gym. And we know <a href="https://pubmed.ncbi.nlm.nih.gov/28700451/">prolonged sitting</a>, for instance, is directly linked to worse back pain. Others may change their sleep routine or sleep less well when it is either too cold or too warm. Once again, a bad night’s sleep can trigger your <a href="https://link.springer.com/article/10.1007/s00586-021-06730-6">back</a> and <a href="https://www.sciencedirect.com/science/article/pii/S1063458421007020">knee</a> pain. Likewise, changes in mood, often experienced in cold weather, trigger increases in both <a href="https://link.springer.com/article/10.1007/s00586-021-06730-6">back</a> and <a href="https://www.sciencedirect.com/science/article/pii/S1063458421007020">knee</a> pain. So these changes in behaviour over winter may contribute to more aches and pains, and not the weather itself. Believing our pain will feel worse in winter (even if this is not the case) may also make us feel worse in winter. This is known as the <a href="https://link.springer.com/article/10.1186/s12891-018-1943-8">nocebo effect</a>. <h2>What to do about winter aches and pains?</h2> It’s best to focus on risk factors for pain you can control and modify, rather than ones you can’t (such as the weather). You can: <ul> <li> become more physically active. This winter, and throughout the year, aim to walk more, or talk to your health-care provider about gentle exercises you can safely do at home, with a physiotherapist, personal trainer or at the pool </li> <li> lose weight if obese or overweight, as this is linked to <a href="https://jamanetwork.com/journals/jama/article-abstract/2799405">lower levels</a> of joint pain and better physical function </li> <li> keep your body warm in winter if you feel some muscle tension in uncomfortably cold conditions. Also ensure your bedroom is nice and warm as we tend to sleep <a href="https://www.sciencedirect.com/science/article/pii/S0033350623003359">less well</a> in cold rooms </li> <li> maintain a healthy diet and <a href="https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(23)00098-X/fulltext">avoid smoking</a> or drinking high levels of alcohol. These are among <a href="https://ard.bmj.com/content/annrheumdis/82/1/48.full.pdf">key lifestyle recommendations</a> to better manage many types of arthritis and musculoskeletal conditions. For people with back pain, for example, a healthy lifestyle is linked with <a href="https://pubmed.ncbi.nlm.nih.gov/36208321/">higher levels</a> of physical function.<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/235117/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> </li> </ul> <a href="https://theconversation.com/profiles/manuela-ferreira-161420">Manuela Ferreira</a>, Professor of Musculoskeletal Health, Head of Musculoskeletal Program, <a href="https://theconversation.com/institutions/george-institute-for-global-health-874">George Institute for Global Health</a> and <a href="https://theconversation.com/profiles/leticia-deveza-1550633">Leticia Deveza</a>, Rheumatologist and Research Fellow, <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/no-your-aches-and-pains-dont-get-worse-in-the-cold-so-why-do-we-think-they-do-235117">original article</a>. </div>

