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When someone living with dementia is distressed or violent, ‘de-escalation’ is vital

<p><em><a href="https://theconversation.com/profiles/steve-macfarlane-4722">Steve Macfarlane</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a></em></p> <p>Today’s <a href="https://www.abc.net.au/news/2023-05-18/cooma-aged-care-home-police-woman-in-hospital-taser/102361018">reporting</a> about the alleged tasering of a 95-year-old woman living at the Yallambee Lodge aged care home in New South Wales has brought the issue of behaviours and psychological symptoms of dementia into <a href="https://www.abc.net.au/news/2023-05-19/advocates-say-taser-clare-nowland-shows-aged-system-failure-/102365442">sharp focus</a>.</p> <p>Over half of those living in residential care <a href="https://www.aihw.gov.au/reports/dementia/dementia-in-aus/contents/aged-care-and-support-services-used-by-people-with-dementia/residential-aged-care">have a dementia diagnosis</a> and up to 95% of those living with dementia will <a href="https://www.ncbi.nlm.nih.gov/books/NBK551552/#:%7E:text=Behavioral%20and%20psychological%20symptoms%20of,%2C%20and%20caregiver%20well%2Dbeing.">experience such behaviours</a> at some point during their passage through the illness. Common behaviours that might be shown by those living with advanced dementia include agitation, anxiety, attempts to leave care, aggression, apathy, sleep disturbance, aimless pacing, psychosis and aggression.</p> <p>The full circumstances surrounding Wednesday’s events are unclear and they are subject to an <a href="https://www.abc.net.au/news/2023-05-19/advocates-say-taser-clare-nowland-shows-aged-system-failure-/102365442">investigation</a> by police. That may take some time. What is clear, however, is that there is much room for improvement in the way behaviours and psychological symptoms of dementia are managed in residential care. Situations that end with police involvement should be avoided.</p> <h2>Calling for help</h2> <p>In its final report in March 2021, the <a href="https://agedcare.royalcommission.gov.au/">Royal Commission into Aged Care Quality and Safety</a> <a href="https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-recommendations.pdf">recommended</a> “all workers engaged by providers who are involved in direct contact with people seeking or receiving services in the aged care system undertake regular training about dementia care and palliative care”.</p> <p>Currently, it is not infrequent for police to be called to respond to incidents in care homes. While programs have been implemented to better equip police to respond to the specific need of those <a href="https://www.nationaltribune.com.au/police-and-psos-better-equipped-to-support-people-living-with-dementia/">living with dementia</a> this work is still in its infancy.</p> <p>Aggression and agitation are two of the most common behavioural symptoms that lead to referral to specialist support services.</p> <p>Dementia Support Australia is a Commonwealth-funded service that has supported aged care homes and home-based carers in managing behaviours and psychological symptoms of dementia since 2016. There were <a href="https://www.aihw.gov.au/reports/dementia/dementia-in-aus/contents/aged-care-and-support-services-used-by-people-with-dementia/dementia-support-australia">8,702 referrals</a> to the service between January and June 2022. The number of referrals has increased in recent years.</p> <p>As an organisation at the frontline of dementia support, we extend our deepest sympathies to the 95-year-old aged care resident, her family, Yallambee Lodge staff and everyone else touched by this devastating incident.</p> <p>One of the advantages of having a national service such as this is that it has enabled the development of a national database that documents not only the nature and severity of the behaviours prompting the referral, but those factors that are most commonly identified as triggers for these behaviours.</p> <h2>3 leading causes</h2> <p>Aggression and agitation are not diagnoses in themselves, but symptoms. Symptoms have causes, and these must be identified in order to adequately address behaviour.</p> <p>The leading contributing factors we have identified in relation to behaviours are:</p> <p><strong>1. Unidentified or under-treated pain</strong></p> <p>This is relevant in over 50% of the cases we see. Earlier research on pain management in the setting of advanced dementia has shown those with a dementia diagnosis who are admitted to hospital with hip fractures tend to be prescribed only a fraction of the analgesia given to <a href="https://pubmed.ncbi.nlm.nih.gov/10799790/">those without dementia</a>.</p> <p><strong>2. Carer approach</strong></p> <p>Care staff receive only minimal levels of training in dementia care as part of their basic qualification and are often unfamiliar with communication strategies tailored towards those with cognitive impairment.</p> <p>Currently, the minimum qualification for a personal care worker involves no compulsory units in <a href="https://www.dementia.org.au/about-us/news-and-stories/news/are-aged-care-workers-required-have-dementia-training">dementia competency</a>. While we do not know the full circumstances from the events this week, the Royal Commission has made recommendations to improve care for those living with dementia. Carer approach is an issue in about a third of the cases we see.</p> <p><strong>3. Over- and under-stimulation</strong></p> <p>In about one quarter of Dementia Support Australia cases boredom and loneliness and/or an environment that does not take into account the specific needs of those living with dementia are an issue.</p> <p>Other common causes of changed behaviour include mood and anxiety disorders, communication difficulties, <a href="https://theconversation.com/what-is-delirium-194631">delirium</a>, sleep problems and poor carer knowledge of the specific likes/dislikes of the individuals they are caring for.</p> <figure><iframe src="https://www.youtube.com/embed/WE65yrnsrPk?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption><span class="caption">People with dementia may react to uncertainty in unexpected ways.</span></figcaption></figure> <h2>Prevention and calming things down</h2> <p>The best way to manage most behavioural changes is to prevent the circumstances that lead to their development in the first place. Prevention is always better than cure.</p> <p>Once behaviours are occurring, there is no single correct way to <a href="https://www.dementia.org.au/national/support-and-services/carers/behaviour-changes/aggressive-behaviours">de-escalate</a> them. The appropriate de-escalation strategies will always be specific to what has caused the altered behaviour in the first place.</p> <p>Unfortunately, when behaviours have escalated to the point where police attendance is required, the responding officers are unlikely to be equipped with the necessary information about the person and their circumstances. That means they won’t be equipped to respond with effective and specific de-escalation strategies.</p> <p>One case in the United States from 2020 involved the arrest of a 73-year-old woman living with dementia, who had left a local store without paying for items <a href="https://edition.cnn.com/2021/04/27/us/loveland-police-officers-video-use-of-force/index.html">worth a small amount</a>. A <a href="https://edition.cnn.com/2021/04/16/us/loveland-lawsuit-use-of-force-arrest/index.html">lawsuit</a> filed following the arrest alleged it resulted in a fractured arm and a dislocated shoulder, and raised national concerns about the way first responders interact with those experiencing cognitive disabilities.</p> <p>Australia needs to learn from yesterday’s events and respond.</p> <p><em>If you are caring for someone with dementia there is help available. <a href="https://www.dementia.com.au/">Dementia Support Australia</a> is a free service, fully funded by the Australian government. Referrals can be made 24-hours a day by calling 1800 699 799.<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/205988/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em><a href="https://theconversation.com/profiles/steve-macfarlane-4722">Steve Macfarlane</a>, Head of Clinical Services, dementia Support Australia, &amp; Associate Professor of Psychiatry, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a></em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/when-someone-living-with-dementia-is-distressed-or-violent-de-escalation-is-vital-205988">original article</a>.</em></p>

