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

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

Body

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Why a one-cent stamp is set to sell for millions

<p>An extremely rare stamp that was once bought for a measly one cent is set to sell for millions of dollars, breaking records at a US auction house. </p> <p>While to the untrained eye, the blue stamp seems like any old stamp, the 1868 one-cent Z-grill is actually the rarest stamp in America due to its unique history and rarity. </p> <p>On June 14th, the one-cent Z-grill will be put up for sale by Robert A. Siegel Auction Galleries, marking the first time the rare stamp has been on auction since 1998. </p> <p>Experts from the New York auction house say it could fetch $6 million to $7.5 million (AUD), which would make it the single most expensive US stamp ever sold.</p> <p>The reason for the extraordinary price comes down to the fact that out of the two known Z-grill stamp copies, the one up for auction is the only copy available for private purchase by collectors, while other historic copy is held at the New York Public Library.</p> <p>The Z-grill is unique due to its signature embossed paper, which was introduced to the US postal service after the Civil War to prevent stamps from being reused. </p> <p>Since 2005, the coveted stamp has belonged to billionaire investor and “bond king” Bill Gross.</p> <p>“It’s considered the trophy of collecting United States stamps,” said Charles Shreve, who has managed and built Gross’ extensive stamp collection for years and serves as director of international auctions at Robert A. Siegel Auction Galleries.</p> <p>“There’s only one. If you want to brag, that’s the stamp.”</p> <p>Mr Gross' entire collection is estimated to be worth $22.6 million to $30 million AUD. The top 100 stamps from the collection will be auctioned off on June 14th, while the remaining stamps will be sold on June 15th.</p> <p>“There’s multiple stamps that’ll bring $500,000 or $750,000 (USD) but the (one-cent) Z-grill is the star of the show,” Shreve said.</p> <p>“I just know some people who are lusting for it, and we want to try to get as many people interested in it as possible.”</p> <p><em>Image credits: Robert A. Siegel Auction Galleries</em></p>

Money & Banking

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Princess of Wales and King Charles: one in two people develop cancer during their lives – the diseases and treatments explained

<p><em><a href="https://theconversation.com/profiles/gavin-metcalf-1340598">Gavin Metcalf</a>, <a href="https://theconversation.com/institutions/anglia-ruskin-university-1887">Anglia Ruskin University</a></em></p> <p>The Princess of Wales released a <a href="https://x.com/KensingtonRoyal/status/1771235267837321694?s=20">moving video message</a> on March 22 to address speculation about her health. In it, the future queen disclosed that she’d been <a href="https://www.bbc.co.uk/news/health-68641710">diagnosed with cancer</a> following tests conducted after she underwent major abdominal surgery at a clinic in London in January.</p> <p>Catherine explained that she was undergoing “preventative chemotherapy” – but emphasised that her surgery had been successful, and that she was “well” and “getting stronger every day”.</p> <p>The message was the <a href="https://www.theguardian.com/uk-news/2024/mar/22/princess-kate-cancer-royal-family-health-annus-horribilis">second announcement</a> of a royal family cancer diagnosis in recent weeks. On February 5, Buckingham Palace <a href="https://www.royal.uk/a-statement-from-buckingham-palace-5Feb24">published a statement</a> that King Charles III had been diagnosed with an undisclosed form of <a href="https://www.bbc.co.uk/news/uk-68208157">cancer, unrelated</a> to the treatment he had been receiving for an enlarged prostate.</p> <figure><iframe src="https://www.youtube.com/embed/3xzKooCaRXU?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p>The statement said that he had begun “regular treatments”. The king postponed all public-facing duties during his treatment, but <a href="https://www.bbc.co.uk/news/uk-68213383">reportedly continued</a> with his “constitutional role as head of state, including completing paperwork and holding private meetings”.</p> <p>Cancer is the <a href="https://www.who.int/news-room/fact-sheets/detail/cancer">leading cause of death</a> worldwide. <a href="https://www.nhs.uk/conditions/cancer/#:%7E:text=The%20cancerous%20cells%20can%20invade,of%20cancer%20during%20their%20lifetime.">One in two</a> people will develop some form of cancer in their lifetime – so the condition will affect almost every family. However, many cancers can be cured if, as appears to be the case with the king, the condition is <a href="https://www.bbc.co.uk/news/uk-68213383">detected early</a> and treated effectively.</p> <h2>What is cancer?</h2> <p>Our bodies are made up of more than 100 billion cells, and cancer typically starts with changes in a small group of cells – or even a single one.</p> <p>We have different cell types depending upon where in the body they are and the function that the cell has. The size, amount and function of each of these cells is normally tightly regulated by genes – groups of codes held within our DNA – that instruct cells how to grow and divide.</p> <p>However, changes (mutations) to DNA can alter the way cells grow and multiply – often forming a lump, or solid tumour. Cancers can also develop in blood cells, such as white blood cell cancer which is known as leukaemia. This type of cancer does not form solid tumours; instead, the cancer builds up in the blood or sometimes the marrow in the core of bones, where blood cells are produced.</p> <p>In all, there are <a href="https://www.cancerresearchuk.org/about-cancer/what-is-cancer/how-cancer-starts/types-of-cancer#:%7E:text=For%20example%2C%20nerves%20and%20muscles,of%20cell%20they%20start%20in.">more than 200</a> types of cancer, but all start with mutations in the DNA contained within each and every cell.</p> <h2>What exactly are mutations?</h2> <p>Think of your DNA as a big recipe book, and your genes as individual recipes for making different dishes. Mutations are smudges or missing words from this recipe that can result in key ingredients not being added into the mix.</p> <figure><iframe src="https://www.youtube.com/embed/8BJ8_5Gyhg8?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p>Regardless of the type of cancer or the cells from which it develops, mutations in our genes can result in a cell no longer understanding its instructions.</p> <p>These mutations can happen by chance when dividing, but can also be the result of lifestyle choices such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6141049/">smoking</a>, <a href="https://www.ndph.ox.ac.uk/news/new-genetic-study-confirms-that-alcohol-is-a-direct-cause-of-cancer#:%7E:text=These%20mutations%20both%20disrupt%20the,aldehyde%20dehydrogenase%202%20(ALDH2).">drinking</a>, and <a href="https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/physical-activity-fact-sheet">inactivity</a>.</p> <p>Research has found that in order for a normal cell to turn into a cancerous cell, anywhere from <a href="https://www.sanger.ac.uk/news_item/1-10-mutations-are-needed-drive-cancer-scientists-find/">one to ten different mutations</a> are normally required.</p> <h2>How is cancer treated?</h2> <p>Treatment options for cancer depend on a variety of factors, including where your cancer is, how large it is, and whether it has spread to other parts of the body. The main treatments for cancer include surgery, chemotherapy, and radiotherapy.</p> <p>Chemotherapy uses drugs to target and kill cells that are rapidly dividing in our bodies. This approach is effective at targeting fast-growing cells in various cancers – but also has negative side effects. It also targets healthy cells that rapidly divide, such as hair and the cells lining our digestive system. This can lead to commonly reported <a href="https://www.nhs.uk/conditions/chemotherapy/side-effects/">side-effects</a> such as hair loss, nausea and diarrhoea.</p> <p><a href="https://www.cancerresearchuk.org/about-cancer/treatment/chemotherapy?gad_source=1&amp;gclid=Cj0KCQjw-_mvBhDwARIsAA-Q0Q6tyQxTuBzU7vVD7SHjQ5dF-fRdqnL7S74-k5LXyTqODydsrPfJVsoaAkgyEALw_wcB&amp;gclsrc=aw.ds">Chemotherapy</a> can be used both preventatively – as in the case of the princess – and therapeutically.</p> <figure><iframe src="https://www.youtube.com/embed/FkZn5u3MIiY?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p>Preventative chemotherapy, also known as <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/adjuvant-therapy">adjuvant chemotherapy</a>, is given after surgery or other primary treatments to eliminate any remaining cancer cells in the body. It aims to reduce the risk of the cancer returning (known as recurrence).</p> <p>Therapeutic chemotherapy is used as a treatment option for cancer that has spread or is well established, such as advanced-stage cancers.</p> <p><a href="https://www.cancerresearchuk.org/about-cancer/treatment/surgery/about">Surgery</a> involves the physical removal of cancerous tissues as well as nearby lymph nodes – small glands which act as filters in your body that cancers can spread through – to eliminate the tumour. Surgery is often used to remove localised cancers that haven’t spread throughout the body.</p> <p><a href="https://www.cancerresearchuk.org/about-cancer/treatment/radiotherapy">Radiotherapy</a> uses high-energy radiation beams that are able to target specific areas where tumour cells are located to destroy or shrink the tumour. Radiotherapy can be applied externally or internally.</p> <p>Chemotherapy, surgery, and radiotherapy are often combined in cancer treatment to improve outcomes for patients.</p> <p>Thanks to developments in cancer research over the last 50 years, survival rates have improved greatly – although the rate of improvement has <a href="https://news.cancerresearchuk.org/2024/02/02/world-cancer-day-2024/#:%7E:text=Improvements%20in%20cancer%20survival%20have%20slowed%20in%20recent%20years&amp;text=Survival%20increased%20three%20to%20five,consistently%20lags%20behind%20comparable%20countries.">slowed recently</a>. Cancer survival depends on various factors such as age – people under 40 have a <a href="https://www.cancer.gov/about-cancer/causes-prevention/risk/age">greater chance</a> of survival – overall health and fitness, as well as family history.</p> <h2>What you should do</h2> <p>Particular changes in your body or warning symptoms could indicate the presence of cancer. These include, but are not limited to:</p> <ul> <li>Unexplained weight loss;</li> <li>Fatigue that doesn’t improve with rest;</li> <li>Changes in bowel or bladder habits;</li> <li>Persistent cough or coughing up blood;</li> <li>Difficulty swallowing;</li> <li>Persistent pain;</li> <li>Noticing lumps, such as in a breast or testicle.</li> </ul> <p>The symptoms may not necessarily be the result of cancer. But it is important to get checked by a doctor if you notice anything out of the ordinary or have had persistent symptoms that don’t ease. Early detection and treatment can <a href="https://www.science.org/doi/full/10.1126/science.aay9040">significantly improve</a> outcomes for many types of cancer.<!-- 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/226456/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/gavin-metcalf-1340598">Gavin Metcalf</a>, Cancer Biologist and Lecturer in Biomedical Science, <a href="https://theconversation.com/institutions/anglia-ruskin-university-1887">Anglia Ruskin 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/princess-of-wales-and-king-charles-one-in-two-people-develop-cancer-during-their-lives-the-diseases-and-treatments-explained-226456">original article</a>.</em></p>

Caring

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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>

Caring

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The one thing you must do before retirement

<p>When you think about planning for retirement, the standard advice is to take a thorough look at your superannuation and finances. Although money is undoubtedly an important aspect of retirement planning, making a plan for your emotion and physical wellbeing is just as crucial.</p> <p>New research from the UK has found that retirement can have a negative impact on your mental and physical health. The study, published by the Institute of Economic Affairs, looked at the impact of retirement on 7,000 people aged 50 to 70, and found that while retirement gives most people a small health booth, over the medium to long-term it causes a “drastic decline in health”. </p> <p>For both men and women, retirement decreases the likelihood of "very good” or "excellent" self-reported health by 40 per cent, increases risk for depression by 40 per cent, and diagnosis of a physical illness by 60 per cent. The study’s lead author, Gabriel Sahlgren, noted: "Work, especially paid work, gives many people a sense of purpose. Losing that may lead to declines in health."</p> <p>The lesson: Make a plan for your emotional and physical health.</p> <p>“Don't wait until you retire to decide how you're going to keep busy,” Dave Bernard, retirement blogger and author of Are You Just Existing and Calling it a Life?, told Prevention, adding, “And you need to look well beyond the first six months.”</p> <p>Just as it’s necessary to make sure your finances are in order before retirement, it’s crucial to ask yourself: What will my new sense of purpose in retirement be?</p> <p>“Many times, adults might not think about what it actually means to be retired, or they think about retirement in abstract terms,” says Angela Curl, an assistant professor in the University of Missouri School of Social Work.</p> <p>She says you need to make concrete plans for retirement. “If you want to volunteer when you are retired, ask yourself where and how often. Having specific plans and steps to follow will help you enter retirement more easily,” says Curl.</p> <p>Creating a plan of how you’ll spend your time when you retire will keep you mentally and physically strong, ensuring that you’ll be healthy enough to enjoy your well-deserved retirement.</p> <p><em>Image credits: Getty Images </em></p>

