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"I love you all": Social media star announces her own death

<p>Social media star Kimberley Nix has passed away at the age of 31 after a gruelling battle with cancer, and has announced the news of her own death to her dedicated followers. </p> <p>The TikTok star, who has amassed a following of 143,000 people as she documented her cancer journey, spoke candidly in a pre-filmed video that was posted to her page, letting her followers know that her "journey here is over". </p> <p>Kimberley, who was also a doctor in training, told her fans that if they were seeing the heartbreaking clip, that she had "passed", before sharing that they had made her "so happy".</p> <p>She captioned the viral video, which has so far amassed more than 5.1 million views, "My journey here is over and I can't thank each and every one of you enough. You have all made me so happy and your comments and support are more than enough to have gotten anyone through anything!"</p> <p>"If you wish, please donate through my link in bio to sarcoma cancer research and follow my husband [Michael MacIsaac] in his updates."</p> <p>At the beginning of the clip, Kimberley said, "Hello followers, if you're seeing this clip, I have passed away peacefully. "</p> <p>Holding back tears, she said that she had a "very beautiful life" that she was "so proud" of. </p> <p>"Those who know me, know I love my pets, my husband, and makeup. And though being a doctor is a big part of my identity, those are the things that matter," she said during the heartbreaking clip.</p> <p>Kim went on to note that in 2021 she got the "opportunity to start making TikTok videos", admitting that she "never thought anything would come of it".</p> <p>"I shared about love, joy, and gratitude because in this journey, I was grateful for the people and the little moments."</p> <p>"Those little parts of your day, like that warm first sip of tea in the morning or how it feels when snow is fresh on your face, those are the most beautiful [moments]."</p> <p>At the end of the clip, she thanked her followers for helping her and said that they meant the world to her. </p> <p>"I can't thank you enough, I will miss you TikTok. I love you all. Thank you for this amazing opportunity, I am in happy tears because I have found so much purpose in the end of my life," she said.</p> <p>"Thank you from the bottom of my heart, goodbye."</p> <p>Kimberley was diagnosed with metastatic sarcoma, which is known as cell cancer, at just 28 years old, and she was finishing up her final year of her internal medicine core residency when she got the diagnosis. </p> <p>She is survived by her husband Michael, who she married in February. </p> <p><em>Image credits: TikTok</em></p>

Caring

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Terminal lucidity: why do loved ones with dementia sometimes ‘come back’ before death?

<p><em><a href="https://theconversation.com/profiles/yen-ying-lim-355185">Yen Ying Lim</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/diny-thomson-1519736">Diny Thomson</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a></em></p> <p>Dementia is often described as “the long goodbye”. Although the person is still alive, dementia slowly and irreversibly chips away at their memories and the qualities that make someone “them”.</p> <p>Dementia eventually takes away the person’s ability to communicate, eat and drink on their own, understand where they are, and recognise family members.</p> <p>Since as early as the <a href="https://pubmed.ncbi.nlm.nih.gov/21764150/">19th century</a>, stories from loved ones, caregivers and health-care workers have described some people with dementia suddenly becoming lucid. They have described the person engaging in meaningful conversation, sharing memories that were assumed to have been lost, making jokes, and even requesting meals.</p> <p>It is estimated <a href="https://pubmed.ncbi.nlm.nih.gov/20010032/">43% of people</a> who experience this brief lucidity die within 24 hours, and 84% within a week.</p> <p>Why does this happen?</p> <h2>Terminal lucidity or paradoxical lucidity?</h2> <p>In 2009, researchers Michael Nahm and Bruce Greyson coined the term “<a href="https://pubmed.ncbi.nlm.nih.gov/21764150/">terminal lucidity</a>”, since these lucid episodes often occurred shortly before death.</p> <p>But not all lucid episodes indicate death is imminent. <a href="https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.13667">One study</a> found many people with advanced dementia will show brief glimmers of their old selves more than six months before death.</p> <p>Lucidity has also been <a href="https://www.sciencedirect.com/science/article/pii/S0167494311001865?via%3Dihub">reported</a> in other conditions that affect the brain or thinking skills, such as meningitis, schizophrenia, and in people with brain tumours or who have sustained a brain injury.</p> <p>Moments of lucidity that do not necessarily indicate death are sometimes called <a href="https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.12579">paradoxical lucidity</a>. It is considered paradoxical as it defies the expected course of neurodegenerative diseases such as dementia.</p> <p>But it’s important to note these episodes of lucidity are temporary and sadly do not represent a reversal of neurodegenerative disease.</p> <h2>Why does terminal lucidity happen?</h2> <p>Scientists have struggled to explain why terminal lucidity happens. Some episodes of lucidity have been reported to occur in the presence of loved ones. Others have reported that <a href="https://psywb.springeropen.com/articles/10.1186/s13612-014-0024-5">music can sometimes improve lucidity</a>. But many episodes of lucidity do not have a distinct trigger.</p> <p><a href="https://www.sciencedirect.com/science/article/pii/S0300957223002162">A research team from New York University</a> speculated that changes in brain activity before death may cause terminal lucidity. But this doesn’t fully explain why people suddenly recover abilities that were assumed to be lost.</p> <p>Paradoxical and terminal lucidity are also very difficult to study. Not everyone with advanced dementia will experience episodes of lucidity before death. Lucid episodes are also unpredictable and typically occur without a particular trigger.</p> <p>And as terminal lucidity can be a joyous time for those who witness the episode, it would be unethical for scientists to use that time to conduct their research. At the time of death, it’s also difficult for scientists to interview caregivers about any lucid moments that may have occurred.</p> <p>Explanations for terminal lucidity extend beyond science. These moments of mental clarity may be a way for the dying person to say final goodbyes, gain closure before death, and reconnect with family and friends. Some believe episodes of terminal lucidity are representative of the person connecting with an afterlife.</p> <h2>Why is it important to know about terminal lucidity?</h2> <p>People can have a variety of reactions to seeing terminal lucidity in a person with advanced dementia. While some will experience it as being peaceful and bittersweet, others may find it deeply confusing and upsetting. There may also be an urge to modify care plans and request lifesaving measures for the dying person.</p> <p>Being aware of terminal lucidity can help loved ones understand it is part of the dying process, acknowledge the person with dementia will not recover, and allow them to make the most of the time they have with the lucid person.</p> <p>For those who witness it, terminal lucidity can be a final, precious opportunity to reconnect with the person that existed before dementia took hold and the “long goodbye” began.<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/202342/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><a href="https://theconversation.com/profiles/yen-ying-lim-355185"><em>Yen Ying Lim</em></a><em>, Associate Professor, Turner Institute for Brain and Mental Health, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/diny-thomson-1519736">Diny Thomson</a>, PhD (Clinical Neuropsychology) Candidate and Provisional Psychologist, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/terminal-lucidity-why-do-loved-ones-with-dementia-sometimes-come-back-before-death-202342">original article</a>.</em></p>

Mind

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Love is in the air! Pilot proposes to flight attendant girlfriend before take off

<p>A pilot has proposed to his flight attendant girlfriend just minutes before take off in a heart-warming display of love. </p> <p>Polish pilot Konrad Hanc was captured emerging from the cockpit before embarking on a flight to Kraków to make a surprising announcement over the PA system. </p> <p>Hanc introduced himself to the passengers before explaining the real reason for his message. </p> <p>“On today’s flight there is a very special person," he began.</p> <p>“Ladies and gentlemen, about one and a half years ago in this job I met the most wonderful person that completely changed my life."</p> <p>“You are most precious to me. You are my greatest dream come true. This is why I have to ask you a favour, honey."</p> <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-permalink="https://www.instagram.com/reel/C6EHHyQskLc/?utm_source=ig_embed&amp;utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/reel/C6EHHyQskLc/?utm_source=ig_embed&amp;utm_campaign=loading" target="_blank" rel="noopener">A post shared by LOT Polish Airlines (@flylot)</a></p> </div> </blockquote> <p>“Will you marry me?” he asked while getting down on one knee, as another flight attendant handed him a bouquet of flowers. </p> <p>His girlfriend, Paula, sprinted up the aisle of the plane before leaping into the arms of her future husband. </p> <p>Passengers watched on in anticipation for her answer with one yelling, “Did she say yes?” to which the beaming captain responded: “She said yes!”</p> <p>Hanc explained that he chose to pop the question on the flight to the Polish city as he met Paula on the same flight just 18 months ago. </p> <p>As the pair embraced in a hug and kiss, passengers erupted in applause, with many taking to the now viral Facebook post to send them well wishes. </p> <p>“I love this! Sweet couple!” one person wrote.</p> <p>”TOTALLYYYYY LOVE IN THE AIR,” another enthusiastic person commented, to which the airline responded: “YES, love IS in the air!”</p> <p><em>Image credits: LOT Polish Airlines</em></p>

Relationships

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Does hosting the Olympics, the World Cup or other major sports events really pay off?

<p><em><a href="https://theconversation.com/profiles/ivan-savin-678930">Ivan Savin</a>, <a href="https://theconversation.com/institutions/escp-business-school-813">ESCP Business School</a></em></p> <p>After a long battle, <a href="https://www.france24.com/en/europe/20240213-paris-booksellers-stay-olympics-macron-bouquiniste-france">Paris’s beloved <em>bouquinistes</em> will be staying put</a> this summer. The decision, announced on 13 February by the French government, came after considerable public backlash to the police prefecture’s original plan to move part of the iconic Seine booksellers elsewhere for the inauguration of the Olympics Games on 26 July.</p> <p>Meanwhile, less than six months away from the event, Parisians continue to grumble over a <a href="https://www.ouest-france.fr/jeux-olympiques/cest-aberrant-ce-maire-vient-dapprendre-que-sa-ville-accueillera-les-jeux-de-paris-ab1fa968-cfd1-11ee-89c0-6cefac77e04a">lack of consultations</a> with locals, warnings of <a href="https://www.rfi.fr/en/france/20231130-paris-vehicle-traffic-to-be-heavily-restricted-during-2024-olympic-games">gridlocked traffic</a>, closed metro stations, extensive video surveillance and other grievances. So for host countries, what was the point of the Olympics, again?</p> <p>In academia, the debate about the potential positive and negative effects of large-scale sporting events is ongoing. Although these events are often associated with substantial economic losses, the long-term benefits are the main argument in favour of hosting them. These include the development of material and soft infrastructure such as hotels, restaurants or parks. Big games can also help put the host region on the map as an attractive place for sports and cultural events, and inspire a better entrepreneurial climate.</p> <h2>The pros and the cons of big sporting events?</h2> <p>The cost of these benefits, as the Parisians have realised, is steep. Host countries appear to suffer from increased tax burdens, low returns on public investments, high construction costs, and onerous running cost of facilities after the event. Communities can also be blighted by noise, pollution, and damage to the environment, while increased criminal activity and potential conflicts between locals and visitors can take a toll on their quality of life. As a result, in the recent past several major cities, including Rome and Hamburg, <a href="https://www.dw.com/en/6-cities-that-rejected-the-olympics/a-46289852">withdrew their bids to host the games</a>.</p> <p>A common feature of the economics of large-scale sporting events is that our expectations of them are more optimistic than what we make of them once they have taken place. Typically, expenditure tends to tip over the original budget, while the revenue-side indicators (such as the number of visitors) are rarely achieved.</p> <p>When analysing the effect of hosting large-scale sporting events on tourist visits, it is important to take into consideration both the positive and negative components of the overall effect. While positive effects may be associated with visitors, negative effects may arise when “regular” tourists refuse to visit the location due to the event. This might be because of overloaded infrastructure, sharp increases in accommodation costs, and inconveniences associated with overcrowding or raucous or/and violent visitors. On top of that, reports of poverty or crime in the global media can actually undermine the location’s attractiveness.</p> <h2>When big sporting events crowd out regular tourists</h2> <p>In an <a href="https://doi.org/10.1177/1527002523120639">article published in the <em>Journal of Sports Economics</em></a> with Igor Drapkin and Ilya Zverev, I assess the effects of hosting large-scale sporting events, such as Winter and Summer Olympics plus FIFA World Cups, on international tourist visits. We utilise a comprehensive dataset on flow of tourists covering the world’s largest destination and origin countries between 1995 and 2019. As a first step, we built an econometric model that effectively predicts the flow of tourists between any pair of countries in our data. Subsequently we compared the predicted tourist inflow in a hypothetical scenario where no large-scale sporting event would have taken place with the actual figures. If the actual figures exceed the predicted ones, we consider the event to have a net positive impact. Otherwise, we consider that it had a “crowding out” effect on “regular” tourists. While conducting this analysis, we distinguished between short-term (i.e., focusing just on the year of the event) and mid-term (year of the event plus three subsequent years).</p> <p>Our results show that the effects of large-scale sporting events vary a lot across host countries: The World Cup in Japan and South Korea 2002 and South Africa 2010 were associated with a distinct increase in tourist arrivals, whereas all other World Cups were either neutral or negative. Among the Summer Olympics, China in 2008 is the only case with a significant positive effect on tourist inflows. The effects of the other four events (Australia 2000, Greece 2004, Great Britain 2012, and Brazil 2016) were found to be negative in the short- and medium-term. As for the Winter Olympics, the only positive case is Russia in 2014. The remaining five events had a negative impact except the one-year neutral effect for Japan 1998.</p> <p>Following large-scale sporting events, host countries are therefore typically less visited by tourists. Out of the 18 hosting countries studied, 11 saw tourist numbers decline over four years, and three did not experience a significant change.</p> <h2>The case for cautious optimism</h2> <p>Our research indicates that the positive effect of hosting large-scale sporting events on tourist inflows is, at best, moderate. While many tourists are attracted by FIFA World Cups and Olympic games, the crowding-out effect of “regular” tourists is strong and often underestimated. This implies that tourists visiting for an event like the Olympics typically dissuade those who would have come for other reasons. Thus, efforts to attract new visitors should be accompanied by efforts to retain the already existing ones.</p> <p>Large-scale sporting events should be considered as part of a long-term policy for promoting a territory to tourists rather than a standalone solution. Revealingly, our results indicate that it is easier to get a net increase in tourist inflows in countries that are less frequent destinations for tourists – for example, those in Asia or Africa. By contrast, the United States and Europe, both of which are traditionally popular with tourists, have no single case of a net positive effect. Put differently, the large-scale sporting events in Asia and Africa helped promote their host countries as tourist destinations, making the case for the initial investment. In the US and Europe, however, those in the last few decades brought little return, at least in terms of tourist inflow.<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/222118/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/ivan-savin-678930">Ivan Savin</a>, Associate professor of quantitative analytics, research fellow at ICTA-UAB, <a href="https://theconversation.com/institutions/escp-business-school-813">ESCP Business School</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/does-hosting-the-olympics-the-world-cup-or-other-major-sports-events-really-pay-off-222118">original article</a>.</em></p>

