Health – The Conversation

Going for a bushwalk? 3 handy foods to have in your backpack (including muesli bars)

2025-01-10T01:38:47Z

This time of year, many of us love to get out and spend time in nature. This may include hiking through Australia’s many beautiful national parks.

Walking in nature is a wonderful activity, supporting both physical and mental health. But there can be risks and it’s important to be prepared.

You may have read the news about hiker, Hadi Nazari, who was recently found alive after spending 13 days lost in Kosciuszko National Park.

He reportedly survived for almost two weeks in the Snowy Mountains region of New South Wales by drinking fresh water from creeks, and eating foraged berries and two muesli bars.

So next time you’re heading out for a day of hiking, what foods should you pack?

Here are my three top foods to carry on a bushwalk that are dense in nutrients and energy, lightweight and available from the local grocery store.

1. Muesli bars

Nazari reportedly ate two muesli bars he found in a mountain hut. Whoever left the muesli bars there made a great choice.

Muesli bars come individually wrapped, which helps them last longer and makes them easy to transport.

They are also a good source of energy. Muesli bars typically contain about 1,500-1,900 kilojoules per 100 grams. The average energy content for a 35g bar is about 614kJ.

This may be a fraction of what you’d usually need in a day. However, the energy from muesli bars is released at a slow to moderate pace, which will help keep you going for longer.

Muesli bars are also packed with nutrients. They contain all three macronutrients (carbohydrate, protein and fat) that our body needs to function. They’re a good source of carbohydrates, in particular, which are a key energy source. An average Australian muesli bar contains 14g of whole grains, which provide carbohydrates and dietary fibre for long-lasting energy.

Muesli bars that contain nuts are typically higher in fat (19.9g per 100g) and protein (9.4g per 100g) than those without.

Fat and protein are helpful for slowing down the release of energy from foods and the protein will help keep you feeling full for longer.

There are many different types of muesli bars to choose from. I recommend looking for those with whole grains, higher dietary fibre and higher protein content.

2. Nuts

Nuts are nature’s savoury snack and are also a great source of energy. Cashews, pistachios and peanuts contain about 2,300-2,400kJ per 100g while Brazil nuts, pecans and macadamias contain about 2,700-3,000kJ per 100g. So a 30g serving of nuts will provide about 700-900kJ depending on the type of nut.

Just like muesli bars, the energy from nuts is released slowly. So even a relatively small quantity will keep you powering on.

Nuts are also full of nutrients, such as protein, fat and fibre, which will help to stave off hunger and keep you moving for longer.

When choosing which nuts to pack, almost any type of nut is going to be great.

Peanuts are often the best value for money, or go for something like walnuts that are high in omega-3 fatty acids, or a nut mix.

Whichever nut you choose, go for the unsalted natural or roasted varieties. Salted nuts will make you thirsty.

Nut bars are also a great option and have the added benefit of coming in pre-packed serves (although nuts can also be easily packed into re-usable containers).

If you’re allergic to nuts, roasted chickpeas are another option. Just try to avoid those with added salt.

Nuts are nature’s savoury snack and are also a great source of energy. Eakrat/Shutterstock

3. Dried fruit

If nuts are nature’s savoury snack, fruit is nature’s candy. Fresh fruits (such as grapes, frozen in advance) are wonderfully refreshing and perfect as an everyday snack, although can add a bit of weight to your hiking pack.

So if you’re looking to reduce the weight you’re carrying, go for dried fruit. It’s lighter and will withstand various conditions better than fresh fruit, so is less likely to spoil or bruise on the journey.

There are lots of varieties of dried fruits, such as sultanas, dried mango, dried apricots and dried apple slices.

These are good sources of sugar for energy, fibre for fullness and healthy digestion, and contain lots of vitamins and minerals. So choose one (or a combination) that works for you.

Don’t forget water

Next time you head out hiking for the day, you’re all set with these easily available, lightweight, energy- and nutrient-dense snacks.

This is not the time to be overly concerned about limiting your sugar or fat intake. Hiking, particularly in rough terrain, places demands on your body and energy needs. For instance, an adult hiking in rough terrain can burn upwards of about 2,000kJ per hour.

And of course, don’t forget to take plenty of water.

Having access to even limited food, and plenty of fresh water, will not only make your hike more pleasurable, it can save your life.

Margaret Murray 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.

Women spend more of their money on health care than men. And no, it’s not just about ‘women’s issues’

2025-01-09T19:02:49Z

Elizaveta Galitckaia/Shutterstock

Medicare, Australia’s universal health insurance scheme, guarantees all Australians access to a wide range of health and hospital services at low or no cost.

Although access to the scheme is universal across Australia (regardless of geographic location or socioeconomic status), one analysis suggests women often spend more out-of-pocket on health services than men.

Other research has found men and women spend similar amounts on health care overall, or even that men spend a little more. However, it’s clear women spend a greater proportion of their overall expenditure on health care than men. They’re also more likely to skip or delay medical care due to the cost.

So why do women often spend more of their money on health care, and how can we address this gap?

Women have more chronic diseases, and access more services

Women are more likely to have a chronic health condition compared to men. They’re also more likely to report having multiple chronic conditions.