Body

Mysterious leg pain that’s quietly killing older Australians

Peripheral Artery Disease (PAD) has long been overshadowed by its more widely recognised counterparts, such as heart attacks and strokes. Often referred to as the “poor cousin” or “Cinderella” of cardiovascular diseases, PAD affects one in five older Australians, yet it remains largely under-diagnosed and misunderstood. However, a wave of optimism is sweeping through the medical community with the launch of <a href="https://www.hri.org.au/our-research/centreforpad" target="_blank" rel="noopener">The Centre for Peripheral Artery Disease</a>, an Australian-first facility dedicated to pioneering research and improving patient outcomes. Spearheaded by the Heart Research Institute, the Centre for Peripheral Artery Disease, marks a significant step forward in addressing the challenges posed by PAD. The centre aims to fill critical gaps in our understanding of the disease, which is responsible for a limb amputation in Australia every two hours. This initiative promises to enhance diagnosis, transform patient care, and raise awareness about PAD. Associate Professor Mary Kavurma, the Centre Lead, is at the forefront of this ground-breaking effort. “We’re supercharging research into PAD because there are still many unknowns about the disease’s biology that could unlock new methods for early detection and better management,” she explains. This research is particularly urgent given the prevalence of PAD among women and First Nations Australians, groups that remain disproportionately affected by this condition. The centre’s mission is to develop a simple blood test for early diagnosis and explore novel therapies that could reduce the need for limb amputations and significantly improve patients’ quality of life. Unlike current treatments that primarily focus on symptom management, this new approach seeks to prevent the disease from progressing. One of the most inspiring aspects of the centre is its commitment to involving patients and their families in the research process. At the inaugural consumer meeting, nearly 20 patients and their carers shared their personal experiences with PAD. Take the story of Simon Josephson, a renowned advertising guru – who famously designed the Solo logo. PAD almost cost him his life after taking more than five years to diagnose. He woke up one morning with a sore leg, thinking he’d overdone it exercising but the 73-year-old – who was otherwise healthy and active – unknowingly had Peripheral Artery Disease, caused by a build-up of plaque in his arteries causing them to narrow and stiffen. It wasn’t until a trip to the hospital emergency department years later that doctors would discover his aorta had expanded to more than twice the usual size and was at risk of rupturing. He immediately underwent open heart surgery and has faced a lengthy recovery. The launch of <a href="https://www.hri.org.au/our-research/centreforpad" target="_blank" rel="noopener">The Centre for Peripheral Artery Disease</a> heralds a new era of hope and progress in the fight against PAD. Through world-leading research, community engagement, and a commitment to patient-centred care, the CPAD is poised to make a profound impact on the lives of many Australians. As Assoc Prof Kavurma aptly put it, “By understanding more about this debilitating condition, we are paving the way for better health outcomes and a brighter future for all those affected by PAD.” Images: CPAD

Caring

Why Greg Lynn could walk free from prison

Greg Lynn has applied to be freed from jail until his sentencing hearing over the murder of Carol Clay. The former Jetstar pilot, who was found guilty of murdering the 73-year-old while she was camping with her secret partner Russell Hill in March 2020, is appealing the guilty verdict which the jury came to after a weeks-long trial in June. The 57-year old appeared in the Supreme Court of Victoria on Friday where Justice Michael Croucher heard the convicted killer had been the victim of prison attacks during his six-week trial. The court heard Lynn's barrister Dermot Dann KC is in the process of compiling submissions calling on Justice Croucher to hold of on sentencing his client until an appeal over his conviction can be heard by the Court of Appeal. If granted, the "stay" of sentence could allow Lynn to apply for bail while his appeal goes through the court. The court also heard that Lynn had been placed in isolation within the Metropolitan Remand Prison for his own safety since the guilty verdict was read, but now fears he will be targeted by inmates at whatever prison he ultimately ends up in. Mr Dann said a successful appeal could result in Lynn being set free altogether without the possibility of a re-trial, due to doubts over whether he could obtain a fair trial because of the significant publicity surrounding the case and the murder conviction. "The chances of a fair re-trial are non-existent," Mr Dann said. The experienced barrister said any potential jurors would have been "polluted or poisoned" by the "inadmissible evidence" that has "flooded" news sites since the guilty verdict was delivered. The court heard Mr Dann believed his client had multiple reasons to push for an appeal over his verdict, including the "unfair" way in which he claimed the Office of Public Prosecutions carried out the trial. Mr Dann reiterated to the court that his client has always maintained his innocence, saying, "He maintains that he's never killed any person at any time, at any place, anywhere, ever." <div data-component="EmphasisedText"> "The long-term future of that guilty verdict must be seen as being in grave doubt." The case was adjourned until a pre-sentence hearing on September 12th. Image credits: Facebook </div>