Travel Tips

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“Love is so sweet": Man's sweet mid-air proposal goes viral

<p>Love is in the air! </p> <p>A smitten passenger took his love to the skies and proposed to his girlfriend while on board an Air Peace flight, with the romantic moment captured on camera. </p> <p>A social media user took to TikTok to share the sweet proposal, with the caption: “POV: My friend was proposed to in a plane.”</p> <p>The minute-long video showed a man getting out of his seat on board the packed plane to use the aircraft’s PA system so that he could ask for his girlfriend’s hand in marriage.</p> <p>“She’s so precious and her name is Precious,” the man said before popping the question. </p> <p> “Please, my Precious, I want to ask, will you marry me?”</p> <p>“If you will, just come out and say ‘yes’ to me, my precious,” he added before walking down the aisle of the aircraft. </p> <p>Other passengers cheered for the couple, and in a second video, the man is seen greeting Precious, then getting down on one knee to offer her the ring.</p> <p>Precious was overjoyed at the proposal and said yes, hugging her new fiance. </p> <p>While it is unclear where the plane was travelling, Air Peace is a Nigerian carrier that operates flights to destinations in West Africa and the Middle East, according to the NY Post. </p> <p>TikTok users were also touched by the romantic act, with many of them congratulating the couple. </p> <p>“This is beautiful,” one wrote. </p> <p>“Love is so sweet for real,” another swooned. </p> <p><em>Images: TikTok</em></p>

Relationships

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Kate Middleton is having ‘preventive chemotherapy’ for cancer. What does this mean?

<p><a href="https://theconversation.com/profiles/ian-olver-1047">Ian Olver</a>, <em><a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a></em></p> <p>Catherine, Princess of Wales, is undergoing treatment for cancer. In a video thanking followers for their messages of support after her major abdominal surgery, the Princess of Wales explained, “tests after the operation found cancer had been present.”</p> <p>“My medical team therefore advised that I should undergo a course of preventative chemotherapy and I am now in the early stages of that treatment,” she said in the two-minute video.</p> <p>No further details have been released about the Princess of Wales’ treatment.</p> <p>But many have been asking what preventive chemotherapy is and how effective it can be. Here’s what we know about this type of treatment.</p> <h2>It’s not the same as preventing cancer</h2> <p>To <a href="https://www.cancer.org.au/about-us/how-we-help/prevention">prevent cancer developing</a>, lifestyle changes such as diet, exercise and sun protection are <a href="https://www.cancer.org.au/about-us/how-we-help/prevention">recommended</a>.</p> <p>Tamoxifen, a hormone therapy drug can be used to reduce the risk of cancer for some patients at <a href="https://www.mayoclinic.org/diseases-conditions/breast-cancer/in-depth/breast-cancer/art-20045353">high risk of breast cancer</a>.</p> <p>Aspirin <a href="https://www.cancer.gov/about-cancer/causes-prevention/research/aspirin-cancer-risk">can also be used</a> for those at high risk of bowel and other cancers.</p> <h2>How can chemotherapy be used as preventive therapy?</h2> <p>In terms of treating cancer, prevention refers to giving chemotherapy after the cancer has been removed, to prevent the cancer from returning.</p> <p>If a cancer is localised (limited to a certain part of the body) with no evidence on scans of it spreading to distant sites, local treatments such as surgery or radiotherapy can remove all of the cancer.</p> <p>If, however, cancer is first detected after it has spread to distant parts of the body at diagnosis, clinicians use treatments such as chemotherapy (anti-cancer drugs), hormones or immunotherapy, which circulate <a href="https://www.healthline.com/health/cancer/metastatic-cancer">around the body</a> .</p> <p>The other use for chemotherapy is to add it before or after surgery or radiotherapy, to prevent the primary cancer <a href="https://www.verywellhealth.com/adjuvant-therapy-5198903">coming back</a>. The surgery may have cured the cancer. However, in some cases, undetectable microscopic cells may have spread into the bloodstream to distant sites. This will result in the cancer returning, months or years later.</p> <p>With some cancers, treatment with chemotherapy, given before or after the local surgery or radiotherapy, can kill those cells and prevent the cancer coming back.</p> <p>If we can’t see these cells, how do we know that giving additional chemotherapy to prevent recurrence is effective? We’ve learnt this from clinical trials. Researchers have compared patients who had surgery only with those whose surgery was followed by additional (or often called adjuvant) chemotherapy. The additional therapy resulted in patients not relapsing and surviving longer.</p> <h2>How effective is preventive therapy?</h2> <p>The effectiveness of preventive therapy depends on the type of cancer and the type of chemotherapy.</p> <p>Let’s consider the common example of bowel cancer, which is at high risk of returning after surgery because of its size or spread to local lymph glands. The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564362/">first chemotherapy tested</a> improved survival by 15%. With more intense chemotherapy, the chance of surviving six years is approaching 80%.</p> <p>Preventive chemotherapy is usually given for three to six months.</p> <h2>How does chemotherapy work?</h2> <p>Many of the chemotherapy drugs stop cancer cells dividing by disrupting the DNA (genetic material) in the centre of the cells. To improve efficacy, drugs which work at different sites in the cell are given in combinations.</p> <p>Chemotherapy is not selective for cancer cells. It kills any dividing cells.</p> <p>But cancers consist of a higher proportion of dividing cells than the normal body cells. A <a href="https://www.canceraustralia.gov.au/cancer-types/breast-cancer/treatment/chemotherapy/how-does-chemotherapy-work#:%7E:text=Chemotherapy%20works%20by%20killing%20cells%20that%20are%20rapidly,cells%20can%20repair%20the%20damage%20and%20can%20recover.">greater proportion of the cancer is killed</a> with each course of chemotherapy.</p> <p>Normal cells can recover between courses, which are usually given three to four weeks apart.</p> <h2>What are the side effects?</h2> <p>The side effects of chemotherapy are usually reversible and are seen in parts of the body where there is normally a high turnover of cells.</p> <p>The production of blood cells, for example, is temporarily disrupted. When your white blood cell count is low, there is an increased risk of infection.</p> <p>Cell death in the lining of the gut leads to mouth ulcers, nausea and vomiting and bowel disturbance.</p> <p>Certain drugs sometimes given during chemotherapy can attack other organs, such as causing numbness in the hands and feet.</p> <p>There are also generalised symptoms such as <a href="https://www.cancervic.org.au/cancer-information/treatments/treatments-types/chemotherapy/side_effects_of_chemotherapy.html">fatigue</a>.</p> <p>Given that preventive chemotherapy given after surgery starts when there is no evidence of any cancer remaining after local surgery, patients can usually resume normal activities within weeks of completing the courses of chemotherapy.<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/226461/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/ian-olver-1047">Ian Olver</a>, Adjunct Professsor, School of Psychology, Faculty of Health and Medical Sciences, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/kate-middleton-is-having-preventive-chemotherapy-for-cancer-what-does-this-mean-226461">original article</a>.</em></p>

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Does intermittent fasting have benefits for our brain?

<p><a href="https://theconversation.com/profiles/hayley-oneill-1458016">Hayley O'Neill</a>, <em><a href="https://theconversation.com/institutions/bond-university-863">Bond University</a></em></p> <p>Intermittent fasting has become a popular dietary approach to help people lose or manage their <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8683964/">weight</a>. It has also been promoted as a way to reset metabolism, control chronic disease, slow ageing and <a href="https://pubmed.ncbi.nlm.nih.gov/27810402">improve overall health</a>.</p> <p>Meanwhile, some research suggests intermittent fasting may offer a different way for the brain to access energy and provide protection against neurodegenerative diseases like <a href="https://link.springer.com/article/10.1007/s11011-023-01288-2">Alzheimer’s disease</a>.</p> <p>This is not a new idea – the ancient Greeks believed fasting <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8839325/">enhanced thinking</a>. But what does the modern-day evidence say?</p> <h2>First, what is intermittent fasting?</h2> <p>Our <a href="https://pubmed.ncbi.nlm.nih.gov/35487190/">diets</a> – including calories consumed, macronutrient composition (the ratios of fats, protein and carbohydrates we eat) and when meals are consumed – are factors in our lifestyle we can change. People do this for cultural reasons, desired weight loss or potential health gains.</p> <p>Intermittent fasting consists of short periods of calorie (energy) restriction where food intake is limited for 12 to 48 hours (usually 12 to 16 hours per day), followed by periods of normal food intake. The intermittent component means a re-occurrence of the pattern rather than a “one off” fast.</p> <p>Food deprivation beyond 24 hours typically constitutes starvation. This is distinct from fasting due to its specific and potentially harmful biochemical alterations and nutrient deficiencies if continued for long periods.</p> <h2>4 ways fasting works and how it might affect the brain</h2> <p>The brain accounts for about <a href="https://theconversation.com/how-much-energy-do-we-expend-thinking-and-using-our-brain-197990">20% of the body’s energy consumption</a>.</p> <p>Here are four ways intermittent fasting can act on the body which could help explain its potential effects on the brain.</p> <p><strong>1. Ketosis</strong></p> <p>The goal of many intermittent fasting routines is to flip a “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5913738/">metabolic switch</a>” to go from burning predominately carbohydrates to burning fat. This is called ketosis and typically occurs after 12–16 hours of fasting, when liver and glycogen stores are depleted. <a href="https://www.ncbi.nlm.nih.gov/books/NBK493179/">Ketones</a> – chemicals produced by this metabolic process – become the preferred energy source for the brain.</p> <p>Due to this being a slower metabolic process to produce energy and potential for lowering blood sugar levels, ketosis can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10844723/">cause symptoms</a> of hunger, fatigue, nausea, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8754590/">low mood</a>, irritability, constipation, headaches, and brain “fog”.</p> <p>At the same time, as glucose metabolism in the brain declines with ageing, studies have shown ketones could provide an alternative energy source to <a href="https://www.science.org/doi/10.1126/science.aau2095">preserve brain function</a> and prevent <a href="https://pubmed.ncbi.nlm.nih.gov/32709961/">age-related neurodegeneration disorders and cognitive decline</a>.</p> <p>Consistent with this, increasing ketones through <a href="https://pubmed.ncbi.nlm.nih.gov/31027873/">supplementation</a> or <a href="https://pubmed.ncbi.nlm.nih.gov/31757576/">diet</a> has been shown to improve cognition in adults with mild cognitive decline and those at risk of Alzheimer’s disease respectively.</p> <p><strong>2. Circadian syncing</strong></p> <p>Eating at times that <a href="https://pubmed.ncbi.nlm.nih.gov/32480126/">don’t match our body’s natural daily rhythms</a> can disrupt how our organs work. Studies in shift workers have suggested this might also make us more prone to <a href="https://pubmed.ncbi.nlm.nih.gov/22010477/">chronic disease</a>.</p> <p>Time-restricted eating is when you eat your meals within a six to ten-hour window during the day when you’re most active. Time-restricted eating causes changes in <a href="https://pubmed.ncbi.nlm.nih.gov/36599299/">expression of genes in tissue</a> and helps the body during rest and activity.</p> <p>A 2021 <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7827225/">study of 883 adults</a> in Italy indicated those who restricted their food intake to ten hours a day were less likely to have cognitive impairment compared to those eating without time restrictions.</p> <p><strong>3. Mitochondria</strong></p> <p>Intermittent fasting may provide <a href="https://pubmed.ncbi.nlm.nih.gov/35218914/">brain protection</a> through improving mitochondrial function, metabolism and reducing oxidants.</p> <p>Mitochondria’s <a href="https://www.genome.gov/genetics-glossary/Mitochondria">main role is to produce energy</a> and they are crucial to brain health. Many age-related diseases are closely related to an energy supply and demand imbalance, likely attributed to <a href="https://www.nature.com/articles/s41574-021-00626-7">mitochondrial dysfunction during ageing</a>.</p> <p>Rodent studies suggest alternate day fasting or reducing calories <a href="https://journals.sagepub.com/doi/10.1038/jcbfm.2014.114">by up to 40%</a> might protect or improve <a href="http://www.ncbi.nlm.nih.gov/pubmed/21861096">brain mitochondrial function</a>. But not all studies support this theory.</p> <p><strong>4. The gut-brain axis</strong></p> <p>The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469458/">gut and the brain communicate with each other</a> via the body’s nervous systems. The brain can influence how the gut feels (think about how you get “butterflies” in your tummy when nervous) and the gut can affect mood, cognition and mental health.</p> <p>In mice, intermittent fasting has shown promise for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5913738/">improving brain health</a> by increasing survival and <a href="https://pubmed.ncbi.nlm.nih.gov/12354284/">formation of neurons</a> (nerve cells) in the hippocampus brain region, which is involved in memory, learning and emotion.</p> <p>There’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8470960/">no clear evidence</a> on the effects of intermittent fasting on cognition in healthy adults. However one 2022 study interviewed 411 older adults and found <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9646955/">lower meal frequency</a> (less than three meals a day) was associated with reduced evidence of Alzheimer’s disease on brain imaging.</p> <p>Some research has suggested calorie restriction may have a protective effect against <a href="https://academic.oup.com/nutritionreviews/article/81/9/1225/7116310">Alzheimer’s disease</a> by reducing oxidative stress and inflammation and promoting vascular health.</p> <p>When we look at the effects of overall energy restriction (rather than intermittent fasting specifically) the evidence is mixed. Among people with mild cognitive impairment, one study showed <a href="https://pubmed.ncbi.nlm.nih.gov/26713821/">cognitive improvement</a> when participants followed a calorie restricted diet for 12 months.</p> <p>Another study found a 25% calorie restriction was associated with <a href="https://pubmed.ncbi.nlm.nih.gov/30968820">slightly improved working memory</a> in healthy adults. But a <a href="https://www.sciencedirect.com/science/article/pii/S0022316623025221?via%3Dihub">recent study</a>, which looked at the impact of calorie restriction on spatial working memory, found no significant effect.</p> <h2>Bottom line</h2> <p>Studies in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9740746/">mice</a> support a role for intermittent fasting in improving brain health and ageing, but few studies in humans exist, and the evidence we have is mixed.</p> <p>Rapid weight loss associated with calorie restriction and intermittent fasting can lead to nutrient deficiencies, muscle loss, and decreased immune function, particularly in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8749464/">older adults</a> whose nutritional needs may be higher.</p> <p>Further, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6314618/">prolonged fasting</a> or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9042193/">severe calorie restriction</a> may pose risks such as fatigue, dizziness, and electrolyte imbalances, which could exacerbate existing health conditions.</p> <p>If you’re considering <a href="https://www.nejm.org/doi/10.1056/NEJMra1905136?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">intermittent fasting</a>, it’s best to seek advice from a health professional such as a dietitian who can provide guidance on structuring fasting periods, meal timing, and nutrient intake. This ensures intermittent fasting is approached in a safe, sustainable way, tailored to individual needs and goals.<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/223181/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><a href="https://theconversation.com/profiles/hayley-oneill-1458016">Hayley O'Neill</a>, Assistant Professor, Faculty of Health Sciences and Medicine, <em><a href="https://theconversation.com/institutions/bond-university-863">Bond University</a></em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/does-intermittent-fasting-have-benefits-for-our-brain-223181">original article</a>.</em></p> <p><em>Image: Getty </em></p>

