tag:theconversation.com,2011:/au/health/articlesHealth – The Conversation2024-03-28T05:45:33Ztag:theconversation.com,2011:article/2247402024-03-28T05:45:33Z2024-03-28T05:45:33ZCurious Kids: what did people use before toothpaste was invented?<figure><img src="https://images.theconversation.com/files/583065/original/file-20240320-28-zza8cd.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-asian-cute-girl-brush-teeth-612960914">Casezy idea/Shutterstock</a></span></figcaption></figure><blockquote>
<p>How does toothpaste work? What did people use before toothpaste was invented? – Amelia, age 7, Meanjin (Brisbane)</p>
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<p><a href="https://theconversation.com/au/topics/curious-kids-36782"><img src="https://images.theconversation.com/files/291898/original/file-20190911-190031-enlxbk.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=90&fit=crop&dpr=1" width="100%"></a></p>
<p>Thanks for your great questions, Amelia. </p>
<p>I’m a dentist, so I know a bit about how toothpaste works and what we used before it was invented.</p>
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Read more:
<a href="https://theconversation.com/curious-kids-do-cats-and-dogs-lose-baby-teeth-like-people-do-98380">Curious Kids: Do cats and dogs lose baby teeth like people do?</a>
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<h2>How does toothpaste work?</h2>
<p>Toothpaste makes your mouth smell fresh and feel clean. If you brush your teeth two times a day, toothpaste also helps protect your teeth from forming holes or cavities. Let’s look at these benefits one at a time.</p>
<p><strong>That fresh feeling</strong></p>
<p>Some <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7245492/">toothpaste ingredients</a> mix with your spit (or saliva) to make a soapy sudsy foam. The sudsy foam turns into slimy slop that you spit out.</p>
<p>Many toothpastes also have a slight sandy feeling to scrub stains off your teeth. This also helps remove the sticky, soft, white globs that grow on your teeth called plaque (pronounced plark). </p>
<p>Plaque is made from sticky bits of food and bacteria (tiny bugs). The bacteria in your plaque live, grow and multiply in your mouth. Some bacteria – such as <a href="https://www.ingentaconnect.com/content/aapd/pd/2021/00000043/00000001/art00002"><em>Streptococcus mutans</em></a> (pronounced strep-toe-cock-us mew-tans) – love to digest the sugary food you eat. Other bacteria in your plaque burp rotten-egg gases that make your breath smell. </p>
<p>No wonder we want to get rid of plaque with gassy bacteria.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/iAQUCF9n3HU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">What is plaque?</span></figcaption>
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<p><strong>Prevents cavities</strong></p>
<p>Even worse, plaque bacteria poo out diarrhoea (pronounced die-ree-a). That diarrhoea is “acidic”, meaning it can dissolve your teeth to form holes. So we brush our teeth twice a day to get rid of as much bacteria and their diarrhoea as we can.</p>
<p>There are lots of special ingredients in toothpastes to prevent holes from forming that include:</p>
<ul>
<li><p><a href="https://www.tandfonline.com/doi/abs/10.1080/19424396.2003.12224154">xylitol</a> (pronounced zy-lee-toll). When bacteria in your plaque eat this, they get constipated and poo less acid</p></li>
<li><p><a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007868.pub3/full">fluoride</a> (pronounced floor-ride). Your teeth have tiny gaps on the surface that are so small you can only see them with a microscope. Fluoride fills these gaps to make your teeth strong. This is how fluoride protects against nasty bacteria poo from dissolving your teeth.</p></li>
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Read more:
<a href="https://theconversation.com/curious-kids-what-is-inside-teeth-187258">Curious Kids: what is inside teeth?</a>
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<h2>What did people use in the olden days?</h2>
<p>People who lived a long time ago didn’t know much about <em>Streptococcus mutans</em> and bacteria poo. They thought getting holes in teeth was part of growing up. They were wrong. But they tried to make their teeth look whiter by using tooth powders.</p>
<p>People in ancient Egypt, China and India used their fingers to rub <a href="https://mansapublishers.com/index.php/jofr/article/view/1834/1444">tooth powders</a> on their teeth.</p>
<p>The first tooth powders were made of crushed animal bones, ox hooves, and egg, snail and oyster shells. Later, people added crushed charcoal (the black stuff you get when you burn bones or wood), powdered tree bark and flavouring herbs.</p>
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<a href="https://images.theconversation.com/files/583315/original/file-20240321-16-u9l7da.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Snail on green leaves" src="https://images.theconversation.com/files/583315/original/file-20240321-16-u9l7da.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/583315/original/file-20240321-16-u9l7da.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/583315/original/file-20240321-16-u9l7da.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/583315/original/file-20240321-16-u9l7da.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/583315/original/file-20240321-16-u9l7da.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/583315/original/file-20240321-16-u9l7da.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/583315/original/file-20240321-16-u9l7da.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">People used to crush snail shells and rub the powder on their teeth.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/snail-muller-gliding-on-wet-leaves-1341770150">Zebra-Studio/Shutterstock</a></span>
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<p>The ancient Romans cleaned their teeth with toothpaste made with <a href="https://mansapublishers.com/index.php/jofr/article/view/1834/1444">pee</a>. </p>
<p>Thank goodness things have changed.</p>
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Read more:
<a href="https://theconversation.com/how-did-people-clean-their-teeth-in-the-olden-days-119588">How did people clean their teeth in the olden days?</a>
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<h2>Thank your lucky stars</h2>
<p>The next time you brush your teeth, think of all those people in the olden days. They made tooth powders with bones and shells, and toothpaste with pee. </p>
<p>Luckily, we now have toothpastes that leave a better taste in your mouth and stop holes forming in your teeth. </p>
<p>But when you brush your teeth, remember to spit out the toothpaste. Don’t rinse it away with water. We want to keep a bit in your mouth to protect your teeth from that nasty bacteria poo. </p>
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<p><em>Hello, Curious Kids! Do you have a question you’d like an expert to answer? Ask an adult to send your question to curiouskids@theconversation.edu.au</em></p><img src="https://counter.theconversation.com/content/224740/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arosha Weerakoon's PhD research on the effect of ageing on mineral and collagen in teeth was funded by Colgate. She is also an Advocate for Oral Health with Colgate. Arosha is a practice owner and works as a general dentist.. </span></em></p>People once used tooth powders made from crushed bone or shells to whiten their teeth. Others rinsed their mouth out with pee. Yuck!Arosha Weerakoon, Senior Lecturer and General Dentist, School of Dentistry, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2267322024-03-28T03:27:34Z2024-03-28T03:27:34ZNSW may end its COVID vaccine mandate for health workers. That doesn’t mean it was a bad idea in the first place<figure><img src="https://images.theconversation.com/files/584921/original/file-20240328-26-z9guow.jpg?ixlib=rb-1.1.0&rect=7%2C14%2C4913%2C3260&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-face-mask-getting-vaccinated-hospital-1954364125">Ground Picture/Shutterstock</a></span></figcaption></figure><p>Months after COVID vaccines were introduced in 2021, governments and private organisations mandated them for various groups. Health and aged care workers were <a href="https://www.sciencedirect.com/science/article/pii/S2211883722000648?via%3Dihub">among the first</a> to need two doses to keep their jobs. </p>
<p>State and territory governments subsequently implemented <a href="https://doi.org/10.1016/j.vaccine.2021.11.056">employment and public space mandates</a> which required people to show proof of vaccination to enter hospitality venues and events. A constellation of private companies also required vaccines for their workers or patrons.</p>
<p>Vaccine mandates receive considerable attention when they’re introduced. For COVID vaccine mandates, policymakers offered reasoning including <a href="https://statements.qld.gov.au/statements/93754">protecting the vulnerable</a>, safeguarding health systems, and <a href="https://www.smh.com.au/national/australia-news-live-covid-19-infections-continue-to-grow-across-the-nation-regional-victoria-lockdown-restrictions-to-be-eased-20210908-p58pyj.html">making it possible</a> to open state borders and lift internal restrictions. <a href="https://gh.bmj.com/content/7/5/e008684">Experts</a> and the public sometimes debated the merits of these policies, but the reasons behind them were relatively clear. </p>
<p>By contrast, the removal of vaccine mandates often appears haphazard. <a href="https://theconversation.com/is-it-time-to-rethink-vaccine-mandates-for-dining-fitness-and-events-we-asked-5-experts-176356">Less is known</a> about how or why it happens, or how it should be done. </p>
<p>However, mandate removal may have just as much of <a href="https://theconversation.com/time-to-remove-vaccine-mandates-not-so-fast-it-could-have-unintended-consequences-180781">an influence</a> on people’s future attitudes and behaviour as mandate imposition. As <a href="https://www.abc.net.au/news/2024-03-26/nsw-health-covid-vaccine-requirements-healthcare-worker/103629276">New South Wales</a> considers removing its COVID vaccine mandate for health-care workers, it’s pertinent to explore how to abolish a vaccine mandate in the right way.</p>
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<h2>Why do mandates end?</h2>
<p>Many COVID vaccine mandates <a href="https://www.cambridge.org/core/journals/epidemiology-and-infection/article/medical-exemptions-to-mandatory-vaccinations-the-state-of-play-in-australia-and-a-pressure-point-to-watch/DAAD8CC98E04828A57F1DEB98B4751B5">terminated</a> when state governments stopped classifying the pandemic as an emergency. The mandates which remained in place covered workers in high-risk settings, but even some of these have since ended. </p>
<p>Queensland and Western Australia removed their COVID vaccine requirements for health workers in 2023, and this week NSW <a href="https://www.abc.net.au/news/2024-03-26/nsw-health-covid-vaccine-requirements-healthcare-worker/103629276">announced</a> it’s considering doing the same. </p>
<p>This is good news. Governments should treat vaccine mandates like other health policies and review them regularly in the context of changing evidence. Some <a href="https://www.mja.com.au/journal/2021/215/11/policy-considerations-mandatory-covid-19-vaccination-collaboration-social">criteria</a> governments should think about when implementing or removing vaccine mandates include:</p>
<p><strong>Disease burden in the community</strong></p>
<p>Governments should consider the rate of severe illness and availability of treatment options and hospital resources. In the case of COVID, the general population has developed high levels of hybrid immunity from vaccination and infection.</p>
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<strong>
Read more:
<a href="https://theconversation.com/queensland-ruling-doesnt-mean-all-covid-vaccine-mandates-were-flawed-heres-why-224646">Queensland ruling doesn't mean all COVID vaccine mandates were flawed. Here's why</a>
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<p><strong>Population vulnerability</strong></p>
<p>Health-care workers are more likely to be exposed to disease, and they may transmit it to patients who are at high risk of serious outcomes. This is why NSW and some other states require staff in health or aged care to get <a href="https://www.lavan.com.au/advice/employment_safety/mandatory_influenza_vaccinations_the_new_norm">flu vaccines</a> each year. </p>
<p><strong>Vaccine effectiveness</strong></p>
<p>It matters how well the mandated vaccine prevents severe disease in people who are vaccinated, which COVID vaccines do well. But whether they reduce transmission to others is also relevant. Importantly, COVID vaccination <a href="https://theconversation.com/no-vaccinated-people-are-not-just-as-infectious-as-unvaccinated-people-if-they-get-covid-171302">reduces</a> but does not prevent disease transmission. Outside an emergency situation, this weakens the argument for mandating vaccination.</p>
<p>Another good reason to revisit NSW’s current two-dose mandate for health workers is the fact it’s obviously outdated. Although some other states and territories <a href="https://www.theage.com.au/politics/victoria/this-midwife-is-double-covid-vaxxed-but-she-s-still-banned-from-returning-to-work-20240208-p5f3eq.html">have required one booster</a>, this did not have to be regular or recent. </p>
<p>Having received two or three doses of the vaccine, often much earlier in the pandemic, is unlikely to offer protection against infection today. Most people – vaccinated or not – have now also developed some immunity through infection. </p>
<p>Since these policies don’t reflect current evidence or recommendations, leaving them in place could actually be damaging. It may erode trust and confidence in the health system and government, both for health-care workers and the public.</p>
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<img alt="A nurse putting on gloves." src="https://images.theconversation.com/files/584928/original/file-20240328-26-dp7jw8.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/584928/original/file-20240328-26-dp7jw8.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/584928/original/file-20240328-26-dp7jw8.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/584928/original/file-20240328-26-dp7jw8.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/584928/original/file-20240328-26-dp7jw8.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/584928/original/file-20240328-26-dp7jw8.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/584928/original/file-20240328-26-dp7jw8.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Health-care workers in a number of Australian jurisdictions need to be vaccinated against COVID.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-nurse-mask-putting-on-gloves-1229815867">Rawpixel.com/Shutterstock</a></span>
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<h2>So how should we repeal mandates responsibly?</h2>
<p>While it’s important to review these policies in changing contexts, there’s a risk vaccine or mandate opponents will use this opportunity to claim mandates were never necessary. </p>
<p>No COVID decisions were perfect, and we should evaluate pandemic decision-making across a range of measures. But the circumstances and justifications for introducing mandates were very different from today. This distinction should be kept in mind when communicating changes in mandate policy. </p>
<p>For NSW and any other jurisdictions considering removing mandates, first, they should consult meaningfully with the community to drive decision-making and communication. This includes engaging with those who are subject to the mandate and those indirectly affected by it. </p>
<p>We applaud NSW Health for <a href="https://www.health.nsw.gov.au/news/Pages/20240325_01.aspx">consulting</a> with health workforce stakeholders. However, they haven’t described consulting with patients or vulnerable groups, who may worry mandate removal exposes them to untenable risk from their health-care providers. It’s important to prepare a communication strategy for this group, too.</p>
<p><a href="https://www.mja.com.au/journal/2021/215/1/communicating-patients-and-public-about-covid-19-vaccine-safety-recommendations">Transparency is key</a> to maintaining trust in public health officials. When a decision is made to alter or remove a mandate, we recommend transparently explaining the decision and the data that informed it. For communicating about mandate removal, spokespeople could provide clear, simple data that compares the burden of disease or immunity rates at the time of implementation versus now. </p>
<p>It’s also crucial any announcement about mandate removal makes clear that vaccination is still recommended. NSW Chief Health Officer Kerry Chant framed the early messaging well, saying NSW Health would continue to <a href="https://www.health.nsw.gov.au/news/Pages/20240325_01.aspx">strongly recommend</a> employees stay <a href="https://www.health.gov.au/resources/publications/atagi-statement-on-the-administration-of-covid-19-vaccines-in-2024?language=en">up-to-date</a> with their COVID vaccinations.</p>
<p>Finally, governments should provide clear and accessible legal and health guidance to private companies. These employers may still have mandatory vaccination policies in place, and need support on how best to consider or announce their removal. </p>
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<em>
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Read more:
<a href="https://theconversation.com/unintended-consequences-of-nzs-covid-vaccine-mandates-must-inform-future-pandemic-policy-new-research-222989">Unintended consequences of NZ's COVID vaccine mandates must inform future pandemic policy – new research</a>
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<p>The abolition of COVID vaccine mandates is an important milestone in our journey out of the pandemic. At the same time, it means governments need to <a href="https://www.nature.com/articles/d41586-022-00495-8">ensure high voluntary vaccine uptake</a>. </p>
<p>This requires funding, efficient service delivery, support for health-care workers who administer vaccines, and persuasive public health campaigns. When governments manage mandate removal well, they make it easier for themselves to continue to protect the public against disease.</p><img src="https://counter.theconversation.com/content/226732/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katie Attwell is a specialist advisor to the Australian Technical Advisory Group on Immunisation. She is a past recipient of a Discovery Early Career Researcher Award funded by the Australian Research Council of the Australian Government (DE19000158). She leads the "Coronavax" project, which is funded by the Government of Western Australia. She leads “MandEval: Effectiveness and Consequences of Australia's COVID-19 Vaccine Mandates” funded by the Medical Research Future Fund of the Australian Government. All funds were paid to her institution. Funders are not involved in the conceptualization, design, data collection, analysis, decision to publish, or preparation of manuscripts.</span></em></p><p class="fine-print"><em><span>Jessica Kaufman receives funding from the Australian government and the Victorian state government. She is the deputy chair of the Collaboration on Social Science and Immunisation.</span></em></p>The move makes sense at this stage of the pandemic. But abolishing a vaccine mandate needs to be done carefully so as not to damage public trust.Katie Attwell, Associate Professor, School of Social Sciences, The University of Western AustraliaJessica Kaufman, Research Fellow, Vaccine Uptake Group, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2263932024-03-27T19:07:40Z2024-03-27T19:07:40ZThe first pig kidney has been transplanted into a living person. But we’re still a long way from solving organ shortages<figure><img src="https://images.theconversation.com/files/584634/original/file-20240327-22-zkx0ie.jpg?ixlib=rb-1.1.0&rect=0%2C73%2C8192%2C5383&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.massgeneral.org/news/press-release/worlds-first-genetically-edited-pig-kidney-transplant-into-living-recipient">Massachusetts General Hospital</a></span></figcaption></figure><p>In a world first, we heard last week that US surgeons had transplanted a kidney from a gene-edited pig into a living human. News reports said the procedure was <a href="https://www.npr.org/sections/health-shots/2024/03/21/1239790816/first-pig-kidney-human-transplant">a breakthrough</a> in xenotransplantation – when an organ, cells or tissues are transplanted from one species to another.</p>
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<figcaption><span class="caption">The world’s first transplant of a gene-edited pig kidney into a live human was announced last week.</span></figcaption>
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<p>Champions of xenotransplantation regard it as <em>the</em> solution to organ shortages across the world. In December 2023, <a href="https://www.anzdata.org.au/anzod/publications-2/organ-waiting-list/">1,445 people</a> in Australia were on the waiting list for donor kidneys. In the United States, more than <a href="https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/">89,000</a> are waiting for kidneys. </p>
<p>One biotech CEO says gene-edited pigs <a href="https://www.technologyreview.com/2015/08/12/248193/surgeons-smash-records-with-pig-to-primate-organ-transplants/">promise</a> “an unlimited supply of transplantable organs”.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6452271/">Not</a>, <a href="https://theconversation.com/organ-transplants-from-pigs-medical-miracle-or-pandemic-in-the-making-175290">everyone</a>, though, <a href="https://onlinelibrary.wiley.com/doi/10.1111/imj.13183">is convinced</a> transplanting animal organs into humans is really the answer to organ shortages, or even if it’s right to use organs from other animals this way.</p>
<p>There are two critical barriers to the procedure’s success: organ rejection and the transmission of <a href="https://journals.sagepub.com/doi/epdf/10.1177/09636897241226849">animal viruses to recipients</a>. </p>
<p>But in the past decade, a new platform and technique known as CRISPR/Cas9 – often shortened to CRISPR – has promised to mitigate these issues.</p>
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<strong>
Read more:
<a href="https://theconversation.com/organ-transplants-from-pigs-medical-miracle-or-pandemic-in-the-making-175290">Organ transplants from pigs: Medical miracle or pandemic in the making?</a>
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<h2>What is CRISPR?</h2>
<p>CRISPR gene editing takes advantage of a system already found in nature. CRISPR’s “genetic scissors” evolved in bacteria and other microbes to help them fend off viruses. Their cellular machinery <a href="https://www.sciencedirect.com/science/article/pii/S0300908415001042#:%7E:text=The%20system%2C%20called%20CRISPR%2DCas,remember%2C%20recognize%20and%20clear%20infections.">allows them</a> to integrate and ultimately destroy viral DNA by cutting it.</p>
<p>In 2012, two teams of scientists <a href="https://www.science.org/doi/10.1126/science.1225829">discovered how to harness</a> this bacterial immune system. This is made up of repeating arrays of DNA and associated proteins, known as “Cas” (CRISPR-associated) proteins. </p>
<p>When they used a particular Cas protein (Cas9) with a “guide RNA” made up of a singular molecule, they found they could <a href="https://pubmed.ncbi.nlm.nih.gov/22745249/">program</a> the CRISPR/Cas9 complex to break and repair DNA at precise locations as they desired. The system could even “knock in” new genes at the repair site. </p>
<p>In 2020, the two scientists leading these teams were awarded a <a href="https://www.nobelprize.org/prizes/chemistry/2020/summary/">Nobel prize</a> for their work.</p>
<p>In the case of the latest xenotransplantation, CRISPR technology was used to <a href="https://www.massgeneral.org/news/press-release/worlds-first-genetically-edited-pig-kidney-transplant-into-living-recipient">edit 69 genes</a> in the donor pig to inactivate viral genes, “humanise” the pig with human genes, and knock out harmful pig genes.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/UKbrwPL3wXE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">How does CRISPR work?</span></figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-crispr-the-gene-editing-technology-that-won-the-chemistry-nobel-prize-147695">What is CRISPR, the gene editing technology that won the Chemistry Nobel prize?</a>
</strong>
</em>
</p>
<hr>
<h2>A busy time for gene-edited xenotransplantation</h2>
<p>While CRISPR editing has brought new hope to the possibility of xenotransplantation, even recent trials show great caution is still warranted.</p>
<p>In 2022 and 2023, two patients with <a href="https://www.medschool.umaryland.edu/news/2023/um-medicine-faculty-scientists-and-clinicians-perform-second-historic-transplant-of-pig-heart-into-patient-with-end-stage-cardiovascular-disease.html#:%7E:text=The%20first%20historic%20surgery%2C%20performed,had%20end%2Dstage%20heart%20disease.">terminal heart diseases</a>, who were ineligible for traditional heart transplants, were granted <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00775-4/abstract">regulatory permission</a> to receive a gene-edited pig heart. These pig hearts had ten genome edits to make them more suitable for transplanting into humans. However, both patients died within several weeks of the procedures. </p>
<p>Earlier this month, we heard a team of surgeons in China transplanted a gene-edited pig liver into a <a href="https://www.nature.com/articles/d41586-024-00853-8">clinically dead man</a> (with family consent). The liver functioned well up until the ten-day limit of the trial.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/you-donate-your-body-to-science-you-die-what-happens-next-1481">You donate your body to science, you die ... what happens next?</a>
</strong>
</em>
</p>
<hr>
<h2>How is this latest example different?</h2>
<p>The gene-edited pig kidney <a href="https://www.massgeneral.org/news/kidney-xenotransplant-faqs">was transplanted</a> into a relatively young, living, legally competent and consenting adult.</p>
<p>The total number of gene edits edits made to the donor pig is very high. The researchers report making <a href="https://www.nature.com/articles/d41586-024-00879-y">69 edits</a> to inactivate viral genes, “humanise” the pig with human genes, and to knockout harmful pig genes.</p>
<p>Clearly, the race to transform these organs into viable products for transplantation is ramping up.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-are-uterus-transplants-who-donates-their-uterus-and-what-are-the-risks-190443">What are uterus transplants? Who donates their uterus? And what are the risks?</a>
</strong>
</em>
</p>
<hr>
<h2>From biotech dream to clinical reality</h2>
<p>Only a few months ago, CRISPR gene editing made its debut in mainstream medicine. </p>
<p>In November, drug regulators in the <a href="https://www.gov.uk/government/news/mhra-authorises-world-first-gene-therapy-that-aims-to-cure-sickle-cell-disease-and-transfusion-dependent-thalassemia">United Kingdom</a> and <a href="https://www.fda.gov/media/174618/download?attachment">US</a> approved the world’s first CRISPR-based genome-editing therapy for human use – a treatment for life-threatening forms of sickle-cell disease. </p>
<p>The treatment, known as <a href="https://sicklecellanemianews.com/ctx001-sickle-cell-disease">Casgevy</a>, uses CRISPR/Cas-9 to edit the patient’s own blood (bone-marrow) stem cells. By disrupting the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2029392">unhealthy gene</a> that gives red blood cells their “sickle” shape, the aim is to produce red blood cells with a healthy spherical shape. </p>
<p>Although the treatment uses the patient’s own cells, the same underlying principle applies to recent clinical xenotransplants: unsuitable cellular materials may be edited to make them therapeutically beneficial in the patient.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/584639/original/file-20240327-26-b7jv5t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Sickle cells have a different shape to healthy round red blood cells" src="https://images.theconversation.com/files/584639/original/file-20240327-26-b7jv5t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/584639/original/file-20240327-26-b7jv5t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/584639/original/file-20240327-26-b7jv5t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/584639/original/file-20240327-26-b7jv5t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/584639/original/file-20240327-26-b7jv5t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/584639/original/file-20240327-26-b7jv5t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/584639/original/file-20240327-26-b7jv5t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">CRISPR technology is aiming to restore diseased red blood cells to their healthy round shape.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/3d-rendered-medical-illustration-sickle-cell-2221001799">Sebastian Kaulitzki/Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/organs-too-risky-to-donate-may-be-safer-than-we-think-we-crunched-the-numbers-and-heres-what-we-found-124993">Organs 'too risky' to donate may be safer than we think. We crunched the numbers and here's what we found</a>
</strong>
</em>
</p>
<hr>
<h2>We’ll be talking more about gene-editing</h2>
<p>Medicine and gene technology regulators are increasingly asked to <a href="https://www.utas.edu.au/__data/assets/pdf_file/0011/1634258/OP12-final-report.pdf">approve new experimental trials</a> using gene editing and CRISPR.</p>
<p>However, neither xenotransplantation nor the therapeutic applications of this technology lead to changes to the genome that can be inherited.</p>
<p>For this to occur, CRISPR edits would need to be applied to the cells at the earliest stages of their life, such as to <a href="https://doi.org/10.1089/crispr.2020.0082">early-stage embryonic cells</a> in vitro (in the lab). </p>
<p>In Australia, intentionally creating heritable alterations to the human genome is a criminal offence carrying <a href="https://classic.austlii.edu.au/au/legis/cth/consol_act/pohcfra2002465/s15.html">15 years’ imprisonment</a>. </p>
<p><a href="https://www.utas.edu.au/__data/assets/pdf_file/0011/1634258/OP12-final-report.pdf">No jurisdiction in the world</a> has laws that <a href="https://doi.org/10.1089/crispr.2020.0082">expressly permits</a> heritable human genome editing. However, some <a href="https://crispr-gene-editing-regs-tracker.geneticliteracyproject.org/russia-germline-embryonic/">countries</a> lack specific regulations about the procedure.</p>
<h2>Is this the future?</h2>
<p>Even without creating inheritable gene changes, however, xenotransplantation using CRISPR is in its infancy.</p>
<p>For all the promise of the headlines, there is not yet one example of a stable xenotransplantation in a living human lasting <a href="https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2019.03060/full">beyond seven months</a>. </p>
<p>While authorisation for this recent US transplant has been granted under the so-called “compassionate use” <a href="https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=312.310">exemption</a>, conventional clinical trials of pig-human xenotransplantation have yet to commence. </p>
<p>But the prospect of such trials would likely require significant improvements in current outcomes to gain regulatory approval <a href="https://www.fda.gov/media/102126/download">in the US</a> or <a href="https://iris.who.int/bitstream/handle/10665/341817/WHO-HTP-EHT-CPR-2011.01-eng.pdf?sequence=1&isAllowed=y">elsewhere</a>. </p>
<p>By the same token, regulatory approval of any “off-the-shelf” xenotransplantation organs, including gene-edited kidneys, would seem <a href="https://link.springer.com/chapter/10.1007/978-981-99-7691-1_24">some way off</a>.</p><img src="https://counter.theconversation.com/content/226393/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christopher Rudge was a member of a research team that designed and convened an Australian citizens' jury on genome editing in 2021-22. This was funded by the Medical Research Future Fund.</span></em></p>Champions of xenotransplantation see it as the solution to organ shortages across the world. But this technology has other applications.Christopher Rudge, Law lecturer, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2267302024-03-27T06:34:25Z2024-03-27T06:34:25ZDraft NDIS bill is the first step to reform – but some details have disability advocates worried<figure><img src="https://images.theconversation.com/files/584681/original/file-20240327-18-1r405e.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C5991%2C3979&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-down-syndrome-man-his-psychologist-2139861125">Drazen Zigic/Shutterstock</a></span></figcaption></figure><p>Since the <a href="https://www.ndisreview.gov.au/">review</a> of the National Disability Insurance Scheme (NDIS) released its recommendations in December, there has been a series of Town Hall events to discuss them around the country – but no actual changes. Today the government introduced a new <a href="https://www.aph.gov.au/Parliamentary_Business/Bills_Legislation/Bills_Search_Results/Result?bId=r7181">bill</a> to make way for NDIS reform. </p>