Legal

"The pain is unbearable": Nick Campo's family speaks out

The parents of a Perth teenager who tragically died in a car crash have started an emotional campaign for road safety in the name of their late son. Budding footballer Nick Campo, who had just turned 18, was the rear passenger in a Toyota HiLux that rolled and collided with a Jeep Patriot in Perth’s southern suburbs on Saturday night and was pronounced <a href="https://www.oversixty.com.au/health/caring/rising-star-footy-player-dies-at-just-18" target="_blank" rel="noopener">dead</a> at the scene. Campo's parents Daniel and Bianca told <a href="https://www.9news.com.au/national/nick-campo-parents-speak-of-unbearable-pain-after-losing-son-to-horror-crash/a5ab695f-d536-4fbb-9a95-088e155e3cba" target="_blank" rel="noopener">9News</a> of their "unbearable pain" since the sudden and tragic loss of their son. "My Nick, he was definitely one of a kind," his mum Bianca said. "I knew he was special, but he was really special to a lot of people." "And he was a beautiful boy, and he's going to be missed by so many, so many people." His father Daniel said his son was "the complete package" but was best known for his quick wit cheekiness. "If you had to sum Nick up in one word, 'cheeky'," he said. "From day dot .... Cheeky, cheeky." Sitting in the ute alongside Nick at the time of the crash were two of his teammates from the South Fremantle Football club, as well as the 17-year-old driver and one other young man. "He loved footy, he loved cricket, he just was so committed," his mum said. "He loved getting around all the boys, you know all the teammates. He loved being in the clubs." The 17-year-old boy accused of being behind the wheel, who was also injured in the crash alongside one of the other passengers, is facing serious charges. Another boy is fighting for his life in Royal Perth Hospital. Nick's parents are praying their son's friend pulls through and don't want other families to go through what they have gone through. "(Because) It is, it is the worst nightmare that you can imagine and the pain is unbearable," his mum said. The family is now channelling their grief towards a road safety campaign called "Call Out for Nick". "If it doesn't look right, that person doesn't look right to drive, the habits - it's got to be called out," his father said. "We see it every day - young kids they think they're bulletproof, they're not." Image credits: Nine

Caring

Optus giving away 20,000 free phones to vulnerable customers

Optus will be giving away 20,000 mobile phones to vulnerable customers ahead of the 3G network shut down. Following the footsteps of Telstra, who gave out <a href="https://www.oversixty.com.au/finance/money-banking/telstra-giving-free-phones-to-elderly-and-remote" target="_blank" rel="noopener">12,000 mobile phones</a> to their most vulnerable remote and elderly customers last month, Optus will offer thousands of free mobile phones to customers enduring financial hardship and vulnerable customers finding it difficult to replace their current phones. “We know that many impacted customers are actually using a 4G handset that reverts to 3G for calls, so it’s vital these customers understand the importance of upgrading their handsets when notified,” Optus’ head of new products Harvey Wright said. Messages have been sent to eligible customers, and the telco giant has also rolled out special deals encouraging Australian's to upgrade. The move to switch off 3G means that soon certain mobile devices will no longer be able to send texts, make calls, or contact triple-0 in an emergency. A few older 4G handsets will also be affected. Telstra will turn off their 3G network on August 31, while Optus will turn it off on September 1. TPG Telecom and Vodafone have already turned it off. Australia's mobile network operators say that the move will help boost the capacity, speed and reliability of the newer 4G and 5G networks. The Australian Mobile Telecommunications Association (AMTA) have also urged customers to take action to ensure that they stay connected. “Whether it’s your day-to-day mobile or one you keep in the drawer for an emergency, we encourage you to check all of your devices to ensure they will be supported once Australia’s 3G networks are switched off,” AMTA chief executive Louise Hyland said. The AMTA suggests that concerned customers should visit their <a href="https://amta.org.au/3g-closure/" target="_blank" rel="noopener">website</a> to find out if their devices will be supported. “It is important to note that while 3G networks are still in operation, those affected mobile devices will continue to connect to any available 3G network while in coverage, to make emergency calls to triple-0,” Hyland said. “However, once the 3G networks are fully closed, these phones will not be able to make emergency calls. “It is crucial to act now if you know you have an older mobile device and you haven’t already upgraded.” Image: Shutterstock

Money & Banking

Tastes from our past can spark memories, trigger pain or boost wellbeing. Here’s how to embrace food nostalgia