Mind

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Five vital questions to ask yourself before booking your next cruise

<p dir="ltr">When it comes to booking your next holiday on the seas, there are a few vital questions to consider before setting sail. </p> <p dir="ltr">It isn't uncommon to be lured in by a seemingly great sale fare, but taking a minute to contemplate the best arrangement for you could stop you making an expensive mistake. </p> <p dir="ltr">Who you go with, where you go, and when you set sail can all greatly impact the quality of your holiday, so ask yourself these questions before you pack your bags. </p> <p dir="ltr"><strong>Who am I travelling with?</strong></p> <p dir="ltr">Picking your travel companions can make or break your holiday, as who you decide to set sail with can drastically change where and when you go. </p> <p dir="ltr">For example if you're travelling with young children, that will rule out most expeditions to Antarctica, as most cruise lines recommend children be at least eight years of age to head to the icy South Pole. </p> <p dir="ltr">If the holiday is a venture for the whole family, most cruise lines advertise which journeys are more kid-friendly, with entertainment onboard for people of all ages.</p> <p dir="ltr"><strong>Where am I going?</strong></p> <p dir="ltr">While there are many spectacular destinations on every cruise lover's bucket list, there are others that require a little more consideration. </p> <p dir="ltr">Do you prefer something tropical featuring a beach-heavy itinerary or fancy something cool climate with plenty of adventure? What was the last holiday you truly enjoyed and what did you love about it? What are you keen to avoid (bustling cities, plenty of days at sea etc)?</p> <p dir="ltr">Once you narrow down what kind of holiday you’re looking for, it’s time to shortlist potential destinations that will tick your every box. </p> <p dir="ltr"><strong>How much is it going to cost me?</strong></p> <p dir="ltr">The first thing every traveller must do before making holiday plans is figuring out how much money you have, and what you are willing to spend.</p> <p dir="ltr">Writing down a budget and designating certain costs is a sure fire way to keep on top of your spending, such as allocating set figures for transport, accommodation, daily spending and luxuries. </p> <p dir="ltr">While you're working out your budget, it's also a good idea to research the cost of meals, drinks, activities and transport at the ports the cruise will be visiting. </p> <p dir="ltr"><strong>What do I want to spend my time onboard doing?</strong></p> <p dir="ltr">Whether you're into golf, felines, death metal, food or general nudity, you can rest assured there's a cruise for you out there.</p> <p dir="ltr">Many cruise lines have started operating themed cruises to match the very niche interests of every traveller, while still giving holidaymakers the chance to see the world with like minded people. </p> <p dir="ltr">Simply Google 'cruise' and your particular interest and prepare to be amazed at what's out there. </p> <p dir="ltr"><strong>Is cruising the best holiday for me?</strong></p> <p dir="ltr">If you've never cruised before, you might be feeling uncertain if you're the kind of person who'll enjoy a cruise. </p> <p dir="ltr">While there's certainly a cruise for every person, whether that be river cruising through Europe or adventures in the Arctic Circle, it's probably not the best idea to book in for a 24-day voyage if you're unsure you'll enjoy it. </p> <p dir="ltr"><em>Image credits: Getty Images</em></p>