<p>Disability minister Bill Shorten <a href="https://ministers.dss.gov.au/media-releases/14256#:%7E:text=The%20Bill%20addresses%20priority%20recommendations,settings%2C%20and%20quality%20and%20safety">said</a> “legislation and rule changes are the key to unlocking a trustworthy and sustainable NDIS and will enable the government to drive change”.</p>
<p>What changes does the bill suggest? And what do people with disability need to know about what might happen next?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/states-agreed-to-share-foundational-support-costs-so-why-the-backlash-against-ndis-reforms-now-226620">States agreed to share foundational support costs. So why the backlash against NDIS reforms now?</a>
</strong>
</em>
</p>
<hr>
<h2>Why now?</h2>
<p>Although the NDIS Review set out a five-year timeframe for reform, many of the items within this bill are needed to modify the NDIS Act and to allow for those changes to take place. One big motivator for action is the government’s commitment to <a href="https://theconversation.com/health-and-housing-measures-announced-ahead-of-budget-and-ndis-costs-in-first-ministers-sights-204675">moderate cost growth of the NDIS</a> – rather than see it <a href="https://ministers.dss.gov.au/speeches/14261">grow to more than one million participants</a> and cost up to A$100 billion a year by 2032.</p>
<p>Some in the disability community have expressed concern about legislation being introduced <a href="https://greens.org.au/news/media-release/secretive-ndis-changes-be-introduced-parliament">without co-design</a> with them. Reports suggest disability advocates who did see the bill before its introduction were subject to non-disclosure agreements. The government says <a href="https://ministers.dss.gov.au/media-releases/14256">co-design</a> will take place over an 18-month period to flesh out the changes.</p>
<p>Although states and territories asked the government to <a href="https://theconversation.com/states-agreed-to-share-foundational-support-costs-so-why-the-backlash-against-ndis-reforms-now-226620">delay</a> introducing this legislation because of concerns over foundational supports, the bill does not mention them. It is mostly focused on the scheme and the work of the National Disability Insurance Agency (NDIA) that administers it.</p>
<h2>What changes are outlined in the legislation?</h2>
<p>There are a large number of changes outlined in the bill and there will be a lot to unpack in coming weeks. Broadly these focus on:</p>
<ul>
<li>how people access the scheme and plans are created</li>
<li>how participants can spend funds</li>
<li>how the NDIA can step in if they have concerns funds are not being spent effectively</li>
<li>the powers of the NDIS Quality and Safeguards Commission.</li>
</ul>
<p>The first big change is in how people will be assessed for entry to the scheme. </p>
<p>At the moment the scheme <a href="https://ourguidelines.ndis.gov.au/home/becoming-participant/applying-ndis/list-conditions-are-likely-meet-disability-requirements">lists impairments</a> that are likely to give people access to the scheme, for example permanent blindness or severe intellectual disability. </p>
<p>The review argued this was unfair because people may have a similar level of need as a result of a condition that isn’t listed. They have had to provide more evidence, which can be difficult to obtain and expensive. It has also meant access has been driven via diagnosis rather than the impact on function and daily activities.</p>
<figure class="align-center ">
<img alt="An NDIS sign on a building." src="https://images.theconversation.com/files/584683/original/file-20240327-24-v9clgo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/584683/original/file-20240327-24-v9clgo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/584683/original/file-20240327-24-v9clgo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/584683/original/file-20240327-24-v9clgo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/584683/original/file-20240327-24-v9clgo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/584683/original/file-20240327-24-v9clgo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/584683/original/file-20240327-24-v9clgo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There will be changes to how people with disability are assessed.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/geelong-victoria-october-26-2019-signage-1533593543">jadecraven/Shutterstock</a></span>
</figcaption>
</figure>
<h2>A new type of assessment</h2>
<p>The changes outlined in the bill will move the NDIS towards a needs-based assessment. </p>
<p>This will be supported by the use of functional assessment tools, removing some need for individuals to collect evidence from medical professionals. </p>
<p>“Your needs assessment will look at your support needs as a whole,” Shorten said. “And we won’t distinguish between primary and secondary disabilities any longer.”</p>
<p>Many of the tools needed for this process do not yet exist. But some in the community are wary given the controversy over proposals to introduce <a href="https://theconversation.com/ndis-independent-assessments-are-off-the-table-for-now-thats-a-good-thing-the-evidence-wasnt-there-164163">Independent Assessments</a> a few years back. Those plans were shelved after significant backlash suggested they could become dehumanising and traumatising.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-want-to-get-bogged-at-a-beach-in-my-wheelchair-and-know-people-will-help-micheline-lee-on-the-way-forward-for-the-ndis-213348">'I want to get bogged at a beach in my wheelchair and know people will help'. Micheline Lee on the way forward for the NDIS</a>
</strong>
</em>
</p>
<hr>
<h2>Tightening control on budgets and supports</h2>
<p>The bill also outlines changes to how individuals can spend their plans. </p>
<p>At the moment plans are made up of a number of categories of funding and line items that set out how plans should be spent. The NDIS Review noted this process is often confusing for individuals and limits how they can spend funds. The changes will allow participants to spend funding allocations in more flexible ways.</p>
<p>The bill defines what constitutes an NDIS support and links to the <a href="https://humanrights.gov.au/our-work/disability-rights/united-nations-convention-rights-persons-disabilities-uncrpd">United Nations Convention on the Rights of Persons with Disabilities</a> for the first time. Examples <a href="https://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;query=Id%3A%22legislation%2Fems%2Fr7181_ems_f83281ef-0f46-4fbb-a59f-2e19439dcacb%22">include</a> “supports that facilitate personal mobility of the person in the manner and at the time of the person’s choice”. </p>
<p>However, holidays, groceries, payment of utility bills, online gambling, perfume, cosmetics, standard household appliances and whitegoods <a href="https://parlinfo.aph.gov.au/parlInfo/download/legislation/ems/r7181_ems_f83281ef-0f46-4fbb-a59f-2e19439dcacb/upload_pdf/JC012589.pdf;fileType=application%2Fpdf">will not qualify as NDIS supports</a>. Participants will only be able to spend funding on those things identified as an NDIS support and which a participant requires as a result of their impairment.</p>
<p>The bill would give the NDIA more power over how participants manage plans. These powers will be used if the NDIA have concerns that an individual is not able to use their plan effectively or someone else might be trying to exploit or coerce them to use their funds in a way that isn’t consistent with their best interests. </p>
<p>The Quality and Safeguards Commission has previously been <a href="https://www.thesaturdaypaper.com.au/news/health/2023/10/14/ndis-commission-the-brink#hrd">criticised</a> for insufficient action. The review suggested a new model of regulation that would be scaled according to the level of participant risk. A <a href="https://www.dss.gov.au/disability-and-carers-standards-and-quality-assurance/ndis-provider-and-worker-registration-taskforce">taskforce</a> examining provider and worker registration will report back some time in the middle of this year. So there are no changes to provider registration in this bill.</p>
<p>There is an expansion of the commission’s compliance and enforcement powers. They will be able to scale up efforts and restrict employment of a support worker when they have been banned by an approved quality auditor.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/recommendations-to-reboot-the-ndis-have-finally-been-released-5-experts-react-215805">Recommendations to reboot the NDIS have finally been released. 5 experts react</a>
</strong>
</em>
</p>
<hr>
<h2>More legislative changes ahead</h2>
<p>These won’t be the last changes we will see to the NDIS legislation in the near future. </p>
<p>The government has already indicated it is likely there will need to be <a href="https://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;query=Id%3A%22legislation%2Fems%2Fr7181_ems_f83281ef-0f46-4fbb-a59f-2e19439dcacb%22">further changes</a> following engagement with the disability community. </p>
<p>Co-design requires trust and the government will be hoping that releasing this legislation without significant engagement with the disability community hasn’t damaged relationships too badly.</p><img src="https://counter.theconversation.com/content/226730/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Helen Dickinson receives funding from ARC, NHMRC and CYDA</span></em></p>Although the NDIS Review set out a five-year timeframe for reform, many of the items within this bill are needed to modify the NDIS Act and to allow for changes to take place.Helen Dickinson, Professor, Public Service Research, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2251802024-03-27T01:24:33Z2024-03-27T01:24:33Z‘Noisy’ autistic brains seem better at certain tasks. Here’s why neuroaffirmative research matters<figure><img src="https://images.theconversation.com/files/582749/original/file-20240319-24-qstvmi.jpg?ixlib=rb-1.1.0&rect=135%2C81%2C5781%2C3854&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/brain-wave-on-electroencephalogram-eeg-epilepsy-562046677">Shutterstock</a></span></figcaption></figure><p>Autism is a <a href="https://www.cell.com/trends/neurosciences/fulltext/S0166-2236(22)00166-7?fbclid=IwAR2plqjNc7PoPCl7S0xzWpK_dCLfzaov9rl7u5wBdt8DaOc6lNrCekYp1RY">neurodevelopmental difference</a> associated with specific experiences and characteristics. </p>
<p>For decades, autism research has focused on behavioural, cognitive, social and communication difficulties. These studies highlighted how autistic people face issues with everyday tasks that allistic (meaning non-autistic) people do not. Some difficulties may include recognising emotions or social cues. </p>
<p>But some research, including our own study, has explored specific advantages in autism. Studies have shown that in some cognitive tasks, autistic people <a href="https://academic.oup.com/brain/article/128/10/2430/274623?login=false">perform better</a> than allistic people. Autistic people may have greater success in identifying a simple shape <a href="https://pubmed.ncbi.nlm.nih.gov/15985068/">embedded within a more complex design</a>, arranging blocks of <a href="https://acamh.onlinelibrary.wiley.com/doi/abs/10.1111/j.1469-7610.1993.tb02095.x">different shapes and colours</a>, or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3976471/">spotting an object within a cluttered visual environment</a> (similar to Where’s Wally?). Such enhanced performance has been recorded in <a href="https://www.sciencedirect.com/science/article/pii/S0960982215005552">babies as young as nine months</a> who show emerging signs of autism. </p>
<p>How and why do autistic individuals do so well on these tasks? The answer may be surprising: more “neural noise”.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-deficits-to-a-spectrum-thinking-around-autism-has-changed-now-there-are-calls-for-a-profound-autism-diagnosis-194049">From deficits to a spectrum, thinking around autism has changed. Now there are calls for a 'profound autism' diagnosis</a>
</strong>
</em>
</p>
<hr>
<h2>What is neural noise?</h2>
<p>Generally, when you think of noise, you probably think of auditory noise, the ups and downs in the amplitude of sound frequencies we hear. </p>
<p>A similar thing happens in the brain with random fluctuations in neural activity. This is called neural noise. </p>
<p>This noise is always present, and comes on top of any brain activity caused by things we see, hear, smell and touch. This means that in the brain, an identical stimulus that is presented multiple times won’t cause exactly the same activity. Sometimes the brain is more active, sometimes less. In fact, even the response to a single stimulus or event will fluctuate continuously.</p>
<h2>Neural noise in autism</h2>
<p>There are many <a href="https://www.nature.com/articles/nrn2258">sources of neural noise</a> in the brain. These include how the neurons become excited and calm again, changes in attention and arousal levels, and biochemical processes at the cellular level, among others. An allistic brain has mechanisms to <a href="https://www.nature.com/articles/nrn3061">manage and use this noise</a>. For instance, cells in the hippocampus (the brain’s memory system) can make use of neural noise to enhance memory encoding and recall.</p>
<p>Evidence for high neural noise in autism can be seen in <a href="https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2011.00051/full">electroencephalography (EEG) recordings</a>, where increased levels of neural fluctuations were observed in autistic children. This means their neural activity is less predictable, showing a wider range of activity (higher ups and downs) in response to the same stimulus. </p>
<p>In simple terms, if we imagine the EEG responses like a sound wave, we would expect to see small ups and downs (amplitude) in allistic brains each time they encounter a stimulus. But autistic brains seem to show bigger ups and downs, demonstrating greater amplitude of neural noise. </p>
<p>Many studies have linked this noisy autistic brain <a href="https://www.cell.com/trends/cognitive-sciences/abstract/S1364-6613(15)00091-1?rss=yes&mobileUi=0">with cognitive, social and behavioural difficulties</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/most-adults-with-autism-can-recognise-facial-emotions-almost-as-well-as-those-without-the-condition-187995">Most adults with autism can recognise facial emotions, almost as well as those without the condition</a>
</strong>
</em>
</p>
<hr>
<h2>But could noise be a bonus?</h2>
<p>The <a href="https://www.cell.com/trends/neurosciences/fulltext/S0166-2236(22)00166-7?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0166223622001667%3Fshowall%3Dtrue">diagnosis of autism has a long clinical history</a>. A shift from the medical to a more social model has also seen advocacy for it to be reframed as a difference, rather than a disorder or deficit. This change has also entered autism research. Neuroaffirming research can examine the uniqueness and strengths of neurodivergence. </p>
<p>Psychology and perception researcher <a href="https://www.sciencedirect.com/science/article/pii/S0042698909003563?via%3Dihub">David Simmons and colleagues</a> at the University of Glasgow were the first to suggest that while high neural noise is generally a disadvantage in autism, it can sometimes provide benefits due to a phenomenon called <a href="https://www.sciencedirect.com/science/article/abs/pii/S1388245703003304?via%3Dihub">stochastic resonance</a>. This is where optimal amounts of noise can <a href="https://theconversation.com/like-to-work-with-background-noise-it-could-be-boosting-your-performance-119598">enhance performance</a>. In line with this theory, high neural noise in the autistic brain might enhance performance for some cognitive tasks.</p>
<p>Our 2023 research <a href="https://www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2023.1110714/full?utm_source=F-NTF&utm_medium=EMLX&utm_campaign=PRD_FEOPS_20170000_ARTICLE">explores this idea</a>. We recruited participants from the general population and investigated their performance on letter-detection tasks. At the same time, we measured their level of autistic traits. </p>
<p>We performed two letter-detection experiments (one in a lab and one online) where participants had to identify a letter when displayed among background visual static of various intensities. </p>
<p>By using the static, we added additional visual noise to the neural noise already present in our participants’ brains. We hypothesised the visual noise would push participants with low internal brain noise (or low autistic traits) to perform better (as suggested by <a href="https://www.sciencedirect.com/science/article/abs/pii/S030101041000193X">previous research</a> on stochastic resonance). The more interesting prediction was that noise would not help individuals who already had a lot of brain noise (that is, those with high autistic traits), because their own neural noise already ensured optimal performance.</p>
<p>Indeed, one of our experiments showed people with high neural noise (high autistic traits) did not benefit from additional noise. Moreover, they showed superior performance (greater accuracy) relative to people with low neural noise when the added visual static was low. This suggests their own neural noise already caused a natural stochastic resonance effect, resulting in better performance. </p>
<p>It is important to note we did not include clinically diagnosed autistic participants, but overall, we showed the theory of enhanced performance due to stochastic resonance in autism has merits. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1652857377383919617"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/autism-is-still-underdiagnosed-in-girls-and-women-that-can-compound-the-challenges-they-face-176036">Autism is still underdiagnosed in girls and women. That can compound the challenges they face</a>
</strong>
</em>
</p>
<hr>
<h2>Why this is important?</h2>
<p>Autistic people face ignorance, prejudice and discrimination that can <a href="https://www.liebertpub.com/doi/abs/10.1089/aut.2021.0005">harm wellbeing</a>. Poor mental and physical health, reduced social connections and <a href="https://theconversation.com/what-are-masking-and-camouflaging-in-the-context-of-autism-and-adhd-193446">increased “camouflaging” of autistic traits</a> are some of the negative impacts that autistic people face.</p>
<p>So, research underlining and investigating the strengths inherent in autism can help reduce stigma, allow autistic people to be themselves and acknowledge autistic people do not require “fixing”. </p>
<p>The autistic brain is different. It comes with limitations, but it also has its strengths.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1621908349942906881"}"></div></p><img src="https://counter.theconversation.com/content/225180/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jeroen van Boxtel receives funding from Australian Government through an Australian Research Council Discovery Project (project number DP220100406), the ACT government.</span></em></p><p class="fine-print"><em><span>Jovana Acevska and Pratik Raul do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>‘Neural noise’ isn’t the sounds you hear, but rather the variability of responses in your brain. Autistic people are thought to have greater variance that can be a disadvantage or a strength.Pratik Raul, PhD candidiate, University of CanberraJeroen van Boxtel, Associate professor, University of CanberraJovana Acevska, Honours Graduate Student, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2242542024-03-26T16:40:09Z2024-03-26T16:40:09ZWant to quit vaping? There’s an app for that<figure><img src="https://images.theconversation.com/files/579066/original/file-20240229-21-z0wh8.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-tattoos-on-arms-hands-2271193519">SeventyFour/Shutterstock</a></span></figcaption></figure><p>More Australians than ever are vaping, according to recently released data.</p>
<p>The National Drug Strategy Household Survey <a href="https://www.aihw.gov.au/getmedia/b8b298cc-6d3f-4ab0-a238-9bd63f300c09/national-drug-strategy-household-survey-2022-2023.pdf?v=20240229072409&inline=true#:%7E:text=interpreted%20with%20caution.-,Use%20of%20illicit%20drugs%20increases%2C%20driven%20by%20hallucinogens,million%20people%20had%20done%20so.">shows</a> the proportion of Australians aged 14 and over who, in 2022–2023, said they currently vaped was 7%. In 2019 it was just 2.5%. Users are most likely to be aged 18-24.</p>
<p>As we learn more about the potential harms of vaping, <a href="https://www.mdpi.com/2673-995X/4/1/3">many</a> will be keen to quit.</p>
<p>But because vapes have only been widespread in recent years, there is <a href="https://www.sciencedirect.com/science/article/abs/pii/S0306460321000836">limited evidence</a> on how to go about quitting. With the addictive nature of nicotine-containing vapes, it can also be hard to stop vaping on your own.</p>
<p>Could apps be the answer? The <a href="https://www.statista.com/statistics/730101/australia-smartphone-ownership-by-age/">vast majority</a> of young people have a smartphone. And we know apps have helped people <a href="https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2770816">quit smoking</a>. So why not use apps to help people quit vaping?</p>
<p>But which apps are best? And which app <a href="https://mhealth.jmir.org/2019/7/e11926/">features</a> should you look for? Our <a href="https://mhealth.jmir.org/2024/1/e55177">recently published study</a> gives us some clues.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/could-messages-from-social-media-influencers-stop-young-people-vaping-a-look-at-the-governments-new-campaign-224621">Could messages from social media influencers stop young people vaping? A look at the government's new campaign</a>
</strong>
</em>
</p>
<hr>
<h2>We tested 30 apps</h2>
<p>We searched the Apple iTunes and Google Play stores in May 2023 to identify apps available in Australia claiming to help people quit vaping.</p>
<p>We then made a shortlist of 20 iOS apps and ten Android apps to assess for:</p>
<ul>
<li><p><a href="https://mhealth.jmir.org/2015/1/e27/">quality</a> (including ease of use, how it engaged users, appearance, and the information it conveyed)</p></li>
<li><p>the potential to <a href="https://mhealth.jmir.org/2019/1/e11130">change behaviour</a> (including setting goals, making an action plan, identifying barriers, monitoring progress and giving feedback).</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/my-teen-is-addicted-to-vaping-how-can-i-help-them-quit-and-manage-their-withdrawal-symptoms-208586">My teen is addicted to vaping. How can I help them quit and manage their withdrawal symptoms?</a>
</strong>
</em>
</p>
<hr>
<h2>Here’s what we found</h2>
<p>The highest rated app overall was the iOS app <a href="https://apps.apple.com/au/app/quit-smoking-stop-vaping-app/id1641262016">Quit smoking. Stop vaping app</a>. This had 19 out of 21 features known to help people change behaviour.</p>
<p>The highest rated app for Android devices was <a href="https://play.google.com/store/apps/details?id=com.despdev.quitsmoking&hl=en_US">Quit Tracker: Stop Smoking</a>, with 15 behaviour change features. </p>
<p>The highest rated app for both <a href="https://play.google.com/store/apps/details?id=org.instaquit.app&hl=en_US">Android</a> and <a href="https://apps.apple.com/us/app/quitsure-quit-smoking-smartly/id1523992725">iOS users</a> was the QuitSure Quit Smoking Smartly app. This had 15 behaviour change features for iOS users and 14 for Android users.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/579068/original/file-20240229-20-gjbt99.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Quit vaping app" src="https://images.theconversation.com/files/579068/original/file-20240229-20-gjbt99.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579068/original/file-20240229-20-gjbt99.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=308&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579068/original/file-20240229-20-gjbt99.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=308&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579068/original/file-20240229-20-gjbt99.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=308&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579068/original/file-20240229-20-gjbt99.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=387&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579068/original/file-20240229-20-gjbt99.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=387&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579068/original/file-20240229-20-gjbt99.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=387&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This ‘Quit smoking. Stop vaping app’ had the most features known to help people change behaviour.</span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/my-teens-vaping-what-should-i-say-3-expert-tips-on-how-to-approach-the-talk-196205">My teen's vaping. What should I say? 3 expert tips on how to approach 'the talk'</a>
</strong>
</em>
</p>
<hr>
<h2>So what should I look for?</h2>
<p>There are key <a href="https://mhealth.jmir.org/2019/7/e11926/">app features</a> to look for in an app that could help you change your behaviour. These features also apply to apps helping people to quit alcohol, or to take more exercise, for instance. These features include:</p>
<ul>
<li><p><strong>full customisability</strong>, allowing individuals to tailor the app to their needs</p></li>
<li><p><strong>goal setting</strong>, allowing individuals to create their own goals, monitor their progress, then update them over time. This is <a href="https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2017.00915/full">more likely</a> to lead to positive behaviour change</p></li>
<li><p><strong>external help</strong>, allowing users to access more help or advice, directly from the app</p></li>
<li><p>apps that are <strong>easy to use</strong> or navigate, so users are more likely to stick with the app.</p></li>
</ul>
<p>But not all apps we assessed scored highly on these. On average, apps only had about nine out of 21 behaviour change features. And only 12 of the 30 apps included a goal-setting feature.</p>
<p>The overall quality of the apps was moderate – scoring about three out of five. While apps were easy to use and navigate, we found they were not always transparent in who funded or developed them.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-apps-and-influencers-are-changing-the-way-we-sleep-for-better-or-for-worse-211749">How apps and influencers are changing the way we sleep, for better or for worse</a>
</strong>
</em>
</p>
<hr>
<h2>Future apps</h2>
<p>Earlier research shows quit smoking apps <a href="https://mhealth.jmir.org/2019/7/e11926/citations">rate higher</a> for their potential to change behaviour than ones to quit vaping.</p>
<p>In one study, researchers found more than half of users of one quit smoking app were still not smoking <a href="https://formative.jmir.org/2023/1/e51658">after a month</a>.</p>
<p>So app developers could look at quit smoking apps to identify strategies and features to develop or update quit vaping apps.</p>
<p>App developers need to create apps with comprehensive goal-setting features. These apps need to be trialled or tested by the developer, users or an external party. This is important as, to our knowledge, no publicly available app has undergone such testing.</p>
<p>As many young people vape to <a href="https://www.sciencedirect.com/science/article/abs/pii/S0306460322001319?via%3Dihub">relieve stress or anxiety</a>, future apps could provide extra features, such as meditation, cognitive behaviour therapy and relaxation.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1617300430966382594"}"></div></p>
<p>Apps need to align with current <a href="https://www.health.nsw.gov.au/tobacco/Publications/e-cigarette-young-people-guide.pdf">guidelines</a> on how to quit vaping, so evidence-based messaging is consistent. Unfortunately, information and guidelines on quitting vaping are in their infancy and vary across different countries or jurisdictions.</p>
<p>Developers also need to ensure they disclose who owns and paid for the app. Is it a commercial company, a research group, a government agency, or a not-for-profit? We found it difficult to tell during our analysis.</p>
<p>Last of all, quit vaping apps need to be updated and improved over time, to iron out bugs, make improvements as the evidence changes, and to respond to changes in how users behave.</p>
<p>In an ideal world, we’d see partnerships between app developers, people who vape, researchers and experts in health behaviour change to develop and update quit vaping apps – ones with the highest chance of actually shifting people’s behaviour.</p>
<hr>
<p><em>We wish to thank Lilian Chan, Rebecca Cerio, Sandra Rickards, Phillipa Hastings, Kate Reakes and Tracey O’Brien from Cancer Institute NSW for their assistance with this research.</em></p><img src="https://counter.theconversation.com/content/224254/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fiona McKay has previously received funding from Cancer Institute NSW (which funded this study) and VicHealth.</span></em></p><p class="fine-print"><em><span>Matthew Dunn has previously received funding from Cancer Institute NSW and VicHealth, and currently receives funding from VicHealth. </span></em></p>Here’s what to look for when you’re browsing for apps.Fiona McKay, Associate Professor of Health Equity, Deakin UniversityMatthew Dunn, Senior Lecturer in Public Health, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2248452024-03-26T16:39:21Z2024-03-26T16:39:21ZAccessibility remains an afterthought – how NZ’s digital health tools risk excluding people with disabilities<figure><img src="https://images.theconversation.com/files/584241/original/file-20240325-26-kehuos.jpg?ixlib=rb-1.1.0&rect=125%2C143%2C5865%2C2820&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Alongside my career path from a PhD in computer science, work as a nurse and ambulance officer and now a university lecturer in nursing, I have become progressively deafblind. </p>
<p>As a result, I have personal experience navigating New Zealand’s health system, both as an employee and patient living with dual sensory loss. </p>
<p>My experiences provide me with a unique perspective on how important it is to integrate technology well into healthcare practices. Currently, accessibility is often lacking or insufficient, both for staff and patients.</p>
<p>My <a href="https://ebooks.hinz.nz/view/260843176/">work</a> focuses on bridging the gap between technology and nursing to make digital health accessible. A broader review of existing research confirms this need: accessibility is often an afterthought in software development, and digital health solutions are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9719765/">designed in a way that makes them inaccessible</a>.</p>
<h2>Accessibility must be part of early software design</h2>
<p>One in four New Zealanders <a href="https://www.odi.govt.nz/home/about-disability/key-facts-about-disability-in-new-zealand/">lives with a disability</a>. Despite this significant portion of the population, digital solutions often overlook their needs.</p>
<p>For example, the YourRide taxi booking app’s launch last year has created difficulties for <a href="https://www.transport.govt.nz/area-of-interest/strategy-and-direction/total-mobility-scheme/">total mobility scheme</a> card holders, with some struggling to access their taxi service equitably. With 89,000 individuals relying on the scheme in 2022, it is essential that they have equity in access to taxi transportation. </p>
<p>The app does not cater for total mobility card holders and a national taxi company is making them call by phone to confirm their status. This is further complicated by a malfunctioning text-as-taxi-approaches system, leaving those without app access no way of knowing how far away the taxi is without phoning the company. </p>
<p>This system has led to delays, multiple phone calls and missed appointments. Had the app been designed with total mobility card holders from the beginning, these issues could have been avoided.</p>
<p>The lack of emphasis on accessibility often begins at the early stages of software development, which <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9719765/">leads to inaccessible digital health solutions</a>. </p>
<p>While major companies like Apple and Microsoft have proprietary accessibility libraries, their usage is not widespread and considerably variable. Some <a href="https://www.powermapper.com/products/sortsite/ads/acc-wcag-testing/?gad_source=1&gclid=CjwKCAjwnv-vBhBdEiwABCYQA1nKUST_PxwiwESoU-_Ha31EtoJHRMjmBIj59YpvRohLKaPTHTYiYRoC_ecQAvD_BwE">accessibility test tools</a> exist for web-based applications, but their implementation varies. And not all digital health solutions are web-based and guidelines for native applications are scarce. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australia-is-lagging-when-it-comes-to-employing-people-with-disability-quotas-for-disability-services-could-be-a-start-199405">Australia is lagging when it comes to employing people with disability – quotas for disability services could be a start</a>