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/megan-lee-490875">Megan Lee</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a>; <a href="https://theconversation.com/profiles/doug-angus-1542552">Doug Angus</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a>, and <a href="https://theconversation.com/profiles/kate-simpson-1542551">Kate Simpson</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Have you ever tried to bring back fond memories by eating or drinking something unique to that time and place? It could be a Pina Colada that recalls an island holiday? Or a steaming bowl of pho just like the one you had in Vietnam? Perhaps eating a favourite dish reminds you of a lost loved one – like the sticky date pudding Nanna used to make? If you have, you have tapped into <a href="https://www.tandfonline.com/doi/full/10.1080/02699931.2022.2142525">food-evoked nostalgia</a>. As researchers, we are exploring how eating and drinking certain things from your past may be important for your mood and mental health. <h2>Bittersweet longing</h2> First named in 1688 by Swiss medical student, <a href="https://www.jstor.org/stable/44437799">Johannes Hoffer</a>, <a href="https://compass.onlinelibrary.wiley.com/doi/10.1111/spc3.12070">nostalgia</a> is that bittersweet, sentimental longing for the past. It is experienced <a href="https://journals.sagepub.com/doi/10.1111/j.1467-8721.2008.00595.x">universally</a> across different cultures and lifespans from childhood into older age. But nostalgia does not just involve positive or happy memories – we can also experience nostalgia for <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2F0022-3514.91.5.975">sad and unhappy moments</a> in our lives. In the <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Femo0000817">short and long term</a>, nostalgia can positively impact our health by improving <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Fa0025167">mood</a> and <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Femo0000817">wellbeing</a>, fostering <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Fa0017597">social connection</a> and increasing quality of life. It can also trigger feelings of <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Femo0000817">loneliness or meaninglessness</a>. We can use nostalgia to <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Fa0025167">turn around a negative mood</a> or enhance our sense of <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Femo0000817">self, meaning and positivity</a>. Research suggests nostalgia alters activity in the <a href="https://academic.oup.com/scan/article/17/12/1131/6585517">brain regions associated with reward processing</a> – the same areas involved when we seek and receive things we like. This could explain the <a href="https://www.sciencedirect.com/science/article/abs/pii/S2352250X22002445?via%3Dihub">positive feelings</a> it can bring. Nostalgia can also increase feelings of loneliness and sadness, particularly if the memories highlight dissatisfaction, grieving, loss, or wistful feelings for the past. This is likely due to activation of <a href="https://www.sciencedirect.com/science/article/pii/S2352250X22002445?casa_token=V31ORDWcsx4AAAAA:Vef9hiwUz9506f5PYGsXH-JxCcnsptQnVPNaAGares2xTU5JbKSHakwGpLxSRO2dNckrdFGubA">brain areas</a> such as the amygdala, responsible for processing emotions and the prefrontal cortex that helps us integrate feelings and memories and regulate emotion. <h2>How to get back there</h2> There are several ways we can <a href="https://psycnet.apa.org/fulltext/2006-20034-013.html">trigger</a> or tap into nostalgia. Conversations with family and friends who have shared experiences, unique objects like photos, and smells can <a href="https://www.sciencedirect.com/science/article/abs/pii/S2352250X23000076">transport us back</a> to old times or places. So can a favourite song or old TV show, reunions with former classmates, even social media <a href="https://www.theverge.com/2015/3/24/8284703/facebook-on-this-day-nostalgia-recap">posts and anniversaries</a>. What we eat and drink can trigger <a href="https://www.emerald.com/insight/content/doi/10.1108/QMR-06-2012-0027/full/html">food-evoked nostalgia</a>. For instance, when we think of something as “<a href="https://theconversation.com/health-check-why-do-we-crave-comfort-food-in-winter-118776">comfort