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Does British tourism really need the royal family?

<p><em><a href="https://theconversation.com/profiles/ross-bennett-cook-1301368">Ross Bennett-Cook</a>, <a href="https://theconversation.com/institutions/university-of-westminster-916">University of Westminster</a></em></p> <p>Love them or loathe them, the royal family are up there with red telephone boxes and scones when it comes to images of Britishness. Souvenir shops are full of their faces, newspapers across the world discuss them, and <a href="https://www.euronews.com/culture/2022/09/13/netflixs-the-crown-skyrockets-in-popularity-following-the-queens-death">television dramas</a> based on their lives have never been more popular.</p> <p>Whenever people are critical of the royal family, the oft-repeated retort is “but think of the tourism!”. This has been particularly common rhetoric recently, as <a href="https://www.independent.co.uk/life-style/royal-family/who-paid-for-coronation-b2334669.html">many people question</a> how a country facing mass strikes and a crippling cost of living crisis can afford the estimated <a href="https://www.lbc.co.uk/news/explained/how-much-king-charles-iii-coronation-cost-who-pays-for-it/">£100 million</a> cost of King Charles III’s coronation.</p> <p>In a recent <a href="https://yougov.co.uk/topics/arts/survey-results/daily/2023/04/18/25178/3">YouGov poll</a>, 51% did not believe the coronation should be paid for by taxpayers. For young people, this figure was even higher, at 62%. But supporters will often use <a href="https://www.independent.co.uk/news/charles-iii-ap-coronation-buckingham-palace-elizabeth-ii-b2326220.html">tourism</a> as justification for lavish expenses.</p> <p>The royal family does bring tourism to the UK. The economic consultancy Centre for Economics and Business Research <a href="https://cebr.com/reports/uk-economy-raises-a-glass-to-337-million-coronation-boost-from-tourism-and-pub-activity/">estimated</a> that the coronation weekend would lead to a £337 million boost from tourism and pub spending.</p> <p>But if the royal family were to disappear, would the UK’s tourism industry suddenly implode?</p> <p>2011 research by <a href="https://webarchive.nationalarchives.gov.uk/ukgwa/20140722183820/http://www.visitbritain.org/mediaroom/archive/2011/vbrwwedding.aspx">Visit Britain</a> found that around 60% of tourists to the UK are likely to visit places associated with the royal family. While there is no more recent specifically royal data, in 2022 Visit Britain found that history and heritage was the biggest <a href="https://www.visitbritain.org/MIDAS-research-project">pull factor to tourists</a>.</p> <p>And while the <a href="https://journals.sagepub.com/doi/10.1177/1468797606071477">international perception</a> of Britain is certainly intertwined with the royal family, this does not tell us whether a reigning royal family is necessary for tourism. After all, the history surrounding the monarchy and places associated with them would still be here even if the royal family was not. Ottoman palaces of Istanbul remain <a href="https://edition.cnn.com/travel/article/most-visited-castles-palaces/index.html">wildly popular</a> attractions 100 years since the collapse of the caliphate, as are the royal châteaus of France or imperial palaces of China.</p> <p>Lack of royalty does not seem to have affected these countries’ appeal, each of which attract <a href="https://www.e-unwto.org/doi/epdf/10.18111/wtobarometereng.2020.18.1.7">more tourists</a> annually than the UK.</p> <h2>A special relationship</h2> <p>The USA is the UK’s <a href="https://www.visitbritain.org/inbound-tourism-trends-old">largest tourist market</a>, and <a href="https://www.telegraph.co.uk/royal-family/2023/05/05/coronation-american-tourists-britain-boom-royal-family-usa/">American tourists</a> do seem to be very fond of things associated with British royalty.</p> <p>But this may change with the new monarch. In a <a href="https://today.yougov.com/topics/entertainment/articles-reports/2021/02/17/british-royals-popular-america-poll">poll taken in February 2021</a>, before the death of Queen Elizabeth II, a whopping 68% of Americans viewed her favourably. The same poll found only 34% had a favourable opinion of Charles – but this has changed in his favour following his accession to the throne, according to a <a href="https://today.yougov.com/topics/international/articles-reports/2023/05/05/americans-think-british-royal-family-charles">poll taken before the coronation</a> which gave him a 50% approval rating in the US. That said, 62% of people in the US said they did not care about the coronation very much or at all.</p> <p>Outside America, the UK’s next largest tourist groups have significantly less interest in the royal family. The holiday firm <a href="https://www.traveldailymedia.com/study-reveals-importance-of-royal-family-to-uk-tourism-industry/">Travelzoo</a> found in 2016 that just 19% of German, 15% of French and only 10% of Spanish travellers want to come to the UK because of the British monarchy.</p> <h2>Where do tourists go?</h2> <p>Typically, when commentators discuss the royal contributions to tourism, they talk about significant events such as weddings, jubilees, coronations and funerals. Even though these events attract huge crowds, they happen rarely and are unrepresentative of the tourism industry as a whole. Research <a href="https://journals.sagepub.com/doi/10.1177/13548166211004361">has found</a> that royal weddings massively improve a country’s image and brand awareness, but are not comparable to major mega events such as the Fifa World Cup, the Super Bowl or the Olympics.</p> <p>Even though royal places are popular, they are far from our most popular attractions. Of Britain’s <a href="https://www.visitbritain.org/annual-survey-visits-visitor-attractions-latest-results">ten most visited</a> free and paid-for attractions in 2021, none were royal attractions. The <a href="https://www.visitbritain.org/sites/default/files/vb-corporate/top_20_listings.pdf">highest ranking</a> royal attraction was the Tower of London, making only 17th on the list.</p> <p>Typically, Chester Zoo attracts more visitors than Windsor Castle or Buckingham Palace, although these statistics do not differentiate between domestic and international tourists. In the most recent <a href="https://www.windsor.gov.uk/dbimgs/Windsor%202017%20Visitor%20Survey%20final%20report%2028_11_17.pdf">Windsor visitor survey</a>, the majority of its tourists came from overseas.</p> <p>Anti-monarchy group <a href="https://www.republic.org.uk/tourism">Republic</a> has disputed the widely cited figure that the monarchy generates £500 million in tourism income for the UK annually – which itself would be only a small fraction of Britain’s £127 billion tourism economy.</p> <p>The group also questions why royalty <a href="https://www.youtube.com/watch?v=9hL9yDOK48A">barely feature</a> on British tourism campaigns or advertisements, if they are so vital to the tourism economy.</p> <p>It is impossible to deny that royalty adds to the UK’s appeal as a tourist destination – the history and associated heritage is famous worldwide. However, what is questionable is whether a reigning monarchy is necessary for this attractiveness to continue.<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/205158/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><a href="https://theconversation.com/profiles/ross-bennett-cook-1301368"><em>Ross Bennett-Cook</em></a><em>, Visiting Lecturer, School of Architecture + Cities, <a href="https://theconversation.com/institutions/university-of-westminster-916">University of Westminster</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/does-british-tourism-really-need-the-royal-family-205158">original article</a>.</em></p>

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How long does menopause last? 5 tips for navigating uncertain times