</strong>
</em>
</p>
<hr>
<p>It is important to integrate accessibility in the design phase of any project. One of the recommendations of a <a href="https://ebooks.hinz.nz/view/260843176/">Digital Health Leadership Summit</a> held in 2023 was that New Zealand should adopt a national strategy for accessibility in digital health, moving away from the fragmented approach. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/34991540/">Community engagement and collaboration are crucial</a> to informing design in digital health and enhancing data collection and analysis. Projects such as <a href="https://www.tewhatuora.govt.nz/our-health-system/digital-health/hira-connecting-health-information/#what-is-hira">Hira</a>, which put in place the foundations for initiatives such as <a href="https://www.tewhatuora.govt.nz/our-health-system/digital-health/my-health-record/#about-my-health-record">My Health Record</a>, foster inclusivity, user-centred design, legislative compliance and equitable resource access. </p>
<p>Considering accessibility in the design phase and upholding ethical standards in digital health is essential. Flexible and adaptable solutions that cater to diverse access needs are necessary, along with clear information, navigation and personalisation to meet the specific requirements of individuals with disabilities. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/treatments-tailored-to-you-how-ai-will-change-nz-healthcare-and-what-we-have-to-get-right-first-219594">Treatments tailored to you: how AI will change NZ healthcare, and what we have to get right first</a>
</strong>
</em>
</p>
<hr>
<h2>Gaps between recommendations and reality</h2>
<p>Unlike some other countries, New Zealand does not have legislation explicitly addressing or policing accessibility. </p>
<p>In 2022, the United Nations examined New Zealand’s performance under the <a href="https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-rights-persons-disabilities">Convention on the Rights of Persons with Disabilities</a> and highlighted:</p>
<blockquote>
<p>… a lack of recognition, across all government portfolio areas, that disability is a whole-of-government responsibility.</p>
</blockquote>
<p>The UN also stressed that legislative and policy frameworks on disability should align with the Treaty of Waitangi to ensure active involvement in decision making and consultation with Māori with disabilities. It recommended a national strategy to increase awareness and promote respect for the rights and dignity of people with disabilities.</p>
<p>The discrepancy between recommendations and reality may be related to employment. Only <a href="https://www.stats.govt.nz/information-releases/labour-market-statistics-disability-june-2023-quarter/">44% of people with disabilities are employed</a>, compared with <a href="https://www.stats.govt.nz/indicators/employment-rate/">69% of those without disabilities</a>. This disparity in employment rates suggests a need for greater inclusivity and support for individuals with disabilities in the workforce. </p>
<figure class="align-center ">
<img alt="A girl in a doctor's room using sign language" src="https://images.theconversation.com/files/584248/original/file-20240325-28-wnh0w6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/584248/original/file-20240325-28-wnh0w6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=395&fit=crop&dpr=1 600w, https://images.theconversation.com/files/584248/original/file-20240325-28-wnh0w6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=395&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/584248/original/file-20240325-28-wnh0w6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=395&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/584248/original/file-20240325-28-wnh0w6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=496&fit=crop&dpr=1 754w, https://images.theconversation.com/files/584248/original/file-20240325-28-wnh0w6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=496&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/584248/original/file-20240325-28-wnh0w6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=496&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">sign languge.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com.au/detail/photo/adorable-smiling-little-caucasian-girl-standing-and-royalty-free-image/1398189833?phrase=sign+language+hospital&adppopup=true">Getty Images/PeopleImages</a></span>
</figcaption>
</figure>
<h2>Perceptions of disability</h2>
<p>In healthcare, staff with access needs appear to be undeserved. </p>
<p>My first experience of this was when I worked as a nurse. I had disclosed my disability and was using a magnifying glass to check drug vials when giving medications. I had made no errors.</p>
<p>But the charge nurse nevertheless told me she no longer wanted me to use a magnifying glass as it decreased the public’s trust. If I had been quicker off the mark, I could have asked how a magnifying glass differs from reading glasses. </p>
<p>Her attitude raises important considerations regarding the perception of disability within healthcare environments. Her request to restrict the use of a tool that allowed error-free medication checks highlights a potential lack of understanding or sensitivity towards the needs of individuals with disabilities.</p>
<p>Last year, a German survey using sign language found that a lack of understanding of disability needs meant that deaf people were choosing not to engage with the healthcare system. </p>
<p>A similar survey in New Zealand could provide valuable insights into the barriers deaf people face. It could compare the effectiveness of digital versus face-to-face consultations and exploring the use of digital solutions such as closed captions in tele-health consultations.</p>
<h2>Lingering undercurrents of discrimination</h2>
<p>The <a href="https://www.odi.govt.nz/guidance-and-resources/a-brief-history-of-disability-in-aotearoa-new-zealand/">historical treatment of individuals with disabilities</a> within pākehā society was marked by a pervasive view of disability as a deficiency. </p>
<p>Rooted in the medical model of health which historically focused on deficits and impairments, the prevailing attitudes towards disability have often been shaped by societal norms that prioritise able-bodiedness. This has led to the marginalisation and stigmatisation of individuals with disabilities, who were seen as a deviation from the norm.</p>
<p>The legacy of these historical perceptions continues to linger. Despite advancements in understanding and awareness, an undercurrent of discrimination and exclusion prevails. This is reflected in the limited access to resources, opportunities and support systems available to individuals with disabilities.</p>
<p>People with disabilities have a long history of distrust in the health and disability systems in New Zealand. Improving education and training, building trust and promoting effective data sharing are essential for enhancing their care and experiences.</p>
<p>My goal is to advocate for this change. I want to ensure that digital health tools are designed with an equity lens, where disability, just like culture and gender, is given due consideration. This isn’t just about technology. It’s about reshaping our society’s approach to health, disability and inclusivity.</p><img src="https://counter.theconversation.com/content/224845/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sally Britnell is affiliated with Health Informatics New Zealand as a Board Member, DeafBlind Association New Zealand as a Board Member and is employed by Auckland University of Technology. </span></em></p>New Zealand has no legislation, nor a national strategy, explicitly addressing or policing accessibility to digital health tools.Sally Britnell, Senior Lecturer in Nursing, Auckland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2266202024-03-26T06:31:36Z2024-03-26T06:31:36ZStates agreed to share foundational support costs. So why the backlash against NDIS reforms now?<figure><img src="https://images.theconversation.com/files/584308/original/file-20240326-28-6cpw93.jpg?ixlib=rb-1.1.0&rect=10%2C0%2C7002%2C4763&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/group-people-holding-hand-together-park-600881606">Rawpixel.com/Shutterstock</a></span></figcaption></figure><p>On Monday evening Australia’s state premiers and territory chief ministers <a href="https://www.smh.com.au/politics/federal/premiers-revolt-over-federal-ndis-law-fearing-cost-time-bomb-20240325-p5ff4x.html">got together and called on</a> the federal government to delay or amend draft laws to overhaul the National Disability Insurance Scheme (NDIS). The laws are to determine how states provide “foundational supports”, a key recommendation of the <a href="https://www.ndisreview.gov.au/resources/reports/working-together-deliver-ndis">NDIS Review</a>. </p>
<p>There was a sense of optimism in December when National Cabinet agreed the states and Commonwealth would <a href="https://theconversation.com/whats-the-difference-between-reasonable-and-necessary-and-foundational-supports-heres-what-the-ndis-review-says-216074">split the funding of foundational supports</a> and the Commonwealth would <a href="https://theconversation.com/states-agree-to-do-more-heavy-lifting-on-disability-in-exchange-for-extra-health-and-gst-funding-219321">add billions to strengthen Medicare</a>. This was meant to ease the costs of specialist support within the NDIS. </p>
<p>So why are the details proving controversial now? And does the backlash mean NDIS reforms might fall over at the first hurdle? </p>
<h2>Creating other avenues of support</h2>
<p>Last year’s NDIS Review was tasked, among other things, with considering the financial sustainability of the scheme. </p>
<p>The review argued there is no single issue driving the growing cost pressure of the NDIS. But the lack of accessible and inclusive mainstream services for people with disability was pushing them into the NDIS. This means more people are on the scheme than was originally intended. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/recommendations-to-reboot-the-ndis-have-finally-been-released-5-experts-react-215805">Recommendations to reboot the NDIS have finally been released. 5 experts react</a>
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</em>
</p>
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<p>We have seen particular growth in the number of young people with autism and developmental delay <a href="https://theconversation.com/australias-rates-of-autism-should-be-celebrated-but-real-life-impact-not-diagnosis-should-determine-ndis-support-217921">entering the NDIS</a>. <a href="https://www.ndis.gov.au/about-us/publications/quarterly-reports">One in ten boys</a> aged between five and seven have an NDIS plan when starting school.</p>
<p>While this could indicate the original scheme estimates were not correct, it’s likely a significant proportion of demand is being driven by a <a href="https://www.theguardian.com/australia-news/2023/dec/07/ndis-review-costs-national-disability-insurance-scheme-bill-shorten">lack of other available supports</a> through mainstream services.</p>
<h2>Supports the states used to provide</h2>
<p>The NDIS was never intended to provide services to all people with disability and about 86% of disabled Australians <a href="https://www.ndis.gov.au/understanding/ndis-each-state">do not have NDIS plans</a>. Those without NDIS plans access the same mainstream services as the rest of the population – be they schools, health services or public transport. </p>
<p>But mainstream services are not always accessible to people with disability. <a href="https://library.bsl.org.au/bsljspui/bitstream/1/13113/1/Olney_etal_Tier2_tipping_point_support_without_individual_NDIS_funding_2022.pdf">Research</a> from the University of Melbourne in 2022 shows the vast majority of Australians with disability who don’t have NDIS plans can’t access the services and supports they need. When this happens people have to go without or pay for additional supports such as taxis, mobility equipment or domestic assistance themselves.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whats-the-difference-between-reasonable-and-necessary-and-foundational-supports-heres-what-the-ndis-review-says-216074">What's the difference between 'reasonable and necessary' and 'foundational' supports? Here's what the NDIS review says</a>
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</p>
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<p>Since the <a href="https://theconversation.com/a-decade-on-the-ndis-has-had-triumphs-challenges-and-controversies-where-to-from-here-208463">establishment of the NDIS</a> over a decade ago, states and territories have pulled back from providing some services for people with disability. </p>
<p>Home and community care programs to support people under 65 years of age with less intensive disability needs, for example, are inconsistent and underfunded in many places. So if a person with disability needs help with some shopping or cleaning, their only option for support may well be to apply to join the NDIS. </p>
<figure class="align-center ">
<img alt="The NDIS’s current system is disconnected and has a support gap." src="https://images.theconversation.com/files/564083/original/file-20231207-27-hiqzt.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564083/original/file-20231207-27-hiqzt.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=466&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564083/original/file-20231207-27-hiqzt.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=466&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564083/original/file-20231207-27-hiqzt.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=466&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564083/original/file-20231207-27-hiqzt.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=585&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564083/original/file-20231207-27-hiqzt.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=585&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564083/original/file-20231207-27-hiqzt.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=585&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The NDIS’s current system is disconnected and has a support gap.</span>
<span class="attribution"><a class="source" href="https://www.ndisreview.gov.au/resources/reports/working-together-deliver-ndis">NDIS Review</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>Are these reforms a surprise?</h2>
<p>The NDIS Review acknowledges the scale of reform outlined in its recommendations are significant and should be transitioned to over a five-year period. But many of the changes that will take place within the NDIS are dependent on having foundational services in place outside the scheme. <a href="https://www.ndisreview.gov.au/resources/reports/working-together-deliver-ndis/part-one-unified-system-support-people-disability-0">Foundational supports</a> are a key priority in the reform process. </p>
<p>The development of a foundational supports strategy should not have taken states and territories by surprise. The day before the NDIS Review was launched in December, National Cabinet reached its decision to share foundational support costs equally between the Commonwealth and states and territories. And at the end of January, the Commonwealth committed A$11.6 million over two years to support the development and implementation of the foundational supports strategy. </p>
<p>Although fresh reports say state and territory leaders fear “uncosted” foundational supports, premiers were <a href="https://www.theguardian.com/australia-news/2023/dec/06/albanese-strikes-105bn-deal-with-states-to-split-cost-of-non-ndis-disability-services-in-return-for-gst-funding">reportedly given an indication of additional costs</a> at the December National Cabinet meeting. </p>
<p>Since then, state and territory governments will have been working to determine exactly what foundational services are needed in their jurisdictions and how many people might want to access these. Given the NDIS Review <a href="https://www.ndisreview.gov.au/resources/reports/working-together-deliver-ndis/preface/recommendations-and-actions">recommended better and more detailed data collection</a>, many of these governments likely don’t have good enough data to easily understand what the demand for these services might be and therefore what they might cost. </p>
<p>While states and territories appear to have signed up to the general direction of reform, the latest reports suggest premiers are concerned at the speed and the scale of the changes. In a context of <a href="https://www.afr.com/politics/another-12b-debt-blowout-in-victoria-sets-scene-for-horror-budget-20240308-p5faxz">tight state budgets</a> there are likely also fears of extra budgetary pressures from developing new systems of support. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/there-is-overwhelming-gender-bias-in-the-ndis-and-the-review-doesnt-address-it-220042">There is overwhelming gender bias in the NDIS – and the review doesn't address it</a>
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<h2>Future disability reform</h2>
<p>Debates over <a href="https://theconversation.com/a-tussle-between-the-federal-and-state-governments-over-disability-supports-is-looming-what-should-happen-next-217839">which parts of government should fund which services</a> are not new. But focusing on who pays for what misses the bigger picture. </p>
<p>Getting a system of foundational supports in place is essential not only for the sustainability of the NDIS but also for all those disabled Australians who are currently going without necessary supports to live their lives. As a signatory to the <a href="https://humanrights.gov.au/our-work/disability-rights/united-nations-convention-rights-persons-disabilities-uncrpd">United Nations Convention on the Rights of Persons with Disability</a>, Australia has a commitment to protect the rights of people with disabilities and ensure their full inclusion in society. </p>
<p>The NDIS is one part of realising this commitment, but it will not be able to achieve this on its own. If they can’t access mainstream services, disabled people are shut out from participation in aspects of daily life we should all be able to take for granted. </p>
<p><a href="https://twitter.com/dougie_herd/status/1772429314794897516">Disability advocates</a> argue delaying tactics from states and territories are unacceptable and <a href="https://www.abc.net.au/listen/programs/radionational-breakfast/-distressing-premiers-push-to-delay-ndis-overhaul/103632124?utm_campaign=abc_listen&utm_content=twitter&utm_medium=content_shared&utm_source=abc_listen">reform needs to happen now</a>. The federal government seems committed to the top recommendation of the NDIS Review. It remains to be seen whether the states and territories are ready to move at the same pace.</p><img src="https://counter.theconversation.com/content/226620/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Helen Dickinson receives funding from ARC, NHMRC and CYDA.</span></em></p>If states and territories agreed to share the cost of foundational supports in December, why are they baulking now?Helen Dickinson, Professor, Public Service Research, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2245072024-03-25T23:54:53Z2024-03-25T23:54:53ZCurious Kids: how is eye colour made? And why are they different colours?<figure><img src="https://images.theconversation.com/files/582452/original/file-20240318-27766-2yz46i.jpeg?ixlib=rb-1.1.0&rect=8%2C8%2C5982%2C3979&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://images.pexels.com/photos/4039320/pexels-photo-4039320.jpeg?auto=compress&cs=tinysrgb&w=1260&h=750&dpr=1">Pexels/Nóra Zahradník</a></span></figcaption></figure><p><strong>“How is eye colour made? And why are they different colours?” – Jane, age 12, from Pascoe Vale South</strong></p>
<p><a href="https://theconversation.com/au/topics/curious-kids-36782"><img src="https://images.theconversation.com/files/291898/original/file-20190911-190031-enlxbk.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=90&fit=crop&dpr=1" width="100%"></a></p>
<p>Hi Jane, </p>
<p>Eyes are so fascinating and I’m glad you asked this question!</p>
<p>When we talk about eye colour, we’re talking about the iris or coloured area around the dark dot (pupil) in the centre of the eye. Like our fingerprints, iris colours are <a href="https://www.sciencedirect.com/topics/computer-science/iris-recognition">unique to each person</a>. </p>
<p>The most common eye colour is brown, then blue, and less often green or hazel. Pigment means a substance that adds colour. The amazing thing is the human body only makes brown iris pigment (melanin) but not blue, green or hazel iris pigments. So how come everyone doesn’t have brown irises?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-what-are-the-main-factors-in-forming-someones-personality-222264">Curious Kids: what are the main factors in forming someone's personality?</a>
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</em>
</p>
<hr>
<h2>‘What colour are your eyes?’</h2>
<p>Iris colours can be brown, blue or green, or mixtures such as brown-yellow, greenish brown or blue-brown. The word “iris” comes from the <a href="https://www.researchgate.net/publication/370608432_On_the_etymology_of_the_word_iris_from_the_name_of_a_God_to_the_eye">Greek word</a> meaning “rainbow”. In ancient Greek stories, a goddess <a href="https://www.britannica.com/topic/Iris-Greek-mythology">called Iris</a> carries messages across a rainbow bridge between Earth and the supernatural world.</p>
<p>Genetics – how physical traits and characteristics pass from one generation to the next – play a part in determining eye colour. In many cases, <a href="https://www.nature.com/articles/s41433-021-01749-x">the genes that produce brown eyes</a> are dominant, but how eye colour genes are passed on is complex. This can mean if one biological parent has brown eyes and another has blue eyes, their child is more likely to have brown eyes. But not always. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-do-we-see-different-colours-when-we-close-our-eyes-154378">Curious Kids: why do we see different colours when we close our eyes?</a>
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</em>
</p>
<hr>
<h2>But what about all the other colours?</h2>
<p>So what is the iris made of? <a href="https://www.nei.nih.gov/sites/default/files/2019-06/parts-of-the-eye.pdf">Our iris is inside the eye</a>, behind a clear layer called the cornea. It’s circular and very thin (less than half a millimetre) and shaped like a donut with a hole in the middle for our pupil. The iris contains many cells, special muscles, blood vessels and nerves, surrounded by a gel material with millions of tiny crisscrossed fibres. </p>
<p>Iris pigment cells – melanocytes – contain pigment particles (melanosomes). Pigment cell numbers for all iris colours are about the same. But pigment particles inside the cells are different. For example, a blue iris does not have as many pigment particles as a brown iris. </p>
<p>The other iris cells make the tiny fibres and gel material in the iris, and other cells help protect the iris from damage. Special iris muscles with thin stretchy fibres can bunch up or relax the iris to control our pupil size in bright or dim light. </p>
<p>The back of the iris has a dark brown surface because of cells filled with brown pigment. This back surface pigment helps our vision as it stops light scattering through the iris. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/582453/original/file-20240318-18-7mjf76.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="close ups of four eye irises, showing different colours and patterns" src="https://images.theconversation.com/files/582453/original/file-20240318-18-7mjf76.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/582453/original/file-20240318-18-7mjf76.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=200&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582453/original/file-20240318-18-7mjf76.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=200&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582453/original/file-20240318-18-7mjf76.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=200&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582453/original/file-20240318-18-7mjf76.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=251&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582453/original/file-20240318-18-7mjf76.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=251&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582453/original/file-20240318-18-7mjf76.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=251&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Iris colours and patterns are unique to each person, like fingerprints.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-eye-iris-on-black-background-2320170915">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-are-people-colour-blind-107599">Curious Kids: why are people colour blind?</a>
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</em>
</p>
<hr>
<p>White or visible light contains a rainbow spectrum of colours from blue to red. As light passes through the iris, the blue light scatters much more than other colours. So blue light bounces back, and this means that if there are fewer pigment particles, we see a blue iris.</p>
<p>Other colours in light, especially red, scatter less and get into the iris between the tiny fibres, gel and cells. Green, hazel or brown irises have more pigment particles that soak up this light. </p>
<p>So the eye colours we see are a result of the scattering of some light colours more or less than others, brown pigment particles soaking up more of some colours, and the number of pigment particles a person has in their iris. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/582454/original/file-20240318-24-72lms1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="young woman smiles and has two different coloured eyes" src="https://images.theconversation.com/files/582454/original/file-20240318-24-72lms1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/582454/original/file-20240318-24-72lms1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582454/original/file-20240318-24-72lms1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582454/original/file-20240318-24-72lms1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582454/original/file-20240318-24-72lms1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582454/original/file-20240318-24-72lms1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582454/original/file-20240318-24-72lms1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some people are born with two different coloured eyes and these don’t change over time.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-portrait-beautiful-young-redhead-model-561622528">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-is-the-sky-blue-and-where-does-it-start-81165">Curious Kids: Why is the sky blue and where does it start?</a>
</strong>
</em>
</p>
<hr>
<h2>Can eye colours change?</h2>
<p>Iris colours can seem to change if different colours are near the eye. For example, different-coloured eye makeup can <a href="https://michaelbach.de/ot/col-context/">“trick” us as to the iris colour we see</a>.</p>
<p>People with little or no iris pigment often have very pale blue irises. These can <a href="https://my.clevelandclinic.org/health/articles/21576-eye-colors">look reddish</a> without the iris pigment to soak up the red light from inside the eye, which then passes through the iris. </p>
<p>Iris colour does not always stay the same during life. Babies born with blue eyes can have brown or hazel eyes by their second birthday because <a href="https://pubmed.ncbi.nlm.nih.gov/31811709/">more dark pigment is made in iris cells after birth</a>. </p>
<p>Iris colour can also change because of <a href="https://www.aao.org/eye-health/tips-prevention/why-are-my-eyes-changing-color#:%7E:text=Injury%20or%20trauma%20to%20the,the%20iris%20can%20be%20seen.">rare diseases or injuries</a>. </p>
<p>Some <a href="https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/latanoprost">eye drops to treat eye pressure</a> make more brown pigment in iris cells, and make eyes appear browner. Some people are born with <a href="https://www.webmd.com/eye-health/heterochromia-iridis">one brown eye and one blue eye</a>, but these stay the same with age – although we’re not sure why. </p>
<p>There’s still so much to discover about irises and eye colour!</p><img src="https://counter.theconversation.com/content/224507/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michele Madigan receives funding from Australian Vision Research. </span></em></p>The most common eye colour is brown, then blue, and less often, green or hazel. But the human body only makes brown iris pigment.Michele Madigan, Associate Professor, Optometry and Vision Science, UNSW Sydney and Clinical Associate Professor, Save Sight Institute, Clinical Ophthalmology, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2241442024-03-25T19:05:37Z2024-03-25T19:05:37ZSummer’s over, so how much sun can (and should) I get?<figure><img src="https://images.theconversation.com/files/583381/original/file-20240321-22-89ys3l.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6016%2C3998&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/woman-sitting-on-beach-shore-during-daytime-f9HmXiFNKXM">Tamara Bellis/Unsplash</a></span></figcaption></figure><p>As we slide of out summer, you might be wondering how careful you need to be about sun exposure. Excessive exposure causes <a href="https://www.cancer.org.au/about-us/policy-and-advocacy/prevention-policy/national-cancer-prevention-policy/skin-cancer-statistics-and-issues/uv-radiation">skin cancer</a>, but sun exposure also has <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9976694/">benefits</a>. How do you balance the two? </p>
<p>A new <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub">position statement</a> from cancer, bone health and other experts <a href="https://www.assc.org.au/wp-content/uploads/2023/01/Sun-Exposure-Summit-PositionStatement_V1.9.pdf">aims to help</a> Australians balance the good and bad effects of sun exposure by taking into account their skin colour, risk of skin cancer, and where they live.</p>
<h2>What are the benefits of sunlight?</h2>
<p>Ultraviolet (UV) radiation (the wavelengths in sunlight that cause skin cancer) also leads to vitamin D production. <a href="https://dermnetnz.org/topics/vitamin-d">Vitamin D</a> is very important for maintaining strong bones, and is likely to have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9976694/">multiple other health benefits</a>. </p>
<p>But vitamin D probably isn’t the whole story. Sunshine, including UV radiation, is thought to affect health in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9976694/">other ways</a> such as improving our mood and reducing the risk of autoimmune diseases and infections. So for many people, avoiding the sun and taking a vitamin D supplement may not be the best approach.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/vitamin-d-supplements-can-keep-bones-strong-but-they-may-also-have-other-benefits-to-your-health-219521">Vitamin D supplements can keep bones strong – but they may also have other benefits to your health</a>
</strong>
</em>
</p>
<hr>
<h2>How much time does it take to make vitamin D?</h2>
<p>It’s complicated, but for most people and most of the year across most of Australia, it’s a lot less than you think.</p>
<p>The <a href="https://onlinelibrary.wiley.com/doi/10.1111/php.13854">amount of time needed</a> depends on the amount of skin covered by clothing and the intensity of UV radiation (indicated by the UV index). More skin exposed and higher UV index equate to less time needed. </p>
<p>Both the UV index and the amount of the year that UV radiation is high increase as you get closer to the equator. In summer, all of Australia is bathed in sunshine. But in winter, opposite ends of the country have <a href="https://onlinelibrary.wiley.com/doi/10.1111/php.13854">very different exposures</a>. </p>
<p>In summer, everybody except those with deeply pigmented skin can make enough vitamin D in <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub">just five minutes</a> between 9am and 3pm, anywhere in Australia, provided they are wearing shorts and a T-shirt. </p>
<p>In winter it’s a different story. In <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub">Darwin and Brisbane</a>, 5–10 minutes between 10am and 3pm will do the trick, but in <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub">Hobart</a>, factoring in winter clothing, it will take nearly an hour in the middle of the day.</p>
<p>Hover your mouse over the lines below to see the length of exposure needed at specific times of day.</p>
<p><iframe id="X5szQ" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/X5szQ/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Staying out for longer than needed doesn’t necessarily make more vitamin D, but it <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub#bib25">does cause skin damage</a>. </p>
<h2>Hang on, what about those with darker skin?</h2>
<p>People with deeply pigmented, brown to black skin accumulate both vitamin D and DNA damage at a much slower rate than people with lighter skin tones. </p>