While men generally die earlier, women are more likely to spend more of their life living with disease. There are also some conditions which affect women more than men, such as autoimmune conditions (for example, multiple sclerosis and rheumatoid arthritis).

Further, medical treatments can sometimes be less effective for women due to a focus on men in medical research.

These disparities are likely significant in understanding why women access health services more than men.

For example, 88% of women saw a GP in 2021–22 compared to 79% of men.

As the number of GPs offering bulk billing continues to decline, women are likely to need to pay more out-of-pocket, because they see a GP more often.

In 2020–21, 4.3% of women said they had delayed seeing a GP due to cost at least once in the previous 12 months, compared to 2.7% of men.

Data from the Australian Bureau of Statistics has also shown women are more likely to delay or avoid seeing a mental health professional due to cost.

Women are more likely to live with chronic medical conditions than men. Drazen Zigic/Shutterstock

Women are also more likely to need prescription medications, owing at least partly to their increased rates of chronic conditions. This adds further out-of-pocket costs. In 2020–21, 62% of women received a prescription, compared to 37% of men.

In the same period, 6.1% of women delayed getting, or did not get prescribed medication because of the cost, compared to 4.9% of men.

Reproductive health conditions

While women are disproportionately affected by chronic health conditions throughout their lifespan, much of the disparity in health-care needs is concentrated between the first period and menopause.

Almost half of women aged over 18 report having experienced chronic pelvic pain in the previous five years. This can be caused by conditions such as endometriosis, dysmenorrhoea (period pain), vulvodynia (vulva pain), and bladder pain.

One in seven women will have a diagnosis of endometriosis by age 49.

Meanwhile, a quarter of all women aged 45–64 report symptoms related to menopause that are significant enough to disrupt their daily life.

All of these conditions can significantly reduce quality of life and increase the need to seek health care, sometimes including surgical treatment.

Of course, conditions like endometriosis don’t just affect women. They also impact trans men, intersex people, and those who are gender diverse.

Diagnosis can be costly

Women often have to wait longer to get a diagnosis for chronic conditions. One preprint study found women wait an average of 134 days (around 4.5 months) longer than men for a diagnosis of a long-term chronic disease.

Delays in diagnosis often result in needing to see more doctors, again increasing the costs.

Despite affecting about as many people as diabetes, it takes an average of between six-and-a-half to eight years to diagnose endometriosis in Australia. This can be attributed to a number of factors including society’s normalisation of women’s pain, poor knowledge about endometriosis among some health professionals, and the lack of affordable, non-invasive methods to accurately diagnose the condition.

There have been recent improvements, with the introduction of Medicare rebates for longer GP consultations of up to 60 minutes. While this is not only for women, this extra time will be valuable in diagnosing and managing complex conditions.

But gender inequality issues still exist in the Medicare Benefits Schedule. For example, both pelvic and breast ultrasound rebates are less than a scan for the scrotum, and no rebate exists for the MRI investigation of a woman’s pelvic pain.

Management can be expensive too

Many chronic conditions, such as endometriosis, which has a wide range of symptoms but no cure, can be very hard to manage. People with endometriosis often use allied health and complementary medicine to help with symptoms.

On average, women are more likely than men to use both complementary therapies and allied health.

While women with chronic conditions can access a chronic disease management plan, which provides Medicare-subsidised visits to a range of allied health services (for example, physiotherapist, psychologist, dietitian), this plan only subsidises five sessions per calendar year. And the reimbursement is usually around 50% or less, so there are still significant out-of-pocket costs.

In the case of chronic pelvic pain, the cost of accessing allied or complementary health services has been found to average A$480.32 across a two-month period (across both those who have a chronic disease management plan and those who don’t).

More spending, less saving

Womens’ health-care needs can also perpetuate financial strain beyond direct health-care costs. For example, women with endometriosis and chronic pelvic pain are often caught in a cycle of needing time off from work to attend medical appointments.

Our preliminary research has shown these repeated requests, combined with the common dismissal of symptoms associated with pelvic pain, means women sometimes face discrimination at work. This can lead to lack of career progression, underemployment, and premature retirement.

More women are prescribed medication than men. PeopleImages.com - Yuri A/Shutterstock

Similarly, with 160,000 women entering menopause each year in Australia (and this number expected to increase with population growth), the financial impacts are substantial.

As many as one in four women may either shift to part-time work, take time out of the workforce, or retire early due to menopause, therefore earning less and paying less into their super.

How can we close this gap?

Even though women are more prone to chronic conditions, until relatively recently, much of medical research has been done on men. We’re only now beginning to realise important differences in how men and women experience certain conditions (such as chronic pain).

Investing in women’s health research will be important to improve treatments so women are less burdened by chronic conditions.

In the 2024–25 federal budget, the government committed $160 million towards a women’s health package to tackle gender bias in the health system (including cost disparities), upskill medical professionals, and improve sexual and reproductive care.

While this reform is welcome, continued, long-term investment into women’s health is crucial.

Mike Armour has previously received a partnership grant between Western Sydney University and Endometriosis Australia to develop a workplace support program for people with endometriosis.

Danielle Howe receives funding from Endometriosis Australia and Western Sydney University for the development of workplace support for people with endometriosis.