<p><em><a href="https://theconversation.com/profiles/yvonne-middlewick-1395795">Yvonne Middlewick</a>, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a></em></p> <p>Around half of the world’s population are women or people who menstruate – yet the way their body works can be a mystery, even to them.</p> <p>Most women will experience periods roughly every month, many will go through childbirth and those who live into midlife will experience menopause.</p> <p>While menopause is a significant time of change, it isn’t talked about much, other than as a punchline. This may contribute to keeping it a <a href="https://www.theguardian.com/membership/2019/sep/21/breaking-the-menopause-taboo-there-are-vital-stories-we-should-continue-to-pursue">taboo topic</a>.</p> <p>So, what happens during menopause? How do you know when it is happening to you? And – the thing most women want to know – how long will it last?</p> <h2>What is menopause?</h2> <p>Menopause is <a href="https://www.nia.nih.gov/health/what-menopause">defined</a> as the permanent cessation of menstruation, which is medically determined to be one year after the final menstrual period. After this time women are considered to be postmenopausal.</p> <p>The <a href="https://pubmed.ncbi.nlm.nih.gov/26598775/">average age</a> of “natural menopause” (that is not caused by a medical condition, treatment or surgery) is considered to be around 51 years.</p> <p>However, natural menopause does not occur suddenly. <a href="https://www.researchgate.net/profile/Riitta-Luoto/publication/46425690_Prevalence_of_menopause_symptoms_and_their_association_with_lifestyle_among_Finnish_middle-aged_women/links/5c5704ac458515a4c7553c7b/Prevalence-of-menopause-symptoms-and-their-association-with-lifestyle-among-Finnish-middle-aged-women.pdf">Changes can begin</a> a number of years before periods stop and most often occur in a woman’s 40s but they can be earlier. Changes <a href="https://pubmed.ncbi.nlm.nih.gov/25686030/">can continue</a> for 10 years or more after periods have stopped.</p> <p>Using hormones such as the oral contraceptive pill or hormone intrauterine devices may make it more <a href="https://pubmed.ncbi.nlm.nih.gov/31934948/">difficult to determine</a> when changes start.</p> <p>Menopause that occurs <a href="https://www.womenshealth.gov/menopause/early-or-premature-menopause#:%7E:text=Menopause%20that%20happens%20before%20age,to%20come%20earlier%20than%20usual.">before 45</a> is called “early menopause”, while menopause before 40 is called “premature menopause”.</p> <h2>What about perimenopause?</h2> <p>Various <a href="https://www.menopause.org.au/hp/information-sheets/glossary-of-terms">terms</a> are used to describe this period of change, including “menopause” or “the menopause”, “menopausal transition”, “perimenopause” or “<a href="https://pubmed.ncbi.nlm.nih.gov/12188398/">climacteric</a>”.</p> <p>These terms tend to refer to the period before and after the final menstrual period, when changes are considered to be related to menopause.</p> <p>The difficulty with the definition of menopause is it can only be decided retrospectively. Yet women can experience changes many years before their periods stop (a lead up usually called “perimenopause”). Also, any <a href="https://www.sciencedirect.com/sdfe/pdf/download/eid/1-s2.0-S0889854518300627/first-page-pdf">changes noticed</a> may not be associated with menopause (because people might not be aware of what to expect) or changes may be associated with a combination of factors such as stress, being busy or other health issues.</p> <h2>So, what is going on?</h2> <p>Through a feminist lens, menopause can be seen as a <a href="https://www.researchgate.net/publication/354652248_The_volcano_within_a_study_of_women's_lived_experience_of_the_journey_through_natural_menopause">complex and diverse experience</a>, influenced by biological, psychological, social and cultural aspects of women’s lives.</p> <p>However, it is usually viewed from the biomedical perspective. This sees it as a biological event, marked by the <a href="https://www.sciencedirect.com/science/article/pii/S0091302220300418">decline</a> in ovarian hormone levels leading to a reduction in reproductive function.</p> <p>The female reproductive system operates because of a finely tuned balance of hormones managed by the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6466056/#:%7E:text=The%20hypothalamic%2Dpituitary%2Dovarian%20(HPO)%20axis%20must%20be,priming%20the%20endometrium%20for%20implantation.">hypothalamic-pituitary-ovarian axis</a>. International <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3340903/">experts</a> have developed a staging system for female reproductive ageing, with seven stages from “early reproductive” years to “late postmenopause”.</p> <p>However, female reproductive hormones do not just affect the reproductive system but <a href="https://www.sciencedirect.com/science/article/pii/S0091302220300418">other aspects</a> of the body’s function. These include the <a href="https://pubmed.ncbi.nlm.nih.gov/26007613/">neurological system</a>, which is linked to hot flushes and night sweats and disrupted sleep. Hormones may also affect the <a href="https://www.nature.com/articles/nrdp20154">heart and body’s blood circulation</a>, bone health and potentially the <a href="https://www.sciencedirect.com/science/article/pii/S0091302220300418">immune system</a>.</p> <p>Menopausal hormone changes may <a href="https://www.thewomens.org.au/health-information/menopause-information/menopause-symptoms/">cause</a> hot flushes, night/cold sweats, mood swings, sleep disruption and tiredness, vaginal dryness.</p> <p>Medical confirmation of menopausal changes in women over 45 years is based on two biological indicators: vasomotor symptoms (those hot flushes and night sweats again) and an <a href="https://www.womenshealth.gov/menopause/early-or-premature-menopause#:%7E:text=Menopause%20that%20happens%20before%20age,to%20come%20earlier%20than%20usual.">irregular menstrual cycle</a>.</p> <p>In early perimenopause the changes to the menstrual cycle may be subtle. Women may not recognise early indicators, unless they keep a record and know what to watch for.</p> <h2>How long does it last?</h2> <p>The body demonstrates an amazing ability to change over a lifetime. In a similar way to adolescence where long-lasting changes occur, the outcome of menopause is also change.</p> <p>Research suggests it is difficult to give an exact time frame for how long menopausal changes occur – the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085137/">average</a> is between four and eight years.</p> <p>The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085137/">Penn Ovarian Ageing Study</a> found 79% of the 259 participants experienced hot flushes starting before the age of 50, most commonly between 45 and 49 years of age.</p> <p>A later report on the same study found one third of women studied experienced <a href="https://womensmidlifehealthjournal.biomedcentral.com/articles/10.1186/s40695-016-0014-2">moderate to severe hot flushes</a> more than ten years after their periods had stopped. A <a href="https://journals.lww.com/menopausejournal/Abstract/2017/03000/Cultural_issues_in_menopause__an_exploratory.11.aspx">2017 study</a> found a small number of women continued to experience hot flushes and other symptoms into their 70s.</p> <p>So overall, the research cannot offer a specific window for perimenopause, and menopause does not appear to mark the end of changes for everyone.</p> <h2>5 tips for uncertain times</h2> <p>Shifts and changes can be recognised early by developing knowledge, paying attention to changes to our bodies and talking about menopause and perimenopause more openly.</p> <p>Here are five tips for moving from uncertainty to certainty:</p> <p><strong>1.</strong> talk to people and find out as much information as you can. The experiences of mothers and sisters may help, for some women there are familial similarities</p> <p><strong>2.</strong> notice any changes to your body and make a note of them, this will help you recognise changes earlier. There are <a href="https://www.redonline.co.uk/wellbeing/a36980118/menopause-apps/">menopause tracking apps</a> available</p> <p><strong>3.</strong> keep a note of your menstrual cycle: start date, duration, flow and note any changes. Again, an app might help</p> <p><strong>4.</strong> if you are worried, seek advice from a GP or nurse that specialises in women’s health. They may suggest ways to help with symptoms or refer to a specialist</p> <p><strong>5.</strong> remember changes are the indicator to pay attention to, not time or your age.</p> <p>Menopause is a natural process and although we have focused here on the time frame and “symptoms”, it can also be a time of freedom (particularly from periods!), reflection and a time to focus on yourself.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/195211/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <figure><iframe src="https://www.youtube.com/embed/lhosPUwWhfI?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption><span class="caption">Women speak about their experiences of menopause.</span></figcaption></figure> <p><em><a href="https://theconversation.com/profiles/yvonne-middlewick-1395795">Yvonne Middlewick</a>, Nurse &amp; Lecturer, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-long-does-menopause-last-5-tips-for-navigating-uncertain-times-195211">original article</a>.</em></p>

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Does the royal family have a right to privacy? What the law says

<p><em><a href="https://theconversation.com/profiles/gemma-horton-1515949">Gemma Horton</a>, <a href="https://theconversation.com/institutions/university-of-sheffield-1147">University of Sheffield</a></em></p> <p>From court cases to conspiracy theories, the royal family’s right to privacy is, somewhat ironically, nearly always in the spotlight. The latest focus is Kate Middleton, Princess of Wales, whose whereabouts have been the subject of <a href="https://www.townandcountrymag.com/society/tradition/a60008117/kate-middleton-health-speculation-conspiracy-theories-online/">online speculation</a> after it was announced she was undergoing abdominal surgery and would be away from public duties until after Easter.</p> <p>This comes just weeks after King Charles <a href="https://www.bbc.co.uk/news/uk-68208157">revealed that he is undergoing treatment for cancer</a>, and a legal settlement between Prince Harry and Mirror Group Newspapers over <a href="https://www.bbc.co.uk/news/uk-68249009">illegal phone hacking</a>.</p> <p>Interest in the personal lives of the royals and other celebrities <a href="https://www.tandfonline.com/doi/full/10.1080/1461670X.2016.1150193">is a constant</a>, driving newspaper sales and online clicks for decades. You only needs to consider the media frenzy that followed Princess Diana to <a href="https://www.tandfonline.com/doi/full/10.1080/17512786.2013.833678">see this</a>, and its potentially devastating consequences.</p> <p>From a legal perspective, the British courts have ruled that everyone – the royal family included – is entitled to a right to privacy. The Human Rights Act incorporates into British law the rights set out by the European Convention on Human Rights. This includes article 8, which focuses on the right to privacy.</p> <p>In the years after the Human Rights Act came into force, courts ruled on a string of cases from celebrities claiming that the press invaded their privacy. Courts had to balance article 8 of the convention against article 10, the right to freedom of expression.</p> <p>Rulings repeatedly stated that, despite being in and sometimes seeking the limelight, celebrities should still be afforded a right to privacy. Some disagree with this position, such as prominent journalist <a href="https://www.independent.co.uk/news/uk/home-news/prince-harry-hacking-piers-morgan-b2336442.html">Piers Morgan, who has criticised</a> the Duke and Duchess of Sussex asking for privacy when they have also released a Netflix documentary, a broadcast interview with Oprah Winfrey and published a memoir.</p> <p>But the courts have made the position clear, as in the case concerning Catherine Zeta-Jones and Michael Douglas after Hello! Magazine published unauthorised photographs from their wedding. The <a href="https://eprints.whiterose.ac.uk/190559/3/Final%20Edited%20Version%20-%20Celebrity%20Privacy%20and%20Celebrity%20Journalism-%20Has%20anything%20changed%20since%20the%20Leveson%20Inquiry_.pdf">court stated</a> that: “To hold that those who have sought any publicity lose all protection would be to repeal article 8’s application to very many of those who are likely to need it.”</p> <p>There is no universal definition of privacy, but scholars have identified key concepts encompassing what privacy can entail. In my own research, I have argued that the <a href="https://eprints.whiterose.ac.uk/190559/3/Final%20Edited%20Version%20-%20Celebrity%20Privacy%20and%20Celebrity%20Journalism-%20Has%20anything%20changed%20since%20the%20Leveson%20Inquiry_.pdf">notion of choice</a> is one of these. Privacy allows us to control the spread of information about ourselves and disclose information to whom we want.</p> <h2>Privacy and the public interest</h2> <p>There are exceptions to these protections if the person involved had no reasonable expectation of privacy, or if it was in the public interest for this information to be revealed. There is no solid, legal definition of the “public interest”, so this is decided on a case-by-case basis.</p> <p><a href="https://www.tandfonline.com/doi/full/10.1080/17577632.2021.1889866">In the past</a>, the public interest defence has been applied because a public figure or official has acted hypocritically and the courts have stated there is a right for a publisher to set the record straight.</p> <p>When it comes to medical records and information concerning health, case law and journalistic <a href="https://www.ipso.co.uk/editors-code-of-practice/">editorial codes of conduct</a> are clear that this information is afforded the utmost protection.</p> <p>Model Naomi Campbell was pictured leaving a Narcotics Anonymous meeting and these images were published by the Daily Mirror. The court found that there had been a public interest in revealing the fact she was attending these meetings, as she had previously denied substance abuse.</p> <p>The House of Lords accepted that there was a public interest in the press “setting the record straight”. Nonetheless, the publication of additional, confidential details, and the photographs of her leaving the meeting were a <a href="https://www.theguardian.com/media/2004/may/06/mirror.pressandpublishing1">step too far</a>. The House of Lords highlighted the importance of being able to keep medical records and information private.</p> <h2>Royal health</h2> <p>When it comes to the royals, the history of <a href="https://www.townandcountrymag.com/society/tradition/a23798094/lindo-wing-st-marys-hospital-facts-photos/">publicity</a> around royal births, often posing with the newborn royal baby outside of the hospital, has set a precedent for what the public can expect about the royals’ medical information. When they choose to go against this tradition, it can frustrate both royal-watchers and publishers.</p> <p>King Charles made the choice to openly speak about his enlarged prostate to “assist public understanding”. And, as Prostate Cancer UK noted, this has worked – they noted a <a href="https://www.independent.co.uk/news/uk/home-news/king-charles-cancer-statement-treatment-b2494190.html">500% increase in people visiting their website</a>. However, he has chosen to not to divulge information about his cancer diagnosis beyond the fact that he is receiving treatment. This is his right.</p> <p>While revealing further information might stop speculation and rumours about his health, it is not the king’s duty to divulge private, medical information. However, if his health begins to impact his ability to act as monarch, the situation could change.</p> <p>It might be that the press finds more information about his health without his knowledge, but unless they have a genuine public interest in publishing this information, privacy should prevail.</p> <p>You would no doubt want your private medical information kept secret, not shared around your workplace and speculated on unless it was absolutely necessary. It is thanks to these laws and court precedent that you don’t have to worry about this. The royal family, regardless of their position, should expect the same standard.</p> <p><a href="https://theconversation.com/profiles/gemma-horton-1515949"><em>Gemma Horton</em></a><em>, Impact Fellow for Centre for Freedom of the Media, <a href="https://theconversation.com/institutions/university-of-sheffield-1147">University of Sheffield</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/does-the-royal-family-have-a-right-to-privacy-what-the-law-says-224881">original article</a>.</em></p>

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Not all mourning happens after bereavement – for some, grief can start years before the death of a loved one