Cruising

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Vital clue emerges in search for missing nine-year-old

<p><span style="font-weight: 400;">Five days into their search for missing nine-year-old Charlise Mutten, police have received a vital clue from witnesses.</span></p> <p><span style="font-weight: 400;">Police and volunteers have continued to search bushland in the NSW Blue Mountains for signs of the girl, while droves of detectives searched for clues around the Mount Wilson estate where she was last seen.</span></p> <p><a rel="noopener" href="https://www.police.nsw.gov.au/news/news_article?sq_content_src=%2BdXJsPWh0dHBzJTNBJTJGJTJGZWJpenByZC5wb2xpY2UubnN3Lmdvdi5hdSUyRm1lZGlhJTJGOTk1OTYuaHRtbCZhbGw9MQ%3D%3D" target="_blank"><span style="font-weight: 400;">Officers</span></a><span style="font-weight: 400;"> from local police, Police Rescue, the Dog Unit and PolAir are also involved in the search efforts, with assistance from the State Emergency Service (SES), Rural Fire Service (RFS), and NSW Ambulance.</span></p> <blockquote class="twitter-tweet"> <p dir="ltr">A large scale coordinated search operation continues in the Blue Mountains. Charlise was last seen wearing a pink top w/ a round neck collar, black skirt &amp; pink Nike thongs. <br /><br />Anyone with info regarding the whereabouts of Charlise should contact Crime Stoppers on 1800 333 000. <a href="https://t.co/JHtK9Nsgsb">https://t.co/JHtK9Nsgsb</a></p> — NSW Police Force (@nswpolice) <a href="https://twitter.com/nswpolice/status/1482132460527886343?ref_src=twsrc%5Etfw">January 14, 2022</a></blockquote> <p><span style="font-weight: 400;">On Monday, neighbours provided </span><a rel="noopener" href="https://www.9news.com.au/national/blue-mountains-missing-girl-charlise-mutten-police-new-south-wales/cbeb653e-c0da-44f4-ac10-80421b64c2fc" target="_blank"><span style="font-weight: 400;">new information</span></a><span style="font-weight: 400;"> about events prior to the reporting of Charlise’s disappearance on Friday, telling police they saw a car driving through the gates of the property at 4.30am.</span></p> <p><span style="font-weight: 400;">Charlise’s mother Kallista told police her daughter had disappeared on Thursday, but didn’t make a report until Friday morning.</span></p> <p><span style="font-weight: 400;">Her fiance Justin Stein then spent several hours speaking to police at Penrith on Friday afternoon, with his car being towed while he was at the station.</span></p> <p><span style="font-weight: 400;">Over the weekend, police seized a white boat from the Mount Wilson property where Charlise was last spotted, before divers searched the Hawkesbury River at Windsor on Sunday.</span></p> <p><img style="width: 500px; height:281.25px;" src="https://oversixtydev.blob.core.windows.net/media/7846882/mutten.jpg" alt="" data-udi="umb://media/fc3a0795d42b4d32bb85138db1553c25" /></p> <p><em><span style="font-weight: 400;">Divers searched the Hawkesbury River for signs of nine-year-old Charlise Mutten, who has been missing since Thursday, January 13. Image: 9News</span></em></p> <p><span style="font-weight: 400;">Monday’s search saw crews of volunteers trek across hundreds of kilometres, with NSW Rural Fire Service commander Peter Bennet saying one crew walked 10 kilometres across rough terrain.</span></p> <p><span style="font-weight: 400;">“It’s very rough terrain out here with canyons,” he said.</span></p> <p><span style="font-weight: 400;">Officers from the Homicide Squad are also heavily involved, though their investigations have been made difficult by conflicting accounts.</span></p> <p><img style="width: 419.46308724832215px; height:500px;" src="https://oversixtydev.blob.core.windows.net/media/7846881/fjc1b-qacachmk4.jpg" alt="" data-udi="umb://media/b998ff4eb1954831b0b62406200e7c72" /></p> <p><em><span style="font-weight: 400;">Charlise is described as being of Caucasian appearance, between 130 and 140cm tall, and has brown hair and brown eyes. Image: NSW Police (Twitter)</span></em></p> <p><span style="font-weight: 400;">Acting Superintendent John Nelson said police were working closely with Charlise’s family, including her mother.</span></p> <p><span style="font-weight: 400;">“For any parent, it’s a very distressing scenario,” he said.</span></p> <p><span style="font-weight: 400;">“She is quite distressed and we are providing her with support.”</span></p> <p><span style="font-weight: 400;">Charlise was last seen wearing a pink top with a round neck collar, a black knee-length skirt, and pink Nike thongs.</span></p> <p><span style="font-weight: 400;">Police are urging anyone with information to contact Crime Stoppers on 1800 333 000.</span></p> <p><em><span style="font-weight: 400;">Image: NSW Police (Twitter)</span></em></p>