Amelia Mardon, Hannah Adler, and Michelle O'Shea 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.

Olive oil is healthy. Turns out olive leaf extract may be good for us too

2025-01-09T01:34:14Z

mtphoto19/Shutterstock

Olive oil is synonymous with the Mediterranean diet, and the health benefits of both are well documented.

Olive oil reduces the risk of heart disease, cancer, diabetes and premature death. Olives also contain numerous healthy nutrients.

Now evidence is mounting about the health benefits of olive leaves, including from studies in a recent review.

Here’s what’s in olive leaves and who might benefit from taking olive leaf extract.

What’s in olive leaves?

Olive leaves have traditionally been brewed as a tea in the Mediterranean and drunk to treat fever and malaria.

The leaves contain high levels of a type of antioxidant called oleuropein. Olives and olive oil contain this too, but at lower levels.

Generally, the greener the leaf (the less yellowish) the more oleuropein it contains. Leaves picked in spring also have higher levels compared to ones picked in autumn, indicating levels of oleuropein reduce as the leaves get older.

Olive leaves also contain other antioxidants such as hydroxytyrosol, luteolin, apigenin and verbascoside.

Antioxidants work by reducing the oxidative stress in the body. Oxidative stress causes damage to our DNA, cell membranes and tissues, which can lead to chronic diseases such as cancer and heart disease.

Are olive leaves healthy?

One review and analysis combined data from 12 experimental studies with 819 participants in total. Overall, olive leaf extract improved risk factors for heart disease. This included healthier blood lipids (fats) and lowering blood pressure.

The effect was greater for people who already had high blood pressure.

Most studies in this review gave olive leaf extract as a capsule, with daily doses of 500 milligrams to 5 grams for six to 48 weeks.

Another review and analysis published late last year looked at data from 12 experimental studies, with a total of 703 people. Some of these studies involved people with high blood lipids, people with high blood pressure, people who were overweight or obese, and some involved healthy people.

Daily doses were 250-1,000mg taken as tablets or baked into bread.

Individual studies in the review showed significant benefits in improving blood glucose (sugar) control, blood lipid levels and reducing blood pressure. But when all the data was combined, there were no significant health effects. We’ll explain why this may be the case shortly.

Olive leaves can be brewed into tea. Picture Partners/Shutterstock

Another review looked at people who took oleuropein and hydroxytyrosol (the antioxidants in olive leaves). This found significant improvement in body weight, blood lipid profiles, glucose metabolism and improvements in bones, joints and cognitive function.

The individual studies included tested either the two antioxidants or olive leaf incorporated into foods such as bread and cooking oils (but not olive oil). The doses were 6-500mg per day of olive leaf extract.

So what can we make of these studies overall? They show olive leaf extract may help reduce blood pressure, improve blood lipids and help our bodies handle glucose.

But these studies show inconsistent results. This is likely due to differences in the way people took olive leaf extract, how much they took and how long for. This type of inconsistency normally tells us we need some more research to clarify the health effects of olive leaves.

Can you eat olive leaves?

Olive leaves can be brewed into a tea, or the leaves added to salads. Others report grinding olive leaves into smoothies.

However the leaves are bitter, because of the antioxidants, which can make them hard to eat, or the tea unpalatable.

Olive leaf extract has also been added to bread and other baked goods. Researchers find this improves the level of antioxidants in these products and people say the foods tasted better.

Olive leaves can taste bitter, which can put people off. But you can bake the extract into bread. Repina Valeriya/Shutterstock

Is olive leaf extract toxic?

No, there seem to be no reported toxic effects of eating or drinking olive leaf extract.

It appears safe up to 1g a day, according to studies that have used olive leaf extract. However, there are no official guidelines about how much is safe to consume.

There have been reports of potential toxicity if taken over 85mg/kg of body weight per day. For an 80kg adult, this would mean 6.8g a day, well above the dose used in the studies mentioned in this article.

Pregnant and breastfeeding women are recommended not to consume it as we don’t know if it’s safe for them.

What should I do?

If you have high blood pressure, diabetes or raised blood lipids you may see some benefit from taking olive leaf extract. But it is important you discuss this with your doctor first and not change any medications or start taking olive leaf extract until you have spoken to them.

But there are plenty of antioxidants in all plant foods, and you should try to eat a wide variety of different coloured plant foods. This will allow you to get a range of nutrients and antioxidants.

Olive leaf and its extract is not going to be a panacea for your health if you’re not eating a healthy diet and following other health advice.

Evangeline Mantzioris is affiliated with Alliance for Research in Nutrition, Exercise and Activity (ARENA) at the University of South Australia. Evangeline Mantzioris has received funding from the National Health and Medical Research Council, and has been appointed to the National Health and Medical Research Council Dietary Guideline Expert Committee.

E-bike popularity is booming. But are they as safe as regular bikes?

2025-01-08T19:08:45Z

topimages/Shutterstock

The popularity of e-bikes has soared over the past decade. Shared electric bikes for rent have become a common sight in major cities worldwide, while private ownership is also rising.

Since 2020, both sales and import of e-bikes have nearly tripled in Australia.

In Germany, nearly half of all bike sales are now e-bikes.