Retirement Life

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"One people, one family": King Charles breaks silence after cancer diagnosis

<p>Amidst concerns and heartfelt wishes, King Charles III has released a statement following his shocking cancer diagnosis.</p> <p>In his first public comments since beginning his treatment, the monarch, while recuperating at Sandringham, expressed his sincere regrets for not being able to attend a significant upcoming event. His words, filled with warmth and gratitude, were directed towards the people of Grenada, a nation close to his heart.</p> <p>As Grenada celebrates its 50th anniversary of independence, King Charles III, although physically absent, sent his love and congratulations, reminiscing about his cherished visit to the Caribbean gem in 2019.</p> <p>“I can only say how sorry I am that I cannot be with you in person to mark this momentous milestone," he wrote. “My thoughts are with everyone across Grenada, Carriacou and Petit Martinique – ‘one people, one family’ – as you celebrate everything you have achieved and all that your future holds. My family join me in sending our heartfelt congratulations to you all.”</p> <p>Despite undergoing treatment, King Charles III's commitment to his duties remains unwavering. Buckingham Palace has reassured the public that while he may step back from public gatherings, he will continue to fulfil his constitutional responsibilities, including regular meetings with the British Prime Minister.</p> <p>The positive update on King Charles III's health was echoed by Queen Camilla, who, during her recent appearance at Salisbury Cathedral, shared encouraging news about her husband's progress. Surrounded by the tranquility of the cathedral, she expressed gratitude for the outpouring of support and well wishes they have received during this challenging time.</p> <p>In a video shared by ITV royal reporter Chris Ship on X, the queen said: "He's doing extremely well under circumstances. We are very touched by all of the letters and messages." </p> <p><em>Images: Getty</em></p>

Caring

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

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

Mind

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4 tips to help your loved one with dementia enjoy the festive season

<p><em><a href="https://theconversation.com/profiles/nikki-anne-wilson-342631">Nikki-Anne Wilson</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a></em></p> <p>The festive season is fast approaching, and if you’re organising celebrations with family or friends, you might be grappling with a seemingly endless to-do list. But as you make these plans, it’s important to consider how you can best include any friends or loved ones living with dementia.</p> <p>While no two people experience dementia in the exact same way, <a href="https://www.dementia.org.au/about-dementia/what-is-dementia">dementia</a> often affects the way people process and respond to their environment. Too much stimulation – like a lot of noise and activity at a Christmas party – can be overwhelming and may cause confusion or agitation.</p> <p>Finding ways to create a <a href="https://www.healthdirect.gov.au/creating-a-calming-home-for-people-with-dementia#:%7E:text=The%20physical%20environment%20is%20important,in%20and%20enjoy%20everyday%20activities.">safe environment</a> at home for your loved one with dementia will help maximise the chances everyone has a good time.</p> <h2>1. Plan ahead, but be flexible</h2> <p>Planning celebrations can be overwhelming for everyone involved, and having excessive expectations can raise stress levels. Try to keep <a href="https://www.dementia.org.au/information/about-you/i-am-a-carer-family-member-or-friend">expectations realistic</a> and in line with the current needs of your friend or loved one living with dementia.</p> <p>For example, people with dementia may experience <a href="https://www.dementia.org.au/information/about-you/i-am-a-carer-family-member-or-friend/personal-care/eating">changes in their appetite</a> or food preferences, or difficulties chewing and swallowing. These changes might make some of the things on your festive menu unappetising or difficult to eat. Be guided by the needs and preferences of the person with dementia and keep options limited to one or two special foods if larger banquets are likely to be overwhelming.</p> <p>Things can change quickly for people living with dementia and their abilities will likely <a href="https://www.dementia.org.au/about-dementia/what-is-dementia/progression-of-dementia#:%7E:text=A%20person%20with%20dementia's%20abilities,over%20a%20number%20of%20years.">vary from day to day</a>. Try to be flexible and have a backup plan in place. For special events, plan to record speeches or ceremonies to share when things are quieter.</p> <p>If you’re planning a large event, consider having a smaller gathering with your loved one with dementia and just a few special people.</p> <h2>2. Stick to the familiar</h2> <p>The sudden appearance of lots of decorations <a href="https://www.dementia.org.au/sites/default/files/helpsheets/Helpsheet-TipsToAssistSocialEngagement03-TipsForHolidayCheer_english.pdf">may be overwhelming</a> for a person with dementia and trigger a negative sensory reaction or distress. Ensure decorations are safe and familiar and put them up slowly over a period of a few days.</p> <p>Try to also stick to familiar traditions and routines. <a href="https://www.alz.org/help-support/caregiving/daily-care/daily-care-plan">Daily routines</a> are an important way of supporting people with dementia and sudden changes <a href="https://memory.ucsf.edu/caregiving-support/behavior-personality-changes#I-Investigate-Possible-Causes">may result in agitation and distress</a>. Stick to routine eating, bathing, and rest times where possible throughout the holiday period.</p> <p>For many people with dementia, long-term memories are less affected than <a href="https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/symptoms/memory-loss">more recent memories</a>. Familiar family traditions can therefore be a good way to <a href="https://www.dementia.org.au/national/support-and-services/carers/therapies-and-communication-approaches">reminisce</a>. Family keepsakes or <a href="https://www.dementia.org.au/sites/default/files/20110303-NSW-LifeHistoryBook.pdf">memory books</a> can also help connect with stories from past celebrations.</p> <h2>3. Have a quiet space</h2> <p>Try to have <a href="https://www.scie.org.uk/dementia/supporting-people-with-dementia/dementia-friendly-environments/noise.asp">a quiet place</a> where the person living with dementia can go if things become overwhelming. Designating a support person who can stay with them throughout the day and take them to a separate room or area away from the action can help to keep things calm.</p> <p>Having some familiar objects or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5432607/#:%7E:text=Passive%20music%20listening%20is%20reported,et%20al.%2C%202013">quiet music</a> in the space can be a good way to block out the noise of activities and reduce agitation.</p> <h2>4. Make sure everyone has a part</h2> <p>Everyone wants to feel a part of the activities on a special day, including people living with dementia. Ensuring everyone has a role to play may mean modifying tasks to suit the abilities of the person with dementia.</p> <p>For example, if you’re hosting an event at home, try to get your friend or relative with dementia involved in the kitchen by tossing the salad or helping to set the table.</p> <p>People with dementia are still the same person, even if their abilities have changed or they can no longer communicate their needs and feelings like they used to. It’s important to treat everyone with dignity and try to include your friends and loved ones with dementia in celebrations whenever possible.</p> <h2>Sometimes, you can’t be together</h2> <p>Despite the best laid plans, sometimes it won’t be possible to share in festive celebrations with your loved one living with dementia. More advanced dementia, <a href="https://www.health.nsw.gov.au/Infectious/covid-19/Pages/racf-latest-advice.aspx">aged care visitor restrictions</a> or even just distance can keep many of us apart from our loved ones.</p> <p>Be prepared for this separation to bring up your own feelings of <a href="https://www.alz.org/help-support/caregiving/caregiver-health/grief-loss-as-alzheimers-progresses">grief or sadness</a>. Look after your mental health as well as the person with dementia.</p> <p>Caring responsibilities still largely <a href="https://www.pmc.gov.au/sites/default/files/resource/download/national-strategy-gender-equality-discussion-paper_0.pdf">fall to women</a> and it’s important to share the load. Where possible, the holidays can be a good time to think about giving primary carers a break to help them recharge for the year ahead.</p> <p>If you’re caring for someone with dementia and need support, <a href="https://www.dementia.org.au/support">Dementia Australia</a> or <a href="https://www.carergateway.gov.au/about?utm_source=google&amp;utm_medium=paid-search&amp;utm_campaign=10841470526&amp;utm_adgroup=146956908840&amp;utm_term=&amp;gclid=CjwKCAjw9-6oBhBaEiwAHv1QvI1uJVJRppcDJtdgYNTDeObUk1tyrNUtLGBqpp3ytjb_khYkGExICBoC_5EQAvD_BwE">Carer Gateway</a> offer useful resources.<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/214944/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><a href="https://theconversation.com/profiles/nikki-anne-wilson-342631"><em>Nikki-Anne Wilson</em></a><em>, Postdoctoral Research Fellow, Neuroscience Research Australia (NeuRA), <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a></em></p> <p><em>Image </em><em>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/4-tips-to-help-your-loved-one-with-dementia-enjoy-the-festive-season-214944">original article</a>.</em></p>

Caring

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5 genius travel hacks no-one talks about

<p>Genius travel influencer Grace Cheng has amassed a large following on Instagram by sharing her luxurious international adventures. But she's not just about the pretty pictures and glamorous destinations; she's also got some practical tips and tricks up her sleeve – one of which makes so much sense you will be a little cross you didn't think of it yourself.</p> <p>In a recent video, Cheng revealed her top five travel hacks that "no one talks about" – and while some of her tips were met with skepticism from readers and viewers, others were completely floored by how simple and effective they were.</p> <p>Tip 1: Freeze water bottles to get them through security</p> <p>Amazing, right? Cheng's first tip is such a game-changer for anyone who's ever had to throw away their water bottle at airport security. She claims you can actually take a full bottle of water through security ... <em>if it's frozen</em>.</p> <p>The logic is that ice is solid and water is liquid, so all you have to do is freeze the water before you leave for the airport. Then, before you hit security, just drink whatever has melted and carry on the rest.</p> <p>Cheng calls this one the "biggest hack ever" – and we're inclined to agree. No more paying for overpriced bottled water at the airport!</p> <p>Tip 2: Use a hair to check for hotel room intruders</p> <p>This one seems a little paranoid, but if you're ever worried about someone entering your hotel room while you're out, Cheng has a clever solution. She suggests taping a hair at the bottom of the door frame. When you come back to your room, you'll see if the hair has been broken or not. If it has, then you know someone has been inside.</p> <p>This is a pretty simple and effective way to check for intruders, and it's definitely worth trying if you're feeling paranoid.</p> <p>Tip 3: Board your economy flight last to get an empty row</p> <p>If you're flying economy, Cheng says you should always board the plane last. This is because it will give you a chance to see which seats are empty.</p> <p>Once you've spotted an empty row, you can politely ask the flight attendant if you can take one of the seats. With a little luck, you'll end up with a whole row to yourself, which is basically like flying business class.</p> <p>Tip 4: Book with the same hotel chain to get upgrades</p> <p>If you're a frequent traveller, Cheng says you should always book with the same hotel chain whenever possible. This is because you'll be more likely to get rewarded with upgrades and better customer service.</p> <p>Hotel chains often have loyalty programs that reward repeat customers. So, if you're always booking with the same hotel chain, you'll eventually start to rack up points that can be redeemed for upgrades, free stays and other perks. Solid tip, Cheng!</p> <p>Tip 5: Always carry a universal power adaptor</p> <p>Cheng says this is one of the most important travel hacks she's ever learned. She used to have to keep buying different adaptors for every country she visited, but now she just carries a universal adaptor with her.</p> <p>This is quite the lifesaver for any traveller who wants to avoid the hassle of finding and buying adaptors in every new country they visit.</p> <p>Overall, Cheng's travel hacks are a mix of clever tips and solid, commonsense advice. But whether you love them or hate them, there's no denying that they're worth checking out.</p> <p>So, next time you're planning a trip, be sure to give Cheng's hacks a try. You might just be surprised at how much they can make your travels easier and more enjoyable!</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-captioned="" data-instgrm-permalink="https://www.instagram.com/reel/CxMol_HLl3w/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/reel/CxMol_HLl3w/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by grace | TravelCreator✨ (@graceccheng)</a></p> </div> </blockquote> <p><em>Images: Travel Creator @graceccheng / Instagram</em></p>

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What are the new COVID booster vaccines? Can I get one? Do they work? Are they safe?