<p><em><a href="https://theconversation.com/profiles/lisa-graham-wisener-1247893">Lisa Graham-Wisener</a>, <a href="https://theconversation.com/institutions/queens-university-belfast-687">Queen's University Belfast</a> and <a href="https://theconversation.com/profiles/audrey-roulston-1512057">Audrey Roulston</a>, <a href="https://theconversation.com/institutions/queens-university-belfast-687">Queen's University Belfast</a></em></p> <p>For many people, grief starts not at the point of death, but from the moment a loved one is diagnosed with a life-limiting illness.</p> <p>Whether it’s the diagnosis of an advanced cancer or a non-malignant condition such as dementia, heart failure or Parkinson’s disease, the psychological and emotional process of grief can begin many months or even years before the person dies. This experience of mourning a future loss is known as <a href="https://link.springer.com/referenceworkentry/10.1007/978-3-319-69892-2_1006-1">anticipatory grief</a>.</p> <p>While not experienced by everyone, anticipatory grief is a <a href="https://spcare.bmj.com/content/bmjspcare/early/2022/02/10/bmjspcare-2021-003338.full.pdf?casa_token=IWNMDFN5SoIAAAAA:2EybwyPcKu73VdrACTNk7jITor-mMIXK8rv76arXgdjV9cA2Y0MV0LyZLLwcYe1rZUAQymOzFYo">common</a> part of the grieving process and can include a range of conflicting, often difficult thoughts and emotions. For example, as well as feelings of loss, some people can experience guilt from wanting their loved one to be free of pain, or imagining what life will be like after they die.</p> <h2>Difficult to define, distressing to experience</h2> <p>Anticipatory grief has proved <a href="https://journals.sagepub.com/doi/full/10.1177/02692163221074540#bibr13-02692163221074540">challenging to define</a>. A <a href="https://journals.sagepub.com/doi/full/10.1177/02692163221074540#bibr13-02692163221074540">systematic review</a> of research studies on anticipatory grief identified over 30 different descriptions of pre-death grief. This lack of consensus has limited research progress, because there’s no shared understanding of how to identify anticipatory grief.</p> <p>Therese Rando, a <a href="https://www.taylorfrancis.com/chapters/edit/10.4324/9781315800806-9/grief-mourning-accommodating-loss-therese-rando">prominent theorist</a>, has proposed that anticipatory grief can help prepare for death, contributing to a more positive grieving experience post-bereavement. Rando also suggests that pre-death mourning can aid with adjustment to the loss of a loved one and reduce the risk of <a href="https://www.cruse.org.uk/understanding-grief/effects-of-grief/complicated-grief/">“complicated grief”</a>, a term that describes persistent and debilitating emotional distress.</p> <figure><iframe src="https://www.youtube.com/embed/AapGn60DZSA?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p>But pre-death mourning doesn’t necessarily mean grief will be easier to work through once a loved one has died. Other <a href="https://www.sciencedirect.com/science/article/pii/S0277953621005724?casa_token=I9mbdSv3d3gAAAAA:MqxN5X_iWbcqa6BYj7IXmImUviheOQWAVA4UBy6795UDuS1uOHG9b245qMkyOiLcvjv_SU6yVA">research evidence</a> shows that it’s possible to experience severe anticipatory grief yet remain unprepared for death.</p> <h2>Carers should seek support</h2> <p>Carers of people with life-limiting illnesses may notice distressing changes in the health of their loved ones. Witnessing close-up someone’s deterioration and decline in independence, memory or ability to perform routine daily tasks, such as personal care, is a painful experience.</p> <p>It is essential, then, for carers to acknowledge difficult emotions and seek support from those around them – especially because caring for a loved one at the end of their life <a href="https://www.mind.org.uk/information-support/helping-someone-else/carers-friends-family-coping-support/your-mental-health/">can be an isolating time</a>.</p> <p>Where possible, it can also be beneficial for carers to offer their loved one <a href="https://compassionatecommunitiesni.com/our-programs/dying-to-talk/">opportunities to reflect</a> on significant life events, attend to unfinished business, and to discuss preferences for funeral arrangements. For some, this may involve supporting loved ones to reconnect with friends and family, helping them to put legal or financial affairs in order, talking about how the illness is affecting them, or making an <a href="https://www.england.nhs.uk/publication/universal-principles-for-advance-care-planning/">advance care plan</a>.</p> <figure><iframe src="https://www.youtube.com/embed/wrJaTXW1Xvk?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <h2>Talking is key</h2> <p>Living with altered family dynamics, multiple losses, transition and uncertainty can be <a href="https://www.tandfonline.com/doi/full/10.1080/07481187.2021.1998935">distressing for all family members</a>. It may be difficult to manage the emotional strain of knowing death is unavoidable, to make sense of the situation, and to <a href="https://hospicefoundation.ie/i-need-help/i-am-seriously-ill/how-to-talk-to-those-you-care-about/">talk about dying</a>.</p> <p>However, talking is key in <a href="https://www.cruse.org.uk/about/blog/important-conversations-death/">preparing for an impending death</a>. Organisations who offer specialist palliative care have information and trained professionals to help with difficult conversations, including <a href="https://www.mariecurie.org.uk/help/support/diagnosed/talking-children/children">talking to children</a> about death and dying.</p> <p>Navigating anticipatory grief can involve self-compassion for both the patient and carer. This includes acknowledging difficult emotions and treating oneself with kindness. Open communication with the person nearing the end of their life can foster emotional connection and help address their concerns, alongside support from the wider circle of family and friends.</p> <p>Extending empathy and understanding to those nearing death – and those grieving their impending loss – will help contribute to a compassionate community that supports those experiencing death, dying and bereavement.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/221629/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/lisa-graham-wisener-1247893">Lisa Graham-Wisener</a>, Lecturer of Health Psychology, <a href="https://theconversation.com/institutions/queens-university-belfast-687">Queen's University Belfast</a> and <a href="https://theconversation.com/profiles/audrey-roulston-1512057">Audrey Roulston</a>, Professor of Social Work in Palliative Care, <a href="https://theconversation.com/institutions/queens-university-belfast-687">Queen's University Belfast</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/not-all-mourning-happens-after-bereavement-for-some-grief-can-start-years-before-the-death-of-a-loved-one-221629">original article</a>.</em></p>

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

<p><em><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></em></p> <p>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>.</p> <p>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>.</p> <p>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:</p> <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> <p>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.</p> <p>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.</p> <h2>More pain doesn’t mean a more serious injury</h2> <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> <h2>Reduce your chance of lasting pain</h2> <p>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:</p> <ul> <li> <p>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</p> </li> <li> <p>reduce your pain system sensitivity. With guidance, patience and persistence, you can learn how to gradually retrain your pain system back towards normal.</p> </li> </ul> <h2>How to reduce your pain sensitivity and learn about pain</h2> <p>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.</p> <p>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.</p> <p>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.</p> <p>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>.</p> <p>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.</p> <p>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" /></p> <p><em><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></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-long-does-back-pain-last-and-how-can-learning-about-pain-increase-the-chance-of-recovery-222513">original article</a>.</em></p>

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Running or yoga can help beat depression, research shows – even if exercise is the last thing you feel like

<p><em><a href="https://theconversation.com/profiles/michael-noetel-147460">Michael Noetel</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a></em></p> <p>At least <a href="https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2021.665019/full">one in ten people</a> have depression at some point in their lives, with some estimates <a href="https://www.sciencedirect.com/science/article/pii/S0749379720301793">closer to one in four</a>. It’s one of the worst things for someone’s wellbeing – worse than <a href="https://www.happinessresearchinstitute.com/_files/ugd/928487_4a99b6e23f014f85b38495b7ab1ac24b.pdf">debt, divorce or diabetes</a>.</p> <p><a href="https://theconversation.com/why-are-so-many-australians-taking-antidepressants-221857">One in seven</a> Australians take antidepressants. Psychologists are in <a href="https://theconversation.com/we-cant-solve-australias-mental-health-emergency-if-we-dont-train-enough-psychologists-here-are-5-fixes-190135">high demand</a>. Still, only <a href="http://dx.doi.org/10.1371/journal.pmed.1003901">half</a> of people with depression in high-income countries get treatment.</p> <p>Our <a href="https://www.bmj.com/content/384/bmj-2023-075847">new research</a> shows that exercise should be considered alongside therapy and antidepressants. It can be just as impactful in treating depression as therapy, but it matters what type of exercise you do and how you do it.</p> <h2>Walk, run, lift, or dance away depression</h2> <p>We found 218 randomised trials on exercise for depression, with 14,170 participants. We analysed them using a method called a network meta-analysis. This allowed us to see how different types of exercise compared, instead of lumping all types together.</p> <p>We found walking, running, strength training, yoga and mixed aerobic exercise were about as effective as <a href="https://theconversation.com/explainer-what-is-cognitive-behaviour-therapy-37351">cognitive behaviour therapy</a> – one of the <a href="https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2018.00004/full">gold-standard treatments</a> for depression. The effects of dancing were also powerful. However, this came from analysing just five studies, mostly involving young women. Other exercise types had more evidence to back them.</p> <p>Walking, running, strength training, yoga and mixed aerobic exercise seemed more effective than antidepressant medication alone, and were about as effective as exercise alongside antidepressants.</p> <p>But of these exercises, people were most likely to stick with strength training and yoga.</p> <p><iframe id="cZaWb" class="tc-infographic-datawrapper" style="border: none;" src="https://datawrapper.dwcdn.net/cZaWb/2/" width="100%" height="400px" frameborder="0"></iframe></p> <p>Antidepressants certainly help <a href="https://www.thelancet.com/article/S0140-6736(17)32802-7/fulltext">some people</a>. And of course, anyone getting treatment for depression should talk to their doctor <a href="https://australia.cochrane.org/news/new-cochrane-review-explores-latest-evidence-approaches-stopping-long-term-antidepressants">before changing</a> what they are doing.</p> <p>Still, our evidence shows that if you have depression, you should get a psychologist <em>and</em> an exercise plan, whether or not you’re taking antidepressants.</p> <h2>Join a program and go hard (with support)</h2> <p>Before we analysed the data, we thought people with depression might need to “ease into it” with generic advice, <a href="https://www.who.int/initiatives/behealthy/physical-activity">such as</a> “some physical activity is better than doing none.”</p> <p>But we found it was far better to have a clear program that aimed to push you, at least a little. Programs with clear structure worked better, compared with those that gave people lots of freedom. Exercising by yourself might also make it hard to set the bar at the right level, given low self-esteem is a symptom of depression.</p> <p>We also found it didn’t matter how much people exercised, in terms of sessions or minutes a week. It also didn’t really matter how long the exercise program lasted. What mattered was the intensity of the exercise: the higher the intensity, the better the results.</p> <h2>Yes, it’s hard to keep motivated</h2> <p>We should exercise caution in interpreting the findings. Unlike drug trials, participants in exercise trials know which “treatment” they’ve been randomised to receive, so this may skew the results.</p> <p>Many people with depression have physical, psychological or social barriers to participating in formal exercise programs. And getting support to exercise isn’t free.</p> <p>We also still don’t know the best way to stay motivated to exercise, which can be even harder if you have depression.</p> <p>Our study tried to find out whether things like setting exercise goals helped, but we couldn’t get a clear result.</p> <p>Other reviews found it’s important to have a <a href="https://pubmed.ncbi.nlm.nih.gov/31923898/">clear action plan</a> (for example, putting exercise in your calendar) and to <a href="https://pubmed.ncbi.nlm.nih.gov/19916637/">track your progress</a> (for example, using an app or smartwatch). But predicting which of these interventions work is notoriously difficult.</p> <p>A <a href="https://www.nature.com/articles/s41586-021-04128-4">2021 mega-study</a> of more than 60,000 gym-goers <a href="https://www.nature.com/articles/s41586-021-04128-4/figures/1">found</a> experts struggled to predict which strategies might get people into the gym more often. Even making workouts fun didn’t seem to motivate people. However, listening to audiobooks while exercising helped a lot, which no experts predicted.</p> <p>Still, we can be confident that people benefit from personalised support and accountability. The support helps overcome the hurdles they’re sure to hit. The accountability keeps people going even when their brains are telling them to avoid it.</p> <p>So, when starting out, it seems wise to avoid going it alone. Instead:</p> <ul> <li> <p>join a fitness group or yoga studio</p> </li> <li> <p>get a trainer or an exercise physiologist</p> </li> <li> <p>ask a friend or family member to go for a walk with you.</p> </li> </ul> <p>Taking a few steps towards getting that support makes it more likely you’ll keep exercising.</p> <h2>Let’s make this official</h2> <p>Some countries see exercise as a backup plan for treating depression. For example, the American Psychological Association only <a href="https://www.apa.org/depression-guideline/">conditionally recommends</a> exercise as a “complementary and alternative treatment” when “psychotherapy or pharmacotherapy is either ineffective or unacceptable”.</p> <p>Based on our research, this recommendation is withholding a potent treatment from many people who need it.</p> <p>In contrast, The Royal Australian and New Zealand College of Psychiatrists <a href="https://www.ranzcp.org/getmedia/a4678cf4-91f5-4746-99d4-03dc7379ae51/mood-disorders-clinical-practice-guideline-2020.pdf">recommends</a> vigorous aerobic activity at least two to three times a week for all people with depression.</p> <p>Given how common depression is, and the number failing to receive care, other countries should follow suit and recommend exercise alongside front-line treatments for depression.</p> <p><em>I would like to acknowledge my colleagues Taren Sanders, Chris Lonsdale and the rest of the coauthors of the paper on which this article is based.</em></p> <p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.</em><!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/223441/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/michael-noetel-147460">Michael Noetel</a>, Senior Lecturer in Psychology, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a></em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/running-or-yoga-can-help-beat-depression-research-shows-even-if-exercise-is-the-last-thing-you-feel-like-223441">original article</a>.</em></p>