food</a>”, there are likely elements of nostalgia at play. Foods you found comforting as a child can evoke memories of being cared for and nurtured by loved ones. The form of these foods and the stories we tell about them may have been handed down through generations. Food-evoked nostalgia can be very powerful because it engages multiple senses: taste, smell, texture, sight and sound. The sense of <a href="https://www.tandfonline.com/doi/full/10.1080/09658211.2013.876048?casa_token=wqShWbRXJaYAAAAA%3AqJabgHtEbPtEQp7qHnl7wOb527bpGxzIJ_JwQX8eAyq1IrM_HQFIng8ELAMyuoFoeZyiX1zeJTPf">smell</a> is closely linked to the limbic system in the brain responsible for emotion and memory making food-related memories particularly vivid and emotionally charged. But, food-evoked nostalgia can also give rise to <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/hpja.873">negative memories</a>, such as of being forced to eat a certain vegetable you disliked as a child, or a food eaten during a sad moment like a loved ones funeral. Understanding why these foods <a href="https://www.tandfonline.com/doi/full/10.1080/02699931.2022.2142525?casa_token=16kAPHUQTukAAAAA%3A9IDvre8yUT8UsuiR_ltsG-3qgE2sdkIFgcrdH3T5EYbVEP9JZwPcsbmsPLT6Kch5EFFs9RPsMTNn">evoke negative memories</a> could help us process and overcome some of our adult food aversions. Encountering these foods in a positive light may help us reframe the memory associated with them. <h2>What people told us about food and nostalgia</h2> Recently <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/hpja.873">we interviewed eight Australians</a> and asked them about their experiences with food-evoked nostalgia and the influence on their mood. We wanted to find out whether they experienced food-evoked nostalgia and if so, what foods triggered pleasant and unpleasant memories and feelings for them. They reported they could use foods that were linked to times in their past to manipulate and influence their mood. Common foods they described as particularly nostalgia triggering were homemade meals, foods from school camp, cultural and ethnic foods, childhood favourites, comfort foods, special treats and snacks they were allowed as children, and holiday or celebration foods. One participant commented: <blockquote> I guess part of this nostalgia is maybe […] The healing qualities that food has in mental wellbeing. I think food heals for us. </blockquote> Another explained <blockquote> I feel really happy, and I guess fortunate to have these kinds of foods that I can turn to, and they have these memories, and I love the feeling of nostalgia and reminiscing and things that remind me of good times. </blockquote> Understanding food-evoked nostalgia is valuable because it provides us with an insight into how our sensory experiences and emotions intertwine with our memories and identity. While we know a lot about how food triggers nostalgic memories, there is still much to learn about the specific brain areas involved and the differences in food-evoked nostalgia in different cultures. In the future we may be able to use the science behind food-evoked nostalgia to help people experiencing dementia to tap into lost memories or in psychological therapy to help people reframe negative experiences. So, if you are ever feeling a little down and want to improve your mood, consider turning to one of your favourite comfort foods that remind you of home, your loved ones or a holiday long ago. Transporting yourself back to those times could help turn things around.<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/232826/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/megan-lee-490875">Megan Lee</a>, Senior Teaching Fellow, Psychology, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a>; <a href="https://theconversation.com/profiles/doug-angus-1542552">Doug Angus</a>, Assistant Professor of Psychology, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a>, and <a href="https://theconversation.com/profiles/kate-simpson-1542551">Kate Simpson</a>, Sessional academic, <a href="https://theconversation.com/institutions/bond-university-863">Bond 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/tastes-from-our-past-can-spark-memories-trigger-pain-or-boost-wellbeing-heres-how-to-embrace-food-nostalgia-232826">original article</a>. </div>