<p><em><a href="https://theconversation.com/profiles/paul-griffin-1129798">Paul Griffin</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a></em></p> <p>As the COVID virus continues to <a href="https://pubmed.ncbi.nlm.nih.gov/36680207/">evolve</a>, so does our vaccine response. From <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/new-covid-19-vaccines-available-to-target-current-variants?language=en">December 11</a>, Australians will have access to <a href="https://www.health.gov.au/news/atagi-recommendations-on-use-of-the-moderna-and-pfizer-monovalent-omicron-xbb15-covid-19-vaccines?language=en">new vaccines</a> that offer better protection.</p> <p>These “monovalent” booster vaccines are expected to be a <a href="https://theconversation.com/cdc-greenlights-two-updated-covid-19-vaccines-but-how-will-they-fare-against-the-latest-variants-5-questions-answered-213341">better match</a> for currently circulating strains of SARS-CoV-2, the virus that causes COVID.</p> <p>Pfizer’s monovalent vaccine will be <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/new-covid-19-vaccines-available-to-target-current-variants?language=en">available</a> to eligible people aged five years and older. The Moderna monovalent vaccine can be used for those aged 12 years and older.</p> <p>Who is eligible for these new boosters? How do they differ from earlier ones? Do they work? Are they safe?</p> <h2>Who’s eligible for the new boosters?</h2> <p>The federal government has accepted the Australian Technical Advisory Group (ATAGI) recommendation to use the new vaccines, after Australia’s regulator <a href="https://www.tga.gov.au/products/covid-19/covid-19-vaccines/covid-19-vaccines-regulatory-status">approved their use last month</a>. However, vaccine eligibility has remained the same since September.</p> <p>ATAGI <a href="https://www.health.gov.au/news/atagi-recommendations-on-use-of-the-moderna-and-pfizer-monovalent-omicron-xbb15-covid-19-vaccines?language=en">recommends</a> Australians aged over 75 get vaccinated if it has been six months or more since their last dose.</p> <p>People aged 65 to 74 are recommended to have a 2023 booster if they haven’t already had one.</p> <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=1000&amp;fit=clip"><img src="https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=315&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=315&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=315&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=396&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=396&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=396&amp;fit=crop&amp;dpr=3 2262w" alt="" /></a><figcaption><span class="caption">For people without risk factors.</span> <span class="attribution"><a class="source" href="https://www.health.gov.au/sites/default/files/2023-10/atagi-recommended-covid-19-vaccine-doses.pdf">Health.gov.au</a></span></figcaption></figure> <p>Adults aged 18 to 64 <em>with</em> underlying risk factors that increase their risk of severe COVID are also recommended to have a 2023 booster if they haven’t had one yet. And if they’ve already had a 2023 booster, they can consider an additional dose.</p> <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=1000&amp;fit=clip"><img src="https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=311&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=311&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=311&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=391&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=391&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=391&amp;fit=crop&amp;dpr=3 2262w" alt="" /></a><figcaption><span class="caption">Advice for people with risk factors.</span> <span class="attribution"><a class="source" href="https://www.health.gov.au/sites/default/files/2023-10/atagi-recommended-covid-19-vaccine-doses.pdf">Health.gov.au</a></span></figcaption></figure> <p>For adults aged 18 to 64 <em>without</em> underlying risk factors who have already received a 2023 booster, an additional dose isn’t recommended. But if you’re aged 18 to 64 and haven’t had a booster in 2023, you can consider an additional dose.</p> <p>Additional doses aren’t recommended for children <em>without</em> underlying conditions that increase their risk of severe COVID. A primary course is not recommended for children aged six months to five years <em>without</em> additional risk factors.</p> <h2>Monovalent, bivalent? What’s the difference?</h2> <p><strong>From monovalent</strong></p> <p>The initial COVID vaccines were “monovalent”. They had one target – the original viral strain.</p> <p>But as the virus mutated, we assigned new letters of the Greek alphabet to each variant. This brings us to Omicron. With this significant change, we saw “immune evasion”. The virus had changed so much the original vaccines didn’t provide sufficient immunity.</p> <p><strong>To bivalent</strong></p> <p>So vaccines were updated to target an early Omicron subvariant, BA.1, plus the original ancestral strain. With two targets, these were the first of the “bivalent” vaccines, which were approved in Australia <a href="https://theconversation.com/omicron-specific-vaccines-may-give-slightly-better-covid-protection-but-getting-boosted-promptly-is-the-best-bet-190736">in 2022</a>.</p> <p>Omicron continued to evolve, leading to more “immune escape”, contributing to repeated waves of transmission.</p> <p>The vaccines were updated again in <a href="https://theconversation.com/havent-had-covid-or-a-vaccine-dose-in-the-past-six-months-consider-getting-a-booster-199096">early 2023</a>. These newer bivalent vaccines target two strains – the ancestral strain plus the subvariants BA.4 and BA.5.</p> <p><strong>Back to monovalent</strong></p> <p>Further changes in the virus have meant our boosters needed to be updated again. This takes us to the recent announcement.</p> <p>This time the booster targets another subvariant of Omicron known as XBB.1.5 (sometimes known as <a href="https://theconversation.com/the-kraken-subvariant-xbb-1-5-sounds-scary-but-behind-the-headlines-are-clues-to-where-covids-heading-198158">Kraken</a>).</p> <p>This vaccine is monovalent once more, meaning it has only one target. The target against the original viral strain has been removed.</p> <p>According to advice given to the World Health Organization <a href="https://www.who.int/news/item/18-05-2023-statement-on-the-antigen-composition-of-covid-19-vaccines">in May</a>, this is largely because immunity to this original strain is no longer required (it’s no longer infecting humans). Raising immunity to the original strain may also hamper the immune response to the newer component, but we’re not sure if this is occurring or how important this is.</p> <p>The United States <a href="https://theconversation.com/cdc-greenlights-two-updated-covid-19-vaccines-but-how-will-they-fare-against-the-latest-variants-5-questions-answered-213341">approved</a> XBB.1.5-specific vaccines from Pfizer and Moderna in <a href="https://www.fda.gov/news-events/press-announcements/fda-takes-action-updated-mrna-covid-19-vaccines-better-protect-against-currently-circulating">mid-September</a>. These updated vaccines have also been <a href="https://www.tga.gov.au/sites/default/files/2023-10/auspar-spikevax-xbb.1.5-231012.pdf">approved in</a> places including Europe, Canada, Japan and Singapore.</p> <p>In Australia, the Therapeutic Goods Administration (TGA) approved them <a href="https://www.tga.gov.au/products/covid-19/covid-19-vaccines/covid-19-vaccines-regulatory-status">in October</a>.</p> <h2>Do these newer vaccines work?</h2> <p>Evidence for the efficacy of these new monovalent vaccines comes from the results of research <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent=&amp;id=CP-2023-PI-02409-1&amp;d=20231117172310101">Pfizer</a> and <a href="https://www.tga.gov.au/resources/auspar/auspar-spikevax-xbb15">Moderna</a> submitted to the TGA.</p> <p>Evidence also comes from a <a href="https://www.medrxiv.org/content/10.1101/2023.08.22.23293434v2">preprint</a> (preliminary research available online that has yet to be independently reviewed) and an update Pfizer <a href="https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2023-09-12/10-COVID-Modjarrad-508.pdf">presented</a> to the US Centers for Disease Control.</p> <p>Taken together, the available evidence shows the updated vaccines produce good levels of antibodies in <a href="https://www.tga.gov.au/resources/auspar/auspar-spikevax-xbb15">laboratory studies</a>, <a href="https://www.medrxiv.org/content/10.1101/2023.08.22.23293434v2">in humans</a> and <a href="https://www.tga.gov.au/resources/auspar/auspar-spikevax-xbb15">mice</a> when compared to previous vaccines and when looking at multiple emerging variants, including EG.5 (sometimes known as <a href="https://theconversation.com/the-who-has-declared-eris-a-variant-of-interest-how-is-it-different-from-other-omicron-variants-211276">Eris</a>). This variant is the one causing high numbers of cases around the world currently, including in Australia. It is very similar to the XBB version contained in the updated booster.</p> <p>The updated vaccines should also cover <a href="https://theconversation.com/how-evasive-and-transmissible-is-the-newest-omicron-offshoot-ba-2-86-that-causes-covid-19-4-questions-answered-212453">BA.2.86 or Pirola</a>, according to <a href="https://www.tga.gov.au/sites/default/files/2023-10/auspar-spikevax-xbb.1.5-231012.pdf">early results</a> from clinical trials and the US <a href="https://www.cdc.gov/respiratory-viruses/whats-new/covid-19-variant.html">Centers for Disease Control</a>. This variant is responsible for a rapidly increasing proportion of cases, with case numbers growing <a href="https://twitter.com/BigBadDenis/status/1725310295596560662?s=19">in Australia</a>.</p> <p>It’s clear the virus is going to continue to evolve. So performance of these vaccines against new variants will continue to be closely monitored.</p> <h2>Are they safe?</h2> <p>The <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent=&amp;id=CP-2023-PI-02409-1&amp;d=20231117172310101">safety</a> of the updated vaccines has also been shown to be similar to previous versions. Studies <a href="https://www.medrxiv.org/content/10.1101/2023.08.22.23293434v2">comparing them</a> found no significant difference in terms of the adverse events reported.</p> <p>Given the availability of the updated vaccines, some countries have removed their approval for earlier versions. This is because newer versions are a closer match to currently circulating strains, rather than any safety issue with the older vaccines.</p> <h2>What happens next?</h2> <p>The availability of updated vaccines is a welcome development, however this is not the end of the story. We need to make sure eligible people get vaccinated.</p> <p>We also need to acknowledge that vaccination should form part of a comprehensive strategy to limit the impact of COVID from now on. That includes measures such as mask wearing, social distancing, focusing on ventilation and air quality, and to a lesser degree hand hygiene. Rapidly accessing antivirals if eligible is also still important, as is keeping away from others if you are infected.<!-- 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/217804/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/paul-griffin-1129798"><em>Paul Griffin</em></a><em>, Professor, Infectious Diseases and Microbiology, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</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-are-the-new-covid-booster-vaccines-can-i-get-one-do-they-work-are-they-safe-217804">original article</a>.</em></p>

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What exactly is a ceasefire, and why is it so difficult to agree on one in Gaza?