Body

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‘Self-love’ might seem selfish. But done right, it’s the opposite of narcissism

<p><em><a href="https://theconversation.com/profiles/ian-robertson-1372650">Ian Robertson</a>, <a href="https://theconversation.com/institutions/university-of-wollongong-711">University of Wollongong</a></em></p> <p>“To love what you are, the thing that is yourself, is just as if you were embracing a glowing red-hot iron” <a href="https://archive.org/details/jungsseminaronni0000jung">said psychonalyst Carl Jung</a>.</p> <p>Some may argue this social media generation does not seem to struggle with loving themselves. But is the look-at-me-ism so easily found on TikTok and Instagram the kind of self-love we need in order to flourish?</p> <p>The language of <a href="https://theconversation.com/teaching-positive-psychology-skills-at-school-may-be-one-way-to-help-student-mental-health-and-happiness-217173">positive psychology</a> can be – and often is – appropriated for all kinds of self-importance, as well as cynical marketing strategies.</p> <p>Loving yourself, though, psychological experts stress, is not the same as behaving selfishly. There’s a firm line between healthy and appropriate forms of loving yourself, and malignant or <a href="https://theconversation.com/how-many-types-of-narcissist-are-there-a-psychology-expert-sets-the-record-straight-207610">narcissistic</a> forms. But how do we distinguish between them?</p> <p>In 2023, researchers Eva Henschke and Peter Sedlmeier conducted <a href="https://www.researchgate.net/publication/355152846_What_is_self-love_Redefinition_of_a_controversial_construct">a series of interviews</a> with psychotherapists and other experts on what self-love is. They’ve concluded it has three main features: self-care, self-acceptance and self-contact (devoting attention to yourself).</p> <p>But as an increasingly individualistic society, are we already devoting too much attention to ourselves?</p> <h2>Philosophy and self-love</h2> <p>Philosophers and psychology experts alike have considered the ethics of self-love.</p> <p>Psychology researcher Li Ming Xue and her colleagues, <a href="https://www.frontiersin.org/articles/10.3389/fpsyg.2021.585719/full">exploring the notion of self-love in Chinese culture</a>, claim “Western philosophers believe that self-love is a virtue”. But this is a very broad generalisation.</p> <p>In the Christian tradition and in much European philosophy, <a href="https://www.tandfonline.com/doi/full/10.1080/10848770.2020.1839209">says philosopher Razvan Ioan</a>, self-love is condemned as a profoundly damaging trait.</p> <p>On the other hand, <a href="https://www.jstor.org/stable/2107991">many of the great Christian philosophers</a>, attempting to make sense of the instruction to love one’s neighbour as oneself, admitted certain forms of self-love were virtuous. In order to love your neighbour as yourself, you must, it would seem, love yourself.</p> <p>In the Western philosophical context, claim Xue and her colleagues, self-love is concerned with individual rights – “society as a whole only serves to promote an individual’s happiness”.</p> <p>This individualistic, self-concerned notion of self-love, they suggest, might come from the Ancient Greek philosophers. In particular, Aristotle. But <a href="https://www.psychologytoday.com/intl/blog/philosophy-stirred-not-shaken/201502/love-yourself-love-your-character">Aristotle thought only the most virtuous</a>, who benefited the society around them, should love themselves. By making this connection, he avoided equating self-love with self-centredness.</p> <p>We should love ourselves not out of vanity, he argued, but in virtue of our capacity for good. Does Aristotle, then, provide principled grounds for distinguishing between proper and improper forms of self-love?</p> <h2>Bar too high?</h2> <p>Aristotle might set the bar too high. If only the most virtuous should try to love themselves, this collides head-on with the idea loving yourself can help us improve and become more virtuous – as <a href="https://link.springer.com/chapter/10.1057/9781137383310_6">philosophers Kate Abramson and Adam Leite have argued</a>.</p> <p>Many psychologists claim self-love is important for adopting the kind and compassionate self-perception crucial for overcoming conditions that weaponise self-criticism, like <a href="https://theconversation.com/clinical-perfectionism-when-striving-for-excellence-gets-you-down-43704">clinical perfectionism</a> and <a href="https://theconversation.com/how-many-people-have-eating-disorders-we-dont-really-know-and-thats-a-worry-121938">eating disorders</a>.</p> <p>More broadly, some argue compassion for oneself is necessary to support honest insights into your own behaviour. They believe we need warm and compassionate self-reflection to avoid the defensiveness that comes with the fear of judgement – even if we’re standing as our own judge.</p> <p>For this reason, a compassionate form of self-love is often necessary to follow Socrates’ advice to “know thyself”, says <a href="https://link.springer.com/article/10.1007/s10677-015-9578-4">philosopher Jan Bransen</a>. Positive self-love, by these lights, can help us grow as people.</p> <h2>Self-love ‘misguided and silly’</h2> <p>But not everyone agrees you need self-love to grow. The late philosopher <a href="https://www.theguardian.com/news/2005/nov/29/guardianobituaries.obituaries">Oswald Hanfling</a> was deeply sceptical of this idea. In fact, he argued the notion of loving oneself was misguided and silly. His ideas are mostly rejected by philosophers of love, but pointing out where they go wrong can be useful.</p> <p>When you love someone, he said, you’re prepared to sacrifice your own interests for those of your beloved. But he thought the idea of sacrificing your own interests made no sense – which shows, he concluded, we can’t love ourselves.</p> <p><a href="https://www.jstor.org/stable/3751159">He wrote</a>: "I may sacrifice an immediate satisfaction for the sake of my welfare in the future, as in the case of giving up smoking. In this case, however, my motive is not love but self-interest. What I reveal in giving up smoking is not the extent of my love for myself, but an understanding that the long-term benefits of giving it up are likely to exceed the present satisfaction of going on with it."</p> <p>We often have conflicting interests (think of someone who is agonising over two different career paths) – and it’s not at all strange to sacrifice certain interests for the sake of others.</p> <p>This is not just a question of sacrificing short-term desires in favour of a long-term good, but a matter of sacrificing something of value for your ultimate benefit (or, so you hope).</p> <h2>Self-compassion</h2> <p>Hanfling fails to consider the role of compassionate self-love. While we might understand it’s in our interests to do something (for instance, repair bridges with someone we’ve fallen out with), it might take a compassionate and open disposition towards ourselves to recognise what’s in our best interests.</p> <p>We might need this self-compassion, too, in order to admit our failures – so we can overcome our defensiveness and see clearly how we’re failing to fulfil <a href="https://link.springer.com/article/10.1007/s10677-015-9578-4">these interests</a>.</p> <p>Self-acceptance in this context does not mean giving ourselves licence to run roughshod over the interests of those around us, nor to justify our flaws as “valid” rather than work on them.</p> <p>Self-love, as promoted by contemporary psychologists, means standing in a compassionate relationship to ourselves. And there’s nothing contradictory about this idea.</p> <p>Just as we strive to develop a supportive, kind relationship to the people we care about – and just as this doesn’t involve uncritical approval of everything they do – compassionate self-love doesn’t mean abandoning valid self-criticism.</p> <p>In fact, self-compassion has the opposite effect. It promotes comfort with the kind of critical self-assessment that helps us grow – which leads to resilience. It breeds the opposite of narcissistic self-absorption.<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/205938/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/ian-robertson-1372650">Ian Robertson</a>, PhD Candidate (Teaching roles at Macquarie &amp; Wollongong), <a href="https://theconversation.com/institutions/university-of-wollongong-711">University of Wollongong</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/self-love-might-seem-selfish-but-done-right-its-the-opposite-of-narcissism-205938">original article</a>.</em></p>

Mind

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What is micellar water and how does it work?

<p><em><a href="https://theconversation.com/profiles/daniel-eldridge-1494633">Daniel Eldridge</a>, <a href="https://theconversation.com/institutions/swinburne-university-of-technology-767">Swinburne University of Technology</a></em></p> <p>Micellar water, a product found in supermarkets, chemists and bathroom cabinets around the world, is commonly used to remove make-up. It’s a very effective cleanser and many people swear by it as part of their skincare routine.</p> <p>So, what is micellar water and why is it so good at getting makeup and sunscreen off? Here’s the science.</p> <h2>What are micelles?</h2> <p>Oil and water generally don’t mix, which is why you’ll struggle to remove makeup and sunscreen (which both contain oils) with just plain water.</p> <p>But micellar water products contain something called micelles – clusters of molecules that are <em>very</em> effective at removing oily substances. To understand why, you need to first know two chemistry terms: hydrophilic and hydrophobic.</p> <p>A hydrophilic substance “loves” water and mixes easily with it. Salt and sugar are examples.</p> <p>A hydrophobic substance “hates” water and generally refuses to mix with it. Examples include oil and wax.</p> <p>Hydrophilic materials will happily mix with other hydrophilic materials. The same goes for hydrophobic substances. But if you try to combine hydrophilic and hydrophobic materials, they won’t mix.</p> <h2>How are micelles formed? It’s all about surfactants</h2> <p>The micelles in micellar water are formed by special molecules known as surfactants.</p> <p>Surfactant stands for surface active agent. These molecules looked at their hydrophilic and hydrophobic brethren and said, why not both? They are typically comprised of two ends: a head group that is hydrophilic and a tail that is hydrophobic.</p> <p>When a small amount of surfactant is added to water, the two ends of the molecule have competing interests. The hydrophilic head wants to be in the water, but the hydrophobic tail can’t stand water.</p> <p>Add enough surfactant and, eventually, we will pass a critical micelle concentration and the surfactants will self-assemble into clusters of approximately 20 to 100 surfactant molecules.</p> <p>All the hydrophilic heads will be pointing outwards, while the hydrophobic tails remain “hidden” at the centre. These clusters are micelles.</p> <p>These micelles have a hydrophilic exterior, meaning that they are very happy to remain mixed throughout water. However, in the centre remains a hydrophobic pocket that’s very good at attracting oils.</p> <p>This is very handy, and helps explain why adding some detergent (a surfactant) to water will allow you to wash an oily saucepan. The surfactant first helps lift of the oil, and then the oil can remained mixed into the water, finding a new home in the hydrophobic centre of the micelle.</p> <figure><iframe src="https://www.youtube.com/embed/fnRBCn8fm2o?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <h2>Micellar water in action</h2> <p>Surfactants are in your dishwashing detergent, your body wash, your shampoo, your toothpaste and even many foods. In all of these cases, they are there to help the water interact with the dirt and oils, and micellar water is no different.</p> <p>When you apply some micellar water to a cotton pad, another convenient interaction occurs. The wet cotton is hydrophilic (loves water). Consequently, some of the micelles will unravel, with the hydrophilic heads being attracted to the wet cotton pad.</p> <p>Now, sticking out from the surface will be a layer of hydrophobic tail groups. These hydrophobic tails cannot wait to attract themselves to makeup, sunscreen, oils, dirt, grease and other contaminants on your face.</p> <p>As you sweep the cotton pad across your skin, these contaminants bind to the hydrophobic tails and are removed from the skin.</p> <p>Some contaminants will also find themselves encapsulated in the hydrophobic centres of the micelle.</p> <p>Either way, a cleaner surface is left behind.</p> <p>Look at how a cotton wipe soaked in micellar water cleans up a small oil spill, in comparison to water alone.</p> <figure><iframe src="https://www.youtube.com/embed/5Nge5FEiuYE?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <h2>So why shouldn’t I just use dishwashing detergent to wash my face?</h2> <p>Technically, that would work as detergent does indeed contain lots of micelle-forming surfactants.</p> <p>But these particular surfactants would probably cause a lot of skin and eye irritation, while also damaging and drying out your skin. Not nice.</p> <p>The surfactants in micellar water are chosen to be mild and well tolerated by most people’s skin. But micellar water isn’t the only skincare product to contain micelles. There are many other face-cleaning products that also make great use of surfactant molecules and work very well too.</p> <p>Now, it’s not perfect. While it is effective at removing a wide range of contaminants, thick or heavy makeup might not come off easily with micellar water (you might need to do a more vigorous clean).</p> <p>Some products say there is “zero residue”, although the fine print clearly states this refers to visible residue.</p> <p>Many products also state there is no rinse off required. Surfactants will remain on your skin after product use, but for many people they don’t cause irritation. If your skin is feeling irritated after using a micellar water product, you can try rinsing afterwards or discontinuing use.</p> <p>And as is the case with many cosmetic products, you should test it first on a small patch of skin before using it all over your face.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/219492/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/daniel-eldridge-1494633"><em>Daniel Eldridge</em></a><em>, Senior Lecturer in Chemistry, <a href="https://theconversation.com/institutions/swinburne-university-of-technology-767">Swinburne University of Technology</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-is-micellar-water-and-how-does-it-work-219492">original article</a>.</em></p>

Beauty & Style

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How does cancer spread to other parts of the body?