Mind

Plastic Free July is a waste of time if the onus is only on consumers

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/bhavna-middha-1061611">Bhavna Middha</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a> and <a href="https://theconversation.com/profiles/ralph-horne-160543">Ralph Horne</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a> Every year, the <a href="https://www.plasticfreejuly.org/">Plastic Free July</a> campaign asks us to refuse single-use plastic. The idea is that making a small change in our daily lives will collectively make a big difference. And hopefully, better behaviour will stick and become a habit. The intent is good, but consumers shouldn’t have to bear full responsibility for plastic pollution. Individual sacrifices – particularly temporary ones – <a href="https://www.sciencedirect.com/science/article/abs/pii/S0301421509004728">won’t make a significant difference</a>. Governments, manufacturers and retailers need to get serious about tackling this problem. If Plastic Free July put pressure on the supply side of the equation, rather than demand, it could be more successful. Our research spans food packaging including plastics, waste, sustainable consumption and social practices. We know consumer demand is only one part of the picture. Eliminating plastic waste requires broader systemic changes. <h2>The cabbage dilemma</h2> Research shows consumers generally want to do the <a href="https://www.sustainability.vic.gov.au/news/news-articles/the-conversation-on-sustainability-has-changed">right thing by the environment</a> but find it <a href="https://theconversation.com/households-find-low-waste-living-challenging-heres-what-needs-to-change-197022">challenging</a>. Coming out of a supermarket with no packaging is difficult. There are few unpackaged food items and even when there is a choice, the unpackaged item may be more <a href="https://www.smh.com.au/politics/federal/want-your-fruit-and-veg-without-the-plastic-you-ll-have-to-pay-more-20231107-p5eib4.html">expensive</a>. Have you ever been stuck in the supermarket, choosing between the large head of cabbage you know you won’t finish before it goes bad, or the plastic-wrapped half-cabbage you really need? Consumers should not be forced to choose between food waste (another huge problem) or plastic waste. Maybe there’s another way. For example, why not sell cabbages of different sizes? Why do we need to grow such large heads of cabbage anyway? Both plastic consumption and food waste can be addressed by changing how we produce and distribute certain foods. <h2>Governments, manufacturers and retailers must drive change</h2> The onus for reducing plastic consumption and waste should be placed firmly on those who make plastic and profit from selling their products, as well as those who make and sell products wrapped in plastic packaging. Research has shown just <a href="https://www.csiro.au/en/news/All/News/2024/April/Global-study-finds-more-than-half-of-branded-plastic-pollution-linked-to-56-companies?utm_source=pocket_shared">56 companies</a> globally are responsible for more than half of the branded plastic pollution that ends up in the environment. Companies profit from using plastics because it is cheaper to use than changing to alternatives, such as cardboard or compostable materials, or using less packaging. This means companies choosing to avoid using plastics face unfair competition. It’s a tough habit to kick. Industry-led <a href="https://productstewardship.us/what-is-epr/#:%7E:text=Stewardship%20can%20be%20either%20voluntary,product%20stewardship%20required%20by%20law">voluntary schemes</a> are <a href="https://www.insidewaste.com.au/91038-2-product-stewardship-schemes/">limited in terms of both participation and outcomes</a>. Many companies are failing to meet their own <a href="https://www.asyousow.org/report-page/2024-plastic-promises-scorecard">plastic reduction goals</a>. Governments need to step in and force companies to take responsibility for the plastic and packaging they manufacture. In practice, this could involve similar schemes to the container deposit scheme for beverage containers, or returning plastics to stores. Replacing voluntary schemes with mandatory regulations and increased producer responsibility means companies will have to <a href="https://www.insidewaste.com.au/91038-2-product-stewardship-schemes/">invest in long-term changes designed with care</a>. <figure><iframe src="https://www.youtube.com/embed/UnXVU-06ciI?wmode=transparent&start=1" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>What’s Plastic Free July?