<p><em><a href="https://theconversation.com/profiles/marika-sosnowski-1415833">Marika Sosnowski</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a></em></p> <p>Barely a week after Hamas’ attack on Israeli soldiers and civilians on October 7 and the subsequent airstrikes by the Israeli Defence Force on the Gaza Strip, talk of a ceasefire had already begun.</p> <p>More than five weeks into the war, calls for a ceasefire have only grown louder. Visiting the White House this week, Indonesian President Joko Widodo <a href="https://www.aljazeera.com/news/2023/11/14/indonesian-president-joko-widodo-urges-biden-to-help-end-gaza-atrocities">said</a>, a “ceasefire is a must for the sake of humanity.”</p> <p>Israel has thus far <a href="https://apnews.com/article/israel-hamas-war-news-11-11-2023-d4d272416107c02e63dabd9548395026">refused</a> to discuss a ceasefire without the release of the 240 hostages being held by Hamas.</p> <p>But what exactly is a ceasefire, and how do they work? And what sort of arrangement would be most effective in Gaza?</p> <h2>Different terms, different meanings</h2> <p>Virtually as old as conflict itself, a ceasefire is an ancient way of formalising a halt to armed violence between warring parties for a certain period of time. Historically, the terms truce and armistice were used as synonyms.</p> <p>Perhaps surprisingly, international humanitarian law has <a href="https://www.chathamhouse.org/2023/11/humanitarian-pauses-and-ceasefires-what-are-differences">no provisions</a> relating specifically to when ceasefires should be negotiated, what they need to contain or how they need to be applied.</p> <p>It is only in the last 50 years or so that a range of new terminology has become commonplace to describe the phenomenon of a “<a href="https://beyondintractability.org/essay/cease-fire">ceasefire</a>”. These include:</p> <ul> <li> <p><a href="https://ru.usembassy.gov/joint-statement-russian-federation-united-states-syria/">cessation of hostilities</a></p> </li> <li> <p><a href="https://www.thenewhumanitarian.org/news/2017/12/04/un-calls-humanitarian-pause-yemen-conditions-capital-deteriorate">humanitarian pauses</a></p> </li> <li> <p><a href="https://www.peaceagreements.org/viewmasterdocument/2093">de-escalation areas</a></p> </li> <li> <p><a href="https://reliefweb.int/report/sudan/un-call-days-tranquility-bears-fruit-more-five-million-children-have-been-vaccinated">days of tranquility</a> (pauses in fighting to allow for immunisation of children)</p> </li> <li> <p><a href="https://kaldorcentre.unsw.edu.au/sites/kaldorcentre.unsw.edu.au/files/Policy_brief_Creating_safe_zones_and_safe_corridors.pdf">safe zones</a> and safe corridors</p> </li> <li> <p><a href="https://osce.org/stories/osce-mirror-patrols-windows-of-hope-eastern-ukraine">windows of silence</a> (one name given to the 2014 ceasefire in Ukraine).</p> </li> </ul> <p>Many of these terms have been used in the Gaza conflict. For instance, in late October, the UN General Assembly <a href="https://press.un.org/en/2023/ga12548.doc.htm">adopted</a> a resolution calling for an “immediate, durable and sustained humanitarian truce leading to cessation of hostilities”.</p> <p>In the Security Council, the US has <a href="https://www.bbc.com/news/world-middle-east-67320520">called</a> for “humanitarian pauses”, but not a “ceasefire”. Russia, meanwhile, has <a href="https://news.un.org/en/story/2023/10/1142427">demanded</a> a “humanitarian ceasefire”, but is unhappy with a “truce” or “pauses”.</p> <p>This week, Hamas said it is willing to <a href="https://www.france24.com/en/middle-east/20231113-%F0%9F%94%B4-live-more-gaza-hospitals-halt-operations-as-israeli-assault-continues">release</a> 70 hostages in exchange for a five-day “truce”.</p> <p>Israeli Prime Minister Benjamin Netanyahu has previously <a href="https://www.theguardian.com/world/2023/nov/04/gaza-ceasefire-talks-ongoing-despite-israeli-pm-rejecting-pause-says-us">rejected</a> a “temporary truce”, but under pressure from the US, has agreed this week to <a href="https://www.aljazeera.com/features/2023/11/10/will-israels-humanitarian-pauses-mean-much-for-gaza-no-say-experts">implement</a> daily four-hour “humanitarian pauses”.</p> <p>While there have been <a href="https://ukraine.un.org/en/174777-glossary-humanitarian-terms-pauses-during-conflict">attempts</a> to differentiate between these terms, states continue to place different emphasis or apply different meanings to them in ad hoc ways. This makes finding common ground difficult.</p> <h2>What could be achieved in Gaza instead</h2> <p>So, if we have no common definitions as a starting point, how do parties come to any useful or enforceable agreement on a ceasefire?</p> <p>Thus far in Gaza, the answer has mostly been they don’t. It may be simplistic to say that words are what we use as humans to make sense of and order the world, but in this context, specifics matter.</p> <p>Arguably, in focusing so squarely on getting to a halt in fighting (whatever we want to call that), we lose sight of many other important factors and actions that may or may not fall under the broad and open-to-interpretation umbrella term of “ceasefire”.</p> <p>For example, Israel and Hamas might find agreement if negotiators focused on more specific details or issues, such as:</p> <ul> <li> <p>the amount of ordnance being used by both sides on a daily basis, and what kind of ordnance</p> </li> <li> <p>where or what is targeted by both sides</p> </li> <li> <p>the number of aid convoys allowed into Gaza, where they would come from, where they would go and what they would be carrying</p> </li> <li> <p>the number and/or nationality of hostages to be released and at what regularity.</p> </li> </ul> <p>I am not a negotiator and this is not an exhaustive list. What it hopes to illustrate is that efforts for a grand-bargain-type ceasefire should not be prioritised over more nuanced, and perhaps tangible, efforts for other types of lulls in fighting.</p> <h2>How ceasefires can be problematic</h2> <p>At the same time, it should not be forgotten that ceasefires can have unintended consequences. Often these consequences are far from beneficial, positive or humanitarian – the kinds of things we expect from a ceasefire.</p> <p>For example, in Syria, local <a href="https://www.washingtonpost.com/politics/2021/06/18/do-ceasefires-syria-work-we-checked-data/">ceasefires</a> and reconciliation agreements have been used during the civil war to allow for the evacuation of citizens from their homes in places like <a href="https://paxforpeace.nl/publications/no-return-to-homs/#:%7E:text=The%2520report%2520'No%2520Return%2520to,cities%2520and%2520neighbourhoods%2520in%2520Syria.">Old Homs</a> and <a href="https://www.middleeasteye.net/opinion/besiege-bombard-retake-reconciliation-agreements-syria">Daraya</a>.</p> <p>Subsequently, a raft of presidential decrees were enacted that enabled the Syrian regime to permanently reappropriate their properties. State-backed <a href="https://www.brookings.edu/articles/beyond-fragility-syria-and-the-challenges-of-reconstruction-in-fierce-states/">reconstruction</a> and development projects such as Basila City (which ironically means “Peace City” in old Aramaic), Marouta and Homs Dream were then built on the land acquired via the ceasefire agreements.</p> <p>Likewise, during the Russian invasion of Ukraine, <a href="https://www.newsweek.com/evacuation-route-offered-fleeing-ukrainians-mined-1685418">humanitarian corridors</a> were implemented that allowed people from the besieged city of Mariupol to evacuate. Shortly afterwards, however, Ukrainian President Volodymyr Zelensky <a href="https://www.novinite.com/articles/214156/Zelensky+accused+Russia+of+Mining+Humanitarian+Corridors">accused</a> Russia of laying landmines within the corridors to thwart civilians’ ability to flee.</p> <p>In another example, humanitarian corridors that Russia <a href="https://www.reuters.com/markets/asia/top-wrap-1-ukrainians-trapped-besieged-city-fighting-blocks-evacuation-efforts-2022-03-07/">proposed</a> setting up would not lead civilians to safety, but rather into Russia or its close ally Belarus.</p> <p>Israel has similarly announced “<a href="https://www.bloomberg.com/news/articles/2023-10-16/israel-announces-another-safe-passage-for-gazans-to-move-south">safe corridors</a>” enabling <a href="https://www.aljazeera.com/features/2023/11/10/will-israels-humanitarian-pauses-mean-much-for-gaza-no-say-experts">mass displacement</a> of civilians from the north to the south of the country. The relocation is <a href="https://www.theguardian.com/world/2023/oct/13/israel-hamas-war-latest-gaza-residents-told-move-ground-assault">supposedly</a> for civilians’ own safety, despite the fact airstrikes are killing civilians there, too. Many also <a href="https://www.newarab.com/news/egypt-israeli-safe-zones-gaza-prelude-displacement">fear</a> the supposed “safe corridors” could lead to a permanent displacement of Gazans.</p> <p>Israel has reportedly also canvassed support for a <a href="https://www.nytimes.com/2023/11/05/world/middleeast/israel-egypt-gaza.html#:%7E:text=Israeli%2520leaders%2520and%2520diplomats%2520have,the%2520border%2520in%2520neighboring%2520Egypt.">humanitarian corridor</a> that would direct Palestinians towards the Sinai peninsula in Egypt, in effect making them an Egyptian problem with little possibility of return. The idea has unsurprisingly been rejected by both the Palestinians and Egypt.</p> <h2>A ceasefire is only the beginning</h2> <p>Despite all this, ceasefires are perhaps the best-formalised tools humans have so far devised to halt the violence of armed conflict for a time.</p> <p>Therefore, given the suffering of civilians on both sides in the Israel-Hamas conflict, it is imperative some form of ceasefire happens. However, we should not be blinded by calls for a ceasefire (whatever terms are used), but stay alert to the hazards that ceasefires can themselves create.</p> <p>In any case, a ceasefire that stops violence for four hours, four days or four months will only be the beginning of the more challenging work that needs to be done to bring meaningful and long-term security and stablity to both Palestinians and Israelis.<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/217683/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><a href="https://theconversation.com/profiles/marika-sosnowski-1415833"><em>Marika Sosnowski</em></a><em>, Postdoctoral research fellow, <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-exactly-is-a-ceasefire-and-why-is-it-so-difficult-to-agree-on-one-in-gaza-217683">original article</a>.</em></p>

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What is the OMAD diet? Is one meal a day actually good for weight loss? And is it safe?