<p><em><a href="https://theconversation.com/profiles/sarah-diepstraten-1495268">Sarah Diepstraten</a>, <a href="https://theconversation.com/institutions/walter-and-eliza-hall-institute-822">Walter and Eliza Hall Institute</a> and <a href="https://theconversation.com/profiles/john-eddie-la-marca-1503690">John (Eddie) La Marca</a>, <a href="https://theconversation.com/institutions/walter-and-eliza-hall-institute-822">Walter and Eliza Hall Institute</a></em></p> <p>All cancers begin in a single organ or tissue, such as the lungs or skin. When these cancers are confined in their original organ or tissue, they are generally more treatable.</p> <p>But a cancer that spreads is much more dangerous, as the organs it spreads to may be vital organs. A skin cancer, for example, might spread to the brain.</p> <p>This new growth makes the cancer much more challenging to treat, as it can be difficult to find all the new tumours. If a cancer can invade different organs or tissues, it can quickly become lethal.</p> <p>When cancer spreads in this way, it’s called metastasis. Metastasis is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6745820/">responsible for</a> the majority (67%) of cancer deaths.</p> <h2>Cells are supposed to stick to surrounding tissue</h2> <p>Our bodies are made up of trillions of tiny cells. To keep us healthy, our bodies are constantly replacing old or damaged cells.</p> <p>Each cell has a specific job and a set of instructions (DNA) that tells it what to do. However, sometimes DNA can get damaged.</p> <p>This damage might change the instructions. A cell might now multiply uncontrollably, or lose a property known as adherence. This refers to how sticky a cell is, and how well it can cling to other surrounding cells and stay where it’s supposed to be.</p> <p>If a cancer cell loses its adherence, it can break off from the original tumour and travel through the bloodstream or lymphatic system to almost anywhere. This is how metastasis happens.</p> <p>Many of these travelling cancer cells will die, but some will settle in a new location and begin to form new cancers.</p> <p>Particular cancers are more likely to metastasise to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381616/">particular organs</a> that help support their growth. Breast cancers commonly metastasise to the bones, liver, and lungs, while skin cancers like melanomas are more likely to end up in the brain and heart.</p> <p>Unlike cancers which form in solid organs or tissues, blood cancers like leukaemia already move freely through the bloodstream, but <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8722462/">can escape</a> to settle in other organs like the liver or brain.</p> <h2>When do cancers metastasise?</h2> <p>The longer a cancer grows, the more likely it is to metastasise. If not caught early, a patient’s cancer may have metastasised even before it’s initially diagnosed.</p> <p>Metastasis can also occur after cancer treatment. This happens when cancer cells are dormant during treatment – drugs may not “see” those cells. These invisible cells can remain hidden in the body, only to wake up and begin growing into a new cancer months or even years later.</p> <p>For patients who already have cancer metastases at diagnosis, identifying the location of the original tumour – called the “primary site” – is important. A cancer that began in the breast but has spread to the liver will probably still behave like a breast cancer, and so will respond best to an anti-breast cancer therapy, and not anti-liver cancer therapy.</p> <p>As metastases can sometimes grow faster than the original tumour, it’s not always easy to tell which tumour came first. These cancers are called “cancers of unknown primary” and are the <a href="https://www.canceraustralia.gov.au/cancer-types/unknown-primary-cancer/statistics">11th most commonly diagnosed cancers in Australia</a>.</p> <p>One way to improve the treatment of metastatic cancer is to improve our ways of detecting and identifying cancers, to ensure patients receive the most effective drugs for their cancer type.</p> <h2>What increases the chances of metastasis and how can it be prevented?</h2> <p>If left untreated, most cancers will eventually acquire the ability to metastasise.</p> <p>While there are currently no interventions that specifically prevent metastasis, cancer patients who have their tumours surgically removed may also be given chemotherapy (or other drugs) to try and weed out any hidden cancer cells still floating around.</p> <p>The best way to prevent metastasis is to diagnose and treat cancers early. Cancer screening initiatives such as Australia’s <a href="https://www.health.gov.au/our-work/national-cervical-screening-program">cervical</a>, <a href="https://www.health.gov.au/our-work/national-bowel-cancer-screening-program">bowel</a>, and <a href="https://www.health.gov.au/our-work/breastscreen-australia-program">breast</a> cancer screening programs are excellent ways to detect cancers early and reduce the chances of metastasis.</p> <p>New screening programs to detect cancers early are being researched for many types of cancer. Some of these are simple: CT scans of the body to look for any potential tumours, such as in England’s new <a href="https://theconversation.com/how-englands-new-lung-cancer-screening-could-save-thousands-of-lives-expert-qanda-208867">lung cancer screening program</a>.</p> <p>Using artificial intelligence (AI) to help examine patient scans is also <a href="https://theconversation.com/ai-can-help-detect-breast-cancer-but-we-dont-yet-know-if-it-can-improve-survival-rates-210800">possible</a>, which might identify new patterns that suggest a cancer is present, and improve cancer detection from these programs.</p> <p>More advanced screening methods are also in development. The United States government’s Cancer Moonshot program is currently funding research into blood tests that could detect <a href="https://theconversation.com/a-blood-test-that-screens-for-multiple-cancers-at-once-promises-to-boost-early-detection-191728">many types of cancer at early stages</a>.</p> <p>One day there might even be a RAT-type test for cancer, like there is for COVID.</p> <h2>Will we be able to prevent metastasis in the future?</h2> <p>Understanding how metastasis occurs allows us to figure out new ways to prevent it. One idea is to <a href="https://www.cancer.gov/news-events/cancer-currents-blog/2019/breast-cancer-chemotherapy-sensitizing-dormant-cells">target dormant cancer cells</a> and prevent them from waking up.</p> <p>Directly preventing metastasis with drugs is not yet possible. But there is hope that as research efforts continue to improve cancer therapies, they will also be more effective at treating metastatic cancers.</p> <p>For now, early detection is the best way to ensure a patient can beat their cancer.<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/219616/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><a href="https://theconversation.com/profiles/sarah-diepstraten-1495268"><em>Sarah Diepstraten</em></a><em>, Senior Research Officer, Blood Cells and Blood Cancer Division, <a href="https://theconversation.com/institutions/walter-and-eliza-hall-institute-822">Walter and Eliza Hall Institute</a> and <a href="https://theconversation.com/profiles/john-eddie-la-marca-1503690">John (Eddie) La Marca</a>, Senior Resarch Officer, <a href="https://theconversation.com/institutions/walter-and-eliza-hall-institute-822">Walter and Eliza Hall Institute</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-does-cancer-spread-to-other-parts-of-the-body-219616">original article</a>.</em></p>

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How long does immunity last after a COVID infection?

<p><em><a href="https://theconversation.com/profiles/lara-herrero-1166059">Lara Herrero</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> and <a href="https://theconversation.com/profiles/dr-wesley-freppel-1408971">Dr Wesley Freppel</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a></em></p> <p>Nearly four years into the pandemic, Australia, like many other countries, is still seeing large numbers of <a href="https://nindss.health.gov.au/pbi-dashboard/">COVID cases</a>. Some 860,221 infections were recorded around the country in 2023, while 30,283 cases have already been reported in 2024.</p> <p>This is likely to be a significant underestimate, with fewer people testing and reporting than earlier in the pandemic. But the signs suggest parts of Australia are experiencing yet <a href="https://www.abc.net.au/news/2024-01-23/covid-19-case-numbers-from-australia-states-and-territories/103374656">another COVID surge</a>.</p> <p>While some lucky people claim to have never had COVID, many are facing our second, third or even fourth infection, often despite having been vaccinated. You might be wondering, how long does immunity last after a previous infection or vaccination?</p> <p>Let’s take a look at what the evidence shows.</p> <h2>B cells and T cells</h2> <p>To answer this question, we need to understand a bit about how <a href="https://theconversation.com/what-happens-in-our-body-when-we-encounter-and-fight-off-a-virus-like-the-flu-sars-cov-2-or-rsv-207023">immunity</a> to SARS-CoV-2 (the virus that causes COVID) works.</p> <p>After being infected or vaccinated, the immune system develops specific antibodies that can neutralise SARS-CoV-2. B cells remember the virus for a period of time. In addition, the immune system produces memory T cells that can kill the virus, and remain in the blood for some months after the clearance of the infection or a vaccination.</p> <p>A <a href="https://www.science.org/doi/full/10.1126/science.abf4063?rfr_dat=cr_pub++0pubmed&amp;url_ver=Z39.88-2003&amp;rfr_id=ori%3Arid%3Acrossref.org">2021 study</a> found 98% of people had antibodies against SARS-CoV-2’s spike protein (a protein on the surface of the virus that allows it to attach to our cells) one month after symptom onset. Six to eight months afterwards, 90% of participants still had these neutralising antibodies in their blood.</p> <p>This means the immune system should have recognised and neutralised the same SARS-CoV-2 variant if challenged within six to eight months (if an infection occurred, it should have resulted in mild to no symptoms).</p> <h2>But what about when the virus mutates?</h2> <p>As we know, SARS-CoV-2 has mutated over time, leading to the emergence of new variants such as alpha, beta, delta and omicron. Each of these variants carries mutations that are new to the immune system, even if the person has been previously infected with an earlier variant.</p> <p>A new variant likely won’t be <a href="https://www.science.org/doi/10.1126/science.adj0070">perfectly recognised</a> – or even <a href="https://www.cell.com/cell/pdf/S0092-8674(21)01578-6.pdf">recognised at all</a> – by the already activated memory T or B cells from a previous SARS-CoV-2 infection. This could explain why people can be so readily reinfected with COVID.</p> <p>A recent <a href="https://www.thelancet.com/article/S0140-6736(22)02465-5/fulltext#seccestitle10">review of studies</a> published up to the end of September 2022 looked at the protection conferred by previous SARS-CoV-2 infections.</p> <p>The authors found a previous infection provided protective immunity against reinfection with the ancestral, alpha, beta and delta variants of 85.2% at four weeks. Protection against reinfection with these variants remained high (78.6%) at 40 weeks, or just over nine months, after the previous infection. This protection decreased to 55.5% at 80 weeks (18 months), but the authors noted there was a lack of data at this time point.</p> <p>Notably, an earlier infection provided only 36.1% protection against a reinfection with omicron BA.1 at 40 weeks. Omicron has been described as an <a href="https://www.nature.com/articles/s41564-022-01143-7">immune escape variant</a>.</p> <p>A prior infection showed a high level of protection against severe disease (above 88%) up to 40 weeks regardless of the variant a person was reinfected with.</p> <h2>What about immunity after vaccination?</h2> <p>So far almost 70 million COVID vaccines <a href="https://www.health.gov.au/topics/covid-19/reporting">have been administered</a> to more than <a href="https://www.health.gov.au/resources/publications/covid-19-vaccine-rollout-update-12-january-2023?language=en">22 million people</a> in Australia. Scientists estimated COVID vaccines prevented around <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00320-6/fulltext">14.4 million deaths</a> in 185 countries in the first year after they became available.</p> <p>But we know COVID vaccine effectiveness wanes over time. A <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2804451?utm_source=For_The_Media&amp;utm_medium=referral&amp;utm_campaign=ftm_links&amp;utm_term=050323">2023 review</a> found the original vaccines were 79.6% and 49.7% effective at protecting against symptomatic delta infection at one and nine months after vaccination respectively. They were 60.4% and 13.3% effective against symptomatic omicron at the same time points.</p> <p>This is where booster doses come into the picture. They’re important to keep the immune system ready to fight off the virus, particularly for those who are more vulnerable to the effects of a COVID infection.</p> <p>Plus, regular booster doses can provide immunity against different variants. COVID vaccines are constantly being <a href="https://mvec.mcri.edu.au/references/covid-19/">reviewed and updated</a> to ensure optimal protection against <a href="https://www.who.int/activities/tracking-SARS-CoV-2-variants">current circulating strains</a>, with the latest shot available designed to target <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/new-covid-19-vaccines-available-to-target-current-variants">the omicron variant XBB 1.5</a>. This is similar to how we approach seasonal flu vaccines.</p> <p>A <a href="https://www.nature.com/articles/s41598-023-50335-6">recent study</a> showed a COVID vaccination provides longer protection against reinfection than natural protection alone. The median time from infection to reinfection in non-vaccinated people was only six months, compared with 14 months in people who had received one, two or three doses of vaccine after their first infection. This is called <a href="https://www.science.org/doi/10.1126/science.abj2258">hybrid immunity</a>, and other research has similarly found it provides better protection than natural infection alone.</p> <p>It also seems timing is important, as receiving a vaccine too soon after an infection (less than six months) appears to be <a href="https://www.nature.com/articles/s41598-023-50335-6">less effective</a> than getting vaccinated later.</p> <h2>What now?</h2> <p>Everyone’s immune system is slightly unique, and SARS-CoV-2 continues to mutate, so knowing exactly how long COVID immunity lasts is complicated.</p> <p>Evidence suggests immunity following infection should generally last six months in healthy adults, and can be prolonged with vaccination. But there are exceptions, and all of this assumes the virus has not mutated so much that it “escapes” our immune response.</p> <p>While many people feel the COVID pandemic is over, it’s important we don’t forget the lessons we have learned. Practices such as wearing a mask and staying home when unwell can reduce the spread of many viruses, not only <a href="https://www.bmj.com/content/375/bmj-2021-068302">COVID</a>.</p> <p>Vaccination is not mandatory, but for older adults eligible for a booster under the <a href="https://www.health.gov.au/news/atagi-update-on-the-covid-19-vaccination-program">current guidelines</a>, it’s a very good idea.<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/221398/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><a href="https://theconversation.com/profiles/lara-herrero-1166059"><em>Lara Herrero</em></a><em>, Research Leader in Virology and Infectious Disease, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> and <a href="https://theconversation.com/profiles/dr-wesley-freppel-1408971">Dr Wesley Freppel</a>, Research Fellow, Institute for Glycomics, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-long-does-immunity-last-after-a-covid-infection-221398">original article</a>.</em></p>