Trends suggest these bikes – equipped with battery-powered motors that assist the rider – will continue to replace many conventional car and bike trips.

But some serious questions about safety remain – and in Australia we still don’t have the data to know how many injuries and even deaths e-bikes are connected to.

What international data tells us

The Netherlands is sometimes called a “cycling paradise” thanks to its extensive cycling infrastructure and high volume of bike riders.

For researchers, there’s another plus: the country maintains thorough records on cycling injuries and fatalities from all types of bikes.

Data collected since 2000 shows Dutch cyclist fatalities remained relatively stable for almost two decades.

However, since 2018, this trend has begun to shift. Cyclist deaths hit a record high in 2022, with 291 fatalities reported — a nearly 25% increase on this century’s previous record (233 deaths in 2000).

This increase coincides with the rapid uptake of e-bikes. Between 2018 and 2021 the number of Dutch e-bike owners shot from 2.2 million to 3.1 million, while the number of regular bike owners declined.

Are e-bikes more deadly?

The Dutch data shows a higher number of cycling crashes still involve regular bikes compared to e-bikes. However, that’s likely because there are simply more regular bikes overall.

When we control the data for the number of e-bikes versus regular bikes, as well as the distance they tend to travel, we can compare the risk.

A clear trend emerges: e-bike riders face a higher risk of dying.

Data from China shows a similar trend.

Between 2011 and 2021, the number of accidents and fatalities per 100,000 people in the city of Guangzhou increased for e-bikes, but decreased for regular bikes.

E-bike fatalities in Guangzhou have continued to rise since 2018, while deaths linked to regular bikes have plateaued.

What about injuries?

Cycling also has non-fatal risks. To look at what kind of injuries e-bikes are involved in, and how severe they are, we can examine hospital data and compare this to regular bikes.

One clinical study looked at 557 patients who presented to a Swiss trauma centre from 2010 to 2015. Traumatic brain injury was more frequent and more severe in e-bikers than in regular bike riders.

In Israel, the National Trauma Registry records all hospitalisations. Between 2013—17 it revealed a dramatic increase in hospitalisation rates for injuries related to e-bikes, while those related to regular bikes decreased. E-bikers were also at greater risk of head injuries compared to regular bike riders.

However, other clinical studies have suggested the patterns of injury severity are similar in riders of e-bikes and regular bikes. For example, a Dutch study found no difference in the frequency or severity of traumatic brain injuries.

So, are e-bikes more unsafe?

Clearly, there is variability across individual studies. But when we combine findings from multiple countries, some clear patterns emerge.

E-bike users are more likely to sustain injuries to their spine and lower extremities (hips, legs, ankles and feet) compared to regular cyclists.

When injured, they are more likely to be admitted to hospital wards or intensive care units, where they also have a higher chance of undergoing surgery – and of dying.

Do we know why e-bikes have greater risks?

Not exactly.

But speed is one prominent factor. E-bikes reach higher speeds with less effort – e-bike riders average around 13.3 km/h compared to 10.4 km/h for regular cyclists.

E-bike riders may often be older and inexperienced cyclists.

This combination of speed and potential physical limitations, along with the heavier weight of e-bikes, increases crash and injury risk.

In the Swiss study above, injured e-bike riders admitted to hospital were significantly older compared to regular cyclists.

The Dutch data also shows the number of e-bike fatalities increases by age, especially for those aged 60 and older.

People who rent e-bikes for quick city trips may not be experienced cyclists. tal mocho/Shutterstock

E-bikes may be linked to other risky behaviours, including not wearing helmets, violating traffic rules and riding under the influence of alcohol – although we don’t have data to know if e-bikers do these more than regular cyclists.

But riders on shared e-bikes in particular are often less likely to wear helmets compared to those on their own bikes. There may be hesitation around using shared helmets, for example, due to hygiene concerns.

What needs to change?

Trends suggest this green mode of transport is here to stay. But two key changes are needed to make e-bikes safer for riders, pedestrians and other road users in Australia.

First, Australia should establish a national registry that tracks injuries and fatalities related to e-bikes. As we don’t currently collate these statistics, policymakers are forced to rely on international data.

Second, we need regulations tailored and proportional to the specific risks of e-bikes. This could mean stricter enforcement of helmet use, speed limits and better regulation of shared e-bike services, such as ensuring helmets are available and well-maintained.

As e-bikes increase in popularity, raising awareness about their risks remains key.

Milad Haghani 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.

‘Cold violence’ – a hidden form of elder abuse in New Zealand’s Chinese community

2025-01-08T00:26:47Z

Getty Images

Elder abuse is prevalent in New Zealand, with one in ten people aged 65 and older experiencing some form of it and only one in 14 abuse cases brought to the attention of a service agency that can intervene.

Last year alone there were numerous media reports featuring accounts of neglect, financial exploitation and physical or verbal abuse of older people.

However, elder abuse is notoriously difficult to study. Those experiencing abuse often avoid disclosing these experiences for a variety of complex reasons. It is often friends, other family members, neighbours or practitioners who realise that something harmful is happening to the older person.