<p><em><a href="https://theconversation.com/profiles/nick-fuller-219993">Nick Fuller</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p>What do British Prime Minister <a href="https://www.sciencefocus.com/the-human-body/one-meal-a-day-diet-omad">Rishi Sunak</a> and singer <a href="https://theconversation.com/one-meal-a-day-diet-popular-with-celebrities-could-do-more-harm-than-good-heres-why-203086">Bruce Springsteen</a> have in common?</p> <p>They’re among an ever-growing group of public figures touting the benefits of eating just one meal a day.</p> <p>As a result, the one meal a day (OMAD) diet is the latest attention-grabbing weight loss trend. Advocates claim it leads to fast, long-term weight loss success and better health, including delaying the ageing process.</p> <p>Like most weight-loss programs, the OMAD diet makes big and bold promises. Here’s what you need to know about eating one meal a day and what it means for weight loss.</p> <h2>The OMAD diet explained</h2> <p>Essentially, the OMAD diet is a type of intermittent fasting, where you fast for 23 hours and consume all your daily calories in one meal eaten within one hour.</p> <p>The OMAD diet rules are presented as simple and easy to follow:</p> <ol> <li> <p>You can eat whatever you want, provided it fits on a standard dinner plate, with no calorie restrictions or nutritional guidelines to follow.</p> </li> <li> <p>You can drink calorie-free drinks throughout the day (water, black tea and coffee).</p> </li> <li> <p>You must follow a consistent meal schedule, eating your one meal around the same time each day.</p> </li> </ol> <p>Along with creating a calorie deficit, resulting in weight loss, advocates believe the OMAD diet’s extended fasting period <a href="https://www.frontiersin.org/articles/10.3389/fphys.2021.771944/full">leads to physiological changes</a> in the body that promote better health, including boosting your metabolism by triggering a process called ketosis, where your body burns stored fat for energy instead of glucose.</p> <h2>What does the evidence say?</h2> <p>Unfortunately, research into the OMAD diet is limited. Most studies have examined its impact on <a href="https://www.cell.com/cell-metabolism/pdf/S1550-4131(18)30512-6.pdf">animals</a>, and the <a href="https://pubmed.ncbi.nlm.nih.gov/35087416/">primary study</a> with humans involved 11 lean, young people following the OMAD diet for a mere 11 days.</p> <p>Claims about the OMAD diet typically rely on research into intermittent fasting, rather than on the OMAD diet itself. There is <a href="https://www.cfp.ca/content/66/2/117.short">evidence</a> backing the efficacy of intermittent fasting to achieve weight loss. However, <a href="https://www.nature.com/articles/s41574-022-00638-x">most studies</a> have focused on short-term results only, typically considering the results achieved across 12 weeks or less.</p> <p>One <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2114833">longer-term study from 2022</a> randomly assigned 139 patients with obesity to either a calorie-restricted diet with time-restricted eating between 8am and 4pm daily, or to a diet with daily calorie restriction alone for 12 months.</p> <p>After 12 months, both groups had lost around the same weight and experienced similar changes in body fat, blood sugar, cholesterol and blood pressure. This indicates long-term weight loss achieved with intermittent fasting is not superior and on a par with that achieved by traditional dieting approaches (daily calorie restriction).</p> <h2>So what are the problems with the OMAD diet?</h2> <p><strong>1. It can cause nutritional deficiencies and health issues.</strong></p> <p>The OMAD diet’s lack of nutritional guidance on what to eat for that one meal a day raises many red flags.</p> <p>The meals we eat every day should include a source of protein balanced with wholegrain carbs, vegetables, fruits, protein and good fats to support <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071223/">optimum health, disease prevention and weight management</a>.</p> <p>Not eating a balanced diet will result in nutritional deficiencies that can result in poor immune function, fatigue and a decrease in bone density, leading to osteoporosis.</p> <p>Fasting for 23 hours a day is also likely to lead to extreme feelings of hunger and uncontrollable cravings, which may mean you consistently eat foods that are not good for you when it’s time to eat.</p> <p><strong>2. It’s unlikely to be sustainable.</strong></p> <p>You might be able to stick with the OMAD diet initially, but it will wear thin over time.</p> <p>Extreme diets – especially ones prescribing extended periods of fasting – aren’t enjoyable, leading to feelings of deprivation and social isolation during meal times. It’s hard enough to refuse a piece of office birthday cake at the best of times, imagine how this would feel when you haven’t eaten for 23 hours!</p> <p>Restrictive eating can also lead to an unhealthy relationship with food, making it even harder to achieve and maintain a healthy weight.</p> <p><strong>3. Quick fixes don’t work.</strong></p> <p>Like other popular intermittent fasting methods, the OMAD diet appeals because it’s easy to digest, and the results appear fast.</p> <p>But the OMAD diet is just another fancy way of cutting calories to achieve a quick drop on the scales.</p> <p>As your weight falls, things will quickly go downhill when your <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4766925/">body activates its defence mechanisms</a> to defend your weight loss. In fact, it will regain weight – a response that stems from our hunter-gatherer ancestors’ need to survive periods of deprivation when food was scarce.</p> <h2>The bottom line</h2> <p>Despite the hype, the OMAD diet is unsustainable, and it doesn’t result in better weight-loss outcomes than its predecessors. Our old habits creep back in and we find ourselves fighting a cascade of physiological changes to ensure we regain the weight we lost.</p> <p>Successfully losing weight long-term comes down to:</p> <ul> <li> <p>losing weight in small manageable chunks you can sustain, specifically periods of weight loss, followed by periods of weight maintenance, and so on, until you achieve your goal weight</p> </li> <li> <p>making gradual changes to your lifestyle to ensure you form habits that last a lifetime.</p> </li> </ul> <p><em><a href="https://theconversation.com/profiles/nick-fuller-219993">Nick Fuller</a>, Charles Perkins Centre Research Program Leader, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-is-the-omad-diet-is-one-meal-a-day-actually-good-for-weight-loss-and-is-it-safe-207723">original article</a>.</em></p>

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We found 3 types of food wasters, which one are you?

<p><em><a href="https://theconversation.com/profiles/trang-nguyen-1454838">Trang Nguyen</a>, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a> and <a href="https://theconversation.com/profiles/patrick-oconnor-109973">Patrick O'Connor</a>, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a></em></p> <p>Each year, Australian households discard about <a href="https://workdrive.zohopublic.com.au/external/06152b9ff5971843391f39fc4d32a847e56fb907c167a4a645887b0a4bc43000">2.5 million tonnes of food</a>. Most (73%) of this food waste <a href="https://www.sciencedirect.com/science/article/pii/S0959652622042081">ends up in landfill</a>.</p> <p>This is costly and contributes to <a href="https://pubmed.ncbi.nlm.nih.gov/37118273/">escalating greenhouse gas emissions</a>, because food waste rotting in landfill produces methane. So reducing household food waste and diverting it from landfill saves money, improves food security and benefits the environment.</p> <p>To address the problem, we need to understand how people generate and dispose of food waste. In <a href="https://doi.org/10.1016/j.foodqual.2023.105000">our new study</a>, we found households fell into three categories – based on the amount of food wasted, how much of that waste was avoidable and how it was sorted. These insights into consumer behaviour point to where the most worthwhile improvements can be made.</p> <figure><iframe src="https://www.youtube.com/embed/JvAFaD5f1Lo?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption></figcaption></figure> <h2>Three types of households</h2> <p>We conducted an online survey of 939 households in metropolitan Adelaide between April and May 2021.</p> <p>The sample closely matched the national Australian population in terms of gender, age and income.</p> <p>We asked about the types of food waste produced, the amount of food waste typically discarded in a week and motivations towards reducing and sorting food waste.</p> <p>We identified three distinct types of households:</p> <p><strong>Warriors</strong> are typically older and highly motivated to reduce and sort food waste. They generate minimal waste (9.6 litres per week), such as bones and vegetable peels, that is mostly unavoidable. This group comprised 39.6% of the sample.</p> <p><strong>Strugglers</strong> mainly consist of families with children who produce the largest amount of food waste (33.1 litres per week). They produce the highest proportion of avoidable food waste, such as uneaten fruits and vegetables, bread and cereals. They are moderately motivated to reduce and sort food waste, but more than half of their food waste still ends up in landfill. This group made up 19.6% of the sample.</p> <p><strong>Slackers</strong> are generally younger. They show little concern about reducing or sorting food waste. Slackers produce the smallest amount of food waste overall (9 litres a week), but the proportion of avoidable food waste (such as mixed leftovers) is significantly higher (38.9%) compared to warriors (24.5%). They are more than twice as likely to live in units, with 17.2% doing so, compared to just 7.8% of warriors. This group was 40.8% of the sample.</p> <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/550951/original/file-20230928-27-f7cw8e.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=1000&amp;fit=clip"><img src="https://images.theconversation.com/files/550951/original/file-20230928-27-f7cw8e.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/550951/original/file-20230928-27-f7cw8e.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=361&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/550951/original/file-20230928-27-f7cw8e.png?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=361&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/550951/original/file-20230928-27-f7cw8e.png?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=361&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/550951/original/file-20230928-27-f7cw8e.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=454&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/550951/original/file-20230928-27-f7cw8e.png?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=454&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/550951/original/file-20230928-27-f7cw8e.png?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=454&amp;fit=crop&amp;dpr=3 2262w" alt="Graphic explainer showing the three types of households with their typical characteristics and food waste behaviours." /></a><figcaption><span class="caption">The three types of households with their typical characteristics and food waste behaviours.</span> <span class="attribution"><a class="source" href="https://doi.org/10.1016/j.foodqual.2023.105000">Trang Nguyen using Canva.com</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure> <h2>What can households do about their food waste?</h2> <p>Reducing household food waste involves changing behaviours in both food management (“upstream”) and waste management (“downstream”).</p> <p>Upstream measures aim to prevent food waste in the first place. For example, households can avoid buying or cooking too much food. Supporting households to plan and buy just the right amount of food is a great starting point.</p> <p>Once food waste has been produced, downstream measures come into play. The focus shifts to how we handle and dispose of this waste.</p> <p>When households engage in food waste recycling they <a href="https://doi.org/10.3390/su131911099">start thinking more</a> about their behaviour including purchasing and cooking.</p> <p>In Australia, food waste management is mainly the responsibility of local councils.</p> <p>There are three ways to target household food waste management and drive behavioural change:</p> <ul> <li> <p>providing kerbside collection of food organics and garden organics, also known as “FOGO”</p> </li> <li> <p>changing social norms around food waste</p> </li> <li> <p>offering economic incentives and disincentives.</p> </li> </ul> <h2>1. Providing a FOGO system</h2> <p>Councils should provide this option at a minimum. This ensures sufficient infrastructure is available to support motivated households to sort food waste.</p> <p>Unfortunately <a href="https://experience.arcgis.com/experience/e6b5c78e1dac47f88e7e475ffacfc49b">fewer than half of Australian councils</a> provide a garden organics system and only a quarter of councils provide a FOGO system.</p> <p>You can explore <a href="https://experience.arcgis.com/experience/e6b5c78e1dac47f88e7e475ffacfc49b">the FOGO interactive map</a> to see how your area stacks up.</p> <p><a href="https://www.greenindustries.sa.gov.au/resources/adelaide-metro-kerbside-waste-performance-report-2021-22">Most councils in metropolitan Adelaide</a> provide access to food waste recycling through the FOGO bin. But <a href="https://doi.org/10.1016/j.jclepro.2022.134636">our research</a> indicates more than half of household food waste still ends up in landfill. So we need additional programs to promote more sustainable behaviours.</p> <h2>2. Changing social norms</h2> <p>Social norms, the unspoken rules about what behaviours are deemed appropriate, can drive behavioural change.</p> <p>Examples of promoting social norms around food waste reduction include a <a href="https://www.stopfoodwaste.com.au/stop-food-waste-nationwide-consumer-campaign-summit-communique/">nationwide consumer campaign</a> on stopping food waste and the <a href="https://www.cityofadelaide.com.au/resident/recycling-waste/kitchen-caddies/">kitchen caddy</a> for benches to increase convenience for collecting food waste.</p> <p>But our research suggests some groups, like slackers, remain unmotivated without additional incentives. Economic incentives might motivate this group to engage in more sustainable behaviours.</p> <h2>3. Economic incentives</h2> <p>Currently, Australians pay for waste management through their council rates. This is a “pay-as-you-own” system.</p> <p>The cost is determined by the property’s value, regardless of the amount of waste generated. Renters indirectly contribute to this cost by paying rent.</p> <p>Neither owner-occupiers nor renters have any incentive to reduce waste generation when the cost is levied on property value rather than the amount of waste.</p> <p>An alternative approach gaining momentum in other parts of the world is the “pay-as-you-throw” approach, such as <a href="https://www.collectors2020.eu/wcs-ppw/stockholm-se/">Stockholm</a> and <a href="https://pocacito.eu/sites/default/files/WasteCharging_Taipei.pdf">Taipei</a>. This system charges households based on the weight of their waste, usually the general waste that needs to be discarded in landfill, while the collection of food waste and other recyclables remains free to encourage waste sorting.</p> <p>Recent <a href="https://doi.org/10.1016/j.jclepro.2023.137363">research</a> in Italy shows pay-as-you-throw schemes result in significant reductions in both the quantity of waste and costs associated with waste disposal in many Italian municipalities.</p> <p>The reduced costs flow on to savings for councils that could potentially reduce waste management fees passed on to homeowners and renters through council rates. Giving households incentives to reduce waste and find alternatives to disposal encourages residents to place a higher value on food that may otherwise be sent to landfill.</p> <h2>Reducing food waste is a win-win</h2> <p>Tackling food waste is a win-win for people and the planet. It’s worth using various approaches to encourage people to change their behaviour.</p> <p>Our findings can help inform the design of interventions aimed at reducing and sorting food waste in specific segments of the Australian population.<!-- 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/214482/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/Dx7RWtfgbVw?wmode=transparent&amp;start=11" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption><span class="caption">No time to waste: Halving Australia’s food waste by 2030 (Fight Food Waste Cooperative Research Centre)</span></figcaption></figure> <p><a href="https://theconversation.com/profiles/trang-nguyen-1454838"><em>Trang Nguyen</em></a><em>, Postdoctoral Fellow, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a> and <a href="https://theconversation.com/profiles/patrick-oconnor-109973">Patrick O'Connor</a>, Associate Professor, <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/we-found-3-types-of-food-wasters-which-one-are-you-214482">original article</a>.</em></p>