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Couple who found love in chemotherapy raise funds for final trip

<p>Ainslie Plumb, 22, and Joe Fan, 29, found love in an unexpected place, at the Royal Brisbane and Women’s Hospital. </p> <p>The couple met in 2022 while they were both undergoing leukaemia treatment. </p> <p>“We met at an event for young people with cancer and became friends following that,” Plumb told <em>7News</em>. </p> <p>“(We) would hang out during our hospital stays, I asked him out in October 2022 and (we) have been together ever since.” </p> <p>While Plumb successfully entered remission, last October, Fan was told that he was now terminal, as doctors had run out of options to treat his Philadelphia chromosome positive acute lymphoblastic leukaemia. </p> <p>With only months left to live, Fan, who has actively given back to the hospital and cancer community by playing his violin for patients and staff and worked with the Queensland Youth Cancer Service, has one final wish - to travel. </p> <p>The couple have set a <a href="https://www.gofundme.com/f/help-joe-live-his-dreams" target="_blank" rel="noopener">GoFundMe</a>, to help raise funds which cover flights, accommodation and specialised travel insurance, for Fan's final trip.</p> <p>“I go through my cancer treatments and observe the toll that takes on my physical and mental wellbeing,” Fan said.</p> <p>“The end of a trip can hopefully mark the start of another — and I have held onto hope, looked forward and dreamed for one more trip, more time, one more experience with that someone I love.”</p> <p>Their first destination will be Taiwan and Hong Kong, where Fan's parents are from and where he spent a majority of his childhood. </p> <p>They also intend to travel to New Zealand and Western Australia to swim with whale sharks at Ningaloo in the state’s north.</p> <p>“We’re aiming at going at the end of February to give us time to co-ordinate with his doctors around his appointments and infusions, which are all booked in advance,” Plumb said. </p> <p>“We recently reached 75 per cent on the fundraiser and are hoping to hit 100 per cent perhaps by the end of January.”</p> <p>As of today, the couple have successfully raised over $21,000 from their $20,000 goal, and have thanked everyone in their community and strangers for their support. </p> <p>“Truly, words do not suffice,” the couple said.</p> <p><em>Images: 7News </em></p>

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What does a building need to call itself ‘accessible’ – and is that enough?

<p><a href="https://theconversation.com/profiles/ilan-wiesel-303040">Ilan W<em>iesel</em></a><em>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> and <a href="https://theconversation.com/profiles/rebecca-bentley-173502">Rebecca Bentley</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a></em></p> <p>The <a href="https://www.ndisreview.gov.au/resources/reports/working-together-deliver-ndis">National Disability Insurance Scheme (NDIS) review</a> and the disability royal commission’s <a href="https://disability.royalcommission.gov.au/system/files/2023-09/Final%20Report%20-%20Volume%207%2C%20Inclusive%20education%2C%20employment%20and%20housing%20-%20Part%20C.pdf">final report</a> both highlighted the crucial role of accessible buildings and homes in ensuring the inclusion of people with disabilities.</p> <p>But the experiences of people with disability show Australia is a very long way from achieving this. There are the stories from people with disability who <a href="https://www.abc.net.au/news/2023-06-25/taylor-swift-concert-disability-access-concerns/102520088">can’t enjoy events</a> or <a href="https://www.abc.net.au/news/2023-03-09/harry-styles-concert-disability-tickets-consumer-rights/102060698">venues</a>. And researchers say even <a href="https://www.unsw.edu.au/arts-design-architecture/our-research/research-impact/case-studies/are-our-accessible-bathrooms-inaccessible-to-people-in-wheelchairs">accessible bathrooms are not usable</a> for half the people with disability.</p> <p>What can be called an accessible building or home? And should standards be improved?</p> <h2>What is accessibility?</h2> <p>The <a href="https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-rights-persons-disabilities">Convention on the Rights of Persons with Disability</a> includes the right to accessibility. Australia’s 1992 <a href="https://humanrights.gov.au/our-work/disability-rights/frequently-asked-questions-access-premises">Disability Discrimination Act</a> includes premises standards to ensure people with disability have “dignified, equitable, cost-effective and reasonably achievable access to buildings, facilities and services”.</p> <p>However, a building is exempt if the owners can demonstrate modifying a building would cause them “unjustifiable hardship”. The burden of making a complaint about an inaccessible building falls on people with disability and the act also does not apply to private homes.</p> <p>Although experts follow different definitions of accessibility, they generally include some key principles:</p> <ul> <li> <p>easy entry and exit into a building</p> </li> <li> <p>easy navigation and functionality in and around the building</p> </li> <li> <p>potential for easy adaptation in response to changing needs of occupants.</p> </li> </ul> <p>An accessible building is one where people of all abilities are able move and carry out activities independently, safely, in comfort and with dignity.</p> <p>For people with disabilities <a href="https://disability.unimelb.edu.au/__data/assets/pdf_file/0010/3969109/Accessible-Housing-Research-Report-22-October-2020.pdf">many buildings are inaccessible</a>. In these buildings, basic everyday activities such as taking a shower or preparing breakfast becomes difficult, tiring, uncomfortable and sometimes dangerous.</p> <p>Some people have been <a href="https://disability.unimelb.edu.au/__data/assets/pdf_file/0010/3969109/Accessible-Housing-Research-Report-22-October-2020.pdf">injured</a> repeatedly in inaccessible homes, for example falling down a staircase. Such injuries may compound their disability. Many people with disabilities worry that if they’re injured at home, they will be forced to move permanently into a nursing home.</p> <p><a href="https://www.sciencedirect.com/science/article/pii/S0016718523001525">Studies</a> have found living in inaccessible homes severely harms the dignity, independence, social inclusion, employment, health and wellbeing of people with disabilities.</p> <p>People become more reliant on family members for support, putting strain on their relationships. Difficulty getting in and out of the house for social activities worsens social isolation. A sense of fatigue also reduces the motivation and capacity to work.</p> <h2>Access through the front door</h2> <p>Dignity is a crucial aspect of accessibility but it is often forgotten. For example, many buildings’ front entry has stairs that make it inaccessible for wheelchair users. There may be an accessible ramp entry in the back of the building. The building is then considered accessible, since wheelchair users can enter and exit. But such a “backdoor treatment” can be experienced as an indignity and discrimination.</p> <p>Accessible toilets are sometimes used for <a href="https://www.sbs.com.au/news/article/most-public-toilets-inaccessible-to-people-with-disabilities/adsx7cnr8">storage, locked or out of order</a>. Again, although the design meets accessibility standards, in practice the building is inaccessible because of poor management.</p> <p>And accessibility is not exclusively about physical disabilities and physical barriers.</p> <p>People with cognitive disabilities, for example, might struggle to find their way in a building if way-finding signs are difficult to understand. <a href="https://theconversation.com/for-people-with-communication-disability-complaining-about-their-treatment-isnt-so-simple-214717">Communication accessibility</a> in building is achieved when the information needed to navigate and use the building is understood by everyone, no matter how they communicate.</p> <h2>Silver, gold and platinum standards</h2> <p>There are different levels of accessibility. In Australia, housing accessibility is most often assessed according to <a href="https://livablehousingaustralia.org.au/wp-content/uploads/2021/02/SLLHA_GuidelinesJuly2017FINAL4.pdf">Livable Housing Australia</a>’s (LHA) three standards of silver, gold and platinum. Silver-level homes have minimal accessibility features, but are designed in a way that enables easy home modifications over time.</p> <p>The silver standard of accessibility requires seven features:</p> <p>• a step-free path of travel from the street or parking area</p> <p>• at least one step-free entrance</p> <p>• internal doors and corridors that allow comfortable movement, including for people using wheelchairs</p> <p>• a toilet on the entry level with easy access</p> <p>• a bathroom with a hobless shower recess, so there isn’t a step-over barrier to entry</p> <p>• reinforced walls around the toilet, shower and bath. These allow installation of grabrails later if needed</p> <p>• stairways designed to reduce the risk of injury and also enable future adaptation.</p> <p>Gold-level homes have additional accessibility features. Platinum homes are designed for people with higher mobility needs and to allow ageing at home.</p> <h2>A patchwork of standards and what the NDIS review says</h2> <p>In 2021 Australian housing ministers <a href="https://www.industry.gov.au/news/building-ministers-meeting-communique-april-2021">agreed for the first time</a> to introduce minimum accessibility standards in the National Construction Code. It followed decades of campaigning by activist groups such as the <a href="https://anuhd.org/">Australian Network for Universal Housing Design</a>, <a href="https://riaustralia.org/">Rights and Inclusion Australia</a> and the <a href="https://www.summerfoundation.org.au/">Summer Foundation</a>.</p> <p>The code requires all new homes be built to silver standards. It does not apply to existing homes and exemptions will apply for some newly built homes because of site restrictions.</p> <p>When the code was introduced, New South Wales and Western Australia announced they would not adopt the new code. Both the NDIS review and the disability royal commission recommended all states and territories <a href="https://disability.royalcommission.gov.au/system/files/2023-09/Final%20Report%20-%20Volume%207%2C%20Inclusive%20education%2C%20employment%20and%20housing%20-%20Part%20C.pdf">immediately adopt</a> the code’s new accessibility standards.</p> <p>A consistent application of the code’s new standards across Australia is a good start. But the code provides only the minimum standard of accessibility. To make buildings and homes truly accessible, we need to improve education on accessibility for designers, operators and consumers.</p> <h2>An urgent national priority</h2> <p>With Australia’s ageing population, most people will experience disability – or have a household member with disability – at some point.</p> <p>Accessible homes and buildings can reduce pressure on the health system and improve quality of life. A consistent national construction code is just the first step urgently needed to improve building accessibility and inclusion so people with disability have autonomy and flourish.<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/217278/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/ilan-wiesel-303040">Ilan Wiesel</a>, Associate Professor in Urban Geography, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> and <a href="https://theconversation.com/profiles/rebecca-bentley-173502">Rebecca Bentley</a>, Professor of Social Epidemiology and Director of the Centre of Research Excellence in Healthy Housing at the Melbourne School of Population and Global Health, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-does-a-building-need-to-call-itself-accessible-and-is-that-enough-217278">original article</a>.</em></p>

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Readers Respond: What's a book you love that most people have never heard of?

<p>Looking for a new book to kickstart your year?  Look no further we've got you covered. </p> <p>Here are a few of our reader's book recommendations that you may not have heard of. </p> <p><strong>Ruth Fontaine</strong> - I’m reading <em>We of the Never Never </em>atm. Not sure if it’s still well known. I’ve read it before but awhile back and love it. I love reading how they lived nearly 120 years ago. </p> <p><strong>Elaine Rosenberg</strong> - <em>The Abbey Girls Series</em> by Elsie J Oxenham.</p> <p><strong>Maryika Welter</strong> - <em>The courage to be disliked.</em> ... Furmitake Kogan, Ichiro Kishimi.</p> <p><strong>Janice Stewart</strong> - <em>A Fortunate Life</em> by Albert Facey</p> <p><strong>Suzanne Midson</strong> - <em>On Our Selection</em> by Steele Rudd. Read it when I was about 10/12. Best laugh ever. Australian humour at its best.</p> <p><strong>Julie Anderson</strong> - <em>Episode of Sparrows</em> by Rumor Goddin </p> <p><strong>Nancie Golsby</strong> - <em>The Half Burned Tree</em> by Dympna Cusack</p> <p><strong>June Maynard</strong> - Sahara, by Paula Constant. Preceded by Slow Journey South. A thrilling, actual account of her adventure.</p> <p><strong>Peter Rayner </strong>- <em>Enforcer</em> by Caesar Campbell</p> <p><strong>Meg Milton</strong> - <em>I Heard the Owl Call My Name</em> by Margaret Craven</p> <p><strong>Edie Dore</strong> - <em>The Curious Incident of the Dog </em>in the Night-time by Mark Haddon.</p> <p><strong>Christine Cornforth</strong> - <em>A Grief Observed</em> by CS Lewis. </p> <p><strong>Wendy Oliver</strong> - <em>The Good Earth</em> by Pearl Buck</p> <p>Do you have any other recommendations that we might have missed?</p> <p><em>Image: Getty</em></p>

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