News

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Home gardens vital for pollinators

<h2><strong style="font-size: 14px;">They provide a rich and diverse nectar source, study finds.</strong></h2> <div class="copy"> <p>Urban areas are a surprisingly rich food reservoir for pollinating insects such as bees and wasps, according to a UK study <a rel="noreferrer noopener" href="https://besjournals.onlinelibrary.wiley.com/doi/10.1111/1365-2745.13598" target="_blank">published</a> in the <em>Journal of Ecology</em>.</p> <p>Home gardens are particularly important, the study found, accounting for 85% of the nectar – sugar-rich liquid that provides pollinators with energy – within towns and cities and the most diverse supply overall.</p> <p>Results showed that just three gardens generated on average around a teaspoon of the liquid gold – enough to attract and fuel thousands of pollinators.</p> <p>“This means that towns and cities could be hotspots of diversity of food – important for feeding many different types of pollinators and giving them a balanced diet,” says lead author Nicholas Tew, from the University of Bristol.</p> <p>“The actions of individual gardeners are crucial,” he adds. “Garden nectar provides the vast majority of all. This gives everyone a chance to help pollinator conservation on their doorstep.”</p> <p><a rel="noreferrer noopener" href="https://www.pollinator.org/pollination" target="_blank">Pollinators</a> include bees, wasps, butterflies, moths, bats and beetles. They are critical for ecosystems and agriculture as most plant species need them to reproduce, and <a rel="noreferrer noopener" href="https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.453.4134&amp;rep=rep1&amp;type=pdf" target="_blank">research suggests</a> their survival relies especially on the diversity of flowering plants.</p> <p>To explore how our sprawling urban areas could support them, Tew’s research group previously led the <a rel="noreferrer noopener" href="http://www.bristol.ac.uk/biology/research/ecological/community/pollinators/" target="_blank">Urban Pollinators Project</a> in collaboration with other universities. They found that cities and gardens – community and private – are vital for pollinators, leading them to question how to quantify and harness this resource.</p> <p>“The gap in our knowledge was how much nectar and pollen urban areas produce and how this compares with the countryside,” Tew explains, “important information if we want to understand how important our towns and cities can be for pollinator conservation and how best to manage them.”</p> <p>So, for the current study, Tew and colleagues measured the supply of nectar in urban areas, farmland and nature reserve landscapes, and then within four towns and cities (Bristol, Edinburgh, Leeds and Reading) to determine how much nectar different land uses produce.</p> <p>To do this, they extracted nectar from more than 3000 flowers comprising nearly 200 plant species using a fine glass tube and quantified it using a refractometer, an instrument that measures how much light refracts when passing through a solution.</p> <p>Then they sourced nectar measurements from other published studies and combined the nectar-per-flower values with numbers of flowers from each species in different habitats as previously measured by the group.</p> <p>Overall, nectar quantity per unit area was similar in urban, farmland and nature reserve landscapes. But urban nectar supply was most diverse, as it was produced by more flowering plant species. And while private gardens supplied similarly large amounts per unit as allotments, they covered more land – nearly a third of towns and cities.</p> <p>It’s important to note the findings are specific to the UK, and maybe parts of western Europe, Tew says. Most urban nectar comes from ornamental species that are not native, which can be attractive to generalist pollinators but may not benefit specialist species that feed from selective native flower species.</p> <p>Thus private gardens in other regions might have different benefits. Australia, for instance, has more endemic species and specialist pollinators than the UK, so while non-natives would still provide some benefit, natives may be more important overall.</p> <p>Most recommendations for attracting pollinators in Australia include supporting native bees and other local specialists. Suggestions include planting more native species and providing <a rel="noreferrer noopener" href="http://www.australianenvironmentaleducation.com.au/australian-animals/australian-pollinator-week/" target="_blank">accommodation</a> for native bees, most of which are solitary species – unlike the familiar, colonial European honeybee.</p> <p>But in general, Tew says home gardeners can all support biodiversity with some key strategies, especially planting as many nectar-rich flowering plants as possible and different species that ensure flowers all year round.</p> <p>Other <a rel="noreferrer noopener" href="https://www.rhs.org.uk/science/conservation-biodiversity/wildlife/plants-for-pollinators" target="_blank">recommendations</a> include mowing the lawn less often to let dandelions, clovers and other plants flower, avoiding <a rel="noreferrer noopener" href="https://cosmosmagazine.com/biology/scientists-call-for-urgent-action-on-bee-killing-insecticides/" target="_blank">pesticides</a> and never spraying open flowers, and covering as much garden area as possible in flowery borders and natural lawns.</p> <!-- Start of tracking content syndication. Please do not remove this section as it allows us to keep track of republished articles --> <img id="cosmos-post-tracker" style="opacity: 0; height: 1px!important; width: 1px!important; border: 0!important; position: absolute!important; z-index: -1!important;" src="https://syndication.cosmosmagazine.com/?id=138747&amp;title=Home+gardens+vital+for+pollinators" alt="" width="1" height="1" /> <!-- End of tracking content syndication --></div> <div id="contributors"> <p><a href="https://cosmosmagazine.com/science/biology/home-gardens-vital-for-pollinators/">This article</a> was originally published on <a href="https://cosmosmagazine.com">Cosmos Magazine</a> and was written by <a href="https://cosmosmagazine.com/contributor/natalie-parletta">Natalie Parletta</a>. Natalie Parletta is a freelance science writer based in Adelaide and an adjunct senior research fellow with the University of South Australia.</p> <p><em>Image: Cosmos Magazine</em></p> </div>