<p>When UV radiation hits a DNA strand, it causes the DNA to become distorted. If the distortion isn’t fixed, it will cause a mistake when the DNA is copied for a new cell, causing a permanent mutation that sometimes leads to cancer. </p>
<p>Melanin, the brown pigment in the skin, absorbs UV photons before that can happen, and the high melanin content in the darkest skin tones provides <a href="https://faseb.onlinelibrary.wiley.com/doi/full/10.1096/fj.201701472R">60 times</a> as much UV protection as the small amount in very fair skin. </p>
<p>The flip side is the risk of vitamin D deficiency is much higher than the risk of skin cancer. </p>
<p>The new statement accounts for this by putting people into <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub">three groups</a> based on their risk of skin cancer, with specialised advice for each group.</p>
<h2>Highest skin cancer risk</h2>
<figure class="align-center ">
<img alt="Red-headed woman" src="https://images.theconversation.com/files/583354/original/file-20240321-22-qfrbj0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/583354/original/file-20240321-22-qfrbj0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/583354/original/file-20240321-22-qfrbj0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/583354/original/file-20240321-22-qfrbj0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/583354/original/file-20240321-22-qfrbj0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/583354/original/file-20240321-22-qfrbj0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/583354/original/file-20240321-22-qfrbj0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People with pale skin that burns easily are in the high-risk group.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/close-up-photo-of-person-with-nose-ring-2146042/">Luriko Yamaguchi/Pexels</a></span>
</figcaption>
</figure>
<p>This includes people with very pale skin that burns easily and tans minimally, but also people with darker white or olive skin who can tan easily but have extra skin cancer risk factors because they: </p>
<ul>
<li>have had <strong>skin cancer</strong> before</li>
<li>have a <strong>family history</strong> of melanomas</li>
<li>have many <strong>moles</strong></li>
<li>are taking <strong>immunosuppressant</strong> medications.</li>
</ul>
<p>For these people, the harms of sun exposure almost certainly <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub">outweigh the benefits</a>.</p>
<p>These people should wear sunscreen every day the <a href="https://www.arpansa.gov.au/our-services/monitoring/ultraviolet-radiation-monitoring/ultraviolet-radiation-index">UV index</a> is forecast to get to <a href="https://www.assc.org.au/peak-health-bodies-recommend-new-approach-to-sunscreen-use/">three or more</a>, and use the <a href="https://www.cancer.org.au/cancer-information/causes-and-prevention/sun-safety/be-sunsmart">five sunsmart steps</a> whenever the UV index is above three: </p>
<ul>
<li><strong>slip</strong> on clothing covering as much of the body as possible</li>
<li><strong>slop</strong> on SPF30+ sunscreen on areas that can’t be covered up</li>
<li><strong>slap</strong> on a hat</li>
<li><strong>seek</strong> shade</li>
<li><strong>slide</strong> on sunglasses.</li>
</ul>
<p>They shouldn’t spend time outdoors deliberately to make vitamin D, but should discuss vitamin D supplements with their doctor. </p>
<h2>Intermediate skin cancer risk</h2>
<figure class="align-center ">
<img alt="Man drinks soda from a cup" src="https://images.theconversation.com/files/583358/original/file-20240321-20-42mfoy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/583358/original/file-20240321-20-42mfoy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/583358/original/file-20240321-20-42mfoy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/583358/original/file-20240321-20-42mfoy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/583358/original/file-20240321-20-42mfoy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/583358/original/file-20240321-20-42mfoy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/583358/original/file-20240321-20-42mfoy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People with skin that tans easily are at intermediate risk.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/man-in-gray-shirt-drinking-from-white-ceramic-mug-TfqM6Kg2Rh4">Jarritos/Unsplash</a></span>
</figcaption>
</figure>
<p>This means people with dark white/olive skin that sometimes burns but tans easily, and who don’t have other skin cancer risk factors. </p>
<p>These people should still apply sunscreen as part of their usual routine on all days when the UV index is forecast to get to <a href="https://www.assc.org.au/peak-health-bodies-recommend-new-approach-to-sunscreen-use/">three or more</a>, but they can spend enough time outdoors to get a “dose” of vitamin D on most days of the week. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-how-does-the-sun-help-your-body-make-vitamin-d-139670">Curious Kids: how does the Sun help your body make vitamin D?</a>
</strong>
</em>
</p>
<hr>
<p>Once the time needed for their vitamin D dose is up, they should also use the <a href="https://www.cancer.org.au/cancer-information/causes-and-prevention/sun-safety/be-sunsmart">slip-slop-slap-seek-slide</a> steps to avoid accumulating DNA damage. </p>
<p>If they’re unable to do this because of health or lifestyle factors, like being housebound, working night shifts, or always covering up with clothing, they should see their doctor about whether they need vitamin D supplements.</p>
<h2>Lowest skin cancer risk</h2>
<figure class="align-center ">
<img alt="Family members sit outside, laughing" src="https://images.theconversation.com/files/583359/original/file-20240321-16-fk5ehb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/583359/original/file-20240321-16-fk5ehb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/583359/original/file-20240321-16-fk5ehb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/583359/original/file-20240321-16-fk5ehb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/583359/original/file-20240321-16-fk5ehb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/583359/original/file-20240321-16-fk5ehb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/583359/original/file-20240321-16-fk5ehb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People with skin that rarely burns have the lowest risk of cancer.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/two-persons-staring-at-each-other-jg_t3PBq5Jo">Eye for Ebony/Unsplash</a></span>
</figcaption>
</figure>
<p>This covers people with deeply pigmented brown to black skin that rarely or never burns. </p>
<p>These people can <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub#bib14">safely spend enough time outdoors</a> to make vitamin D and get the other benefits of sunshine. But because more time is needed, it can be difficult, particularly when the weather is cold. Vitamin D supplements might be needed. </p>
<p>They don’t need to routinely protect their skin, but might need to <a href="https://www.cancer.org.au/cancer-information/causes-and-prevention/sun-safety/be-sunsmart">slip-slop-slap-seek-slide</a> if they are outdoors for more than two hours.</p>
<h2>How do I get the feel-good effects of sunshine?</h2>
<p>Spending time outdoors in the early morning is the best way to get the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9976694/">feel-good effects</a> of sunshine. An early morning walk is a great idea for all of us, but it won’t make vitamin D.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-i-be-getting-my-vitamin-d-levels-checked-211268">Should I be getting my vitamin D levels checked?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/224144/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katie Lee receives funding from the National Health and Medical Research Council for a student stipend. </span></em></p><p class="fine-print"><em><span>Rachel Neale receives funding from the National Health and Medical Research Council for grants related to vitamin D and sunscreen. She was the lead author of the manuscript describing the revised position statement and chaired the Summit that led to the revised recommendations.</span></em></p>Excessive exposure causes skin cancer, but sun exposure also has benefits. How do you balance the two?Katie Lee, PhD Candidate, Dermatology Research Centre, The University of QueenslandRachel Neale, Principal research fellow, QIMR Berghofer Medical Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2262412024-03-25T05:14:48Z2024-03-25T05:14:48ZNew research suggests intermittent fasting increases the risk of dying from heart disease. But the evidence is mixed<figure><img src="https://images.theconversation.com/files/583947/original/file-20240325-24-b5vorr.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C6000%2C3979&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/chrononutrition-chrono-watch-fruits-clock-intermittent-2134213237">Food Photo Master/Shutterstock</a></span></figcaption></figure><p>Intermittent fasting has gained popularity in recent years as a dietary approach with potential health benefits. So you might have been surprised to see <a href="https://www.bloomberg.com/news/articles/2024-03-18/intermittent-fasting-linked-to-heart-risks-in-research-surprise">headlines</a> last week suggesting the practice could increase a person’s risk of death from heart disease.</p>
<p>The news stories were based on recent <a href="https://newsroom.heart.org/news/8-hour-time-restricted-eating-linked-to-a-91-higher-risk-of-cardiovascular-death">research</a> which found a link between time-restricted eating, a form of intermittent fasting, and an increased risk of death from cardiovascular disease, or heart disease. </p>
<p>So what can we make of these findings? And how do they measure up with what else we know about intermittent fasting and heart disease?</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1771497705937747975"}"></div></p>
<h2>The study in question</h2>
<p>The research was presented as a <a href="https://s3.amazonaws.com/cms.ipressroom.com/67/files/20242/8-h+TRE+and+mortality+AHA+poster_031924.pdf">scientific poster</a> at an American Heart Association conference last week. The full study hasn’t yet been published in a peer-reviewed journal.</p>
<p>The researchers used data from the National Health and Nutrition Examination Survey (<a href="https://www.cdc.gov/nchs/nhanes/about_nhanes.htm">NHANES</a>), a long-running survey that collects information from a large number of people in the United States.</p>
<p>This type of research, known as observational research, involves analysing large groups of people to identify relationships between lifestyle factors and disease. The study covered a 15-year period.</p>
<p>It showed people who ate their meals within an eight-hour window faced a 91% increased risk of dying from heart disease compared to those spreading their meals over 12 to 16 hours. When we look more closely at the data, it suggests 7.5% of those who ate within eight hours died from heart disease during the study, compared to 3.6% of those who ate across 12 to 16 hours.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/does-intermittent-fasting-have-benefits-for-our-brain-223181">Does intermittent fasting have benefits for our brain?</a>
</strong>
</em>
</p>
<hr>
<p>We don’t know if the authors controlled for other factors that can influence health, such as body weight, medication use or diet quality. It’s likely some of these questions will be answered once the full details of the study are published.</p>
<p>It’s also worth noting that participants may have eaten during a shorter window for a range of reasons – not necessarily because they were intentionally following a time-restricted diet. For example, they may have had a poor appetite due to illness, which could have also influenced the results. </p>
<h2>Other research</h2>
<p>Although this research may have a number of limitations, its findings aren’t entirely unique. They align with several other published studies using the NHANES data set.</p>
<p>For example, one <a href="https://www.sciencedirect.com/science/article/pii/S0939475323004209#appsec1">study</a> showed eating over a longer period of time reduced the risk of death from heart disease by 64% in people with heart failure.</p>
<p>Another <a href="https://www.frontiersin.org/articles/10.3389/fnut.2023.937771/full">study</a> in people with diabetes showed those who ate more frequently had a lower risk of death from heart disease.</p>
<p>A <a href="https://link.springer.com/article/10.1186/s12966-023-01556-5#Abs1">recent study</a> found an overnight fast shorter than ten hours and longer than 14 hours increased the risk dying from of heart disease. This suggests too short a fast could also be a problem.</p>
<h2>But I thought intermittent fasting was healthy?</h2>
<p>There are conflicting results about <a href="https://www.nature.com/articles/s41574-022-00638-x#Sec2">intermittent fasting</a> in the scientific literature, partly due to the different types of intermittent fasting. </p>
<p>There’s time restricted eating, which limits eating to a period of time each day, and which the current study looks at. There are also different patterns of fast and feed days, such as the well-known <a href="https://www.sciencedirect.com/science/article/pii/S0002916522002167">5:2 diet</a>, where on fast days people generally consume about 25% of their energy needs, while on feed days there is no restriction on food intake.</p>
<p>Despite these different fasting patterns, <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00098-1/fulltext">systematic reviews</a> of randomised controlled trials (RCTs) consistently demonstrate benefits for intermittent fasting in terms of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8092432/">weight loss</a> and <a href="https://academic.oup.com/nutritionreviews/advance-article/doi/10.1093/nutrit/nuad155/7475915">heart disease risk factors</a> (for example, blood pressure and cholesterol levels). </p>
<p>RCTs indicate intermittent fasting yields <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/oby.23568">comparable improvements</a> in these areas to other dietary interventions, such as daily moderate energy restriction.</p>
<figure class="align-center ">
<img alt="A group of people eating around a table." src="https://images.theconversation.com/files/583949/original/file-20240325-29-244jlr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/583949/original/file-20240325-29-244jlr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/583949/original/file-20240325-29-244jlr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/583949/original/file-20240325-29-244jlr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/583949/original/file-20240325-29-244jlr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/583949/original/file-20240325-29-244jlr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/583949/original/file-20240325-29-244jlr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There are a variety of intermittent fasting diets.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/photo-of-people-eating-together-3184182/">Fauxels/Pexels</a></span>
</figcaption>
</figure>
<h2>So why do we see such different results?</h2>
<p>RCTs directly compare two conditions, such as intermittent fasting versus daily energy restriction, and control for a range of factors that could affect outcomes. So they offer insights into causal relationships we can’t get through observational studies alone. </p>
<p>However, they often focus on specific groups and short-term outcomes. On average, these studies follow participants for around 12 months, leaving long-term effects unknown.</p>
<p>While observational research provides valuable insights into population-level trends over longer periods, it relies on self-reporting and cannot demonstrate cause and effect. </p>
<p>Relying on people to accurately report their own eating habits is tricky, as they may have difficulty remembering what and when they ate. This is a long-standing issue in observational studies and makes relying only on these types of studies to help us understand the relationship between diet and disease challenging.</p>
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Read more:
<a href="https://theconversation.com/does-it-matter-what-time-of-day-i-eat-and-can-intermittent-fasting-improve-my-health-heres-what-the-science-says-203762">Does it matter what time of day I eat? And can intermittent fasting improve my health? Here's what the science says</a>
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<p>It’s likely the relationship between eating timing and health is more complex than simply eating more or less regularly. Our bodies are controlled by a group of internal clocks (our <a href="https://www.ahajournals.org/doi/full/10.1161/CIRCRESAHA.123.323520#d1e1860">circadian rhythm</a>), and when our behaviour doesn’t align with these clocks, such as when we eat at unusual times, our bodies can have trouble managing this.</p>
<h2>So, is intermittent fasting safe?</h2>
<p>There’s no simple answer to this question. RCTs have shown it appears a safe option for weight loss in the short term.</p>
<p>However, people in the NHANES dataset who eat within a limited period of the day appear to be at higher risk of dying from heart disease. Of course, many other factors could be causing them to eat in this way, and influence the results.</p>
<p>When faced with conflicting data, it’s generally agreed among scientists that RCTs provide a higher level of evidence. There are too many unknowns to accept the conclusions of an epidemiological study like this one without asking questions. Unsurprisingly, it has been subject to <a href="https://www.forbes.com/sites/brucelee/2024/03/23/claims-that-intermittent-fasting-increases-death-risk-by-91-are-premature/?sh=223b055c428f">criticism</a>.</p>
<p>That said, to gain a better understanding of the long-term safety of intermittent fasting, we need to be able follow up individuals in these RCTs over five or ten years. </p>
<p>In the meantime, if you’re interested in trying intermittent fasting, you should speak to a health professional first.</p><img src="https://counter.theconversation.com/content/226241/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Recent research found eating within an eight-hour window increased risk of death from heart disease. But it’s complicated.Kaitlin Day, Lecturer in Human Nutrition, RMIT UniversitySharayah Carter, Lecturer Nutrition and Dietetics, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2209462024-03-24T19:06:41Z2024-03-24T19:06:41ZWe created a VR tool to test brain function. It could one day help diagnose dementia<figure><img src="https://images.theconversation.com/files/583308/original/file-20240321-22-fi7z9f.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5756%2C3842&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/photograph-of-a-man-in-a-red-sweatshirt-holding-a-virtual-reality-headset-6667710/">Kampus Production/Pexels</a></span></figcaption></figure><p>If you or a loved one have noticed changes in your memory or thinking as you’ve grown older, this could reflect typical changes that occur with ageing. In some cases though, it might suggest something more, such as the onset of dementia.</p>
<p>The best thing to do if you have concerns is to make an appointment with your GP, who will probably run some tests. Assessment is important because if there is something more going on, <a href="https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=09da7f8f782d61bb23411c18ba0af0faae918cdc">early diagnosis</a> can enable prompt access to the right <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/gps.2191?casa_token=4xa6QPERgQkAAAAA:znhnzCjFlILbkI3ffikVOJAVx5vtCe2qFb9DydvjbFOwlvrYTcNHrKhG7hpDQY-yyRviyUTWhaW7DU27">interventions</a>, supports and care. </p>
<p>But current methods of dementia screening have <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2301149">limitations</a>, and testing can be daunting for patients.</p>
<p>Our research suggests virtual reality (VR) could be a useful cognitive screening tool, and mitigate some of the challenges associated with current testing methods, opening up the possibility it may one day play a role in dementia diagnosis.</p>
<h2>Where current testing is falling short</h2>
<p>If someone is worried about their memory and thinking, their GP might ask them to complete a series of quick tasks that check things like the ability to follow simple instructions, basic arithmetic, memory and orientation.</p>
<p>These sorts of screening tools are really good at confirming cognitive problems that may already be very apparent. But <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010783.pub2/full">commonly used screening tests</a> are <a href="https://link.springer.com/article/10.1186/s13195-019-0474-3">not always so good</a> at detecting early and more subtle difficulties with memory and thinking, meaning such changes could be missed until they get worse. </p>
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Read more:
<a href="https://theconversation.com/these-12-things-can-reduce-your-dementia-risk-but-many-australians-dont-know-them-all-191504">These 12 things can reduce your dementia risk – but many Australians don't know them all</a>
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<p>A <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9492323/">clinical neuropsychological assessment</a> is better equipped to <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/ene.12488?casa_token=PUj3o1rEfrQAAAAA%3A_fa1cOudFpdvoGx_0u6QJRG2gzuRVWJ8h6x5qrQOKc2J7hwPjYox20DcEhRaRqyZdRXXHEkBIXuRgIH5nw">detect early changes</a>. This involves a comprehensive review of a patient’s personal and medical history, and detailed assessment of cognitive functions, including attention, language, memory, executive functioning, mood factors and more. However, this can be costly and the testing can take several hours.</p>
<p>Testing is also somewhat removed from everyday experience, not directly tapping into activities of daily living.</p>
<h2>Enter virtual reality</h2>
<p>VR technology uses computer-generated environments to create immersive experiences that feel like real life. While VR is often used for entertainment, it has increasingly found applications in health care, including in <a href="https://link.springer.com/article/10.1007/s10055-020-00495-x">rehabilitation</a> and <a href="https://journals.sagepub.com/doi/full/10.1177/0269215517694677?casa_token=-T4Vh6ZsSXYAAAAA:2S7tM5qS25Oe0YQLCqdd0wPlspOIZPv9exKcc6InL5Wn4nfyetfzQOJxgBjb-6F0LGJPWggozMEoJQ">falls prevention</a>. </p>
<p>Using VR for cognitive screening is still a new area. VR-based cognitive tests generally create a scenario such as shopping at a supermarket or driving around a city to ascertain how a person would perform in these situations.</p>
<p>Notably, they engage various senses and cognitive processes such as sight, sound and spatial awareness in immersive ways. All this may reveal subtle impairments which can be missed by standard methods.</p>
<p>VR assessments are also often more engaging and enjoyable, potentially reducing anxiety for those who may feel uneasy in traditional testing environments, and improving compliance compared to standard assessments.</p>
<figure class="align-center ">
<img alt="A senior woman sitting on a bed with her hand to her face." src="https://images.theconversation.com/files/583309/original/file-20240321-28-p3dtg4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/583309/original/file-20240321-28-p3dtg4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/583309/original/file-20240321-28-p3dtg4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/583309/original/file-20240321-28-p3dtg4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/583309/original/file-20240321-28-p3dtg4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/583309/original/file-20240321-28-p3dtg4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/583309/original/file-20240321-28-p3dtg4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Millions of people around the world have dementia.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-woman-suffering-headache-2138485783">pikselstock/Shutterstock</a></span>
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<p>Most studies of VR-based cognitive tests have explored their capacity to pick up <a href="https://www.frontiersin.org/articles/10.3389/fnhum.2021.628818/full">impairments in spatial memory</a> (the ability to remember where something is located and how to get there), and the results have been promising.</p>
<p>Given VR’s potential for assisting with diagnosis of cognitive impairment and dementia remains largely untapped, our team developed an online computerised game (referred to as semi-immersive VR) to see how well a person can remember, recall and complete everyday tasks. In our VR game, which lasts about 20 minutes, the user role plays a waiter in a cafe and receives a score on their performance.</p>
<p>To assess its potential, we enlisted more than 140 people to play the game and provide feedback. The results of this research are published across three recent papers.</p>
<h2>Testing our VR tool</h2>
<p>In our <a href="https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-024-02478-3">most recently published study</a>, we wanted to verify the accuracy and sensitivity of our VR game to assess cognitive abilities.</p>
<p>We compared our test to an existing screening tool (called the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2913129/">TICS-M</a>) in more than 130 adults. We found our VR task was able to capture meaningful aspects of cognitive function, including recalling food items and spatial memory.</p>
<p>We also found younger adults performed better in the game than older adults, which echoes the pattern commonly seen in regular memory tests.</p>
<figure class="align-center ">
<img alt="A senior man sitting outdoors using a laptop." src="https://images.theconversation.com/files/583311/original/file-20240321-18-smy2uf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/583311/original/file-20240321-18-smy2uf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/583311/original/file-20240321-18-smy2uf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/583311/original/file-20240321-18-smy2uf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/583311/original/file-20240321-18-smy2uf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/583311/original/file-20240321-18-smy2uf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/583311/original/file-20240321-18-smy2uf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Adults of a range of ages tried our computerised game.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-man-working-on-laptop-garden-1488244298">pikselstock/Shutterstock</a></span>
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<p>In a <a href="https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-024-04767-y">separate study</a>, we followed ten adults aged over 65 while they completed the game, and interviewed them afterwards. We wanted to understand how this group – who the tool would target – perceived the task.</p>
<p>These seniors told us they found the game user-friendly and believed it was a promising tool for screening memory. They described the game as engaging and immersive, expressing enthusiasm to continue playing. They didn’t find the task created anxiety.</p>
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Read more:
<a href="https://theconversation.com/we-gave-palliative-care-patients-vr-therapy-more-than-50-said-it-helped-reduce-pain-and-depression-symptoms-223186">We gave palliative care patients VR therapy. More than 50% said it helped reduce pain and depression symptoms</a>
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<p>For a third study, we spoke to <a href="https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-023-02413-y">seven health-care professionals</a> about the tool. Overall they gave positive feedback, and noted its dynamic approach to age-old diagnostic challenges.</p>
<p>However, they did flag some concerns and potential barriers to implementing this sort of tool. These included resource constraints in clinical practice (such as time and space to carry out the assessment) and whether it would be accessible for people with limited technological skills. There was also some scepticism about whether the tool would be an accurate method to assist with dementia diagnosis. </p>
<p>While our initial research suggests this tool could be a promising way to assess cognitive performance, this is not the same as diagnosing dementia. To improve the test’s ability to accurately detect those who likely have dementia, we’ll need to make it more specific for that purpose, and carry out further research to validate its effectiveness.</p>
<p>We’ll be conducting more testing of the game soon. Anyone interested in giving it a go to help with our research can register on <a href="https://brainhealthhub.com.au/projects/leaf-cafe-virtual-reality/">our team’s website</a>.</p><img src="https://counter.theconversation.com/content/220946/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Current methods of screening for dementia have a range of limitations. Using virtual reality for cognitive screening is still a new area, but it’s showing promise.Joyce Siette, Research Theme Fellow in Health and Wellbeing, Western Sydney UniversityPaul Strutt, Senior Lecturer in Psychology, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2264612024-03-23T23:30:03Z2024-03-23T23:30:03ZKate Middleton is having ‘preventive chemotherapy’ for cancer. What does this mean?<p>Catherine, Princess of Wales, is undergoing treatment for cancer. In a video thanking followers for their messages of support after her major abdominal surgery, the Princess of Wales explained, “tests after the operation found cancer had been present.” </p>
<p>“My medical team therefore advised that I should undergo a course of preventative chemotherapy and I am now in the early stages of that treatment,” she said in the two-minute video. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1771237869509644455"}"></div></p>
<p>No further details have been released about the Princess of Wales’ treatment.</p>
<p>But many have been asking what preventive chemotherapy is and how effective it can be. Here’s what we know about this type of treatment. </p>
<h2>It’s not the same as preventing cancer</h2>
<p>To <a href="https://www.cancer.org.au/about-us/how-we-help/prevention">prevent cancer developing</a>, lifestyle changes such as diet, exercise and sun protection are <a href="https://www.cancer.org.au/about-us/how-we-help/prevention">recommended</a>. </p>
<p>Tamoxifen, a hormone therapy drug can be used to reduce the risk of cancer for some patients at <a href="https://www.mayoclinic.org/diseases-conditions/breast-cancer/in-depth/breast-cancer/art-20045353">high risk of breast cancer</a>. </p>
<p>Aspirin <a href="https://www.cancer.gov/about-cancer/causes-prevention/research/aspirin-cancer-risk">can also be used</a> for those at high risk of bowel and other cancers. </p>
<h2>How can chemotherapy be used as preventive therapy?</h2>
<p>In terms of treating cancer, prevention refers to giving chemotherapy after the cancer has been removed, to prevent the cancer from returning. </p>
<p>If a cancer is localised (limited to a certain part of the body) with no evidence on scans of it spreading to distant sites, local treatments such as surgery or radiotherapy can remove all of the cancer. </p>
<p>If, however, cancer is first detected after it has spread to distant parts of the body at diagnosis, clinicians use treatments such as chemotherapy (anti-cancer drugs), hormones or immunotherapy, which circulate <a href="https://www.healthline.com/health/cancer/metastatic-cancer">around the body</a> . </p>
<p>The other use for chemotherapy is to add it before or after surgery or radiotherapy, to prevent the primary cancer <a href="https://www.verywellhealth.com/adjuvant-therapy-5198903">coming back</a>. The surgery may have cured the cancer. However, in some cases, undetectable microscopic cells may have spread into the bloodstream to distant sites. This will result in the cancer returning, months or years later. </p>
<p>With some cancers, treatment with chemotherapy, given before or after the local surgery or radiotherapy, can kill those cells and prevent the cancer coming back.</p>
<p>If we can’t see these cells, how do we know that giving additional chemotherapy to prevent recurrence is effective? We’ve learnt this from clinical trials. Researchers have compared patients who had surgery only with those whose surgery was followed by additional (or often called adjuvant) chemotherapy. The additional therapy resulted in patients not relapsing and surviving longer. </p>
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Read more:
<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">Princess of Wales and King Charles: one in two people develop cancer during their lives – the diseases and treatments explained</a>
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<h2>How effective is preventive therapy?</h2>
<p>The effectiveness of preventive therapy depends on the type of cancer and the type of chemotherapy. </p>