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How to tell if your loved one is depressed

<p>Around one in 10 people suffer from depression and anxiety, meaning it’s likely at some stage in your life someone you know will be suffering and need your help. These are five of the less-obvious signs and symptoms that a friend or family member might be going through a hard time.</p> <p><strong>1. They seem exhausted all the time</strong></p> <p>Changes to a sleeping patterns can be a sign of depression, whether it’s not sleeping enough or sleeping too much.  </p> <p>Tip: Help your loved one by taking them out for the day to re-set their body clock.</p> <p><strong>2. They never want to socialise anymore</strong></p> <p>If your loved one is finding it difficult to leave the house and attend any social events, even for a catch-up over coffee, that they would normally enjoy, it could be a sign</p> <p>Tip: Recognise that at the time it is very hard for your loved one to go out and socialise. Reassure them that you’d love to catch-up with them, and if it does get too much that you’re happy to do something they’d be happy with.</p> <p><strong>3. They get frustrated at everything</strong></p> <p>Does your loved one seem to be losing their patience more than usual? Anger and irritability, more than usual, can be a sign of depression.</p> <p>Tip: Chat to your friend about their feelings of frustration and irritability. You will be better placed to see if it’s a passing mood or longer-term change.</p> <p><strong>4. Their appetite has changed</strong></p> <p>Whether your loved one is constantly and consistently “not hungry” or they’re eating a lot more than usual and gaining weight, changes in appetite are a common sign of depression.</p> <p>Tip: People living with depression are often exhausted, where the thought of making meals or even what to eat, can be an overwhelming decision. Help prepare some meals for your loved one.</p> <p><strong>5. They’ve suddenly lost self-confidence</strong></p> <p>A loss of self-confidence and self-esteem is a common sign of depression. When a loved one starts to feel like everything they do is rubbish, it can be difficult to feel otherwise.</p> <p>Tip: When a loved one says they feel useless, reassure them with specific examples and evidence that it’s not true at all.</p> <p><em>Image credits: Getty Images</em></p>

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Handkerchief or tissue? Which one’s better for our health and the planet?

<p><em><a href="https://theconversation.com/profiles/mark-patrick-taylor-11394">Mark Patrick Taylor</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> and <a href="https://theconversation.com/profiles/hester-joyce-122106">Hester Joyce</a>, <a href="https://theconversation.com/institutions/la-trobe-university-842">La Trobe University</a></em></p> <p>Maybe you have hay fever, COVID, a cold or the flu, and are reaching for a tissue or handkerchief.</p> <p>But which one’s better at stopping infections spreading? Which has a smaller environmental impact? Is it the hanky, which has been with us since at least Roman times? Or the more recent and widely-used paper tissue?</p> <p>You might be surprised at the results.</p> <h2>A short history of the handkerchief and tissue</h2> <p>Today, we think of hankies as something to wipe noses, and catch coughs and sneezes. But such a simple square of cloth has a complex history.</p> <p>In the first century, the Romans <a href="http://margaretroedesigns.com/wp-content/uploads/HandkerchiefHist.pdf">used</a> a <em>sudarium</em> (Latin for sweat cloth) to wipe off sweat, or to mask the mouth and face.</p> <p>Over time, people have used what we now call a handkerchief or hanky, as a head covering, as a veil and for disguise, to clean hands, for wounds and to staunch blood.</p> <p>Wealthy people have used them to signify class and manners, and for discretely wiping away phlegm rather than smearing snot on sleeves or down skirts. Royalty have used them to indicate wealth and power through their gifts of fine linen and silk handkerchiefs to favoured subjects. Henry VIII owned an extensive collection, some embossed with gold and silver.</p> <p>Handkerchiefs have also been <a href="https://www.bl.uk/collection-items/italian-handkerchief">markers of</a> love, fidelity and sexual preferences. In the late 19th century the “handkerchief code” was a system of colour coding and handkerchief placement used to indicate sexual preferences, <a href="https://www.refinery29.com/en-au/lgbtq-secret-handkerchief-code-language">which is still active</a> in LGBTQ+ communities today.</p> <p>We can <a href="https://www.euppublishing.com/doi/epub/10.3366/cult.2020.0214">trace the origins</a> of paper tissue to China in the 2nd century BC. But it wasn’t until the 1920s that tissue as we know it today <a href="https://www.kleenex.co.uk/kleenex-history">was developed</a> to remove make-up and wipe runny noses from hay fever.</p> <h2>So, which one is better for our health?</h2> <p>More than 100 years ago, a cloth hanky was considered a “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5248216/pdf/hosplond73063-0008b.pdf">little flag of Death</a>” because of the germs it carried and how it contaminated pockets it was left in. Later, we were urged to use a hanky <a href="http://resource.nlm.nih.gov/101449736">as</a> “coughs and sneezes spread diseases”.</p> <figure class="align-right zoomable"><figcaption></figcaption></figure> <p>Today, we know nasal secretions harbour cold-type viruses that can be <a href="https://onlinelibrary.wiley.com/doi/10.1002/jmv.22027">transferred</a> to a <a href="https://www.abc.net.au/health/talkinghealth/factbuster/stories/2011/06/02/3231404.htm">range of surfaces</a> – hands, handkerchiefs, tissues, door knobs, keyboards – sometimes surviving <a href="https://doi.org/10.1093/oxfordjournals.aje.a113473">long after</a> the initial exposure.</p> <p>So blowing your nose into a reusable cotton hanky, then touching another object, means these viruses can spread. Even if you put your cotton hanky in the wash immediately, you’d likely contaminate surfaces on the way, such as doorknobs, and use your infected hands to operate the washing machine.</p> <p>Viruses don’t tend to <a href="https://doi.org/10.1093/infdis/146.1.47">survive so long</a> on tissues. As long as you throw tissues away after using them, and don’t leave them lying around for others to pick up, the chance of passing germs to others from a used tissue is far lower.</p> <p>Then there’s the question of whether hankies or tissues are effective barriers to coughing and respiratory spray.</p> <p>Basic cloth coverings, such as handkerchiefs or bandannas, can catch sputum, as can tissues. But several studies have shown they do not effectively <a href="https://doi.org/10.1021/acs.nanolett.0c02211">filter</a> <a href="https://aaqr.org/articles/aaqr-13-06-oa-0201.pdf">respiratory aerosols</a>, or <a href="https://doi.org/10.1177/153567601001500204">stop you inhaling</a> pollutants, pathogens or <a href="https://doi.org/10.1016/j.ijheh.2018.03.012">small airborne particles</a>.</p> <h2>Which one is better for the planet?</h2> <p>If you want to look at environmental considerations, US company Ecosystem Analytics <a href="https://ecosystem-analytics.com/wp-content/uploads/2013/10/Complete-LCA-Facial-Tissue-Handkerchief.pdf">compared</a> resusable cotton hankies to disposable paper tissues using a <a href="https://doi.org/10.1007/BF02978505">lifecycle analysis</a>. It considered four measures of environmental impacts associated with production, transport, use and disposal:</p> <ul> <li> <p>climate change (sum of greenhouse gases: carbon dioxide, methane, water vapour, nitrous oxide and CFCs)</p> </li> <li> <p>ecosystem quality (chemical pollution of land and water)</p> </li> <li> <p>human health (carcinogenic and non‐carcinogenic toxicity to humans)</p> </li> <li> <p>resources (total energy requirements of non‐renewable energy and mineral extraction).</p> </li> </ul> <p>The verdict? Across the four measures, a cotton hanky had five to seven times greater impact than an equivalent tissue.</p> <p>And, by far, the greatest impacts were related to the production of each of these products, rather than using or disposing of them.</p> <p>If you’re still keen to use a cotton hanky, you could opt for organic cotton, which has a <a href="https://www.sei.org/publications/ecological-footprint-water-analysis-cotton-hemp-polyester/">lower ecological footprint</a> compared to standard cotton produced in the same location. But organic cotton production has <a href="https://www.nytimes.com/wirecutter/blog/is-organic-cotton-better-for-the-environment/">lower yields</a> than its conventional equivalent, meaning more land is needed to produce an equivalent amount, compounding the total environmental impact.</p> <p>If you want to feel better about using tissues, ones made from recycled material may be a better option. Their manufacture leads to <a href="https://doi.org/10.1007/s11367-013-0597-x">fewer</a> greenhouse gas emissions compared with making regular tissues.</p> <h2>The verdict</h2> <p>Wiping our noses with paper tissues we dispose of properly after use (and don’t store in our pocket), made from recycled material, is preferable from both a health and environmental perspective.</p> <p>But tissues don’t quite have the same panache as the historic and versatile cloth hanky.<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/213065/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><a href="https://theconversation.com/profiles/mark-patrick-taylor-11394"><em>Mark Patrick Taylor</em></a><em>, Chief Environmental Scientist, EPA Victoria; Honorary Professor, School of Natural Sciences, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> and <a href="https://theconversation.com/profiles/hester-joyce-122106">Hester Joyce</a>, Adjunct Associate Professor, Creative Arts, <a href="https://theconversation.com/institutions/la-trobe-university-842">La Trobe 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/handkerchief-or-tissue-which-ones-better-for-our-health-and-the-planet-213065">original article</a>.</em></p>

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World mourns the passing of one of the true greats of cinema