Some forms of ill treatment are immediately identifiable as abuse. But elder abuse can also be very subtle, which makes it difficult for older people to pinpoint when it happens and for others in the community to recognise it.

Our recent study explores a poorly understood form of elder abuse known as “cold violence” within the Chinese community in Aotearoa New Zealand. We interviewed older Chinese migrants, midlife Chinese migrants caring for older parents and practitioners supporting Chinese migrant families.

Although participants saw similarities in types of elder abuse across cultural groups, they described cold violence as particularly common.

What is ‘cold violence’

Cold violence is a form of emotional abuse that occurs within care relationships. It happens when the person with more power and resources in the relationship completely and intentionally withdraws communication and emotional support for a sustained period. Cold violence is used to punish people for particular conduct or to limit their independence and freedom.

This form of abuse is incredibly difficult to detect. Other forms of abuse have clear signs. Physical abuse may leave telltale marks. Suspicious bank transactions can be monitored and traced. Signs of neglect may be seen in malnutrition and poor hygiene. They are materially evident.

Cold violence, on the other hand, is open to interpretation. By strategically withdrawing emotional support and care, people can powerfully punish the older person without leaving any evidence, thus maintaining plausible deniability.

This makes cold violence difficult for older people to identify and for service providers or authorities to challenge. Family members and carers can argue they didn’t do anything wrong. This failure to respond to need is what makes cold violence a form of abuse.

Chinese culture values reverence for older generations. Getty Images

Understanding the context

Participants in our study commonly mentioned refusal to engage with older family members.

It’s like they see you but act as if they don’t.

Chinese culture values filial reverence and there is an expectation that the concerns and needs of older generations are prioritised. Being rejected by family is very damaging.

Consequently, older Chinese people in our study considered cold violence as the most unacceptable form of abuse that can happen to an older person. They told us that withdrawal of verbal communication and emotional care was made worse by demeaning nonverbal behaviours, such as looks of “disdain” or “disgust”.

They agreed that being treated this way had a “negative impact on their mental health”, making them “feel heartbroken”. One participant likened it to mental torture.

Experiencing cold violence can also leave older people unable to meet their basic needs. In the context of Chinese family arrangements, older parents who migrated in later life are often highly dependent on younger family members.

They might lack language skills, the ability to drive and knowledge of institutional systems necessary to independently navigate everyday life. In these situations, the withdrawal by family members is a highly destabilising experience, leaving older people unsure how to act and often without alternative sources of support.

Making sense of cold violence

Family carers are commonly under significant financial, emotional and time pressure and receive relatively little formal support for care. However, there was a clear mismatch between how practitioners and family carers framed emotional withdrawal as carer stress and the way it was experienced by older people as cold violence.

Chinese migrants providing care for older parents agreed that cold violence was concerning. However, they saw it as the unintentional outcome of limited time and resources. As one participant explained:

There are old people above and young children below, and their energy is limited […] They have tried their best.

Practitioners also attributed neglectful behaviour to carer stress.

This mismatch highlights the need to understand older people’s perspectives and to provide continuous education about less obvious forms of elder abuse. Awareness raising should extend beyond older people to include family members, practitioners and the wider community.

Cold violence is not unique to the Chinese community, but it may be experienced differently across cultural groups. Regardless of the cultural context, being treated in this way is an unsettling and undermining experience for older people.

We have a collective responsibility to create safe environments for people to be able to age with dignity. This starts with understanding how our actions can intentionally or unintentionally cause harm to older people in our families and communities.

Ágnes Szabó has received funding from the Ageing Well National Science Challenge and the Royal Society of New Zealand.

Mary Breheny has received funding from the Ageing Well National Science Challenge for this research.

Polly Yeung has received funding from the Ageing Well National Science Challenge for this research.

Blood, urine and other bodily fluids: how your leftover pathology samples can be used for medical research

2025-01-08T00:07:15Z

Kaboompics.com/Pexels

A doctor’s visit often ends with you leaving with a pathology request form in hand. The request form soon has you filling a sample pot, having blood drawn, or perhaps even a tissue biopsy taken.

After that, your sample goes to a clinical pathology lab to be analysed, in whichever manner the doctor requested. All this is done with the goal of getting to the bottom of the health issue you’re experiencing.

But after all the tests are done, what happens with the leftover sample? In most cases, leftover samples go in the waste bin, destined for incineration. Sometimes though, they may be used again for other purposes, including research.

Who can use my leftover samples?

The samples we’re talking about here cover the range of samples clinical labs receive in the normal course of their testing work. These include blood and its various components (including plasma and serum), urine, faeces, joint and spinal fluids, swabs (such as from the nose or a wound), and tissue samples from biopsies, among others.

Clinical pathology labs often use leftover samples to practise or check their testing methods and help ensure test accuracy. This type of use is a vital part of the quality assurance processes labs need to perform, and is not considered research.

Leftover samples can also be used by researchers from a range of agencies such as universities, research institutes or private companies.

They may use leftover samples for research activities such as trying out new ideas or conducting small-scale studies (more on this later). Companies that develop new or improved medical diagnostic tests can also use leftover samples to assess the efficacy of their test, generating data needed for regulatory approval.

What about informed consent?