<p>Let’s consider the common example of bowel cancer, which is at high risk of returning after surgery because of its size or spread to local lymph glands. The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564362/">first chemotherapy tested</a> improved survival by 15%. With more intense chemotherapy, the chance of surviving six years is approaching 80%. </p>
<p>Preventive chemotherapy is usually given for three to six months. </p>
<h2>How does chemotherapy work?</h2>
<p>Many of the chemotherapy drugs stop cancer cells dividing by disrupting the DNA (genetic material) in the centre of the cells. To improve efficacy, drugs which work at different sites in the cell are given in combinations. </p>
<p>Chemotherapy is not selective for cancer cells. It kills any dividing cells.</p>
<p>But cancers consist of a higher proportion of dividing cells than the normal body cells. A <a href="https://www.canceraustralia.gov.au/cancer-types/breast-cancer/treatment/chemotherapy/how-does-chemotherapy-work#:%7E:text=Chemotherapy%20works%20by%20killing%20cells%20that%20are%20rapidly,cells%20can%20repair%20the%20damage%20and%20can%20recover.">greater proportion of the cancer is killed</a> with each course of chemotherapy.</p>
<p>Normal cells can recover between courses, which are usually given three to four weeks apart.</p>
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Read more:
<a href="https://theconversation.com/explainer-what-is-chemotherapy-and-how-does-it-work-76403">Explainer: what is chemotherapy and how does it work?</a>
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<h2>What are the side effects?</h2>
<p>The side effects of chemotherapy are usually reversible and are seen in parts of the body where there is normally a high turnover of cells. </p>
<p>The production of blood cells, for example, is temporarily disrupted. When your white blood cell count is low, there is an increased risk of infection. </p>
<p>Cell death in the lining of the gut leads to mouth ulcers, nausea and vomiting and bowel disturbance. </p>
<p>Certain drugs sometimes given during chemotherapy can attack other organs, such as causing numbness in the hands and feet. </p>
<p>There are also generalised symptoms such as <a href="https://www.cancervic.org.au/cancer-information/treatments/treatments-types/chemotherapy/side_effects_of_chemotherapy.html">fatigue</a>. </p>
<p>Given that preventive chemotherapy given after surgery starts when there is no evidence of any cancer remaining after local surgery, patients can usually resume normal activities within weeks of completing the courses of chemotherapy.</p><img src="https://counter.theconversation.com/content/226461/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Olver receives funding from the Australian Research Council. </span></em></p>Here’s what we know about this type of treatment.Ian Olver, Adjunct Professsor, School of Psychology, Faculty of Health and Medical Sciences, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2236432024-03-22T00:14:57Z2024-03-22T00:14:57ZWhat’s the difference between autism and Asperger’s disorder?<figure><img src="https://images.theconversation.com/files/581137/original/file-20240312-16-5zslsi.jpg?ixlib=rb-1.1.0&rect=25%2C352%2C5566%2C3194&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-headphones-relaxing-home-late-704548654">Stokkete/Shutterstock</a></span></figcaption></figure><p>Swedish climate activist Greta Thunberg describes herself as having <a href="https://www.theguardian.com/environment/2019/sep/02/greta-thunberg-responds-to-aspergers-critics-its-a-superpower">Asperger’s</a> while others on the autism spectrum, such as Australian comedian Hannah Gatsby, <a href="https://www.theguardian.com/stage/2022/mar/19/hannah-gadsby-autism-diagnosis-little-out-of-whack">describe</a> themselves as “autistic”. But what’s the difference?</p>
<p>Today, the previous diagnoses of “Asperger’s disorder” and “autistic disorder” both fall within the diagnosis of autism spectrum disorder, or ASD. </p>
<p>Autism describes a “neurotype” – a person’s thinking and information-processing style. Autism is one of the forms of diversity in human thinking, which comes with strengths and challenges. </p>
<p>When these challenges become overwhelming and impact how a person learns, plays, works or socialises, a diagnosis of <a href="https://www.psychiatry.org/patients-families/autism/what-is-autism-spectrum-disorder">autism spectrum disorder</a> is made. </p>
<h2>Where do the definitions come from?</h2>
<p>The Diagnostic and Statistical Manual of Mental Disorders (DSM) outlines the criteria clinicians use to diagnose mental illnesses and behavioural disorders.</p>
<p>Between 1994 and 2013, autistic disorder and Asperger’s disorder were the two primary diagnoses related to autism in the fourth edition of the manual, the DSM-4. </p>
<p>In 2013, the DSM-5 collapsed both diagnoses into one <a href="https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596">autism spectrum disorder</a>. </p>
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Read more:
<a href="https://theconversation.com/its-25-years-since-we-redefined-autism-heres-what-weve-learnt-125053">It's 25 years since we redefined autism – here's what we've learnt</a>
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<h2>How did we used to think about autism?</h2>
<p>The two thinkers behind the DSM-4 diagnostic categories were Baltimore psychiatrist Leo Kanner and Viennese paediatrician Hans Asperger. They described the challenges faced by people who were later diagnosed with autistic disorder and Asperger’s disorder. </p>
<p>Kanner and Asperger observed patterns of behaviour that differed to typical thinkers in the domains of communication, social interaction and flexibility of behaviour and thinking. The variance was associated with challenges in adaptation and distress. </p>
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<img alt="Children in a 1950s classroom" src="https://images.theconversation.com/files/581138/original/file-20240312-24-z8htwz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/581138/original/file-20240312-24-z8htwz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=383&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581138/original/file-20240312-24-z8htwz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=383&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581138/original/file-20240312-24-z8htwz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=383&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581138/original/file-20240312-24-z8htwz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=482&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581138/original/file-20240312-24-z8htwz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=482&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581138/original/file-20240312-24-z8htwz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=482&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Kanner and Asperger described different thinking patterns in children with autism.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/czechoslovak-socialist-republic-circa-1950s-retro-390664261">Roman Nerud/Shutterstock</a></span>
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<p>Between the 1940s and 1994, the majority of those diagnosed with autism also had an intellectual disability. Clinicians became focused on the accompanying intellectual disability as a necessary part of autism.</p>
<p>The introduction of Asperger’s disorder shifted this focus and acknowledged the diversity in autism. In the DSM-4 it superficially looked like autistic disorder and Asperger’s disorder were different things, with the Asperger’s criteria stating there could be no intellectual disability or delay in the development of speech. </p>
<p>Today, as a legacy of the recognition of the autism itself, the <a href="https://www.aihw.gov.au/reports/disability/autism-in-australia/contents/autism">majority of people</a> diagnosed with autism spectrum disorder – the new term from the DSM-5 – don’t a have an accompanying intellectual disability.</p>
<h2>What changed with ‘autism spectrum disorder’?</h2>
<p>The move to autism spectrum disorder brought the previously diagnosed autistic disorder and Asperger’s disorder under the one new diagnostic umbrella term. </p>
<p>It made clear that other diagnostic groups – such as intellectual disability – can co-exist with autism, but are separate things. </p>
<p>The other major change was acknowledging communication and social skills are intimately linked and not separable. Rather than separating “impaired communication” and “impaired social skills”, the diagnostic criteria changed to “impaired social communication”. </p>
<p>The introduction of the spectrum in the diagnostic term further clarified that people have varied capabilities in the flexibility of their thinking, behaviour and social communication – and this can change in response to the context the person is in. </p>
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Read more:
<a href="https://theconversation.com/tiktok-is-teaching-the-world-about-autism-but-is-it-empowering-autistic-people-or-pigeonholing-them-192093">TikTok is teaching the world about autism – but is it empowering autistic people or pigeonholing them?</a>
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<h2>Why do some people prefer the old terminology?</h2>
<p>Some people feel the clinical label of Asperger’s allowed a much more refined understanding of autism. This included recognising the achievements and great societal contributions of people with known or presumed autism. </p>
<p>The contraction “Aspie” played an enormous part in the shift to positive identity formation. In the time up to the release of the DSM-5, <a href="https://xminds.org/resources/Documents/Web%20files/Aspie%20Criteria%20by%20Attwood.pdf">Tony Attwood and Carol Gray</a>, two well known thinkers in the area of autism, highlighted the strengths associated with “being Aspie” as something to be proud of. But they also raised awareness of the challenges. </p>
<h2>What about identity-based language?</h2>
<p>A more recent shift in language has been the reclamation of what was once viewed as a slur – “autistic”. This was a shift from person-first language to identity-based language, from “person with autism spectrum disorder” to “autistic”. </p>
<p>The neurodiversity rights movement describes its aim to <a href="https://researchonline.jcu.edu.au/71531/1/JCU_71531_AAM.pdf">push back</a> against a breach of human rights resulting from the wish to cure, or fundamentally change, people with autism.</p>
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<img alt="Boy responds to play therapist" src="https://images.theconversation.com/files/581141/original/file-20240312-16-gmqam6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/581141/original/file-20240312-16-gmqam6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581141/original/file-20240312-16-gmqam6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581141/original/file-20240312-16-gmqam6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581141/original/file-20240312-16-gmqam6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581141/original/file-20240312-16-gmqam6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581141/original/file-20240312-16-gmqam6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Autism is one of the forms of diversity in human thinking, which comes with strengths and challenges.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-autism-boy-during-therapy-school-1914170926">Alex and Maria photo/Shutterstock</a></span>
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<p>The movement uses a “social model of disability”. This views disability as arising from societies’ response to individuals and the failure to adjust to enable full participation. The inherent challenges in autism are seen as only a problem if not accommodated through reasonable adjustments. </p>
<p>However the social model contrasts itself against a very outdated medical or clinical model. </p>
<p>Current clinical thinking and practice focuses on <a href="https://www.collegianjournal.com/article/S1322-7696(22)00122-6/fulltext">targeted</a> supports to reduce distress, promote thriving and enable optimum individual participation in school, work, community and social activities. It doesn’t aim to cure or fundamentally change people with autism. </p>
<p>A diagnosis of autism spectrum disorder signals there are challenges beyond what will be solved by adjustments alone; individual supports are also needed. So it’s important to combine the best of the social model and contemporary clinical model.</p>
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Read more:
<a href="https://theconversation.com/from-deficits-to-a-spectrum-thinking-around-autism-has-changed-now-there-are-calls-for-a-profound-autism-diagnosis-194049">From deficits to a spectrum, thinking around autism has changed. Now there are calls for a 'profound autism' diagnosis</a>
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<img src="https://counter.theconversation.com/content/223643/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Cashin receives funding from the Australian Government National Disability Insurance Agency Information Linkages and Capacity Building Grant Scheme Grant number 4-DW65XKD. This is a mainstream capacity building grant to build the capacity to care for people with ASD and/or intellectual disability in mainstream healthcare. </span></em></p>Some people describe themselves as having Asperger’s disorder, while others call themselves autistic. But is there a difference?Andrew Cashin, Professor of Nursing, School of Health and Human Sciences, Southern Cross UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2195942024-03-21T18:58:32Z2024-03-21T18:58:32ZTreatments tailored to you: how AI will change NZ healthcare, and what we have to get right first<p>Imagine this: a novel virus is rapidly breaking out nationwide, resulting in an epidemic. The government introduces vaccination mandates and a choice of different vaccines is available. </p>
<p>But not everyone is getting the same vaccine. When you sign up for vaccination, you are sent a vial with instructions to send a sample of your saliva to the nearest laboratory. Just a few hours later you receive a message telling you which vaccine you should get. Your neighbour also signed up for vaccination. But their vaccine is different from yours. </p>
<p>Both of you are now vaccinated and protected, although each of you received your vaccines depending on “who you are”. Your genetics, age, gender, and myriad of other factors are captured in a “model” that predicts and determines the best option to protect you from the virus.</p>
<p>It all sounds a bit like science fiction. But since the <a href="https://www.genome.gov/human-genome-project">decoding of the human genome in 2003</a>, we have entered the age of precision prevention. </p>
<p>New Zealand has a long-standing newborn screening programme. This includes <a href="https://www.auckland.ac.nz/en/news/2023/11/30/newborn-genomic-sequencing-sick-babies.html">genome sequencing machines available nationwide</a> and a <a href="https://www.tewhatuora.govt.nz/our-health-system/genetic-health-service-nz/about/">genetic health service</a>. Programmes such as these open up the possibilities of public health genomics and precision public health for everyone.</p>
<p>The further expansion of these programmes, as well as the expansion of the use of artificial intelligence and machine learning to enable a shift to more personalised preventive care, will change how public health care is delivered.</p>
<p>At the same time, these developments raise wider concerns over individual choice versus the greater good, personal privacy, and who is responsible for the protection of New Zealanders and their health information.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1768051677905707508"}"></div></p>
<h2>What is precision prevention?</h2>
<p>Think of precision prevention (also known as personalised prevention) as public health action tailored to the individual rather than broader groups of society. </p>
<p>This targeted healthcare is achieved by balancing a range of variables (including your genes, life history and environment) with your risks (including everything that changes within you as you grow older). </p>
<p>While advances in genomics are making precision prevention possible, machine learning algorithms fuelled by our personal data have made it closer to a reality. </p>
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Read more:
<a href="https://theconversation.com/its-2030-and-precision-medicine-has-changed-health-care-this-is-what-it-looks-like-90539">It's 2030, and precision medicine has changed health care – this is what it looks like</a>
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<p>We generate data about ourselves every day – via social media, smartwatches and other wearable devices – helping to train algorithms to match medical prevention measures with individuals. </p>
<p>Combine all of these with AI-driven predictive modelling, and you have a system that can predict the current and future state of your health with an eerie level of accuracy, and <a href="https://www.forbes.com/sites/forbestechcouncil/2022/01/25/how-ai-could-predict-medical-conditions-and-revive-the-healthcare-system/?sh=362288726c47">help you take steps to prevent disease</a>. </p>
<h2>Safety and delay</h2>
<p>The Prime Minister’s Chief Science Advisor recently <a href="https://www.pmcsa.ac.nz/artificial-intelligence-2/ai-in-healthcare/">published a report</a> mapping out the landscape of artificial intelligence and machine learning in New Zealand over the next five years. </p>
<p>While the report authors didn’t specifically reference “precision prevention”, they did include examples of this approach, such as <a href="https://edition.cnn.com/2023/08/01/health/ai-breast-cancer-detection/index.html">computer vision augmented mammography</a>. </p>
<p>But as the report suggests, adoption tends to fall behind the pace of innovation in AI. Te Whatu Ora–Health New Zealand has also <a href="https://www.tewhatuora.govt.nz/our-health-system/digital-health/national-ai-and-algorithm-expert-advisory-group-naiaeag-te-whatu-ora-advice-on-the-use-of-large-language-models-and-generative-ai-in-healthcare/">not approved</a> emerging large language models and generative artificial intelligence tools as safe and effective for use in healthcare. </p>
<p>This means generative AI-driven precision prevention practices, such as conversational AI for public health messaging, may have to wait before they can be deemed safe to use. </p>
<h2>Move forward with caution</h2>
<p>There is much to be excited about the prospects of the use of artificial intelligence and machine learning in ushering in a new age of precision prevention and preventive health. But at the same time, we must temper this with caution. </p>
<p>Artificial intelligence and machine learning may increase access and utilisation of healthcare by lowering barriers to medical knowledge and reducing human bias. But government and medical agencies need to reduce barriers related to digital literacy and access to online platforms.</p>
<p>For those with limited access to online resources or who have limited digital literacy, the already existent inequity of access to care and health could worsen. </p>
<p>Artificial intelligence also has a <a href="https://arstechnica.com/gadgets/2023/04/generative-ai-is-cool-but-lets-not-forget-its-human-and-environmental-costs/">significant environmental impact</a>. <a href="https://arxiv.org/pdf/1906.02243.pdf">One study</a> found several common large AI models can emit over 270,000 tonnes of carbon dioxide during their life cycle.</p>
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Read more:
<a href="https://theconversation.com/these-scientists-are-using-dna-to-target-new-drugs-for-your-genes-medicine-made-for-you-part-1-131986">These scientists are using DNA to target new drugs for your genes – Medicine made for you part 1</a>
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<p>Finally, technology is a shifting landscape. Proponents of precision healthcare must be careful with children and marginalised communities and their access to resources. Maintaining privacy and choice is essential – everyone should be in a position to control what they share with the AI agents. </p>
<p>In the end, each of us is different, and we all have our different needs for our health and for our lives. Moving more people to preventive care through precision healthcare will reduce the financial burden on the health system. </p>
<p>But as the report from the prime minister’s chief science officer emphasises, machine learning algorithms are a nascent field. We need more public education and awareness before the technology becomes part of our everyday lives.</p><img src="https://counter.theconversation.com/content/219594/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arindam Basu does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>As New Zealand readies itself for AI-assisted medical treatment targeted to individuals, officials need to ensure the benefits outweigh the risks.Arindam Basu, Associate Professor, Epidemiology and Environmental Health, University of CanterburyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2263032024-03-21T05:48:21Z2024-03-21T05:48:21ZAttempts to access Kate Middleton’s medical records are no surprise. Such breaches are all too common<p>The <a href="https://www.abc.net.au/news/2024-03-20/claim-hospital-staff-tried-to-access-kate-middleton-health-info/103608066">alleged</a> data breach involving Catherine, Princess of Wales tells us something about health privacy. If hospital staff can apparently access a future queen’s medical records without authorisation, it can happen to you. </p>
<p>Indeed it may have already happened to you, given many breaches of health data go under the radar.</p>
<p>Here’s why breaches of health data keep on happening.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1770527635057021383"}"></div></p>
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Read more:
<a href="https://theconversation.com/yes-kate-middletons-photo-was-doctored-but-so-are-a-lot-of-images-we-see-today-225553">Yes, Kate Middleton's photo was doctored. But so are a lot of images we see today</a>
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<h2>What did we learn this week?</h2>
<p>Details of the alleged data breaches, by <a href="https://www.mirror.co.uk/news/royals/breaking-kate-middleton-three-london-32401247">up to three staff</a> at The London Clinic, emerged in the UK media this week. These breaches are alleged to have occurred after the princess had abdominal surgery at the private hospital earlier this year.</p>
<p>The UK Information Commissioner’s Office <a href="https://ico.org.uk/about-the-ico/media-centre/news-and-blogs/2024/03/ico-statement-in-response-to-reports-of-data-breach-at-the-london-clinic/">is investigating</a>. Its report should provide some clarity about what medical data was improperly accessed, in what form and by whom. But it is unlikely to identify whether this data was given to a third party, such as a media organisation.</p>
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Read more:
<a href="https://theconversation.com/after-the-medicare-breach-we-should-be-cautious-about-moving-our-health-records-online-80472">After the Medicare breach, we should be cautious about moving our health records online</a>
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<h2>Health data isn’t always as secure as we’d hope</h2>
<p>Medical records are inherently sensitive, providing insights about individuals and often about biological relatives.</p>
<p>In an ideal world, only the “right people” would have access to these records. These are people who “need to know” that information and are aware of the responsibility of accessing it.</p>
<p>Best practice digital health systems typically try to restrict overall access to databases through hack-resistant firewalls. They also try to limit access to specific types of data through grades of access.</p>
<p>This means a hospital accountant, nurse or cleaner does not get to see everything. Such systems also incorporate blocks or alarms where there is potential abuse, such as unauthorised copying.</p>
<p>But in practice each health records ecosystem – in GP and specialist suites, pathology labs, research labs, hospitals – is less robust, often with fewer safeguards and weaker supervision.</p>
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Read more:
<a href="https://theconversation.com/vaccination-status-when-your-medical-information-is-private-and-when-its-not-168846">Vaccination status – when your medical information is private and when it's not</a>
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<h2>This has happened before</h2>
<p>Large health-care providers and insurers, including major hospitals or chains of hospitals, have a <a href="https://www.theguardian.com/australia-news/2023/dec/22/st-vincents-health-australia-hack-cyberattack-data-stolen-hospital-aged-care-what-to-do">worrying</a> <a href="https://www.afr.com/technology/medical-information-leaked-in-nsw-health-hack-20210608-p57z7k">history</a> of <a href="https://www.innovationaus.com/oaic-takes-pathology-company-to-court-over-data-breach/">digital breaches</a>. </p>
<p>Those breaches include hackers accessing the records of millions of people. The <a href="https://www.theguardian.com/world/2022/nov/11/medical-data-hacked-from-10m-australians-begins-to-appear-on-dark-web">Medibank</a> data breach involved more than ten million people. The <a href="https://www.hipaajournal.com/healthcare-data-breach-statistics/">Anthem</a> data breach in the United States involved more than 78 million people.</p>
<p>Hospitals and clinics have also had breaches specific to a particular individual. Many of those breaches involved unauthorised sighting (and often copying) of hardcopy or digital files, for example by nurses, clinicians and administrative staff. </p>
<p>For instance, this has happened to public figures such as <a href="https://www.latimes.com/archives/la-xpm-2008-mar-15-me-britney15-story.html">singer</a> <a href="https://journals.lww.com/healthcaremanagerjournal/abstract/2009/01000/health_information_privacy__why_trust_matters.11.aspx">Britney Spears</a>, actor <a href="https://www.nytimes.com/2007/10/10/nyregion/10clooney.html">George Clooney</a> and former United Kingdom prime minister <a href="https://www.theguardian.com/uk-news/2024/mar/20/when-fame-and-medical-privacy-clash-kate-and-other-crises-of-confidentiality">Gordon Brown</a>.</p>
<p>Indeed, the Princess of Wales has had her medical privacy breached before, in 2012, while in hospital pregnant with her first child. This was no high-tech hacking of health data.</p>
<p>Hoax callers from an Australian radio station <a href="https://theconversation.com/did-2day-fm-break-the-law-and-does-it-matter-11250">tricked</a> hospital staff into divulging details over the phone of the then Duchess of Cambridge’s health care.</p>
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Read more:
<a href="https://theconversation.com/did-2day-fm-break-the-law-and-does-it-matter-11250">Did 2Day FM break the law? And does it matter?</a>
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<h2>Tip of the iceberg</h2>
<p>Some unauthorised access to medical information goes undetected or is indeed undetectable unless there is an employment dispute or media involvement. Some is identified by colleagues.</p>
<p>Records about your health <em>might</em> have been improperly sighted by someone in the health system. But you are rarely in a position to evaluate the data management of a clinic, hospital, health department or pathology lab. </p>
<p>So we have to trust people do the right thing.</p>
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Read more:
<a href="https://theconversation.com/what-is-hipaa-5-questions-answered-about-the-medical-privacy-law-that-protects-trumps-test-results-and-yours-147805">What is HIPAA? 5 questions answered about the medical privacy law that protects Trump's test results and yours</a>
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<h2>How could we improve things?</h2>
<p>Health professions have long emphasised the need to protect these records. For instance, medical ethics bodies <a href="https://www.bmj.com/content/350/bmj.h2255">condemn</a> medical students who <a href="https://www.abc.net.au/news/2014-04-14/picture-sharing-app-for-doctors-raises-privacy-concerns/5389226">share</a> intimate or otherwise inappropriate images of patients. </p>
<p>Different countries have various approaches to protecting who has access to medical records and under what circumstances.</p>
<p>In Australia, for instance, we have a mix of complex and inconsistent laws that vary across jurisdictions, some covering privacy in general, others specific to health data. There isn’t one comprehensive law and set of standards <a href="https://theconversation.com/governments-privacy-review-has-some-strong-recommendations-now-we-really-need-action-200079">vigorously administered</a> by one well-resourced watchdog.</p>
<p>In Australia, it’s mandatory to report <a href="https://www.oaic.gov.au/privacy/notifiable-data-breaches">data breaches</a>, including breaches of health data. This reporting system is currently <a href="https://theconversation.com/governments-privacy-review-has-some-strong-recommendations-now-we-really-need-action-200079">being updated</a>. But this won’t necessarily prevent data breaches.</p>
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Read more:
<a href="https://theconversation.com/governments-privacy-review-has-some-strong-recommendations-now-we-really-need-action-200079">Government's privacy review has some strong recommendations – now we really need action</a>
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<p>Instead, we need to incentivise Australian organisations to improve how they handle sensitive health data.</p>
<p>The best policy <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1475-4932.12693">nudges</a> involve increasing penalties for breaches. This is so organisations act as responsible custodians rather than negligent owners of health data.</p>
<p>We also need to step-up enforcement of data breaches and make it easier for victims to sue for breaches of privacy – princesses and tradies alike.</p>
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Read more:
<a href="https://theconversation.com/wheres-kate-speculation-about-the-missing-princess-is-proof-the-palaces-media-playbook-needs-a-re-write-225562">Where’s Kate? Speculation about the 'missing' princess is proof the Palace’s media playbook needs a re-write</a>
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<img src="https://counter.theconversation.com/content/226303/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Arnold spent several years as the Australian representative on OECD Health Informatics working parties. He is a former director of the Australian Privacy Foundation</span></em></p>If it can happen to a future queen, it can happen to you. Maybe it already has.Bruce Baer Arnold, Associate Professor, School of Law, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2262232024-03-20T22:21:47Z2024-03-20T22:21:47ZElon Musk says ketamine can get you out of a ‘negative frame of mind’. What does the research say?<p>X owner Elon Musk <a href="https://thenightly.com.au/business/cnbc-elon-musk-suggests-his-prescription-ketamine-use-is-good-for-investors-c-14000709?utm_source=sendgrid&utm_medium=email">recently described</a> using small amounts of ketamine “once every other week” to manage the “chemical tides” that cause his depression. He says it’s helpful to get out of a “negative frame of mind”.</p>
<p>This has caused a range of reactions in the media, including on X (formerly Twitter), from strong support for Musk’s choice of treatment, to allegations he has a drug problem.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1770169081510977939"}"></div></p>
<p>But what exactly is ketamine? And what is its role in the treatment of depression?</p>
<h2>It was first used as an anaesthetic</h2>
<p>Ketamine is a <a href="https://doi.org/10.3389/fnhum.2016.00612">dissociative anaesthetic</a> used in surgery and to relieve pain. </p>
<p>At certain doses, people are awake but are disconnected from their bodies. This makes it useful for paramedics, for example, who can continue to talk to injured patients while the drug blocks pain but without affecting the person’s breathing or blood flow. </p>
<p>Ketamine is also used to sedate animals in veterinary practice. </p>
<p>Ketamine is a mixture of two molecules, usually referred to a S-Ketamine and R-Ketamine.</p>
<p>S-Ketamine, or esketamine, is stronger than R-Ketamine and was approved in 2019 in the United States under the drug name Spravato for serious and long-term <a href="https://doi.org/10.1080/14740338.2022.2066651">depression</a> that has not responded to at least two other types of treatments.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/fda-approves-promising-new-drug-called-esketamine-for-treatment-resistant-depression-111966">FDA approves promising new drug, called esketamine, for treatment-resistant depression</a>
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</em>
</p>
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<p>Ketamine is thought to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6717708/">change chemicals in the brain</a> that affect mood.