Home & Garden

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Coronavirus reinfection cases: what we know so far – and the vital missing clues

<p>To date, there have been six published cases of COVID-19 reinfection, with various other unverified accounts from around the world. Although this is a comparably small fraction of the millions of people known to have been infected, should we be concerned? To unpick this puzzle, we must first consider what we mean by immunity.</p> <p><strong>How immunity works</strong><br />When we are infected with any pathogen, our immune system quickly responds to try to contain the threat and minimise any damage. Our first line of defence is from immune cells, known as innate cells. These cells are not usually enough to eliminate a threat, which is where having a more flexible “adaptive” immune response comes into play – our lymphocytes.</p> <p>Lymphocytes come in two main varieties: B lymphocytes, which make antibodies, and T lymphocytes, which include cells that directly kill the germy invaders.</p> <p>As antibodies are readily measured in blood, they are often used to indicate a good adaptive immune response. However, over time, antibodies levels in our blood wane, but this doesn’t necessarily mean protection is lost. We retain some lymphocytes that know how to deal with the threat – our memory cells. Memory cells are remarkably long-lived, patrolling our body, ready to spring into action when needed.</p> <p>Vaccines work by creating memory cells without the risk of a potentially fatal infection. In an ideal world, it would be relatively easy to create immunity, but it’s not always that straightforward.</p> <p>Although our immune system has evolved to deal with a huge variety of pathogens, these germs have also evolved to hide from the immune system. This arms race means that some pathogens such as malaria or HIV are very tricky to deal with.</p> <p>Infections that have spilled over from animals - zoonotic diseases - are also challenging for our immune system because they can be completely novel. The virus that causes COVID-19 is such a zoonotic disease, originating in bats.</p> <p>COVID-19 is caused by a betacoronavirus. Several betacoronaviruses are already common in the human population – most familiar as a cause of the common cold. Immunity to these cold-causing viruses isn’t that robust but immunity to the more serious conditions, Mers and Sars, is more durable.</p> <p>Data to date on COVID-19 shows that antibodies can be detected three months after infection, although, as with Sars and Mers, antibodies gradually decrease over time.</p> <p>Of course, antibody levels are not the only indication of immunity and don’t tell us about T lymphocytes or our memory cells. The virus causing COVID-19 is structurally similar to Sars, so perhaps we can be more optimistic about a more durable protective response – time will tell. So how worried then should we be about reports of reinfection with COVID-19?</p> <p><strong>How worried should we be?</strong><br />The handful of case reports on reinfection with COVID-19 don’t necessarily mean that immunity is not occurring. Issues with testing could account for some reports because “virus” can be detected after infection and recovery. The tests look for viral RNA (the virus’s genetic material), and viral RNA that cannot cause infection can be shed from the body even after the person has recovered.</p> <p>Conversely, false-negative results happen when the sample used in testing contains insufficient viral material to be detected – for example, because the virus is at a very low level in the body. Such apparent negative results may account for cases in which the interval between the first and second infection is short. It is hugely important, therefore, to use additional measures, such as viral sequencing and immune indicators.</p> <p>Reinfection, even in immunity, can happen, but usually this would be mild or asymptomatic because the immune response protects against the worst effects. Consistent with this is that most verified cases of reinfection reported either no or mild symptoms. However, one of the latest verified cases of reinfection – which happened just 48 days after the initial infection – actually had a more severe response to reinfection.</p> <p>What might account for the worse symptoms the second time round? One possibility is the patient did not mount a robust adaptive immune response first time round and that their initial infection was largely contained by the innate immune response (the first line of defence). One way to monitor this would be to assess the antibody response as the type of antibody detected can tell us something about the timing of infection. But unfortunately, antibody results were not analysed in the recent patient’s first infection.</p> <p>Another explanation is that different viral strains caused the infections with a subsequent impact on immunity. Genetic sequencing did show differences in viral strains, but it isn’t known if this equated to altered immune recognition. Many viruses share structural features, enabling immune responses to one virus to protect against a similar virus. This has been suggested to account for the lack of symptoms in young children who frequently get colds caused by betacoronaviruses.</p> <p>However, a recent study, yet to be peer-reviewed, found that protection against cold-causing coronaviruses did not protect against COVID-19. In fact, antibodies recognising similar viruses can be dangerous – accounting for the rare phenomenon of antibody-dependent enhancement of disease (ADE). ADE occurs when antibodies enhance viral infection of cells with potentially life-threatening consequences.</p> <p>It should be emphasised, though, that antibodies are only one indicator of immunity and we have no data on either T lymphocytes or memory cells in these cases. What these cases emphasise is a need to standardised approaches in order to capture the critical information for robust evaluation of the threat of reinfection.</p> <p>We are still learning about the immune response to COVID-19, and every piece of new data is helping us unpick the puzzle of this challenging virus. Our immune system is a powerful ally in the fight against infection, and only by unlocking it can we ultimately hope to defeat COVID-19.</p> <p><em>Written by Sheena Cruickshank. This article first appeared on <a href="https://theconversation.com/coronavirus-reinfection-cases-what-we-know-so-far-and-the-vital-missing-clues-147960">The Conversation</a>.</em></p>