If you’ve ever participated in a medical research project such as a clinical trial, you may be familiar with the concept of informed consent. In this process, you have the opportunity to learn about the study and what your participation involves, before you decide whether or not to participate.

So you may be surprised to learn using leftover samples for research purposes without your consent is permitted in most parts of Australia, and elsewhere. However, it’s only allowed under certain conditions.

In Australia, the National Health and Medical Research Council (NHMRC) offers guidance around the use of leftover pathology samples.

One of the conditions for using leftover samples without consent for research is that they were received and retained by an accredited pathology service. This helps ensure the samples were collected safely and properly, for a legitimate clinical reason, and that no additional burdens or risk of harm to the person who provided the sample will be created with their further use.

Another condition is anonymity: the leftover samples must be deidentified, and not easily able to be reidentified. This means they can only be used in research if the identity of the donor is not needed.

Leftover pathology samples are sometimes used in medical research. hedgehog94/Shutterstock

The decision to allow a particular research project to use leftover pathology samples is made by an independent human research ethics committee which includes consumers and independent experts. The committee evaluates the project and weighs up the risks and potential benefits before permitting an exemption to the need for informed consent.

Similar frameworks exist in the United States, the United Kingdom, India and elsewhere.

What research might be done on my leftover samples?

You might wonder how useful leftover samples are, particularly when they’re not linked to a person and their medical history. But these samples can still be a valuable resource, particularly for early-stage “discovery” research.

Research using leftover samples has helped our understanding of antibiotic resistance in a bacterium that causes stomach ulcers, Helicobacter pylori. It has helped us understand how malaria parasites, Plasmodium falciparum, damage red blood cells.

Leftover samples are also helping researchers identify better, less invasive ways to detect chronic diseases such as pulmonary fibrosis. And they’re allowing scientists to assess the prevalence of a variant in haemoglobin that can interfere with widely used diagnostic blood tests.

All of this can be done without your permission. The kinds of tests researchers do on leftover samples will not harm the person they were taken from in any way. However, using what would otherwise be discarded allows researchers to test a new method or treatment and avoid burdening people with providing fresh samples specifically for the research.

When considering questions of ethics, it could be argued not using these samples to derive maximum benefit is in fact unethical, because their potential is wasted. Using leftover samples also minimises the cost of preliminary studies, which are often funded by taxpayers.

The use of leftover pathology samples in research has been subject to some debate. Andrey_Popov/Shutterstock

Inconsistencies in policy

Despite NHMRC guidance, certain states and territories have their own legislation and guidelines which differ in important ways. For instance, in New South Wales, only pathology services may use leftover specimens for certain types of internal work. In all other cases consent must be obtained.

Ethical standards and their application in research are not static, and they evolve over time. As medical research continues to advance, so too will the frameworks that govern the use of leftover samples. Nonetheless, developing a nationally consistent approach on this issue would be ideal.

Striking a balance between ensuring ethical integrity and fostering scientific discovery is essential. With ongoing dialogue and oversight, leftover pathology samples will continue to play a crucial role in driving innovation and advances in health care, while respecting the privacy and rights of individuals.

Christine Carson is a founder with a financial interest in Cytophenix, a company developing new diagnostic tests. Her work is supported by government funding sources, philanthropy and private companies.

The views expressed here are the author's own and are not those of Monash University.

hMPV may be spreading in China. Here’s what to know about this virus – and why it’s not cause for alarm

2025-01-07T06:27:42Z

Five years on from the first news of COVID, recent reports of an obscure respiratory virus in China may understandably raise concerns.

Chinese authorities first issued warnings about human metapneumovirus (hMPV) in 2023, but media reports indicate cases may be increasing again during China’s winter season.

For most people, hMPV will cause symptoms similar to a cold or the flu. In rare cases, hMPV can lead to severe infections. But it isn’t likely to cause the next pandemic.

What is hMPV?

hMPV was first discovered in 2001 by scientists from the Netherlands in a group of children where tests for other known respiratory viruses were negative.

But it was probably around long before that. Testing of samples from the 1950s demonstrated antibodies against this virus, suggesting infections have been common for at least several decades. Studies since have found hMPV in almost all regions in the world.

Australian data prior to the COVID pandemic found hMPV to be the third most common virus detected in adults and children with respiratory infections. In adults, the two most common were influenza and RSV (respiratory syncytial virus), while in children they were RSV and parainfluenza.

Like influenza, hMPV is a more significant illness for younger and older people.

Studies suggest most children are exposed early in life, with the majority of children by age five having antibodies indicating prior infection. In general, this reduces the severity of subsequent infections for older children and adults.

In young children, hMPV most commonly causes infections of the upper respiratory tract, with symptoms including runny nose, sore throat, fever as well as ear infections. These symptoms usually resolve over a few days to a week in children, and 1–2 weeks in adults.

hMPV causes cold and flu-like symptoms in young children. PeopleImages.com - Yuri A/Shutterstock

Although most infections with hMPV are relatively mild, it can cause more severe disease in people with underlying medical conditions, such as heart disease. Complications can include pneumonia, with shortness of breath, fever and wheezing. hMPV can also worsen pre-existing lung diseases such as asthma or emphysema. Additionally, infection can be serious in people with weakened immune systems, particularly those who have had bone marrow or lung transplants.