While the exact way ketamine works on the brain is not known, scientists think it changes the amount of the neurotransmitter glutamate and therefore changes symptoms of <a href="https://doi.org/10.3389/fnhum.2016.00612">depression</a>. </p>
<h2>How was it developed?</h2>
<p>Ketamine was first synthesised by chemists at the Parke Davis pharmaceutical company in Michigan in the United States as an anaesthetic. It was tested on a group of prisoners at Jackson Prison in Michigan in 1964 and found to be fast acting with <a href="https://pubs.asahq.org/anesthesiology/article/113/3/678/10426/Taming-the-Ketamine-Tiger">few side effects</a>.</p>
<p>The US Food and Drug Administration <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5126726/">approved</a> ketamine as a general anaesthetic in 1970. It is now on the World Health Organization’s core list of essential medicines for health systems worldwide as an <a href="https://www.who.int/publications/i/item/WHO-MHP-HPS-EML-2021.02">anaesthetic drug</a>. </p>
<p>In 1994, following patient reports of improved depression symptoms after surgery where ketamine was used as the anaesthetic, researchers began studying the effects of low doses of ketamine on <a href="https://pubmed.ncbi.nlm.nih.gov/8122957/">depression</a>. </p>
<figure class="align-center ">
<img alt="Depressed woman looks down" src="https://images.theconversation.com/files/583066/original/file-20240320-16-cf5ntq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/583066/original/file-20240320-16-cf5ntq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/583066/original/file-20240320-16-cf5ntq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/583066/original/file-20240320-16-cf5ntq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/583066/original/file-20240320-16-cf5ntq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/583066/original/file-20240320-16-cf5ntq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/583066/original/file-20240320-16-cf5ntq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Researchers have been investigating ketamine for depression for 30 years.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-attractive-latin-woman-lying-home-1147331690">SB Arts Media/Shutterstock</a></span>
</figcaption>
</figure>
<p>The first clinical trial results were <a href="https://www.biologicalpsychiatryjournal.com/article/S0006-3223(99)00230-9/abstract">published in 2000</a>. In the trial, seven people were given either intravenous ketamine or a salt solution over two days. Like the earlier case studies, ketamine was found to reduce symptoms of depression quickly, often within hours and the effects lasted up to seven days. </p>
<p>Over the past 20 years, researchers have studied the effects of ketamine on <a href="https://doi.org/10.1016/j.neuropharm.2022.109305">treatment resistant depression, bipolar disorder</a>, <a href="https://theconversation.com/ketamine-can-rapidly-reduce-symptoms-of-ptsd-and-depression-new-study-finds-216077">post-traumatic sress disorder</a> <a href="https://pubmed.ncbi.nlm.nih.gov/34199023/">obsessive-compulsive disorder, eating disorders and for reducing substance use</a>, with generally positive results. </p>
<p>One study in a <a href="https://www.sciencedirect.com/science/article/pii/S0165032723006110">community clinic</a> providing ketamine intravenous therapy for depression and anxiety found the majority of patients reported improved depression symptoms eight weeks after starting regular treatment.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ketamine-injections-for-depression-a-new-study-shows-promise-but-its-one-of-many-options-209591">Ketamine injections for depression? A new study shows promise, but it's one of many options</a>
</strong>
</em>
</p>
<hr>
<p>While this might sound like a lot of research, it’s not. A <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00304-8/fulltext">recent review</a> of randomised controlled trials conducted up to April 2023 looking at the effects of ketamine for treating depression found only 49 studies involving a total of 3,299 patients worldwide. In comparison, in 2021 alone, there were 1,489 studies being conducted on <a href="https://www.centerwatch.com/articles/25599-oncology-trials-outpacing-rest-of-the-field-in-complexity-and-duration-study-shows#:%7E:text=The%20number%20of%20investigational%20drugs,genetic%20sequencing%20technologies%2C%20CSDD%20says.">cancer drugs</a>. </p>
<h2>Is ketamine prescribed in Australia?</h2>
<p>Even though the research results on ketamine’s effectiveness are encouraging, scientists still don’t really know how it works. That’s why it’s not readily available from GPs in Australia as a standard depression treatment. Instead, ketamine is mostly used in specialised clinics and research centres. </p>
<p>However, the clinical use of ketamine is increasing. <a href="https://www.tga.gov.au/sites/default/files/auspar-esketamine-hydrochloride-210507-pi.pdf">Spravato nasal spray</a> was <a href="https://www.tga.gov.au/resources/auspmd/spravato">approved</a> by the Australian Therapuetic Goods Administration (TGA) in 2021. It must be administered under the <a href="https://adf.org.au/insights/ketamine-treat-depression/">direct supervision</a> of a health-care professional, usually a psychiatrist. </p>
<p>Spravato <a href="https://www.tga.gov.au/resources/auspmd/spravato">dosage</a> and frequency varies for each person. People usually start with three to six doses over several weeks to see how it works, moving to fortnightly treatment as a maintenance dose. The nasal spray <a href="https://www.unsw.edu.au/newsroom/news/2023/10/why-low-cost-ketamine-is-still-inaccessible-to-many-with-severe-">costs</a> <a href="https://www.medicalrepublic.com.au/esketamine-snubbed-by-pbac-again/17835">between A$600 and $900</a> per dose, which will significantly limit many people’s access to the drug. </p>
<p>Ketamine can be prescribed “off-label” by GPs in Australia who can prescribe schedule 8 drugs. This means it is up to the GP to assess the person and their medication needs. But <a href="https://www.medicalrepublic.com.au/caution-as-esketamine-approved-for-depression/4975#:%7E:text=GPs%20and%20other%20clinicians%20can,8%20drug%20poses%20serious%20risks.">experts in the drug</a> recommend caution because of the lack of research into negative side-effects and longer-term effects. </p>
<h2>What about its illicit use?</h2>
<p>Concern about use and misuse of ketamine is heightened by highly publicised deaths connected to the <a href="https://www.pbs.org/newshour/arts/autopsy-report-shows-actor-matthew-perry-died-from-effects-of-ketamine">drug</a>. </p>
<p>Ketamine has been used as a recreational drug since the 1970s. People report it makes them feel euphoric, trance-like, floating and dreamy. However, the amounts used recreationally are typically higher than those used <a href="https://pubmed.ncbi.nlm.nih.gov/16529526/">to treat depression</a>. </p>
<p>Information about deaths due to ketamine is limited. Those that are reported are <a href="https://journals.sagepub.com/doi/10.1177/02698811211021588">due to accidents or ketamine combined with other drugs</a>. No deaths have been reported in <a href="https://pubmed.ncbi.nlm.nih.gov/36410032/">treatment settings</a>.</p>
<h2>Reducing stigma</h2>
<p>Depression is the third leading cause of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6717708/">disability worldwide</a> and effective treatments are needed. </p>
<p>Seeking medical advice about treatment for depression is wiser than taking Musk’s advice on <a href="https://www.washingtonpost.com/wellness/2022/05/04/wellbutrin-elon-musk-antidepressant/">which drugs to use</a>. </p>
<p>However, Musk’s public discussion of his mental health challenges and experiences of treatment has the potential to reduce stigma around depression and help-seeking for mental health conditions. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ketamine-can-rapidly-reduce-symptoms-of-ptsd-and-depression-new-study-finds-216077">Ketamine can rapidly reduce symptoms of PTSD and depression, new study finds</a>
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</em>
</p>
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<p><em>Clarification: this article previously referred to a systematic review looking at oral ketamine to treat depression. The article has been updated to instead cite a review that encompasses other routes of administration as well, such as intravenous and intranasal ketamine.</em></p><img src="https://counter.theconversation.com/content/226223/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julaine Allan receives funding from the Australian Government to conduct research on mental health and substance use interventions, treatments and outcomes. </span></em></p>What exactly is ketamine and what is its role in the treatment of depression?Julaine Allan, Associate Professor, Mental Health and Addiction, Rural Health Research Institute, Charles Sturt UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2253502024-03-20T19:04:14Z2024-03-20T19:04:14ZFeeding young kids on a budget? Parents say the mental load is crushing<figure><img src="https://images.theconversation.com/files/581546/original/file-20240313-24-4oq51f.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C998%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/funny-playful-girl-eating-awkwardly-exasperating-2254525865">Nicoleta Ionescu/Shutterstock</a></span></figcaption></figure><p>Feeding babies and toddlers can be challenging at the best of times. But when families can’t afford enough food, let alone the <a href="https://raisingchildren.net.au/toddlers/nutrition-fitness/daily-food-guides/babies-toddlers-food-groups">recommended</a> range of different coloured <a href="https://theconversation.com/want-your-child-to-eat-more-veggies-talk-to-them-about-eating-the-rainbow-195563">vegetables</a>, or <a href="https://theconversation.com/could-my-child-have-low-iron-and-what-are-my-options-if-they-do-210899">iron-rich</a> meats, it’s tougher still.</p>
<p>In our <a href="https://pubmed.ncbi.nlm.nih.gov/38428454/">recently published</a> research, parents told us how much effort they put in to feeding children when there is little money. </p>
<p>They also told us how the ever-present juggle of budgets and the realities of family life strained relationships and increased their mental load.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/im-scared-we-wont-have-money-for-food-how-children-cope-with-food-insecurity-in-australia-161671">'I'm scared we won't have money for food': how children cope with food insecurity in Australia</a>
</strong>
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<h2>Living in poverty</h2>
<p>In the cost of living crisis, <a href="https://povertyandinequality.acoss.org.au/wp-content/uploads/2023/03/Poverty-in-Australia-2023_Who-is-affected.pdf">one in six</a> Australian children live in poverty. More families than ever are <a href="https://urldefense.com/v3/__https://www.aph.gov.au/DocumentStore.ashx?id=c1c0ba46-9dee-4128-b5bd-642d64416711&subId=732384__;!!NVzLfOphnbDXSw!FaAwkb1CMQGRU78jYbQ7klcS518qR07p-sL7r0IdFjFR0oIvQW_Y5TtV6owVwShkoUFAswDX4TwfUZLVyA84nGGR-YM$">seeking help</a> from food banks.</p>
<p>So we asked parents what it was like to feed young children when money was tight. We interviewed 29 Australian parents with at least one child between six months and three years old. Most had an income around or below the poverty line. </p>
<p>The average age of parents was 32 years, including 28 mothers and one father. This is what they told us.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/successful-failures-the-problem-with-food-banks-86546">'Successful failures' – the problem with food banks</a>
</strong>
</em>
</p>
<hr>
<h2>Family tensions rise</h2>
<p>Families’ financial position was precarious, with little buffer to cope with more financial strain. One parent told us:</p>
<blockquote>
<p>We’re still on the one income […] We try and get a lot of free vegetables from the food banks and whatnot. We’ve borrowed money in the past, but the main thing we do is make sure [our child’s] food is fine.</p>
</blockquote>
<p>This uncertainty about money flowed into relationship tension, and stress about food waste and the food bill. Another parent, who said they had lost weight due to not eating proper meals, told us:</p>
<blockquote>
<p>Things have been tense, and [my partner’s] pretty upset about outgoing money for [food …].</p>
</blockquote>
<p>There was also strain when young children created a mess with food or threw it on the floor:</p>
<blockquote>
<p>But then my partner’s like ‘why are you buying that bunch of bananas? Most of it’s, like, in his hair.’ As trivial as it might sound to some households, [it] caused a lot of stress in ours.</p>
</blockquote>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/581548/original/file-20240313-22-42xeqb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Mum with toddler on lap offering banana" src="https://images.theconversation.com/files/581548/original/file-20240313-22-42xeqb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/581548/original/file-20240313-22-42xeqb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581548/original/file-20240313-22-42xeqb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581548/original/file-20240313-22-42xeqb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581548/original/file-20240313-22-42xeqb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581548/original/file-20240313-22-42xeqb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581548/original/file-20240313-22-42xeqb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">More banana can end up in a child’s hair than in the mouth. And that can cause stress.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/adorable-baby-funny-face-while-trying-1587936844">Joaquin Corbalan P/Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-many-australians-are-going-hungry-we-dont-know-for-sure-and-thats-a-big-part-of-the-problem-195360">How many Australians are going hungry? We don't know for sure, and that's a big part of the problem</a>
</strong>
</em>
</p>
<hr>
<h2>Making trade-offs and sacrifices</h2>
<p>Parents described feeding the family as a difficult balance. They put the needs of children and partners first. They often hid their sacrifices from their partners. One parent told us:</p>
<blockquote>
<p>My partner doesn’t miss out anywhere near as much as what I do. He doesn’t know that either. […] But there is many, many, many days where I will go without a meal.</p>
</blockquote>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-home-brand-foods-healthy-if-you-read-the-label-you-may-be-pleasantly-surprised-189445">Are home-brand foods healthy? If you read the label, you may be pleasantly surprised</a>
</strong>
</em>
</p>
<hr>
<h2>The unseen mental load</h2>
<p>Not having enough money increased the load caused by the thinking, planning and emotional strain of getting enough food to feed everyone. One participant said:</p>
<blockquote>
<p>It’s always there in the back of my mind […], what would I do if I really didn’t have anything left to feed all of us.</p>
</blockquote>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-asked-same-gender-couples-how-they-share-the-mental-load-at-home-the-results-might-surprise-you-208667">We asked same-gender couples how they share the 'mental load' at home. The results might surprise you</a>
</strong>
</em>
</p>
<hr>
<h2>Resilience and creativity</h2>
<p>Parents described multiple strategies to make the most of the food they had. </p>
<blockquote>
<p>We will now go to the fruit and vegetable shop that’s quite far away from our house because it’s cheaper to buy it in bulk [… We] pre-plan, absolutely, and meal plan.</p>
</blockquote>
<p>Despite hardships, parents adapted to challenges by being creative with food and cooking. One parent said:</p>
<blockquote>
<p>In the last food parcel I got there was this big bag of polenta, […] you don’t want to be wasteful […]. I’ll look at […] simple recipes that have that ingredient […] and go from there.</p>
</blockquote>
<p>Parents valued mealtimes as family time, to connect and share. Parents tried to make the most of their situation and remember that when it comes to meals, “basic doesn’t mean bad”.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-we-overthinking-family-meals-5-realistic-tips-to-ease-the-pressure-200731">Are we overthinking family meals? 5 realistic tips to ease the pressure</a>
</strong>
</em>
</p>
<hr>
<h2>What does this mean for supporting families?</h2>
<p>Health professionals working with parents need to know many struggle to feed their family. It’s not just a matter of budgeting or cooking; parents already do that. The high mental load parents experience needs to be recognised. Programs and support should be accessible, brief and realistic.</p>
<p><a href="https://raisingchildren.net.au/toddlers/nutrition-fitness/common-concerns/toddler-not-eating">Common advice</a>, such as offering food many times and providing variety to children, may need to be adapted. Variety could be sourced from foods on special, and food waste reduced by offering small amounts of new foods at first.</p>
<p>We also need to ensure the food offered in childcare centres is <a href="https://www.mdpi.com/2072-6643/12/4/968">adequate and healthy</a>. Providing good-quality <a href="https://theconversation.com/australian-schools-are-starting-to-provide-food-but-we-need-to-think-carefully-before-we-ditch-the-lunchbox-193536">school meals</a> would relieve the pressure on parents to supply a healthy lunchbox, or give money for the canteen. This would give all Australian children the chance to enjoy a variety of nutritious foods, regardless of their situation at home.</p>
<hr>
<p><em>We would like to thank the families who so generously shared their time and stories with us. We also acknowledge our research team: Smita Nambiar-Mann, Robyn Penny and Danielle Gallegos.</em></p><img src="https://counter.theconversation.com/content/225350/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kimberley Baxter receives funding from a grant from the Children's Hospital Foundation (Reference number WCCNR03). She is a
member of Dietitians Australia. </span></em></p><p class="fine-print"><em><span>Rebecca Byrne receives funding from the National Health and Medical Research Council, the Australian Research Council and the Children's Hospital Foundation. </span></em></p>Parents told us how the ever-present juggle of budgets and the realities of family life strained relationships and increased their mental load.Kimberley Baxter, Research Fellow, Centre for Childhood Nutrition Research, Queensland University of TechnologyRebecca Byrne, Dietitian and Lecturer, Queensland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2249622024-03-20T00:08:53Z2024-03-20T00:08:53ZNow you can get UTI antibiotics from pharmacies without prescription. Here’s what to know<figure><img src="https://images.theconversation.com/files/581151/original/file-20240312-29-6jfwhi.jpg?ixlib=rb-1.1.0&rect=18%2C37%2C6164%2C4078&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pharmacist-giving-medicine-box-customer-pharmacy-1785830159">Shutterstock</a></span></figcaption></figure><p>Urinary tract infections can be a minor medical annoyance or lead to a hospital stay – especially for older people.</p>
<p>If you think you might have a urinary tract infection (UTI) you need prompt advice and often antibiotics. But it can be <a href="https://www.abc.net.au/news/2023-06-21/urgent-gp-appointments-difficult-to-get-in-regional-rural-areas/102496354">difficult to get an appointment</a> with your doctor at short notice, especially in rural areas. </p>
<p>Now trained <a href="https://www.guild.org.au/guild-branches/wa/business-support/uti">pharmacists</a> in most Australian states are able to review your symptoms and supply antibiotics if appropriate. </p>
<p>But there are still times when you should see a doctor.</p>
<h2>What is a UTI? And when is it serious?</h2>
<p>The <a href="https://training.seer.cancer.gov/anatomy/urinary/components/">urinary tract</a> consists of the kidneys, ureters, and bladder and urethra. It’s the body system responsible for producing, storing and removing urine from the body. </p>
<p>When bacteria invade the urinary system – mostly from the bowel or the skin – they can multiply and cause infection. </p>
<p>Roughly <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502976/">half of all women</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502976/">one in 20 men</a> will have a UTI at least once in their lifetime. The risk increases with age. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502976/">One in ten</a> postmenopausal women report having a UTI in the last year.</p>
<p>Typical signs of infection include a painful or burning sensation when urinating, feeling like you need to urinate urgently and often and cloudy or foul-smelling urine. In more severe cases symptoms can include fever, lethargy and pain in the lower back. </p>
<p>In older adults, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9827929/#:%7E:text=Delirium%20is%20a%20common%20atypical,and%20complex%20relationship%20between%20them.">UTIs can cause confusion, agitation and falls</a>.</p>
<p>For some people, UTIs can have <a href="https://www.ncbi.nlm.nih.gov/books/NBK482344/">serious complications</a>, such as kidney damage, kidney failure or infection in the blood (sepsis), particularly if treatment is delayed. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-do-i-keep-getting-urinary-tract-infections-and-why-are-chronic-utis-so-hard-to-treat-223008">Why do I keep getting urinary tract infections? And why are chronic UTIs so hard to treat?</a>
</strong>
</em>
</p>
<hr>
<h2>A common reason for hospital admission</h2>
<p>UTIs are the <a href="https://www.safetyandquality.gov.au/our-work/healthcare-variation/fourth-atlas-2021/chronic-disease-and-infection-potentially-preventable-hospitalisations/24-kidney-infections-and-urinary-tract-infections">second most common</a> cause of preventable hospital visits in Australia. Across the country they are <a href="https://outbreakproject.com.au/2020/11/17/australias-multi-billion-dollar-superbug-crisis/">reported</a> to result in 100,000 emergency department visits and 75,000 hospital stays each year. </p>
<p>The rate of hospitalisation for UTIs for Aboriginal and Torres Strait Islander people is around <a href="https://www.safetyandquality.gov.au/our-work/healthcare-variation/fourth-atlas-2021/chronic-disease-and-infection-potentially-preventable-hospitalisations/24-kidney-infections-and-urinary-tract-infections">double</a> the rate for other Australians. People aged over 65 years are <a href="https://www.safetyandquality.gov.au/our-work/healthcare-variation/fourth-atlas-2021/chronic-disease-and-infection-potentially-preventable-hospitalisations/24-kidney-infections-and-urinary-tract-infections">five times</a> more likely to be hospitalised with a UTI than younger Australians.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/581162/original/file-20240312-26-vuano6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="older woman sits on couch and shows pained expression, clutches lower stomach" src="https://images.theconversation.com/files/581162/original/file-20240312-26-vuano6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/581162/original/file-20240312-26-vuano6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581162/original/file-20240312-26-vuano6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581162/original/file-20240312-26-vuano6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581162/original/file-20240312-26-vuano6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581162/original/file-20240312-26-vuano6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581162/original/file-20240312-26-vuano6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Older people are much more likely to be hospitalised with a UTI.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/asian-elderly-senior-woman-stomach-ache-2391031945">Shutterstock</a></span>
</figcaption>
</figure>
<h2>A quicker option</h2>
<p>The newly rolled out pharmacist consultations do not replace the option of visiting your GP. But they do provide an additional choice.</p>
<p>In <a href="https://statements.qld.gov.au/statements/95679">Queensland</a>, <a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+programs+and+practice+guidelines/medicines+and+drugs/sa+community+pharmacy+uti+services/sa+community+pharmacy+uti+services#:%7E:text=From%201%20March%202024%2C%20eligible,a%20prescription%20from%20a%20doctor.">South Australia</a> and <a href="https://www.health.wa.gov.au/Articles/S_T/Treatment-of-urinary-tract-infection-by-pharmacists">Western Australia</a> the legislation has been changed to allow pharmacists to supply antibiotics to treat women (or people with female anatomy) aged 18 to 65 years with uncomplicated UTIs.</p>
<p>In <a href="https://www.health.nsw.gov.au/pharmaceutical/Pages/pharmacy-trial-uti.aspx">New South Wales</a>, the <a href="https://www.health.act.gov.au/health-professionals/pharmaceutical-services/act-pharmacy-uti-and-oral-contraceptive-pill-trial">ACT</a>, <a href="https://www.premier.vic.gov.au/pharmacists-delivering-accessible-health-care-victorians">Victoria</a> and <a href="https://www.health.tas.gov.au/pharmacyscope">Tasmania</a> trials allowing pharmacists to treat UTIs in the same patient group are underway or have been announced.</p>
<p>This approach to provide accessible and timely treatment options for UTIs through pharmacies aligns with that in <a href="https://www.psnz.org.nz/healthservices/utis">New Zealand</a>, the <a href="https://www.england.nhs.uk/long-read/launch-of-nhs-pharmacy-first-advanced-service/">United Kingdom</a> and <a href="https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwibvafH0OOEAxV4plYBHU9RBeEQFnoECBsQAQ&url=https%3A%2F%2Fwww.pharmacists.ca%2Fcpha-ca%2Fassets%2FFile%2Feducation-practice-resources%2FUncomplicated_UTI.pdf&usg=AOvVaw1E6EnFunmJRdVF8wD_AxuN&opi=89978449">Canada</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cranberry-juice-can-prevent-recurrent-utis-but-only-for-some-people-203926">Cranberry juice can prevent recurrent UTIs, but only for some people</a>
</strong>
</em>
</p>
<hr>
<h2>Not for everyone</h2>
<p>State guidelines direct pharmacists to only provide antibiotics to women (or people with female anatomy) aged 18 to 65 years with uncomplicated UTIs. If the pharmacist finds warning signs for a serious infection, or a complicated UTI, you will be referred for further consultation with a doctor. </p>
<p>Under this program, UTIs that occur in people who have an anatomically male urinary tract, are under 18 years or over 65, or are pregnant would be considered to have complicated UTIs, and such patients would be referred to their doctor.</p>
<p>Some other situations where UTIs are considered <a href="https://www.health.wa.gov.au/Articles/S_T/Treatment-of-urinary-tract-infection-by-pharmacists">complicated</a> and should be assessed by a doctor include when they occur in people with kidney disease, urinary catheters, a condition that weakens the immune system (such as diabetes, cancer or HIV) or reoccurring symptoms. </p>
<p>To supply antibiotics for UTI treatment pharmacists are required to undertake additional training. Pharmacists can only prescribe antibiotics according to an agreed evidence-based treatment guideline, <a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/b52bbef1-4fed-4502-96ed-3ebf97ebdee1/Community+Pharmacy+UTI+Service+SA+Management+Protocol+-+Final1.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-b52bbef1-4fed-4502-96ed-3ebf97ebdee1-oRYPyBR">such as South Australia’s</a>. </p>
<p>Pharmacists will assess if you are eligible for the pharmacy UTI service and ask specific questions to check your symptoms match those of an uncomplicated UTI or for warning signs you need to see a doctor. If treatment is appropriate, they will ask questions about your medical and medication history to determine which type of antibiotic is most suitable for you.</p>
<p>Pharmacists will not test urine for bacteria, as Australian guidelines state antibiotic treatment <a href="https://tgldcdp.tg.org.au/searchAction?appendedinputbuttons=UTI">can be started</a> for women with uncomplicated UTIs straight away. If your symptoms or history suggest urine testing might be required the pharmacist will refer you to a doctor. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/581161/original/file-20240312-22-r54i0o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="medical clinicians holds urine test and indicator" src="https://images.theconversation.com/files/581161/original/file-20240312-22-r54i0o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/581161/original/file-20240312-22-r54i0o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581161/original/file-20240312-22-r54i0o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581161/original/file-20240312-22-r54i0o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581161/original/file-20240312-22-r54i0o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581161/original/file-20240312-22-r54i0o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581161/original/file-20240312-22-r54i0o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Pharmacists won’t test urine samples.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doctor-doing-test-strip-labstix-urine-1493181821">Shutterstock</a></span>
</figcaption>
</figure>
<p>You can get a record of the consultation that you can share with your doctor. The requirements for documentation differ in different states but pharmacists can upload information to <a href="https://www.digitalhealth.gov.au/initiatives-and-programs/my-health-record">My Health Record</a> (if you haven’t opted out and are happy for them to do so).</p>
<p>This new service is not without <a href="https://theconversation.com/should-pharmacists-be-able-to-prescribe-common-medicines-like-antibiotics-for-utis-we-asked-5-experts-195277">controversy</a>. GPs have expressed concerns about misdiagnosis and <a href="https://theconversation.com/do-you-really-need-antibiotics-curbing-our-use-helps-fight-drug-resistant-bacteria-217920">antimicrobial resistance</a> where the bacteria could evolve and become much harder to treat. Detailed procedures have been developed for pharmacists to minimise these risks. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/do-you-really-need-antibiotics-curbing-our-use-helps-fight-drug-resistant-bacteria-217920">Do you really need antibiotics? Curbing our use helps fight drug-resistant bacteria</a>
</strong>
</em>
</p>
<hr>
<h2>What else can you do?</h2>
<p>While taking antibiotics to <a href="https://www.healthdirect.gov.au/urinary-tract-infection-uti">treat a UTI</a> you should also <a href="https://www.continence.org.au/urinary-tract-infection-uti">drink lots of water</a> and ensure you empty your bladder completely every time you go to the toilet.</p>
<p>Pain relievers can help ease discomfort from a UTI. But it’s important to speak with your pharmacist or doctor to find the best pain management option for you.</p><img src="https://counter.theconversation.com/content/224962/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jacinta L. Johnson is employed as the Senior Pharmacist for Research within SA Pharmacy and is a Board Director for the Society of Hospital Pharmacists of Australia. In the last five years, she has received research funding or consultancy funds (for development and delivery of educational materials) from SA Health, the Medical Research Future Fund, the Hospital Research Foundation – Parkinson's, the Pharmaceutical Society of Australia, the Pharmacy Guild of Australia, the Society of Hospital Pharmacists of Australia, the Australian College of Pharmacy, Mundipharma Pty Ltd, Aspen Pharmacare Australia Pty Ltd, Reckitt Benckiser (Australia) Pty Ltd and Viatris Pty Ltd. Jacinta has not received funding from any organisation related to pharmacist consultations for provision of antibiotics for urinary tract infections.</span></em></p><p class="fine-print"><em><span>Wern Chai does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Older people and Aboriginal and Torres Strait Islander people are at much greater risk of hospitalisation from UTI. Prompt medical care is important.Jacinta L. Johnson, Senior Lecturer in Pharmacy Practice, University of South AustraliaWern Chai, Lecturer in Pharmacy and Pharmacology, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2235442024-03-19T19:45:12Z2024-03-19T19:45:12ZHalf of Australians in aged care have depression. Psychological therapy could help<figure><img src="https://images.theconversation.com/files/581494/original/file-20240313-16-lmeqav.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5991%2C3997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/elderly-woman-sitting-on-wheelchair-looking-2033086775">sasirin pamai/Shutterstock</a></span></figcaption></figure><p>While many people maintain positive emotional wellbeing as they age, around half of older Australians living in residential aged care have <a href="https://research.sahmri.org.au/en/publications/the-prevalence-trends-and-determinants-of-mental-health-disorders">significant levels of depression</a>. Symptoms such as low mood, lack of interest or pleasure in life and difficulty sleeping are common. </p>