International Travel

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Why it’s vital that we remember our elders

<p><em><strong>Husband-and-wife comedians and commentators Jeremy Elwood and Michele A'Court give their views.</strong></em></p> <p><strong><em><span style="text-decoration: underline;">Michelle A’Court</span></em></strong></p> <p>This week I will take my father's winter jackets and jerseys to the City Mission. My mother has lovingly washed and folded them. That's what she did for Dad for 62 years and she has taken great care with doing it for the last time.</p> <p>She has given me strict instructions to pass on to the good people at the Mission. These clothes are not to be sold. She wants no price tags pinned to his jumpers and coats. They are to be given, she says, to men sleeping rough, who could do with some layers between them and winter. It matters to her that men who have lived a very different life from my father can wear something that has been cared for.</p> <p>If you can find ways to be warm, there are things to love about winter. Like the oranges and camellias throwing their colour around on Route 27 between home and Rotorua last weekend. This is my favourite road, and the car is warm, and it's the day after my birthday, and I'm not at all bothered about being a year older. If I'm sad about anything it's that for the first time in I don't know how many years, there's no card with Dad's handwriting in it. He didn't ever write much, but he insisted on being the one to do it. "Love, Mother &amp; Father". He would have liked the drive.</p> <p>Sometimes in my car I listen to music, other times I'm tuned to the news. In one bulletin, there is five million dollars from our government to kick-start the next America's Cup campaign. In another, the Aged Care Association says rest homes need an injection of $10 million to stay afloat. The women at the heart of the industry deserve their newly won pay equity, a spokesperson says, but employers are struggling to cover the increase. As little from the government as $100,000 each to help rest homes transition would make all the difference. My father didn't make it to a rest home but I think of how much care he needed at the end, and worry again about the men who have lived a different life.</p> <p>More numbers in other bulletins - $26 million earned from food, beverage and accommodation for the Lions' tour, a welcome boost for local businesses. Some people are having a grand winter.</p> <p>The other story about the rugby was the apparent ignominy of a drawn final match, and therefore a drawn test series. Much chatter about the French ref, and some dissection of the rules. Disappointment and a sense that "not winning" is the same as "losing".</p> <p>And all I can think is that, really, coming equal would be a terrific thing.</p> <p><em><strong><span style="text-decoration: underline;">Jeremy Elwood</span></strong></em><br /> <br /> My first hospitality job was as a bartender in Dunedin. The neighbourhood the bar was in was home to a couple of hotels, band rehearsal spaces and three halfway houses. This was in the mid 1990s, the period in which the government was moving mental health treatment out of the old institutions, and towards a more community based approach, with wildly varying degrees of success. So as you can imagine, our clientele was equally varied.</p> <p>One regular was a man in his late 60s or early 70s, quite well dressed in a shabby chic, hand me down kind of way. He always came in mid-afternoon, carrying a briefcase. He would order a beer, sit down, and open that case to reveal it was completely filled with ballpoint pens, which he would meticulously, and silently, begin to count while he drank.</p> <p>He was harmless – most of the time. We quickly worked out, however, that he had a two-beer limit. As soon as a third went down, his personality would change in Jekyll and Hyde-like fashion. He would become abusive, start throwing things, and even try and reach over the bar to grab bottles. Needless to say, this only happened twice – once when I was working, and once when someone new, and unfamiliar with the situation, was on.</p> <p>We didn't ban him from the premises. It was painfully clear to all of the staff that his two beers were a weekly indulgence, and quite simply he had nowhere else to go. He was one of those faceless, forgotten men who have fallen off the radar of all but the carers, doctors and, so often, bartenders who come into contact with them. Or that's what I assumed.</p> <p>One day, however, he came in wearing a badge that read "World's Best Dad."</p> <p>It was Father's Day.</p> <p>The emotional punch floored me. To realise that this man, with his pens and his two drink maximum, was part of a family. Loved, remembered, and acknowledged.</p> <p>As are all the elderly men you see, or don't see, as they drift around the edges of our society. In a culture which idolises youth, it is vital that we remember the aged. The thing about youth is you grow out of it. Most of us will get old, and many of us won't have the benefits of financial security and good health as we do. Some will have family to support them, but many more will not, and as they age they will fade from the public consciousness like a decaying photograph, unless we all prevent that.  </p> <p>So to those who are working so tirelessly, and too often thanklessly, to keep these men warm, safe and remembered, thank you.</p> <p><em>Written by Jeremy Elwood and Michelle A’Court. First appeared on <a href="http://www.stuff.co.nz/" target="_blank"><strong><span style="text-decoration: underline;">Stuff.co.nz.</span></strong></a></em></p>