But the generally mild nature of the illness, the widespread detection of antibodies reflecting broad population exposure and immunity, combined with a lack of any known major pandemics in the past due to hMPV, suggests there’s no cause for alarm.

Are there any vaccines or treatments?

It is presumed that hMPV is transmitted by contact with respiratory secretions, either through the air or on contaminated surfaces. Therefore, personal hygiene measures and avoiding close contact with other people while unwell should reduce the risk of transmission.

The virus is a distant cousin of RSV for which immunisation products have recently become available, including vaccines and monoclonal antibodies. This has led to the hope that similar products may be developed for hMPV, and Moderna has recently started trials into a mRNA hMPV vaccine.

There are no treatments that have been clearly demonstrated to be effective. But for severely unwell patients certain antivirals may offer some benefit.

Why are we hearing so many reports of respiratory viruses now?

Since the COVID pandemic, the pattern of many respiratory infections has changed. For example, in Australia, influenza seasons have started earlier (peaking in June–July rather than August–September).

Many countries, including Australia, are reporting an increased number of cases of whooping cough (pertussis).

In China, there have been reports of increased cases of mycoplasma, a bacterial cause of pneumonia, as well as influenza and hMPV.

There are many factors that may have impacted the epidemiology of respiratory pathogens. These include the interruption to respiratory virus transmission due to public health measures taken during the COVID pandemic, environmental factors such as climate change, and for some diseases, post-pandemic changes in vaccine coverage. It may also be the usual variation we see with respiratory infections – for example, pertussis outbreaks are known to occur every 3–4 years.

For hMPV in Australia, we don’t yet have stable surveillance systems to form a good picture of what a “usual” hMPV season looks like. So with international reports of outbreaks, it will be important to monitor the available data for hMPV and other respiratory viruses to inform local public health policy.

Allen Cheng receives funding from the Australian Government for respiratory virus surveillance. He is a member of the Australian Technical Advisory Group on Immunisation, the National Respiratory Virus Surveillance Committee and the Communicable Diseases Network of Australia, advising governments on surveillance and immunisation.

What is reformer pilates? And is it worth the cost?

2025-01-07T00:31:29Z

Ahmet Kurt/Unsplash

Reformer pilates is steadily growing in popularity, with new studios opening regularly in major cities all over the world.

But what exactly is reformer pilates? And how does it compare with regular pilates and other types of exercise?

Classes aren’t cheap so let’s look at the potential benefits and drawbacks to help you decide if it’s right for you.

Pilates with special equipment

Pilates is a mode of exercise that focuses on core stability and flexibility, while also addressing muscular strength and endurance, balance and general fitness. At first glance, it might look a bit like yoga, with some more traditional weight training components thrown in.

Reformer pilates uses a piece of equipment called a “reformer”. This looks like a narrow bed that slides along a carriage, has straps to hold onto, and has adjustable springs that add resistance to movement. You perform pilates on the reformer to _target specific muscle groups and movement patterns.

The reformer was first designed to help people recover from injuries. However, it has now become common for general fitness and even sports performance.

Unlike normal pilates, also known as “mat pilates”, which only uses your body weight, the reformer adds resistance, meaning you can change the difficulty according to your current level of fitness.

This not only provides a way to overload your muscles, but can make the exercise session more aerobically demanding, which has been proposed to improve cardiovascular fitness.

Mat pilates uses your body weight. Kampus Productions/Pexels

What are the benefits of reformer pilates?

Despite being around for decades, there is surprisingly little research looking at the benefits of reformer pilates. However, what we have seen so far suggests it has a similar effect to other modes of exercise.

Reformer pilates has been shown to help with weight loss, cause some small increases in muscle mass, and enhance cognitive function. All of these benefits are commonly seen when combining weight training and cardio into the same routine.

Similarly, among older adults, it has been shown to improve strength, enhance flexibility and may even reduce the risk of falling.

From a rehabilitation perspective, there is some evidence indicating reformer pilates can improve shoulder health and function, reduce lower back pain and increase flexibility.

Finally, there is some evidence suggesting a single session of reformer pilates can improve two key markers of cardiovascular health, being flow-mediated dilation and pulse wave velocity, while also improving cholesterol and insulin levels. This suggests reformer pilates could lead to long-term improvements in heart and metabolic health, although more research is needed to confirm this.

Reformer pilates was first designed to help people recover from injuries. Kampus Productions/Pexels

However, there are some key things to consider when discussing these benefits. Most of this research is quite exploratory and comes from a very small number of studies. So we do not know whether these findings will apply to everyone.

Very few studies compared reformer pilates to other types of exercise. Therefore, while it can improve most aspects of health and function, it’s unlikely reformer pilates provides the optimal mode of exercise for each individual component of physical fitness.

Traditional weight training, for example, will likely cause larger improvements in strength than reformer pilates. Similarly, stretching will probably make you more flexible. And running or cycling will make you fitter.

However, if you want a type of exercise that gives you broad overall health benefits, it could be a good option.

What are the downsides of reformer pilates

Reformer pilates is not for everyone.