<p>Rates of depression in aged care appear to be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8251748/">increasing</a>, and without adequate treatment, symptoms can be enduring and significantly impair older adults’ quality of life. </p>
<p>But only a minority of aged care residents with depression receive services specific to the condition. Less than 3% of Australian aged care residents access <a href="https://static1.squarespace.com/static/5b8c84fc4cde7abe6c3e7d7c/t/637af471f1a9621ed169fc24/1669002355850/Gov+mental+Health+infographic+FINAL_19-10-2022.pdf">Medicare-subsidised mental health services</a>, such as consultations with a psychologist or psychiatrist, each year. </p>
<figure class="align-center ">
<img alt="An infographic showing the percentage of Australian aged care residents with depression (53%)." src="https://images.theconversation.com/files/582461/original/file-20240318-16-8nfghk.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/582461/original/file-20240318-16-8nfghk.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=476&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582461/original/file-20240318-16-8nfghk.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=476&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582461/original/file-20240318-16-8nfghk.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=476&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582461/original/file-20240318-16-8nfghk.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=598&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582461/original/file-20240318-16-8nfghk.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=598&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582461/original/file-20240318-16-8nfghk.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=598&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Cochrane Australia</span></span>
</figcaption>
</figure>
<p>Instead, residents are typically prescribed a medication by their GP to manage their mental health, which they often take for several months or years. A <a href="https://www.jamda.com/article/S1525-8610(24)00082-3/abstract">recent study</a> found six in ten Australian aged care residents take antidepressants.</p>
<p>While antidepressant medications may help many people, we lack robust evidence on whether they work for <a href="https://www.jamda.com/article/S1525-8610(11)00306-9/abstract">aged care residents with depression</a>. Researchers <a href="https://academic.oup.com/biomedgerontology/article/77/5/1055/6425112">have described</a> “serious limitations of the current standard of care” in reference to the widespread use of antidepressants to treat frail older people with depression.</p>
<p>Given this, we wanted to find out whether psychological therapies can help manage depression in this group. These treatments address factors contributing to people’s distress and provide them with skills to manage their symptoms and improve their day-to-day lives. But to date researchers, care providers and policy makers haven’t had clear information about their effectiveness for treating depression among older people in residential aged care. </p>
<p>The good news is the <a href="https://www.cochranelibrary.com/web/cochrane/content?templateType=full&urlTitle=/cdsr/doi/10.1002/14651858.CD013059.pub2&doi=10.1002/14651858.CD013059.pub2&type=cdsr&contentLanguage=es">evidence we published today</a> suggests psychological therapies may be an effective approach for people living in aged care. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-are-so-many-australians-taking-antidepressants-221857">Why are so many Australians taking antidepressants?</a>
</strong>
</em>
</p>
<hr>
<h2>We reviewed the evidence</h2>
<p>Our research team searched for randomised controlled trials published over the past 40 years that were designed to test the effectiveness of psychological therapies for depression among aged care residents 65 and over. We identified 19 trials from seven countries, including Australia, involving a total of 873 aged care residents with significant symptoms of depression.</p>
<p>The studies tested several different kinds of psychological therapies, which we classified as cognitive behavioural therapy (CBT), behaviour therapy or reminiscence therapy. </p>
<p>CBT involves teaching practical skills to help people re-frame negative thoughts and beliefs, while behaviour therapy aims to modify behaviour patterns by encouraging people with depression to engage in pleasurable and rewarding activities. Reminiscence therapy supports older people to reflect on positive or shared memories, and helps them find meaning in their life history.</p>
<p>The therapies were delivered by a range of professionals, including psychologists, social workers, occupational therapists and trainee therapists. </p>
<figure class="align-center ">
<img alt="An infographic depicting what the researchers measured in the review." src="https://images.theconversation.com/files/582462/original/file-20240318-26-4oweov.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/582462/original/file-20240318-26-4oweov.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=486&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582462/original/file-20240318-26-4oweov.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=486&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582462/original/file-20240318-26-4oweov.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=486&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582462/original/file-20240318-26-4oweov.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=611&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582462/original/file-20240318-26-4oweov.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=611&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582462/original/file-20240318-26-4oweov.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=611&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Cochrane Australia</span></span>
</figcaption>
</figure>
<p>In these studies, psychological therapies were compared to a control group where the older people did not receive psychological therapy. In most studies, this was “usual care” – the care typically provided to aged care residents, which may include access to antidepressants, scheduled activities and help with day-to-day tasks. </p>
<p>In some studies psychological therapy was compared to a situation where the older people received extra social contact, such as visits from a volunteer or joining in a discussion group.</p>
<h2>What we found</h2>
<p>Our results showed psychological therapies may be effective in reducing symptoms of depression for older people in residential aged care, compared with usual care, with effects lasting up to six months. While we didn’t see the same effect beyond six months, only two of the studies in our review followed people for this length of time, so the data was limited.</p>
<p>Our findings suggest these therapies may also improve quality of life and psychological wellbeing. </p>
<p>Psychological therapies mostly included between two and ten sessions, so the interventions were relatively brief. This is positive in terms of the potential feasibility of delivering psychological therapies at scale. The three different therapy types all appeared to be effective, compared to usual care. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/too-many-australians-living-in-nursing-homes-take-their-own-lives-92112">Too many Australians living in nursing homes take their own lives</a>
</strong>
</em>
</p>
<hr>
<p>However, we found psychological therapy may not be more effective than extra social contact in reducing symptoms of depression. Older people commonly feel bored, lonely and socially isolated in aged care. The activities on offer are often <a href="https://onlinelibrary.wiley.com/doi/10.1111/jocn.14978">inadequate</a> to meet their needs for stimulation and interest. So identifying ways to increase meaningful engagement day-to-day could improve the mental health and wellbeing of older people in aged care.</p>
<h2>Some limitations</h2>
<p>Many of the studies we found were of relatively poor quality, because of small sample sizes and potential risk of bias, for example. So we need more high-quality research to increase our confidence in the findings.</p>
<p>Many of the studies we reviewed were also old, and important gaps remain. For example, we are yet to understand the effectiveness of psychological therapies for people from diverse cultural or linguistic backgrounds. </p>
<p>Separately, we need better research to evaluate the effectiveness of antidepressants among aged care residents.</p>
<h2>What needs to happen now?</h2>
<p>Depression should not be considered a “normal” experience at this (or any other) stage of life, and those experiencing symptoms should have equal access to a range of effective treatments. The <a href="https://www.royalcommission.gov.au/system/files/2021-03/final-report-volume-2.pdf">royal commission into aged care</a> highlighted that Australians living in aged care don’t receive enough mental health support and called for this issue to be addressed.</p>
<p>While there have been some efforts to provide <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajag.12895">psychological services</a> in residential aged care, the unmet need remains very high, and much more must be done. </p>
<p>The focus now needs to shift to how to implement psychological therapies in aged care, by increasing the competencies of the aged care workforce, training the next generation of psychologists to work in this setting, and funding these programs in a cost-effective way. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-our-residential-aged-care-system-doesnt-care-about-older-peoples-emotional-needs-103336">How our residential aged-care system doesn't care about older people's emotional needs</a>
</strong>
</em>
</p>
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<img src="https://counter.theconversation.com/content/223544/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tanya Davison currently receives research funding from the Medical Research Future Fund (MRFF), Australian Research Council (ARC), and Aged Care Research and Industry Innovation Australia (ARIIA). She is employed as Director of Research Discovery at Silverchain (an Australian in-home care provider) and is a committee member of the Australian Psychological Society (APS) Psychology and Ageing Interest Group. </span></em></p><p class="fine-print"><em><span>Sunil Bhar currently receives research funding from the Medical Research Future Fund (MRFF), Australian Research Council (ARC), National Health and Medical Research Council (NHMRC), Aged Care Research and Industry Innovation Australia (ARIIA), The Ian Potter Foundation (IPF) and Arcare Family Foundation (AFF). He is the Director of the Swinburne Wellbeing Clinic for Older Adults (a free counselling service for aged care residents) and is employed as Professor of Clinical Psychology at Swinburne University. He is a committee member of the Australian Psychological Society (APS) Psychology and Ageing Interest Group.</span></em></p>A new review looks at whether psychological therapies, such as cognitive behavioural therapy, are an effective way to treat older people in aged care with symptoms of depression.Tanya Davison, Adjunct professor, Health & Ageing Research Group, Swinburne University of TechnologySunil Bhar, Professor of Clinical Psychology, Swinburne University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2258802024-03-19T04:27:53Z2024-03-19T04:27:53ZWhy scrapping the term ‘long COVID’ would be harmful for people with the condition<figure><img src="https://images.theconversation.com/files/582695/original/file-20240319-28-gsqe8u.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6000%2C3988&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/lonely-young-woman-feeling-depressed-stressed-636183893">kitzcorner/Shutterstock</a></span></figcaption></figure><p>The assertion from Queensland’s chief health officer <a href="https://www.abc.net.au/news/2024-03-15/long-covid-symptoms-queensland-chief-health-officer-john-gerrard/103587836">John Gerrard</a> that it’s time to stop using the term “long COVID” has made waves in <a href="https://www.theaustralian.com.au/breaking-news/long-covid-should-be-scrapped-over-fears-its-probably-harmful-qld-chief-health-officer/news-story/61d3a2328dbfb0e3e0a79b02474bac3e">Australian</a> and <a href="https://nypost.com/2024/03/14/lifestyle/no-such-thing-as-long-covid-health-agency-says-in-shock-claim-unnecessary-fear/">international media</a> over recent days.</p>
<p>Gerrard’s comments were related to <a href="https://www.eurekalert.org/news-releases/1037611">new research</a> from his team finding long-term symptoms of COVID are similar to the ongoing symptoms following other viral infections.</p>
<p>But there are limitations in this research, and problems with Gerrard’s argument we should drop the term “long COVID”. Here’s why.</p>
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<h2>A bit about the research</h2>
<p>The study involved texting a survey to 5,112 Queensland adults who had experienced respiratory symptoms and had sought a PCR test in 2022. Respondents were contacted 12 months after the PCR test. Some had tested positive to COVID, while others had tested positive to influenza or had not tested positive to either disease. </p>
<p>Survey respondents were asked if they had experienced ongoing symptoms or any functional impairment over the previous year. </p>
<p>The study found people with respiratory symptoms can suffer long-term symptoms and impairment, regardless of whether they had COVID, influenza or another respiratory disease. These symptoms are often referred to as “post-viral”, as they linger after a viral infection. </p>
<p>Gerrard’s research will be presented in April at the European Congress of Clinical Microbiology and Infectious Diseases. It hasn’t been published in a peer-reviewed journal.</p>
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<strong>
Read more:
<a href="https://theconversation.com/i-have-covid-how-likely-am-i-to-get-long-covid-218808">I have COVID. How likely am I to get long COVID?</a>
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<p>After the research was publicised last Friday, some experts highlighted flaws in the study design. For example, <a href="https://www.msn.com/en-au/news/australia/co-lead-of-long-covid-clinic-says-qld-study-on-covid-is-an-unusual-approach-to-public-health/vi-BB1jV5oA#details">Steven Faux</a>, a long COVID clinician interviewed on ABC’s television news, said the study excluded people who were hospitalised with COVID (therefore leaving out people who had the most severe symptoms). He also noted differing levels of vaccination against COVID and influenza may have influenced the findings. </p>
<p>In addition, Faux pointed out the survey would have excluded many older people who may not use smartphones.</p>
<p>The authors of the research have acknowledged some of these and other limitations in their study.</p>
<h2>Ditching the term ‘long COVID’</h2>
<p>Based on the research findings, <a href="https://www.eurekalert.org/news-releases/1037611">Gerrard said in a press release</a>: </p>
<blockquote>
<p>We believe it is time to stop using terms like ‘long COVID’. They wrongly imply there is something unique and exceptional about longer term symptoms associated with this virus. This terminology can cause unnecessary fear, and in some cases, hypervigilance to longer symptoms that can impede recovery.</p>
</blockquote>
<p>But Gerrard and his team’s findings cannot substantiate these assertions. Their survey only documented symptoms and impairment after respiratory infections. It didn’t ask people how fearful they were, or whether a term such as long COVID made them especially vigilant, for example.</p>
<figure class="align-center ">
<img alt="A man sits on a bed, appears exhausted." src="https://images.theconversation.com/files/582697/original/file-20240319-18-aci07e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/582697/original/file-20240319-18-aci07e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582697/original/file-20240319-18-aci07e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582697/original/file-20240319-18-aci07e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582697/original/file-20240319-18-aci07e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582697/original/file-20240319-18-aci07e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582697/original/file-20240319-18-aci07e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Tens of thousands of Australians, and millions of people worldwide, have long COVID.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/depressed-overweight-man-on-bed-home-1575723550">New Africa/Shutterstock</a></span>
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<p>In discussing Gerrard’s conclusions about the terminology, Faux noted that even if only 3% of people develop long COVID (the survey found 3% of people had functional limitations after a year), this would equate to some 150,000 Queenslanders with the condition. He <a href="https://www.msn.com/en-au/news/australia/co-lead-of-long-covid-clinic-says-qld-study-on-covid-is-an-unusual-approach-to-public-health/vi-BB1jV5oA#details">said</a>:</p>
<blockquote>
<p>To suggest that by not calling it long COVID you would be […] somehow helping those people not to focus on their symptoms is a curious conclusion from that study.</p>
</blockquote>
<p>Another clinician and researcher, Philip Britton, <a href="https://www.scimex.org/newsfeed/expert-reaction-long-covid-may-be-no-different-to-other-long-term-virus-effects">criticised Gerrard’s conclusion</a> about the language as “overstated and potentially unhelpful”. He noted the term “long COVID” is recognised by the World Health Organization as a valid description of the condition.</p>
<h2>A cruel irony</h2>
<p>An <a href="https://www.science.org/doi/full/10.1126/science.adl0867">ever-growing body of research</a> continues to show how COVID can cause harm to the body across organ systems and cells. </p>
<p>We know from the experiences shared by people with long COVID that the condition can be highly disabling, preventing them from engaging in study <a href="https://www.sbs.com.au/news/article/daniel-has-long-covid-it-has-cost-him-more-than-100-000/j8e18pxji">or paid work</a>. It can also harm relationships with their friends, family members, and <a href="https://www.abc.net.au/news/2023-12-27/long-covid-mecfs-health-damaging-relationships-crisis/103205564">even their partners</a>.</p>
<p>Despite all this, people with long COVID have often felt gaslit and unheard. When seeking treatment from health-care professionals, many people with long COVID report they have been <a href="http://bmjopen.bmj.com/content/12/1/e050979.abstract">dismissed</a> or turned away. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/social-media-activism-trucker-caps-the-fascinating-story-behind-long-covid-168465">Social media, activism, trucker caps: the fascinating story behind long COVID</a>
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<p>Last Friday – the day Gerrard’s comments were made public – was actually <a href="https://www.longcovidawareness.life/">International Long COVID Awareness Day</a>, organised by activists to draw attention to the condition. </p>
<p>The response from people with long COVID was immediate. They shared their anger <a href="https://twitter.com/SMpwrgr/status/1768456837861618005?s=20">on social media</a> about Gerrard’s comments, especially their timing, on a day designed to generate greater recognition for their illness.</p>
<p>Since the start of the COVID pandemic, patient communities have <a href="https://pubmed.ncbi.nlm.nih.gov/35307048/">fought for recognition</a> of the long-term symptoms many people faced. </p>
<p>The term “<a href="https://theconversation.com/social-media-activism-trucker-caps-the-fascinating-story-behind-long-covid-168465">long COVID</a>” was in fact coined by people suffering persistent symptoms after a COVID infection, who were seeking words to describe what they were going through. </p>
<p>The role people with long COVID have played in defining their condition and bringing medical and public attention to it demonstrates <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850205/">the possibilities of patient-led expertise</a>. For decades, people with invisible or “silent” conditions such as ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) have had to fight ignorance from health-care professionals and stigma from others in their lives. They have often been told their disabling symptoms are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10819994/">psychosomatic</a>.</p>
<p>Gerrard’s comments, and the media’s amplification of them, repudiates the term “long COVID” that community members have chosen to give their condition an identity and support each other. This is likely to cause distress and exacerbate feelings of abandonment.</p>
<h2>Terminology matters</h2>
<p>The words we use to describe illnesses and conditions are incredibly powerful. <a href="https://blogs.bmj.com/bmj/2020/10/01/why-we-need-to-keep-using-the-patient-made-term-long-covid/">Naming a new condition</a> is a step towards better recognition of people’s suffering, and hopefully, better diagnosis, health care, treatment and acceptance by others.</p>
<p>The term “long COVID” provides an easily understandable label to convey patients’ experiences to others. It is well known to the public. It has been routinely used in news media reporting and and in many reputable <a href="https://www.science.org/doi/10.1126/science.adl0867">medical journal articles</a>. </p>
<p>Most importantly, scrapping the label would further marginalise a large group of people with a chronic illness who have often been left to struggle behind closed doors.</p><img src="https://counter.theconversation.com/content/225880/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deborah Lupton is affiliated with OzSAGE.</span></em></p>People with long COVID have already fought hard to become visible.Deborah Lupton, SHARP Professor, Vitalities Lab, Centre for Social Research in Health and Social Policy Centre, and the ARC Centre of Excellence for Automated Decision-Making and Society, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2253542024-03-18T19:21:57Z2024-03-18T19:21:57ZStudy links microplastics with human health problems – but there’s still a lot we don’t know<figure><img src="https://images.theconversation.com/files/582403/original/file-20240317-28-ha8xio.jpg?ixlib=rb-1.1.0&rect=62%2C0%2C7008%2C4668&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/microplastics-hand-air-pollution-aquatic-food-2164471827">Naiyana Somchitkaeo/Shutterstock</a></span></figcaption></figure><p>A <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2309822">recent study</a> published in the prestigious New England Journal of Medicine has linked microplastics with risk to human health.</p>
<p>The study involved patients in Italy who had a condition called carotid artery plaque, where plaque builds up in arteries, potentially blocking blood flow. The researchers analysed plaque specimens from these patients. </p>
<p>They found those with carotid artery plaque who had microplastics and nanoplastics in their plaque had a higher risk of heart attack, stroke, or death (compared with carotid artery plaque patients who didn’t have any micro- or nanoplastics detected in their plaque specimens). </p>
<p>Importantly, the researchers didn’t find the micro- and nanoplastics <em>caused</em> the higher risk, only that it was correlated with it. </p>
<p>So, what are we to make of the new findings? And how does it fit with the broader evidence about microplastics in our <a href="https://www.science.org/doi/10.1126/sciadv.aax1157">environment</a> and <a href="https://www.sciencedirect.com/science/article/pii/S0160412022001258">our bodies</a>?</p>
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<h2>What are microplastics?</h2>
<p>Microplastics are plastic particles less than five millimetres across. Nanoplastics are less than one micron in size (1,000 microns is equal to one millimetre). The precise size classifications <a href="https://doi.org/10.1016/j.envpol.2018.01.024">are still a matter of debate</a>. </p>
<p>Microplastics and nanoplastics are created when everyday products – including clothes, food and beverage packaging, home furnishings, plastic bags, toys and toiletries – degrade. Many personal care products contain microsplastics in the form of microbeads.</p>
<p>Plastic is also used widely in agriculture, and can degrade over time into microplastics and nanoplastics.</p>
<p>These particles are made up of common polymers such as polyethylene, polypropylene, polystyrene and polyvinyl chloride. The constituent chemical of polyvinyl chloride, vinyl chloride, is <a href="https://wwwn.cdc.gov/TSP/ToxFAQs/ToxFAQsDetails.aspx?faqid=281&toxid=51">considered carcinogenic</a> by the <a href="https://19january2017snapshot.epa.gov/sites/production/files/2016-09/documents/vinyl-chloride.pdf">US Environmental Protection Agency</a>.</p>
<p>Of course, the actual risk of harm depends on your level of exposure. As toxicologists are fond of <a href="https://onlinelibrary.wiley.com/doi/10.1111/bcpt.12622">saying</a>, it’s the dose that makes the poison, so we need to be careful to not over-interpret emerging research.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australians-are-washing-microplastics-down-the-drain-and-its-ending-up-on-our-farms-223079">Australians are washing microplastics down the drain and it's ending up on our farms</a>
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<h2>A closer look at the study</h2>
<p>This new study in the New England Journal of Medicine was a small cohort, initially comprising 304 patients. But only 257 completed the follow-up part of the study 34 months later. </p>
<p>The study had a number of limitations. The first is the findings related only to asymptomatic patients undergoing carotid endarterectomy (a procedure to remove carotid artery plaque). This means the findings might not be applicable to the wider population.</p>
<p>The authors also point out that while exposure to microplastics and nanoplastics has been likely increasing in recent decades, heart disease rates have been <a href="https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.115.015293">falling</a>.</p>
<p>That said, the fact so many people in the study had detectable levels of microplastics in their body is notable. The researchers found detectable levels of polyethylene and polyvinyl chloride (two types of plastic) in excised carotid plaque from 58% and 12% of patients, respectively. </p>
<p>These patients were more likely to be younger men with diabetes or heart disease and a history of smoking. There was no substantive difference in where the patients lived.</p>
<p>Inflammation markers in plaque samples were more elevated in patients with detectable levels of microplastics and nanoplastics versus those without. </p>
<figure class="align-center ">
<img alt="Plastic bottles washed up on a beach." src="https://images.theconversation.com/files/582404/original/file-20240317-18-nz99jb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/582404/original/file-20240317-18-nz99jb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582404/original/file-20240317-18-nz99jb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582404/original/file-20240317-18-nz99jb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582404/original/file-20240317-18-nz99jb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582404/original/file-20240317-18-nz99jb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582404/original/file-20240317-18-nz99jb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Microplastics are created when everyday products degrade.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-waste-beach-1234533793">JS14/Shutterstock</a></span>
</figcaption>
</figure>
<p>And, then there’s the headline finding: patients with microplastics and nanoplastics in their plaque had a higher risk of having what doctors call “a primary end point event” (non-fatal heart attack, non-fatal stroke, or death from any cause) than those who did not present with microplastics and nanoplastics in their plaque.</p>
<p>The authors of the study note their results “do not prove causality”.</p>
<p>However, it would be remiss not to be cautious. The history of environmental health is replete with examples of what were initially considered suspect chemicals that avoided proper regulation because of what the US National Research Council refers to as the “<a href="https://nap.nationalacademies.org/catalog/12209/science-and-decisions-advancing-risk-assessment">untested-chemical assumption</a>”. This assumption arises where there is an absence of research demonstrating adverse effects, which obviates the requirement for regulatory action. </p>
<p>In general, more research is required to find out whether or not microplastics cause harm to human health. Until this evidence exists, we should adopt the precautionary principle; absence of evidence should not be taken as evidence of absence.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/were-all-ingesting-microplastics-at-home-and-these-might-be-toxic-for-our-health-here-are-some-tips-to-reduce-your-risk-159537">We're all ingesting microplastics at home, and these might be toxic for our health. Here are some tips to reduce your risk</a>
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</em>
</p>
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<h2>Global and local action</h2>
<p>Exposure to microplastics in our home, work and outdoor environments is inevitable. Governments across the globe have started to acknowledge we must intervene. </p>
<p>The <a href="https://www.un.org/en/climatechange/nations-agree-end-plastic-pollution">Global Plastics Treaty</a> will be enacted by 175 nations from 2025. The treaty is designed, among other things, to limit microplastic exposure globally. Burdens are greatest <a href="https://doi.org/10.1016/j.envpol.2022.119957">especially in children</a> and especially those in low-middle income nations. </p>
<p>In Australia, legislation <a href="https://www.epa.vic.gov.au/about-epa/our-programs-and-projects/single-use-plastics-ban">ending single use plastics</a> will help. So too will the increased rollout of <a href="https://recyclingnearyou.com.au/containerdeposit/">container deposit schemes</a> that include plastic bottles.</p>
<p>Microplastics pollution is an area that requires a collaborative approach between researchers, civil societies, industry and government. We believe the formation of a “microplastics national council” would help formulate and co-ordinate strategies to tackle this issue.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-problem-with-oodies-hooded-blankets-are-cosy-but-they-are-not-great-for-oceans-or-our-health-163087">The problem with Oodies: hooded blankets are cosy but they are not great for oceans or our health</a>
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<p>Little things matter. Small actions by individuals can also translate to significant overall environmental and human health benefits. </p>
<p>Choosing natural materials, fabrics, and utensils not made of plastic and disposing of waste thoughtfully and appropriately – including recycling wherever possible – is helpful.</p><img src="https://counter.theconversation.com/content/225354/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark Patrick Taylor is a full-time employee of EPA Victoria, appointed to the statutory role of Chief Environmental Scientist.
He previously received funding via an Australian Government Citizen Science Grant (2017-2020), CSG55984 ‘Citizen insights to the composition and risks of household dust’ (the DustSafe project). Outputs from this project included published work on microplastics with Drs Neda Sharifi Soltani and Scott Wilson who were at Macquarie University at that time.