<p>Renowned British-Irish actor, Sir Michael Gambon, celebrated worldwide for his iconic portrayal of Albus Dumbledore in the beloved Harry Potter film series, has passed away at the age of 82.</p> <p>In an official statement relayed by his publicist, it was confirmed that he succumbed to pneumonia, leaving his family and fans heartbroken. The statement issued by his family reads, "We are devastated to announce the loss of Sir Michael Gambon. Beloved husband and father, Michael died peacefully in the hospital with his wife Anne and son Fergus by his side."</p> <p>Michael Gambon's acting journey spanned more than half a century, with one of his most significant milestones being his assumption of the role of Dumbledore in the Harry Potter series, succeeding the late Richard Harris in 2004. In characteristic humility, Gambon downplayed his performance, often remarking that he merely portrayed himself "with a stuck-on beard and a long robe".</p> <p>The Harry Potter franchise expressed its grief, stating, "He brought immeasurable joy to Harry Potter fans from all over the world with his humour, kindness, and grace. We will forever hold his memory in our hearts."</p> <blockquote class="twitter-tweet"> <p dir="ltr" lang="en">We are incredibly saddened to hear of the passing of Sir Michael Gambon. He brought immeasurable joy to Harry Potter fans from all over the world with his humour, kindness and grace. We will forever hold his memory in our hearts. <a href="https://t.co/1CoTF3zeTo">pic.twitter.com/1CoTF3zeTo</a></p> <p>— Harry Potter (@harrypotter) <a href="https://twitter.com/harrypotter/status/1707371391866028071?ref_src=twsrc%5Etfw">September 28, 2023</a></p></blockquote> <p>James Phelps, known for his portrayal of Fred Weasley in the series, shared a touching anecdote on Instagram, recounting how Gambon generously helped him rehearse a script during the filming of "Harry Potter and the Half-Blood Prince". Phelps hailed Gambon as both a legend on and off the camera, describing him as funny and always willing to share his knowledge.</p> <p>Gambon embarked on his acting career in the early 1960s, initially treading the boards of the stage before transitioning to television and film. His filmography boasted remarkable performances, such as his portrayal of a psychotic mob leader in Peter Greenaway's <em>The Cook, the Thief, His Wife & Her Lover</em> in 1989 and his portrayal of the elderly King George V in Tom Hooper's <em>The King's Speech</em> in 2010.</p> <p>Despite an early start in engineering apprenticeship, Gambon's passion for acting remained unwavering. He recounted to <em>The Herald</em> newspaper in 2004 that he always knew he would become an actor. His breakthrough came in 1962 when he auditioned for the legendary Laurence Olivier, who subsequently appointed him as one of the founding members of the National Theatre at the Old Vic, alongside emerging talents like Derek Jacobi and Maggie Smith.</p> <p>Gambon's reputation soared on the stage, with his portrayal of Galileo in John Dexter's <em>Life of Galileo</em> in 1980 being a standout moment. In the 1980s, his lead role in the TV series <em>The Singing Detective</em> garnered widespread acclaim, earning him one of his four BAFTA Awards. Additionally, he clinched three Olivier Awards and two Screen Actors Guild Awards for ensemble cast performances in <em>Gosford Park</em> (2001) and <em>The King's Speech</em>.</p> <p>Acknowledged for his contributions to drama, Gambon was honoured as a Commander of the British Empire in 1992 and subsequently knighted in 1998. Despite these prestigious titles, he often displayed a mischievous side, weaving tales such as showing fellow actors a forged signed photograph of Robert De Niro, among other playful antics.</p> <p>In 2015, Gambon retired from the stage due to long-term memory issues, yet he continued to grace the screen with his talent until 2019. In a 2002 interview, he expressed that his work made him feel "the luckiest man in the world".</p> <p><em>Images: Getty / Instagram</em></p>

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What does having a ‘good relationship with food’ mean? 4 ways to know if you’ve got one

<p><em><a href="https://theconversation.com/profiles/clare-collins-7316">Clare Collins</a>, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> and <a href="https://theconversation.com/profiles/tracy-burrows-172931">Tracy Burrows</a>, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a></em></p> <p>Travelling on a train recently you couldn’t help but overhear two women deep in conversation about a mutual obsession with food, including emotional triggers that pushed them towards chocolate and pizza.</p> <p>They shared feeling guilty about a perceived lack of willpower around food and regularly rummaging through the fridge looking for tasty treats to help soothe emotions. Both lamented not being able to stop and think before eating.</p> <p>Their discussion was a long way from talking about physiological requirements for food to fuel your body and meet essential nutrient needs. Instead, it was highly emotive.</p> <p>It got me thinking about the meaning of a healthy relationship with food, how a person’s eating behaviours develop, and how a “good” relationship can be nurtured. Here’s what a “healthy” food relationship can look like.</p> <h2>What does a ‘good relationship with food’ mean?</h2> <p>You can check whether your relationship with food is “<a href="https://www.rwapsych.com.au/blog/what-does-a-healthy-relationship-with-food-and-eating-look-like/">healthy</a>” by seeing how many items on this list you tick “yes” to. Are you:</p> <ol> <li> <p>in tune with your body cues, meaning you’re aware when you are hungry, when you’re not, and when you’re feeling full?</p> </li> <li> <p>eating appropriate amounts and variety of foods across all food groups, at regular intervals so your nutrient, health and wellbeing needs are met?</p> </li> <li> <p>comfortable eating with others and also eating alone?</p> </li> <li> <p>able to enjoy food, without feelings of guilt or it dominating your life?</p> </li> </ol> <p>If you didn’t get many ticks, you might need to work on improving your relationship with food.</p> <h2>Why does a good relationship with food matter?</h2> <p>A lot of “no” responses indicate you may be using food as a coping mechanism in response to <a href="https://pubmed.ncbi.nlm.nih.gov/36863205/">negative emotions</a>. The problem is this <a href="https://pubmed.ncbi.nlm.nih.gov/36839185/">triggers the brain’s reward centre</a>, meaning although you feel better, this behaviour becomes reinforced, so you are more likely to keep eating in response to negative emotions.</p> <p>Emotional eating and bouts of uncontrolled eating are more likely to be associated with <a href="https://pubmed.ncbi.nlm.nih.gov/36863205">eating disorder symptoms</a> and with having a worse quality diet, including lower intakes of vegetable and higher intakes of nutrient-poor foods.</p> <p>A review of studies on food addiction and mental health found healthy dietary patterns were associated with a lower risk of both disordered eating and <a href="https://pubmed.ncbi.nlm.nih.gov/29368800/">food addiction</a>. Higher intakes of vegetables and fruit were found to be associated with <a href="https://pubmed.ncbi.nlm.nih.gov/35586735/">lower perceived stress</a>, tension, worry and lack of joy in a cohort of more than 8,000 Australian adults.</p> <h2>How to develop a healthy food relationship</h2> <p>There are ways to improve your relationship with food. Here are some tips:</p> <p><strong>1. keep a ‘food mood’ <a href="https://nomoneynotime.com.au/ebooks-meal-plans-more/nmnt-food-and-mood-diary">diary</a>.</strong> Writing down when and where you eat and drink, whom you’re with, what you’re doing, and how all this makes you feel, will give you personal insights into when, what and why you consume the things you do. This helps increase awareness of emotions including stress, anxiety, depression, and factors that influence eating and drinking.</p> <p><strong>2. reflect on what you wrote</strong> in your food mood diary, especially “why” you’re eating when you eat. If reasons include stress, low mood or other emotions, create a distraction list featuring activities such as going for a walk or listening to music, and put it on the fridge, noticeboard or in your phone, so it’s easy to access.</p> <p><strong>3. practise <a href="https://pubmed.ncbi.nlm.nih.gov/28848310/">mindful eating</a>.</strong> This means slowing down so you become very aware of what is happening in your body and mind, moment by moment, when eating and drinking, without making any judgement about your thoughts and feelings. Mindless eating occurs when you eat without thinking at all. Being <a href="https://www.headspace.com/mindfulness/mindful-eating">mindful</a> means taking the time to check whether you really are hungry, or whether it’s “eye” hunger <a href="https://theconversation.com/health-check-six-tips-for-losing-weight-without-fad-diets-52496">triggered by seeing food</a>, “nose” hunger triggered by smells wafting from shops or cafes, “emotional hunger” triggered by feelings, or true, tummy-rumbling hunger.</p> <p><strong>4. learn about <a href="https://nomoneynotime.com.au/hacks-myths-faqs/healthy-eating-why-caring-about-the-foods-you-eat-is-worth-it">your nutrient needs</a>.</strong> Learning why your body needs specific vitamins and minerals and the foods they’re in, rather than just mentally coding food as “good” or “bad”, can help you drop the guilt. Banning “bad” foods makes you want them more, and like them more. Mindfulness can help you gain an <a href="https://pubmed.ncbi.nlm.nih.gov/24035461/">appreciation of foods that are both</a> pleasing and nourishing.</p> <p><strong>5. focus on getting enjoyment from food.</strong> Mindless eating can be reduced by focusing on enjoying food and the pleasure that comes from preparing and sharing food with others. One <a href="https://pubmed.ncbi.nlm.nih.gov/24035461/">intervention</a> for women who had concerns about dieting and weight control used workshops to raise their awareness of food cues that prompt eating, including emotions, or being in places they normally associate with eating, and also sensory aspects of food including taste, touch, smell, sound and texture. It also aimed to instruct them in how to embrace pleasure from social, emotional and cultural aspects of food. The intervention led to a reduction in overeating in response to emotional cues such as sadness and stress. Another <a href="https://pubmed.ncbi.nlm.nih.gov/33347469/">review</a> of 11 intervention studies that promoted eating pleasure and enjoyment found promising results on healthy eating, including better diet quality, healthier portion sizes, healthier food choices and greater liking of healthy foods. Participants also reported healthy food tasted better and got easier to cook more often at home.</p> <h2>Where to get help to improve your relationship with food</h2> <p>A healthy relationship with food also means the absence of <a href="https://www.healthdirect.gov.au/eating-disorders">disordered eating</a>, including binge eating, bulimia and anorexia.</p> <p>If you, or someone you know, shows <a href="https://www.rwapsych.com.au/blog/what-does-a-healthy-relationship-with-food-and-eating-look-like/">signs suggesting disordered eating</a>, such as regularly using restrictive practices to limit food intake, skipping meals, food rituals dictating which foods or combinations to eat at specific times, binge eating, feeling out of control around food, secret eating, inducing vomiting, or use of diet pills, follow up with a GP or health professional.</p> <p>You can get more information from <a href="https://insideoutinstitute.org.au/about-us">InsideOut</a>, an Australian institute for eating disorders. Try their online <a href="https://insideoutinstitute.org.au/for-myself">food relationship “check-up”</a> tool.</p> <p>The <a href="https://butterfly.org.au/">Butterfly Foundation</a> also has specific resources for <a href="https://butterfly.org.au/back-to-school-a-body-image-and-mental-health-guide-for-parents-and-children/">parents</a> and <a href="https://butterfly.org.au/">teachers</a> and a helpline operating from 8am to midnight, seven days a week on 1800 334673.<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/202622/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/clare-collins-7316">Clare Collins</a>, Laureate Professor in Nutrition and Dietetics, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> and <a href="https://theconversation.com/profiles/tracy-burrows-172931">Tracy Burrows</a>, Professor Nutrition and Dietetics, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</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-having-a-good-relationship-with-food-mean-4-ways-to-know-if-youve-got-one-202622">original article</a>.</em></p>

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"One of the greats": Elton John's stirring tribute to Michael Parkinson