Retirement Life

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Why grandparents are extremely vital to grandkids lives

<p>The once popular perception of grandparents as frail, kindly old people sitting in rocking chairs is now more or less obsolete. Improved health outcomes and increased life expectancy mean that grandparents now spend more time caring for and engaging with their grandchildren than ever before.</p> <p>With increasing numbers of children living in families where both parents work, many grandparents have become an important source of child care and general support.</p> <p>The benefits of grandparents and grandchildren spending time together are many. Dr Julie Green, Executive Director of the Raising Children Network, reports that "Children with a warm, loving relationship with their grandparents are more likely to be resilient, have higher self-esteem and cope better with the challenges of life."</p> <p>Grandchildren report that their grandparents provide a link to the past; they are role models, nurturers, listeners and a support network in times of family disharmony.</p> <p>While grandparents report an increased sense of wellbeing, feelings of being part of a family and broader society and an improved social life through their connections with their grandchildren. Grandparents also play an important role in helping parents to manage stress associated with juggling work and family commitments.</p> <p>Increased involvement in the lives of their grandchildren comes with the expectation that grandparents will maintain a relationship that is consistent with the parenting practices of their adult children. But this can be challenging for some grandparents.</p> <p>A recent study in the Journal of Family Studies found that many grandparents felt they were constantly negotiating between 'being there' for their grandchildren and 'interfering' by offering advice where it wasn't requested or overstepping the mark when it came to parental authority.</p> <p>Dr Tania Trapolini, a clinical psychologist at the Children's Psychology Clinic, explains that children thrive on consistency and consistency between parents and other care givers is crucial to their development. "Children learn about the world and how to relate to those around them through their everyday interactions with their parents and other important caregivers, such as grandparents. Consistency in interactions and parenting practices helps them to feel a sense of security and stability because they understand what is expected of them and know how their needs, including boundaries and their need for comfort when they are upset, will be met."</p> <p>Dr Trapolini added that behavioural problems could result from a lack of consistency "Mixed messages can be confusing for children. Inconsistency contributes to challenging behaviours in children as they will 'try things on' with different carers and push boundaries because they don't know what the outcomes might be."</p> <p>Dr Trapolini acknowledges that it is not always easy to communicate about parenting "It can be difficult for adult children to confront their own parents or in-laws about feeling undermined or invalidated because there can be tricky dynamics at play that can be triggering for some individuals."</p> <p>She recommends that parents take a collaborative approach:  "Involve grandparents and brainstorm with them about how to manage certain behaviours. Maintain open communication about the parenting practices that are really important to you and what behaviours you might be working on and how."</p> <p>"Consistency is not only important for children, it ultimately helps the whole family. It helps parents to feel respected, empowered and validated in their parenting decisions and practices and if a collaborative approach is taken, grandparents can feel involved and valued."</p> <p>Dr Green recommends that grandparents give their adult children time to develop their own parenting style and to realise that parents and grandparents are both constantly learning how to fulfil their roles as carers and that there is no one size fits all when in comes to parenting.</p> <p>"Adult children may parent in a similar way to their parents or very differently and it is important for grandparents to give their own children space to develop their own parenting style and gain confidence," she said.</p> <p>Dr Green believes that it is helpful for grandparents to give thought to what sort of grandparents they want to be and to communicate this from the outset. "It helps to be open and clear about how much you want to do as a grandparent. This helps everyone involved to understand where the boundaries are."</p> <p>She also believes that it takes time and "some trial and error" to learn about giving help and advice to adult children. She also recommends compliments, "If you think your children are doing a good job, let them know. It builds confidence and opens up a conversation."</p> <p>Dr Green also hopes that grandparents view the time they share with their grandchildren as much more than child care. “It is a chance for grandparents to have input into their grandchild's development; a chance to have one on one time to tell stories and do enjoyable things together that adds to a child's healthy development."</p> <p>Written by Sussana Smith. Appeared on <strong><span style="text-decoration: underline;"><a href="http://www.stuff.co.nz/">Stuff.co.nz</a></span></strong>. </p> <p><strong>Related links:</strong></p> <p><em><strong><span style="text-decoration: underline;"><a href="/lifestyle/family-pets/2015/12/life-lessons-from-grandparents/">Top 10 life lessons kids learn from grandparents</a></span></strong></em></p> <p><em><strong><span style="text-decoration: underline;"><a href="/lifestyle/family-pets/2015/10/quotes-about-siblings/">9 heart-warming quotes about siblings</a></span></strong></em></p> <p><em><strong><span style="text-decoration: underline;"><a href="/lifestyle/family-pets/2015/10/role-of-grandparents/">The 10 “types” of grandparents</a></span></strong></em></p>