</span></em></p><p class="fine-print"><em><span>Scott P. Wilson works for the Australian Microplastic Assessment Project run by the not for profit organisation the Total Environment Centre. He has previously received funding from the NSW EPA for research into microplastic source tracking in Deewhy Lagoon and for developing a Microlitter Reduction Framework. </span></em></p>Microplastics are created when everyday products – including clothes, food and beverage packaging, home furnishings, plastic bags, toys and toiletries – degrade.Mark Patrick Taylor, Chief Environmental Scientist, EPA Victoria; Honorary Professor, School of Natural Sciences, Macquarie UniversityScott P. Wilson, Research Director, Australian Microplastic Assessment Project (AUSMAP); Honorary Senior Research Fellow, School of Natural Sciences, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2258982024-03-18T02:53:31Z2024-03-18T02:53:31ZWho will look after us in our final years? A pay rise alone won’t solve aged-care workforce shortages<figure><img src="https://images.theconversation.com/files/582419/original/file-20240318-28-8rjewg.jpg?ixlib=rb-1.1.0&rect=293%2C173%2C6948%2C4191&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-elderly-woman-talking-friend-sitting-1641889408">Aila Images/Shutterstock</a></span></figcaption></figure><p>Aged-care workers will receive a significant pay increase after the Fair Work Commission <a href="https://www.fwc.gov.au/documents/decisionssigned/pdf/2024fwcfb150.pdf">ruled</a> they deserved substantial wage rises of up to 28%. The federal government <a href="https://ministers.dewr.gov.au/burke/fair-work-decision-aged-care">has committed to</a> the increases, but is yet to announce when they will start. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1768557710537068889"}"></div></p>
<p>But while wage rises for aged-care workers are welcome, this measure alone will not fix all workforce problems in the sector. The number of people over 80 is expected to <a href="https://treasury.gov.au/sites/default/files/2023-08/p2023-435150.pdf">triple over the next 40 years</a>, driving an increase in the number of aged care workers needed.</p>
<h2>How did we get here?</h2>
<p>The Royal Commission into Aged Care Quality and Safety, which delivered its <a href="https://www.royalcommission.gov.au/aged-care/final-report">final report</a> in March 2021, identified a litany of tragic failures in the regulation and delivery of aged care. </p>
<p>The former Liberal government was dragged reluctantly to accept that a total revamp of the aged-care system was needed. But its <a href="https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/respect-care-and-dignity-aged-care-royal-commission-452-million-immediate-response-as-government-commits-to-historic-reform-to-deliver-respect-and-care-for-senior-australians#:%7E:text=Minister%20for%20Senior%20Australians%20and,%2C%20dementia%2C%20food%20and%20nutrition.">weak response</a> left the heavy lifting to the incoming Labor government.</p>
<p>The current government’s response started well, with a <a href="https://theconversation.com/anthony-albanese-offers-2-5-billion-plan-to-fix-crisis-in-aged-care-180419">significant injection of funding</a> and a promising regulatory response. But it too has failed to pursue a visionary response to the problems identified by the Royal Commission.</p>
<p>Action was needed on four fronts:</p>
<ul>
<li>ensuring enough staff to provide care</li>
<li>building a functioning regulatory system to encourage good care and weed out bad providers </li>
<li>designing and introducing a fair payment system to distribute funds to providers and</li>
<li>implementing a financing system to pay for it all and achieve intergenerational equity.</li>
</ul>
<p>A government taskforce which proposed a <a href="https://theconversation.com/what-will-aged-care-look-like-for-the-next-generation-more-of-the-same-but-higher-out-of-pocket-costs-225551">timid response to the fourth challenge</a> – an equitable financing system – was released at the start of last week.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-will-aged-care-look-like-for-the-next-generation-more-of-the-same-but-higher-out-of-pocket-costs-225551">What will aged care look like for the next generation? More of the same but higher out-of-pocket costs</a>
</strong>
</em>
</p>
<hr>
<p>Consultation closed on a <a href="https://media.opan.org.au/uploads/2024/03/240308_Aged-Care-Act-Exposure-Draft-Joint-Submission_FINAL.pdf">very poorly designed new regulatory regime</a> the week before.</p>
<p>But the big news came at end of the week when the Fair Work Commission handed down a further <a href="https://www.fwc.gov.au/documents/decisionssigned/pdf/2024fwcfb150.pdf">determination</a> on what aged-care workers should be paid, confirming and going beyond a previous <a href="https://www.fwc.gov.au/documents/sites/work-value-aged-care/decisions-statements/2022fwcfb200.pdf">interim determination</a>. </p>
<h2>What did the Fair Work Commission find?</h2>
<p>Essentially, the commission determined that work in industries with a high proportion of women workers has been traditionally undervalued in wage-setting. This had consequences for both care workers in the aged-care industry (nurses and <a href="https://training.gov.au/Training/Details/CHC33021">Certificate III-qualified</a> personal-care workers) and indirect care workers (cleaners, food services assistants).</p>
<p>Aged-care staff will now get significant pay increases – 18–28% increase for personal care workers employed under the Aged Care Award, inclusive of the increase awarded in the interim decision. </p>
<figure class="align-center ">
<img alt="Older person holding a stabilising bar" src="https://images.theconversation.com/files/582420/original/file-20240318-26-tyvjf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/582420/original/file-20240318-26-tyvjf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582420/original/file-20240318-26-tyvjf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582420/original/file-20240318-26-tyvjf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582420/original/file-20240318-26-tyvjf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582420/original/file-20240318-26-tyvjf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582420/original/file-20240318-26-tyvjf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The commission determined aged care work was undervalued.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/elderly-woman-holding-on-handrail-safety-774216670">Shutterstock/Toa55</a></span>
</figcaption>
</figure>
<p>Indirect care workers were awarded a general increase of 3%. Laundry hands, cleaners and food services assistants will receive a further 3.96% <a href="https://www.fwc.gov.au/documents/decision-summaries/2024fwcfb150-summary.pdf">on the grounds</a> they “interact with residents significantly more regularly than other indirect care employees”.</p>
<p>The final increases for registered and enrolled nurses will be determined in the next few months.</p>
<h2>How has the sector responded?</h2>
<p>There has been no push-back from employer groups or conservative politicians. This suggests the uplift is accepted as fair by all concerned. </p>
<p>The interim increases of up to 15% probably facilitated this acceptance, with the <a href="https://theconversation.com/what-does-the-budget-mean-for-medicare-medicines-aged-care-and-first-nations-health-192842">recognition of the community</a> that care workers should be paid more than fast food workers.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/itll-take-more-than-15-to-beat-the-stigmas-turning-people-off-aged-care-206670">It'll take more than 15% to beat the stigmas turning people off aged care</a>
</strong>
</em>
</p>
<hr>
<p>There was <a href="https://www.accpa.asn.au/media-releases/accpa-welcomes-further-aged-care-wage-rises">no criticism from aged-care providers</a> either. This is probably because they are facing difficulty in recruiting staff at current wage rates. And because government payments to providers reflect the <a href="https://www.ihacpa.gov.au/">actual cost of aged care</a>, increased payments will automatically flow to providers. </p>
<p>When the increases will flow has yet to be determined. The government is due to give its recommendations for staging implementation by mid-April.</p>
<h2>Is the workforce problem fixed?</h2>
<p>An increase in wages is necessary, but alone is not sufficient to solve workforce shortages. </p>
<p>The health- and social-care workforce is <a href="https://www.jobsandskills.gov.au/data/employment-projections">predicted</a> to grow faster than any other sector over the next decade. The “care economy” will <a href="https://theconversation.com/care-economy-to-balloon-in-an-australia-of-40-5-million-intergenerational-report-211876">grow</a> from around 8% to around 15% of GDP over the next 40 years.</p>
<p>This means a greater proportion of school-leavers will need to be attracted to the aged-care sector. Aged care will also need to attract and retrain workers displaced from industries in decline and attract suitably skilled migrants and refugees with appropriate language skills.</p>
<figure class="align-center ">
<img alt="Nursing students practise their skills" src="https://images.theconversation.com/files/582422/original/file-20240318-20-x7i1u3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/582422/original/file-20240318-20-x7i1u3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582422/original/file-20240318-20-x7i1u3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582422/original/file-20240318-20-x7i1u3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582422/original/file-20240318-20-x7i1u3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582422/original/file-20240318-20-x7i1u3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582422/original/file-20240318-20-x7i1u3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Aged care will need to attract workers from other sectors.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/nursing-students-learning-how-rescue-patients-1941429475">nastya_ph/Shutterstock</a></span>
</figcaption>
</figure>
<p>The <a href="https://theconversation.com/demand-driven-funding-for-universities-is-frozen-what-does-this-mean-and-should-the-policy-be-restored-116060">caps on university and college enrolments</a> imposed by the previous government, coupled with weak student demand for places in key professions (such as nursing), has meant workforce shortages will continue for a few more years, despite the allure of increased wages. </p>
<p>A significant increase in intakes into university and vocational education college courses preparing students for health and social care is still required. Better pay will help to increase student demand, but funding to expand place numbers will ensure there are enough qualified staff for the aged-care system of the future. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/changes-are-coming-for-australias-aged-care-system-heres-what-we-know-so-far-222757">Changes are coming for Australia's aged care system. Here's what we know so far</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/225898/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Duckett is Deputy Chancellor of RMIT University which i.a. provides education for the aged care sector.</span></em></p>While wage rises for aged care workers are welcome, this measure alone will not fix all workforce problems in the sector.Stephen Duckett, Honorary Enterprise Professor, School of Population and Global Health, and Department of General Practice and Primary Care, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2256682024-03-17T19:01:29Z2024-03-17T19:01:29ZWhy is toddler milk so popular? Follow the money<figure><img src="https://images.theconversation.com/files/582110/original/file-20240315-28-i7q9zu.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C997%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/toddler-hands-holding-cup-white-fresh-2057012747">FotoDuets/Shutterstock</a></span></figcaption></figure><p>Toddler milk is popular and becoming more so. Just over a <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jhn.12851">third of Australian toddlers</a> drink it. Parents <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01933-X/fulltext">spend</a> hundreds of millions of dollars on it globally. Around the world, toddler milk makes up nearly half of <a href="https://onlinelibrary.wiley.com/doi/10.1111/mcn.13097">total formula milk sales</a>, with a 200% growth since 2005. Growth is expected to continue.</p>
<p>We’re concerned about the growing popularity of toddler milk – about its nutritional content, cost, how it’s marketed, and about the impact on the health and feeding of young children. Some of us voiced our concerns on the <a href="https://www.abc.net.au/news/2024-03-12/toddler-milk-nutrition-benefits-marketing-parents/103517864">ABC’s 7.30 program recently</a>.</p>
<p>But what’s in toddler milk? How does it compare to cow’s milk? How did it become so popular?</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/gOFTZmptaN0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">We shared our concerns about toddler milk and what this means for parents and children.</span></figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/misleading-food-labels-contribute-to-babies-and-toddlers-eating-too-much-sugar-3-things-parents-can-do-194168">Misleading food labels contribute to babies and toddlers eating too much sugar. 3 things parents can do</a>
</strong>
</em>
</p>
<hr>
<h2>What is toddler milk? Is it healthy?</h2>
<p>Toddler milk is marketed as appropriate for children aged one to three years. This <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10140693/">ultra-processed food</a> <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/nutrition-and-packaging-characteristics-of-toddler-foods-and-milks-in-australia/1C6BA80843B773FC058BD3087D1A22BA">contains</a>:</p>
<ul>
<li><p>skim milk powder (cow, soy or goat)</p></li>
<li><p>vegetable oil</p></li>
<li><p>sugars (including added sugars)</p></li>
<li><p>emulsifiers (to help bind the ingredients and improve the texture)</p></li>
<li><p>added vitamins and minerals.</p></li>
</ul>
<p>Toddler milk <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/nutrition-and-packaging-characteristics-of-toddler-foods-and-milks-in-australia/1C6BA80843B773FC058BD3087D1A22BA">is usually</a> lower in calcium and protein, and higher in sugar and calories than regular cow’s milk. Depending on the brand, a serve of toddler milk can contain as much sugar as a <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/nutrition-and-packaging-characteristics-of-toddler-foods-and-milks-in-australia/1C6BA80843B773FC058BD3087D1A22BA">soft drink</a>. </p>
<p>Even though toddler milks have <a href="https://link.springer.com/article/10.1007/s00394-019-01950-5">added vitamins and minerals</a>, these are <a href="https://iris.who.int/bitstream/handle/10665/373358/9789240081864-eng.pdf?sequence=1">found in and better absorbed</a> from <a href="https://www.healthline.com/nutrition/synthetic-vs-natural-nutrients">regular foods and breastmilk</a>. Toddlers do not need the level of nutrients found in these products if they are eating a varied diet. </p>
<p>Global health authorities, including the <a href="https://iris.who.int/bitstream/handle/10665/373358/9789240081864-eng.pdf?sequence=1">World Health Organization</a> (WHO), and Australia’s <a href="https://www.eatforhealth.gov.au/sites/default/files/files/the_guidelines/n56_infant_feeding_guidelines_150917(1).pdf">National Health and Medical Research Council</a>, do not recommend toddler milk for healthy toddlers.</p>
<p>Some children with specific metabolic or dietary medical problems might need tailored alternatives to cow’s milk. However, these products generally are not toddler milks and would be a specific product prescribed by a health-care provider. </p>
<p><a href="https://www.choice.com.au/babies-and-kids/feeding-your-baby/first-foods/articles/are-toddler-milks-necessary">Toddler milk</a> is also up to <a href="https://nutritionj.biomedcentral.com/articles/10.1186/s12937-022-00765-1">four to five times</a> more expensive than regular cow’s milk. “Premium” toddler milk (the same product, with higher levels of vitamins and minerals) is more expensive. </p>
<p>With the <a href="https://theconversation.com/undernourished-stressed-and-overworked-cost-of-living-pressures-are-taking-a-toll-on-australians-health-223625">cost-of-living crisis</a>, this means families might choose to go without other essentials to afford toddler milk.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/582090/original/file-20240315-30-3y4x18.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman holding blue plastic spoon of formula powder over open tin of formula, milk bottle in background" src="https://images.theconversation.com/files/582090/original/file-20240315-30-3y4x18.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/582090/original/file-20240315-30-3y4x18.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582090/original/file-20240315-30-3y4x18.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582090/original/file-20240315-30-3y4x18.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582090/original/file-20240315-30-3y4x18.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582090/original/file-20240315-30-3y4x18.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582090/original/file-20240315-30-3y4x18.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Toddler milk is more expensive than cow’s milk and contains more sugar.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/powder-milk-blue-spoon-on-light-779728180">Dragana Gordic/Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/8-everyday-foods-you-might-not-realise-are-ultra-processed-and-how-to-spot-them-197993">8 everyday foods you might not realise are ultra processed – and how to spot them</a>
</strong>
</em>
</p>
<hr>
<h2>How toddler milk was invented</h2>
<p>Toddler milk was created so infant formula companies could <a href="https://www.who.int/docs/default-source/nutritionlibrary/breastfeeding/information-note-cross-promotion-infant-formula.pdf?sfvrsn=81a5b79c_1">get around rules</a> preventing them from advertising their infant formula. </p>
<p>When manufacturers <a href="https://www.jandonline.org/article/S2212-2672(21)01197-7/abstract">claim benefits</a> of their toddler milk, many parents assume these claimed benefits apply to infant formula (known as <a href="https://www.who.int/docs/default-source/nutritionlibrary/breastfeeding/information-note-cross-promotion-infant-formula.pdf?sfvrsn=81a5b79c_1">cross-promotion</a>). In other words, marketing toddler milks also boosts interest in their infant formula.</p>
<p>Manufacturers also create brand loyalty and recognition by making the labels of their toddler milk look similar to their infant formula. For parents who used infant formula, toddler milk is positioned as the next stage in feeding.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/if-youre-feeding-with-formula-heres-what-you-can-do-to-promote-your-babys-healthy-growth-106165">If you're feeding with formula, here's what you can do to promote your baby's healthy growth</a>
</strong>
</em>
</p>
<hr>
<h2>How toddler milk became so popular</h2>
<p>Toddler milk is <a href="https://academic.oup.com/nutritionreviews/article-abstract/82/3/425/7172846?redirectedFrom=fulltext&login=false">heavily marketed</a>. Parents <a href="https://pubmed.ncbi.nlm.nih.gov/37203416/">are told</a> toddler milk is healthy and provides extra nutrition. Marketing <a href="https://uconnruddcenter.org/wp-content/uploads/sites/2909/2020/09/Infant-Formula-and-Toddler-Milk-Brief_9-23-19.pdf">tells parents</a> it will benefit their child’s growth and development, their brain function and their immune system.</p>
<p>Toddler milk is also presented as a <a href="https://uconnruddcenter.org/wp-content/uploads/sites/2909/2020/09/Infant-Formula-and-Toddler-Milk-Brief_9-23-19.pdf">solution</a> to fussy eating, which is common in toddlers.</p>
<p>However, regularly drinking toddler milk could increase the risk of <a href="https://www.researchgate.net/profile/Kathy-Cowbrough-2/publication/44645020_Feeding_the_toddler_12_months_to_3_years--challenges_and_opportunities/links/53e2409e0cf2d79877aa22e5/Feeding-the-toddler-12-months-to-3-years--challenges-and-opportunities.pdf">fussiness</a> as it reduces opportunities for toddlers to try new foods. It’s also sweet, needs no chewing, and essentially displaces energy and nutrients that whole foods provide.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/582092/original/file-20240315-20-3y4x18.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Toddler wearing bib with food smeared on face" src="https://images.theconversation.com/files/582092/original/file-20240315-20-3y4x18.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/582092/original/file-20240315-20-3y4x18.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582092/original/file-20240315-20-3y4x18.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582092/original/file-20240315-20-3y4x18.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582092/original/file-20240315-20-3y4x18.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582092/original/file-20240315-20-3y4x18.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582092/original/file-20240315-20-3y4x18.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Toddler milk is said to help fussy eating, but it may make things worse.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-girl-toddler-picking-her-food-492304303">zlikovec/Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-tell-if-your-kids-fussy-eating-phase-is-normal-92118">How to tell if your kid's 'fussy eating' phase is normal</a>
</strong>
</em>
</p>
<hr>
<h2>Growing concern</h2>
<p>The <a href="https://www.who.int/news/item/28-04-2022-who-reveals-shocking-extent-of-exploitative-formula-milk-marketing">WHO</a>, along with public health academics, has been raising concerns about the marketing of toddler milk for years.</p>
<p>In Australia, moves to curb how toddler milk is promoted have gone nowhere. Toddler milk is in a category of foods that are <a href="https://www.legislation.gov.au/F2008B00660/asmade/text">allowed to be fortified</a> (to have vitamins and minerals added), with no marketing restrictions. The Australian Competition & Consumer Commission also <a href="https://www.accc.gov.au/media-release/accc-to-reauthorise-agreement-to-not-advertise-infant-formula-seeks-submissions-on-toddler-milk-advertising">has concerns</a> about the rise of toddler milk marketing. Despite this, there is no change in how it’s regulated.</p>
<p>This is in contrast to <a href="https://www.health.gov.au/topics/pregnancy-birth-and-baby/breastfeeding-infant-nutrition/marketing-infant-formula">voluntary marketing restrictions</a> in Australia for infant formula.</p>
<h2>What needs to happen?</h2>
<p>There is <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01933-X/fulltext">enough evidence</a> to show the marketing of commercial milk formula, including toddler milk, influences parents and undermines child health.</p>
<p>So governments need to act to protect parents from this marketing, and to put <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01933-X/fulltext">child health over profits</a>. </p>
<p>Public health authorities and advocates, including us, are calling for the restriction of marketing (not selling) of all formula products for infants and toddlers from birth through to age three years.</p>
<p>Ideally, this would be mandatory, government-enforced marketing restrictions as opposed to <a href="https://www.health.gov.au/topics/pregnancy-birth-and-baby/breastfeeding-infant-nutrition/marketing-infant-formula">industry self-regulation</a> in place currently for infant formulas.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/essays-on-health-how-food-companies-can-sneak-bias-into-scientific-research-65873">Essays on health: how food companies can sneak bias into scientific research</a>
</strong>
</em>
</p>
<hr>
<h2>We musn’t blame parents</h2>
<p>Toddlers are eating <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/mcn.13097">more processed foods</a> (including toddler milk) than ever because time-poor parents are seeking a convenient option to ensure their child is getting adequate nutrition.</p>
<p>Formula manufacturers have used this information, and created a demand for an unnecessary product. </p>
<p>Parents want to do the best for their toddlers, but they need to know the marketing behind toddler milks is misleading.</p>
<p>Toddler milk is an unnecessary, unhealthy, expensive product. Toddlers just need whole foods and breastmilk, and/or cow’s milk or a non-dairy, milk alternative.</p>
<p>If parents are worried about their <a href="https://raisingchildren.net.au/toddlers/nutrition-fitness">child’s eating</a>, they should see a health-care professional.</p>
<hr>
<p><em>Anthea Rhodes, a paediatrician from Royal Children’s Hospital Melbourne and a lecturer at the University of Melbourne, co-authored this article.</em></p><img src="https://counter.theconversation.com/content/225668/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jennifer McCann is a researcher with the Institute for Physical Activity and Nutrition (IPAN), a co-chair of the Infant and Toddler Foods Alliance, and a member of the Public Health Association of Australia. </span></em></p><p class="fine-print"><em><span>Karleen Gribble is a member of the Public Health Association of Australia, the World Breastfeeding Trends Initiative, the Australian Breastfeeding Association, the Infant and Toddler Food Research Alliance and the Infant and Young Child Feeding in Emergencies Core Group. </span></em></p><p class="fine-print"><em><span>Naomi Hull is a member of, and volunteers for, the Australian Breastfeeding Association and is a member of the Public Health Association of Australia. She is also an executive on the Infant and Toddler Food Research Alliance. Naomi is the National Coordinator for the World Breastfeeding Trends Initiative Australia.</span></em></p>Toddler milk is high in sugar and can leave toddlers reluctant to try new foods. It’s also heavily marketed to time-poor parents. We’re worried.Jennifer McCann, Lecturer Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin UniversityKarleen Gribble, Adjunct Associate Professor, School of Nursing and Midwifery, Western Sydney UniversityNaomi Hull, PhD candidate, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2237362024-03-14T22:29:22Z2024-03-14T22:29:22ZWhat is minoxidil, the anti-balding hair growth treatment? Here’s what the science says<figure><img src="https://images.theconversation.com/files/579728/original/file-20240304-24-fy5cnb.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4256%2C2822&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hiker-man-backpack-walking-looking-mountain-2024434988">Lia Kos/Shutterstock</a></span></figcaption></figure><p>Hair loss (also known as alopecia) often affects the scalp but can occur anywhere on the body. It’s very common and usually nothing to worry about; about <a href="https://www.sciencedirect.com/science/article/pii/S0022202X15525840">half of Australian men</a> show signs of visible baldness at age 50 and <a href="https://www.sciencedirect.com/science/article/pii/S0022202X15525840">over a quarter of Australian women</a> report hair thinning by the same age. It’s often genetic.</p>
<p>But if you’ve noticed hair loss and are worried by it, see a GP or dermatologist for a diagnosis before trying any treatments. Products claiming to reverse hair loss are everywhere, but few have been scientifically tested for how well they work.</p>
<p>One group of products that have actually been scientifically tested, however, are known as topical minoxidil products. These include products such as Regaine®.</p>
<p>So, do they work? Here’s what the research evidence says, what you can realistically expect and what you need to know if you’re considering this treatment.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/579711/original/file-20240304-24-7l5aya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A happy and handsome man with receding hairline relaxes in a park while listening to headphones." src="https://images.theconversation.com/files/579711/original/file-20240304-24-7l5aya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579711/original/file-20240304-24-7l5aya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579711/original/file-20240304-24-7l5aya.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579711/original/file-20240304-24-7l5aya.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579711/original/file-20240304-24-7l5aya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579711/original/file-20240304-24-7l5aya.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579711/original/file-20240304-24-7l5aya.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Hair loss is very common, and often has a genetic cause.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mature-man-red-basecap-sunglasses-white-2414090295">TunedIn by Westend61/Shutterstock</a></span>
</figcaption>
</figure>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-art-of-balding-a-brief-history-of-hairless-men-199531">The art of balding: a brief history of hairless men</a>
</strong>
</em>
</p>
<hr>
<h2>What is minoxidil – and does it work?</h2>
<p>Topical minoxidil usually comes as a kind of foam or serum you apply to your scalp.</p>
<p>It’s been approved by the <a href="https://www.tga.gov.au/">Therapeutic Goods Administration</a>, Australia’s regulatory authority for therapeutic goods, for the treatment of hereditary hair loss in males and females. Minoxidil is also available in tablet form, but this isn’t currently approved for hair loss (more on that later).</p>
<p>So, is topical minoxidil effective? In short – yes, but the results vary widely from person to person, and it needs to be used consistently over several months to see results.</p>
<p>Scientists don’t know exactly how minoxidil works. It may affect the different phases of the hair life cycle, thereby encouraging growth. It also <a href="https://www.tandfonline.com/doi/full/10.1080/09546634.2021.1945527?casa_token=KhIM_u0u8nwAAAAA:5njp_XE5cHhip454ycvU1p9p_t0VVzpjRu0ozDZ9YqNb04fmhmngWzYeiowZcG5UugLQkTVIzCcj7A">opens up blood vessels</a> near hair follicles. </p>
<p>This increases blood flow, which in turn delivers more oxygen and nutrients to the hair. </p>
<p>While minoxidil is unlikely to restore a full head of thick, lush, hair, it can slow down hair loss and can <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007628.pub4/full?highlightAbstract=minoxidil">stimulate regrowth</a>. </p>
<p>It is the over-the-counter option with the most evidence. Two strengths are available: 5% and 2%.</p>
<p>An analysis of randomised controlled trials found minoxidil applied to the scalp twice a day increased the number of hairs per square centimetre by <a href="https://pubmed.ncbi.nlm.nih.gov/28396101/">eight to 15 hairs</a>, with the higher strength treatment having a slightly greater effect. </p>
<h2>Can I use it for non-genetic balding?</h2>
<p>There are many causes of hair loss. The main cause in both males and females is a hereditary condition called androgenic alopecia.</p>
<p>Although topical minoxidil is only approved for use in Australia for androgenic alopecia, there is some evidence it can also help in other conditions that cause hair loss. </p>
<p>For example, it may hasten hair regrowth in patients who have lost hair due to <a href="https://www.jaad.org/article/S0190-9622(96)90500-9/abstract">chemotherapy</a>. </p>
<p>Unfortunately, minoxidil is not effective when the hair follicle is gone, like after a burn injury.</p>
<p>Although small studies have found promising results using minoxidil to promote hair growth on the face (for <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/1346-8138.13312">beard</a> or <a href="https://pubmed.ncbi.nlm.nih.gov/24471459/">eyebrow</a> enhancement), topical minoxidil products are not currently approved for this use. More research is required.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/579723/original/file-20240304-30-fan36r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man who is balding is admiring a sunset." src="https://images.theconversation.com/files/579723/original/file-20240304-30-fan36r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579723/original/file-20240304-30-fan36r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579723/original/file-20240304-30-fan36r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579723/original/file-20240304-30-fan36r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579723/original/file-20240304-30-fan36r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579723/original/file-20240304-30-fan36r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579723/original/file-20240304-30-fan36r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The main cause of hair loss is a hereditary condition called androgenic alopecia.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/silhouette-bald-vacationer-sunglasses-backpack-on-2333317813">tativophotos/Shutterstock</a></span>
</figcaption>
</figure>
<h2>What else do I need to know?</h2>
<p>Minoxidil won’t work well for everyone. Early in treatment you might notice a temporary increase in <a href="https://pubmed.ncbi.nlm.nih.gov/22409453/">hair shedding</a>, as it alters the hair cycle to make way for new growth. Minoxidil needs to be trialled for three to six months to determine if it’s effective.</p>
<p>And as it doesn’t cure hair loss, you must <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jdv.14624?casa_token=P-zW7kDNRs8AAAAA%3AaUgUzxU7lbwBpg1BYPajOfXFhpb_mU5g_ounZ6GtjsLLkHO_AdVQ2Kf-8zZkW80ykBj3N_sOsyn392uc">continue</a> to use it each day to maintain the effect. If you stop, you will start losing the new hair growth <a href="https://www.nps.org.au/assets/medicines/1f8127a5-2a98-4013-a7c3-a53300feb0e5-reduced.pdf">within three to four months</a>.</p>
<p>Minoxidil products may not be suitable for everyone. If you have any medical conditions or take any medications, you should speak with your doctor or pharmacist before using minoxidil products. </p>
<p>It has not been tested for safety in <a href="https://www.nps.org.au/assets/medicines/1f8127a5-2a98-4013-a7c3-a53300feb0e5-reduced.pdf">people under 18, over 65, or those who are pregnant</a>.</p>
<p>You can read the <a href="https://www.nps.org.au/medicine-finder/regaine-for-men-regular-strength-application">consumer medicines information sheet</a> for more information about using over-the-counter minoxidil products. </p>
<p>Many people do not like to use minoxidil solution or foams long-term because they need to be applied everyday day, which can be inconvenient. Or they may notice side effects, such as scalp irritation and changes to hair texture. </p>
<p>Some people <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jdv.14624?casa_token=P-zW7kDNRs8AAAAA%3AaUgUzxU7lbwBpg1BYPajOfXFhpb_mU5g_ounZ6GtjsLLkHO_AdVQ2Kf-8zZkW80ykBj3N_sOsyn392uc">tolerate the foam products better</a> than the solution, as the solution contains more of a compound called propylene glycol (which can irritate the skin).</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/579725/original/file-20240304-20-fan36r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman noticed hair in her hairbrush." src="https://images.theconversation.com/files/579725/original/file-20240304-20-fan36r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579725/original/file-20240304-20-fan36r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579725/original/file-20240304-20-fan36r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579725/original/file-20240304-20-fan36r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579725/original/file-20240304-20-fan36r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579725/original/file-20240304-20-fan36r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579725/original/file-20240304-20-fan36r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Hair loss affects women, too.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/closeup-comb-brush-long-loss-hair-684900076">zentradyi3ell/Shutterstock</a></span>
</figcaption>
</figure>
<h2>What about the oral tablet form of minoxidil?</h2>
<p>Minoxidil is also available on prescription as an oral tablet. While traditionally used for high blood pressure, it has also been used as a treatment for hair loss.</p>
<p>In 2020, a <a href="https://www.jaad.org/article/S0190-9622(20)32109-5/abstract">systematic review</a> identified 17 studies involving 634 patients using oral minoxidil for various hair loss conditions. </p>
<p>The authors found oral minoxidil was effective and generally well tolerated in healthy people who were having trouble using the topical products.</p>
<p>The review noted oral minoxidil may increase hair growth over the whole body and may cause heart-related side effects in some patients. More research is required.</p>
<p>In Australia, oral minoxidil is available under the trade name <a href="https://www.nps.org.au/assets/medicines/df29e16f-6464-4652-ba1f-a53300fed275.pdf">Loniten</a>®. However, it is currently only approved for use in high blood pressure. </p>
<p>When people seek a prescription treatment for a non-approved purpose, this is called “off-label” prescribing. Off-label prescribing of oral minoxidil, potentially for use in alopecia, may have contributed to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10170338/">shortages</a> of Loniten® tablets in recent years. This can reduce availability of this medicine for people who need it for high blood pressure.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/big-hair-bald-how-much-difference-your-hair-really-makes-to-keep-you-cool-or-warm-201380">Big hair? Bald? How much difference your hair really makes to keep you cool or warm</a>
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</em>
</p>
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<img src="https://counter.theconversation.com/content/223736/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jacinta Johnson is Senior Pharmacist for Research within SA Pharmacy and Board Director for the Society of Hospital Pharmacists of Australia. In the last five years, she has received research funding or consultancy funds (for development and delivery of educational materials) from SA Health, the Medical Research Future Fund, the Hospital Research Foundation – Parkinson's, the Pharmaceutical Society of Australia, the Pharmacy Guild of Australia, the Society of Hospital Pharmacists of Australia, Mundipharma Pty Ltd, Aspen Pharmacare Australia Pty Ltd, Viatris Pty Ltd. and Reckitt Benckiser (Australia) Pty Ltd. No funding has been received relating to minoxidil.
</span></em></p><p class="fine-print"><em><span>Kirsten Staff does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Here’s what you can realistically expect and what you need to know if you’re considering this treatment.Jacinta L. Johnson, Senior Lecturer in Pharmacy Practice, University of South AustraliaKirsten Staff, Senior Lecturer in Pharmacy, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.