</figcaption></figure> <h2>Cities are built around plastic</h2> Our previous research has shown plastic performs an essential role in some, <a href="https://rgs-ibg.onlinelibrary.wiley.com/doi/full/10.1111/geoj.12457">constrained circumstances</a>. We found vulnerable householders often rely on plastic to make life manageable, such as using plastics to cover belongings on the balcony, or using plastic cutlery and plates in student apartments with minimal kitchen space. This includes people with accessibility needs, people relying on public transport to shop for groceries, or people who are financially constrained or living in small high-rise <a href="https://theconversation.com/we-cant-keep-putting-apartment-residents-waste-in-the-too-hard-basket-200545">apartments</a>. Unsustainable lifestyles are not so much a choice as a product of poorly planned cities, housing and regulations. It is all very well if you are mobile and well-located, but if you live in a <a href="https://www.abc.net.au/news/2015-07-08/food-deserts-have-serious-consequences-for-residents-experts/6605230">poorly serviced</a> distant suburb and <a href="https://www.unsw.edu.au/newsroom/news/2023/01/are-you-living-in-a-food-desert--these-maps-suggest-it-can-reall">transport groceries or takeaway food</a> or buy things on the go, then plastic is perhaps the only current affordable way to make it work. So campaigns and solutions that do not consider how <a href="https://rgs-ibg.onlinelibrary.wiley.com/doi/full/10.1111/geoj.12457">everyday lives and economy</a> are intertwined with plastics can <a href="https://www.nature.com/articles/s42949-024-00149-w">exclude people and spaces</a> who can’t access the alternatives. For example, there are ways to make <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/1745-5871.12464">convenience eating more sustainable</a> in education settings. We have shown how <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/1745-5871.12390">canteens and microwaves</a> in shared spaces can enable people to access affordable food with their friends, as in <a href="https://www.charlesabroad.cz/post/german-university-canteens-why-do-they-beat-the-czech-ones">University Mensa in Germany</a>. Our <a href="https://cur.org.au/project/tackling-food-related-single-use-plastics-in-diverse-consumption-contexts/">new research</a> will explore how single-use food-related plastics and packaging form an integral part of our daily lives, including shopping, work, cooking and storage. Sometimes new policies inadvertently disadvantage certain groups and communities, such as the aged, less mobile, people living in apartments, or low socio-economic groups. Before we roll out new policies and regulations, we need to understand the roles these materials play and the kinds of services and value they provide. We aim to develop a framework to inform policies and strategies that enable a just and inclusive transition to reduced plastic use. <h2>What about after July?</h2> Plastic Free July and similar campaigns are based on idea that making a temporary change will lead to more permanent lifestyle changes. But research shows temporary shifts are <a href="http://www.demand.ac.uk/wp-content/uploads/2016/03/DEMAND2016_Full_paper_42-Shove.pdf">very different</a> to <a href="https://pure.manchester.ac.uk/ws/portalfiles/portal/32468813/FULL_TEXT.PDF">structural, permanent shifts</a> in <a href="https://www.taylorfrancis.com/chapters/edit/10.4324/9781315816494-1/introduction-social-practices-intervention-sustainability-beyond-behaviour-change-yolande-strengers-cecily-maller?context=ubx&refId=d608abad-39f9-4bb2-8754-56e9e2000c5e">practices</a>. Supermarkets will still wrap items in plastic and sell single-use plastic, even if we try to buy less during Plastic Free July. Ultimately, the focus should be on designing effective infrastructure and policy solutions for lasting results, considering how demand for plastic is produced in the first place. Some of these changes will require a shift in community expectations and food culture. Rather than pointing the finger at consumers, let’s get to work on redesigning our cities. We need to rethink how everyday practices, manufacturing and distribution systems are structured to eliminate plastic waste.<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/233436/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/bhavna-middha-1061611">Bhavna Middha</a>, ARC DECRA and Senior Research Fellow, Centre for Urban Research, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a> and <a href="https://theconversation.com/profiles/ralph-horne-160543">Ralph Horne</a>, Associate Deputy Vice Chancellor, Research & Innovation, College of Design & Social Context, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT 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/plastic-free-july-is-a-waste-of-time-if-the-onus-is-only-on-consumers-233436">original article</a>. </div>