<p>The entertainment world has been cast into a somber veil of mourning as it bids farewell to the iconic Michael Parkinson, the legendary interviewer who has left us at the age of 88.</p> <p>Elton John, David Attenborough, Michael Caine, Eric Idle ...the long list of luminaries who have joined the chorus of heartfelt tributes to the "TV titan" and the undisputed "king of the chat show" seems limitless.</p> <p>The poignant words of Oscar-winning Michael Caine resonate with a sense of irreparable loss: “Michael Parkinson was irreplaceable," he wrote. "He was charming, always wanted to have a good laugh. He brought the best of everyone he met. Always looked forward to be interviewed by him.”</p> <p>David Attenborough's reflection on his interactions with the man affectionately known as "Parky" evokes a sense of melancholic nostalgia: “He was extremely generous, he wanted you to shine and would always laugh at your jokes and give you an opportunity to make them sound funnier than in fact they were. It was always friendly, it was always thorough, it was always intelligent, it was always a pleasure to do it and I think that came over no matter who his interviewee was.”</p> <p>Elton John said Parkinson was “a TV legend who was one of the greats. I loved his company and his incredible knowledge of cricket and Barnsley Football Club. A real icon who brought out the very best in his guests. Condolences and love to Mary and his family."</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-captioned="" data-instgrm-permalink="https://www.instagram.com/p/CwC4JoBMmKq/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/CwC4JoBMmKq/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Elton John (@eltonjohn)</a></p> </div> </blockquote> <p>The reminiscences continue, with Stephen Fry's words dripping with a bittersweet tone, saying that being interviewed by Parkinson was an experience of impossibly intense thrill.</p> <p>“The genius of Parky was that (unlike most people (and most of his guests, me included) he was always 100 per cent himself. On camera and off. ‘Authentic’ is the word I suppose,” he wrote. “For one of the shows I was on with Robin Williams, a genius of unimaginable comic speed and brilliance. Now they’re both gone.</p> <p>“One should get used to the parade of people constantly falling off the edge, but frankly one doesn’t. So long #parky.”</p> <p>The poignant announcement of the loss came from Parkinson's family. “After a brief illness Sir Michael Parkinson passed away peacefully at home last night in the company of his family,” the statement read.</p> <p>“The family request that they are given privacy and time to grieve.”</p> <p>The memories flood in as the recollection of Parkinson's rise to prominence in the 1970s fills the air with a sense of wistfulness. His list of more than 2000 interviewees includes luminaries such as Sir Billy Connolly, Muhammad Ali, Prince Philip, Sir Elton John, Madonna, and Paul McCartney.</p> <p>Four-time guest Muhammad Ali's absence echoes through time as Parkinson's voice emerges: “When people ask me who I most enjoyed interviewing, I’m unable to give them an answer”, Parkinson once said in an interview. “If they ask me who was the most remarkable man I ever met, I answer without hesitation – Muhammad Ali. I interviewed him four times – I lost on every occasion.”</p> <p>These titanic verbal sparring matches stand as poignant testimonies of the show's indelible legacy, underscoring their magnetic effect on millions of viewers.</p> <p>Among the program's other poignant moments, the chaos induced by Rod Hull's puppet Emu assaulting Parkinson on his own talk show couch remains etched in memory. Parkinson jestingly admitted that his career would forever be epitomised by "that bloody bird".</p> <p><em>Images: Getty / BBC 1</em></p>

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Not all mental health apps are helpful. Experts explain the risks, and how to choose one wisely

<p><em><a href="https://theconversation.com/profiles/jeannie-marie-paterson-6367">Jeannie Marie Paterson</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a>; <a href="https://theconversation.com/profiles/nicholas-t-van-dam-389879">Nicholas T. Van Dam</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a>, and <a href="https://theconversation.com/profiles/piers-gooding-207492">Piers Gooding</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a></em></p> <p>There are thousands of mental health apps available on the app market, offering services including meditation, mood tracking and counselling, among others. You would think such “health” and “wellbeing” apps – which often present as solutions for conditions such as <a href="https://www.headspace.com/">anxiety</a> and <a href="https://www.calm.com">sleeplessness</a> – would have been rigorously tested and verified. But this isn’t necessarily the case.</p> <p>In fact, many may be taking your money and data in return for a service that does nothing for your mental health – at least, not in a way that’s backed by scientific evidence.</p> <h2>Bringing AI to mental health apps</h2> <p>Although some mental health apps connect users with a <a href="https://www.betterhelp.com/get-started/?go=true&amp;utm_source=AdWords&amp;utm_medium=Search_PPC_c&amp;utm_term=betterhelp+australia_e&amp;utm_content=133525856790&amp;network=g&amp;placement=&amp;target=&amp;matchtype=e&amp;utm_campaign=15228709182&amp;ad_type=text&amp;adposition=&amp;kwd_id=kwd-401317619253&amp;gclid=Cj0KCQjwoeemBhCfARIsADR2QCtfZHNw8mqpBe7cLfLtZBD-JZ5xvAmDCfol8npbAAH3ALJGYvpngtoaAtFlEALw_wcB¬_found=1&amp;gor=start">registered therapist</a>, most provide a fully automated service that bypasses the human element. This means they’re not subject to the same standards of care and confidentiality as a registered mental health professional. Some aren’t even designed by mental health professionals.</p> <p>These apps also increasingly claim to be incorporating artificial intelligence into their design to make personalised recommendations (such as for meditation or mindfulness) to users. However, they give little detail about this process. It’s possible the recommendations are based on a user’s previous activities, similar to Netflix’s <a href="https://help.netflix.com/en/node/100639">recommendation algorithm</a>.</p> <p>Some apps such as <a href="https://legal.wysa.io/privacy-policy#aiChatbot">Wysa</a>, <a href="https://www.youper.ai/">Youper</a> and <a href="https://woebothealth.com/">Woebot</a> use AI-driven chatbots to deliver support, or even established therapeutic interventions such as cognitive behavioural therapy. But these apps usually don’t reveal what kinds of algorithms they use.</p> <p>It’s likely most of these AI chatbots use <a href="https://www.techtarget.com/searchenterpriseai/feature/How-to-choose-between-a-rules-based-vs-machine-learning-system">rules-based systems</a> that respond to users in accordance with predetermined rules (rather than learning on the go as adaptive models do). These rules would ideally prevent the unexpected (and often <a href="https://www.vice.com/en/article/pkadgm/man-dies-by-suicide-after-talking-with-ai-chatbot-widow-says">harmful and inappropriate</a>) outputs AI chatbots have become known for – but there’s no guarantee.</p> <p>The use of AI in this context comes with risks of biased, discriminatory or completely inapplicable information being provided to users. And these risks haven’t been adequately investigated.</p> <h2>Misleading marketing and a lack of supporting evidence</h2> <p>Mental health apps might be able to provide certain benefits to users <em>if</em> they are well designed and properly vetted and deployed. But even then they can’t be considered a substitute for professional therapy targeted towards conditions such as anxiety or depression.</p> <p>The <a href="https://theconversation.com/pixels-are-not-people-mental-health-apps-are-increasingly-popular-but-human-connection-is-still-key-192247">clinical value</a> of automated mental health and mindfulness apps is <a href="https://www.sciencedirect.com/science/article/abs/pii/S1077722918300233?casa_token=lwm1E6FhcG0AAAAA:saV7szbZl4DqbvmZiomLG9yMWi_4-zbmy3QCtQzVEQr957QX1E7Aiqkm5BcEntR0mVFgfDVo">still being assessed</a>. Evidence of their efficacy is generally <a href="https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0000002">lacking</a>.</p> <p>Some apps make ambitious claims regarding their effectiveness and refer to studies that supposedly support their benefits. In many cases these claims are based on less-than-robust findings. For instance, they may be based on:</p> <ul> <li><a href="https://sensa.health/">user testimonials</a></li> <li>short-term studies with narrow <a href="https://www.wired.co.uk/article/mental-health-chatbots">or homogeneous cohorts</a></li> <li><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9533203/">studies involving</a> researchers or funding from the very group <a href="https://www.theguardian.com/us-news/2022/apr/13/chatbots-robot-therapists-youth-mental-health-crisis">promoting the app</a></li> <li>or evidence of the benefits of a <a href="https://www.headspace.com/meditation/anxiety">practice delivered face to face</a> (rather than via an app).</li> </ul> <p>Moreover, any claims about reducing symptoms of poor mental health aren’t carried through in contract terms. The fine print will typically state the app does not claim to provide any physical, therapeutic or medical benefit (along with a host of other disclaimers). In other words, it isn’t obliged to successfully provide the service it promotes.</p> <p>For some users, mental health apps may even cause harm, and lead to increases in the very <a href="https://pubmed.ncbi.nlm.nih.gov/34074221/">symptoms</a> people so often use them to address. The may happen, in part, as a result of creating more awareness of problems, without providing the tools needed to address them.</p> <p>In the case of most mental health apps, research on their effectiveness won’t have considered <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9505389/">individual differences</a> such as socioeconomic status, age and other factors that can influence engagement. Most apps also will not indicate whether they’re an inclusive space for marginalised people, such as those from culturally and linguistically diverse, LGBTQ+ or neurodiverse communities.</p> <h2>Inadequate privacy protections</h2> <p>Mental health apps are subject to standard consumer protection and privacy laws. While data protection and <a href="https://cybersecuritycrc.org.au/sites/default/files/2021-07/2915_cscrc_casestudies_mentalhealthapps_1.pdf">cybersecurity</a> practices vary between apps, an investigation by research foundation Mozilla <a href="https://foundation.mozilla.org/en/privacynotincluded/articles/are-mental-health-apps-better-or-worse-at-privacy-in-2023">concluded that</a> most rank poorly.</p> <p>For example, the mindfulness app <a href="https://www.headspace.com/privacy-policy">Headspace</a> collects data about users from a <a href="https://foundation.mozilla.org/en/privacynotincluded/headspace/">range of sources</a>, and uses those data to advertise to users. Chatbot-based apps also commonly repurpose conversations to predict <a href="https://legal.wysa.io/privacy-policy">users’ moods</a>, and use anonymised user data to train the language models <a href="https://www.youper.ai/policy/privacy-policy">underpinning the bots</a>.</p> <p>Many apps share so-called <a href="https://theconversation.com/popular-fertility-apps-are-engaging-in-widespread-misuse-of-data-including-on-sex-periods-and-pregnancy-202127">anonymised</a> data with <a href="https://www.wysa.com/">third parties</a>, such as <a href="https://www.headspace.com/privacy-policy">employers</a>, that sponsor their use. Re-identification of <a href="https://www.unimelb.edu.au/newsroom/news/2017/december/research-reveals-de-identified-patient-data-can-be-re-identified">these data</a> can be relatively easy in some cases.</p> <p>Australia’s Therapeutic Goods Administration (TGA) doesn’t require most mental health and wellbeing apps to go through the same testing and monitoring as other medical products. In most cases, they are lightly regulated as <a href="https://www.tga.gov.au/how-we-regulate/manufacturing/medical-devices/manufacturer-guidance-specific-types-medical-devices/regulation-software-based-medical-devices">health and lifestyle</a> products or tools for <a href="https://www.tga.gov.au/sites/default/files/digital-mental-health-software-based-medical-devices.pdf">managing mental health</a> that are excluded from TGA regulations (provided they meet certain criteria).</p> <h2>How can you choose an app?</h2> <p>Although consumers can access third-party rankings for various mental health apps, these often focus on just a few elements, such as <a href="https://onemindpsyberguide.org/apps/">usability</a> or <a href="https://foundation.mozilla.org/en/privacynotincluded/categories/mental-health-apps/">privacy</a>. Different guides may also be inconsistent with each other.</p> <p>Nonetheless, there are some steps you can take to figure out whether a particular mental health or mindfulness app might be useful for you.</p> <ol> <li> <p>consult your doctor, as they may have a better understanding of the efficacy of particular apps and/or how they might benefit you as an individual</p> </li> <li> <p>check whether a mental health professional or trusted institution was involved in developing the app</p> </li> <li> <p>check if the app has been rated by a third party, and compare different ratings</p> </li> <li> <p>make use of free trials, but be careful of them shifting to paid subscriptions, and be wary about trials that require payment information upfront</p> </li> <li> <p>stop using the app if you experience any adverse effects.</p> </li> </ol> <p>Overall, and most importantly, remember that an app is never a substitute for real help from a human professional.<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/211513/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/jeannie-marie-paterson-6367">Jeannie Marie Paterson</a>, Professor of Law, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a>; <a href="https://theconversation.com/profiles/nicholas-t-van-dam-389879">Nicholas T. Van Dam</a>, Associate Professor, School of Psychological Sciences, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a>, and <a href="https://theconversation.com/profiles/piers-gooding-207492">Piers Gooding</a>, Postdoctoral Research Fellow, Disability Research Initiative, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/not-all-mental-health-apps-are-helpful-experts-explain-the-risks-and-how-to-choose-one-wisely-211513">original article</a>.</em></p>

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