Family & Pets

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Easy yoga moves you can do at home for health and vitality

<p>If you’ve been keen to dip your toe into the world of yoga but haven’t known where to start, we’ve got the guide for you! These easy, at-home yoga postures are ideal for any skill level (even completely beginners!) and have a multitude of health and wellness benefits. Practicing daily or a couple of times a week can have a profoundly positive impact on your energy levels and sense of contentment and calm. So what are you waiting for? Dive in today!</p> <p><strong><span style="text-decoration: underline;">You will need:</span></strong></p> <ul> <li>Comfortable and loose-fitting clothes</li> <li>A yoga mat (if you have one) or otherwise a non-slip surface will do</li> </ul> <p><strong><span style="text-decoration: underline;">Exercises:</span></strong></p> <p><strong>1. Tree pose:</strong> To elongate your body and calm a racing mind.</p> <ul> <li>Stand comfortably with feet hip-width apart, weight distributed evenly.</li> <li>Shift weight to your left foot and bring the sole of your right foot as high up your left leg as you can, forming a “triangle” shape.</li> <li>Bring your hands together in front of you, as if in prayer, and hold the posture for 30 seconds before switching sides.</li> </ul> <p><strong>2. Warrior 1 pose:</strong> Tostrengthen your upper body and open up your chest.</p> <ul> <li>Stand comfortably with your feet hip-width apart.</li> <li>Focusing your weight and attention on your right foot and keeping it still with toes pointing forward, bend your right knee deeply.</li> <li>Place your left foot about a metre behind you, toes turned outwards, away from the body.</li> <li>Raise both arms above your head so that palms are touching and look upwards towards them.</li> <li>Take three deep breaths then return to standing.</li> <li>Repeat five to 10 times.</li> </ul> <p><strong>3. Half chair pose:</strong> To strengthen your thighs.</p> <ul> <li>Stand about 30cm away from a supportive and sturdy wall.</li> <li>Push your bottom back so that it makes contact and rests against the wall, like you’re “sitting” on it.</li> <li>Raise your arms forward and over your head so that you can see them, palms facing inwards.</li> <li>Gently bend your knees into a comfortable squat position.</li> <li>Breathe deeply and try to hold for 10 to 20 seconds.</li> </ul> <p><strong>4. Mountain pose:</strong> To correct your posture and stand tall.</p> <ul> <li>Stand comfortably with the bases of your big toes touching and your heels slightly apart.</li> <li>Place your hands by your sides, palms facing outwards.</li> <li>Breathe deeply and raise your arms up towards each other and over your head.</li> <li>Look upwards at your hands, elongating your neck and breathing deeply.</li> <li>Hold for 30 seconds.</li> </ul>

Mind