Home & Garden

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

Walking can prevent low back pain, a new study shows

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/tash-pocovi-1293184">Tash Pocovi</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>; <a href="https://theconversation.com/profiles/christine-lin-346821">Christine Lin</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>; <a href="https://theconversation.com/profiles/petra-graham-892602">Petra Graham</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>, and <a href="https://theconversation.com/profiles/simon-french-713564">Simon French</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> Do you suffer from low back pain that recurs regularly? If you do, you’re not alone. Roughly <a href="https://pubmed.ncbi.nlm.nih.gov/31208917/">70% of people</a> who recover from an episode of low back pain will experience a new episode in the following year. The recurrent nature of low back pain is a major contributor to the <a href="https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(23)00098-X/fulltext">enormous burden</a> low back pain places on individuals and the health-care system. In our new study, published today in <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00755-4/fulltext">The Lancet</a>, we found that a program combining walking and education can effectively reduce the recurrence of low back pain. <h2>The WalkBack trial</h2> We randomly assigned 701 adults who had recently recovered from an episode of low back pain to receive an individualised walking program and education (intervention), or to a no treatment group (control). Participants in the intervention group were guided by physiotherapists across six sessions, over a six-month period. In the first, third and fifth sessions, the physiotherapist helped each participant to develop a personalised and progressive walking program that was realistic and tailored to their specific needs and preferences. The remaining sessions were short check-ins (typically less than 15 minutes) to monitor progress and troubleshoot any potential barriers to engagement with the walking program. Due to the COVID pandemic, most participants received the entire intervention via telehealth, using video consultations and phone calls. The program was designed to be manageable, with a target of five walks per week of roughly 30 minutes daily by the end of the six-month program. Participants were also encouraged to continue walking independently after the program. Importantly, the walking program was combined with education provided by the physiotherapists during the six sessions. This education aimed to give people a better understanding of pain, reduce fear associated with exercise and movement, and give people the confidence to self-manage any minor recurrences if they occurred. People in the control group received no preventative treatment or education. This reflects what <a href="https://www.sciencedirect.com/science/article/abs/pii/S2468781222001308?via%3Dihub">typically occurs</a> after people recover from an episode of low back pain and are discharged from care. <h2>What the results showed</h2> We monitored the participants monthly from the time they were enrolled in the study, for up to three years, to collect information about any new recurrences of low back pain they may have experienced. We also asked participants to report on any costs related to their back pain, including time off work and the use of health-care services. The intervention reduced the risk of a recurrence of low back pain that limited daily activity by 28%, while the recurrence of low back pain leading participants to seek care from a health professional decreased by 43%. Participants who received the intervention had a longer average period before they had a recurrence, with a median of 208 days pain-free, compared to 112 days in the control group. Overall, we also found this intervention to be cost-effective. The biggest savings came from less work absenteeism and less health service use (such as physiotherapy and massage) among the intervention group. This trial, like all studies, had some limitations to consider. Although we tried to recruit a wide sample, we found that most participants were female, aged between 43 and 66, and were generally well educated. This may limit the extent to which we can generalise our findings. Also, in this trial, we used physiotherapists who were up-skilled in health coaching. So we don’t know whether the intervention would achieve the same impact if it were to be delivered by other clinicians. <h2>Walking has multiple benefits</h2> We’ve all heard the saying that “prevention is better than a cure” – and it’s true. But this approach has been largely neglected when it comes to low back pain. Almost all <a href="https://www.sciencedirect.com/science/article/pii/S0140673618304896?via%3Dihub">previous studies</a> have focused on treating episodes of pain, not preventing future back pain. A limited number of <a href="https://pubmed.ncbi.nlm.nih.gov/26752509/">small studies</a> have shown that exercise and education can help prevent low back pain. However, most of these studies focused on exercises that are not accessible to everyone due to factors such as high cost, complexity, and the need for supervision from health-care or fitness professionals. On the other hand, walking is a free, accessible way to exercise, including for people in rural and remote areas with limited access to health care. Walking also delivers many other <a href="https://www.vichealth.vic.gov.au/sites/default/files/VH_Benefits-of-Walking-Summary2020.pdf">health benefits</a>, including better heart health, improved mood and sleep quality, and reduced risk of several chronic diseases. While walking is not everyone’s favourite form of exercise, the intervention was well-received by most people in our study. Participants <a href="https://pubmed.ncbi.nlm.nih.gov/37271689/">reported</a> that the additional general health benefits contributed to their ongoing motivation to continue the walking program independently. <h2>Why is walking helpful for low back pain?</h2> We don’t know exactly why walking is effective for preventing back pain, but <a href="https://www.e-jer.org/journal/view.php?number=2013600295">possible reasons</a> could include the combination of gentle movements, loading and strengthening of the spinal structures and muscles. It also could be related to relaxation and stress relief, and the release of “feel-good” endorphins, which <a href="https://my.clevelandclinic.org/health/body/23040-endorphins">block pain signals</a> between your body and brain – essentially turning down the dial on pain. It’s possible that other accessible and low-cost forms of exercise, such as swimming, may also be effective in preventing back pain, but surprisingly, <a href="https://pubmed.ncbi.nlm.nih.gov/34783263/">no studies</a> have investigated this. Preventing low back pain is not easy. But these findings give us hope that we are getting closer to a solution, one step at a time.<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/231682/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/tash-pocovi-1293184">Tash Pocovi</a>, Postdoctoral research fellow, Department of Health Sciences, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>; <a href="https://theconversation.com/profiles/christine-lin-346821">Christine Lin</a>, Professor, Institute for Musculoskeletal Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, Professor of Physiotherapy, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>; <a href="https://theconversation.com/profiles/petra-graham-892602">Petra Graham</a>, Associate Professor, School of Mathematical and Physical Sciences, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>, and <a href="https://theconversation.com/profiles/simon-french-713564">Simon French</a>, Professor of Musculoskeletal Disorders, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie 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/walking-can-prevent-low-back-pain-a-new-study-shows-231682">original article</a>. </div>

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Walking can prevent low back pain, a new study shows

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