First and foremost, classes can be expensive compared to other fitness options. You need to be doing at least two to three sessions per week of any type of exercise to maximise the benefits. So even if you can find a class for A$20 or $30, paying for two or three classes a week (or buying a weekly or monthly subscription) is a significant outlay.

Second, it’s not as accessible as other exercise. Even if you can afford it, not every town or suburb has a reformer pilates studio.

Cost and access are major barriers. Or you might get better results with specific modes of exercises. Karolina Grabowska/Pexels

Third, the effectiveness of your workout is likely to be impacted by how competent your instructor is. There are a host of different pilates qualifications you can get in Australia, and some take much less time than others. With this in mind, it might be best to look for accredited pilates instructors, although this will further reduce the number of options you have available.

Finally, there is a learning curve. While you will get better over time, the exercise will likely be less effective during those first few weeks (or months) when you are getting used to the machine and the movements.

Is it right for you?

Reformer pilates can be a great addition to your fitness routine, especially if you’re looking for a low-impact way to build strength and flexibility.

But if you have more specific goals, you might need a more specific mode of exercise. For example, if you need to get stronger to improve your ability to manage your daily life, then strength training is probably your best bet. Likewise, if your goal is to run a marathon, you will get more specific benefits from running.

The cost and availability of reformer pilates make it less accessible for some people. With this in mind, if you are after similar benefits at a lower price point, mat pilates might be a better option. Not only does it have evidence suggesting it can improve strength and fitness, but it is something you can do at home if you find a good resource (YouTube could be a good starting point here).

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.

Can apps and digital resources support your child with autism or ADHD? Here’s what to look for

2025-01-06T19:02:57Z

Fabio Principe/Shutterstock

Neurodevelopmental conditions such as attention deficit hyperactivity disorder (ADHD) and autism affect about one in ten children. These conditions impact development, behaviour and wellbeing.

But children with these conditions and their caregivers often can’t get the support they need. Families report difficulties accessing health-care providers and experience long wait lists to receive care.

Digital tools, such as apps and websites, are often viewed as a solution to these gaps. With a single click or a download, families might be able to access information to support their child.

There are lots of digital tools available, but it’s hard to know what is and isn’t useful. Our new study evaluated freely available digital resources for child neurodevelopment and mental health to understand their quality and evidence base.

We found many resources were functional and engaging. However, resources often lacked evidence for the information provided and the claimed positive impact on children and families.

This is a common problem in the digital resource field, where the high expectations and claims of impact from digital tools to change health care have not yet been realised.

What type of resources?

Our study identified 3,435 separate resources, of which 112 (43 apps and 69 websites) met our criteria for review. These resources all claimed to provide information or supports for child neurodevelopment, mental health or wellbeing.

Resources had to be freely available, in English and have actionable information for children and families.

The most common focus was on autism, representing 17% of all resources. Resources suggested they provided strategies to promote speech, language and social development, and to support challenging behaviours.

Other common areas included language and communication (14%), and ADHD (10%).

Resources had various purposes, including journalling and providing advice, scheduling support, and delivering activities and strategies for parents. Resources delivered information interactively, with some apps organising content into structured modules.

Resources also provided options for alternative and assistive communication for people with language or communication challenges.

Most apps were functional and accessible

Our first question was about how engaging and accessible the information was. Resources that are hard to use aren’t used frequently, regardless of the information quality.

We evaluated aesthetics, including whether digital tools were easy to use and navigate, stylistically consistent, with clean and appealing graphics for users.

Most resources were rated as highly engaging, with strong accessibility and functionality.

Most apps and websites we evaluated were engaging. jamesteohart/Shutterstock

But many lacked quality information

We ranked resources on various features from 1 (inadequate) to 5 (excellent), with a ranking of 3 considered acceptable. These ratings looked at how credible the resource was and whether there was evidence supporting it.

Despite their functionality, 37% of reviewed apps did not meet the minimum acceptable standards for information quality. This means many apps could not be recommended. Most websites fared better than apps.

There also wasn’t a lot of scientific evidence to suggest using either apps or digital resources actually helped families. Studies show long-term engagement with digital tools is rare, and downloads don’t correspond to frequent usage or benefits.

Digital tools are often viewed as a panacea to health-care gaps, but the evidence is yet to show they fill such gaps. Digital health is a fast-moving field and resources are often made available before they have been properly evaluated.

What should you look for in digital resources?

We found the highest quality resources were developed in collaboration with institutions, such as health, university or government groups.

One highly rated resource was the Raising Children’s Network and the associated app, Raising Healthy Minds. These are co-developed with a university and hospital, and by people with appropriate qualifications.

This resource provides information to support children’s overall health, development and wellbeing, with dedicated sections addressing neurodevelopmental needs and concerns.

The Raising Children Network provides resources for child health, including neurodevelopmental needs. Raising Children Network screenshot

Our research shows parents can assess whether digital resources are high quality by checking they are:

factually correct. Look for where the app or resource is getting its information. Does the author have the qualifications and training to provide the information? Are they a registered health expert who is accountable to a regulatory body (such as AHPRA, the Australian Health Practitioners Regulation Agency) for providing information that does not cause harm?
consistent across multiple credible sources, such as health institutions.
linked to supporting information. Look for reliable links to reputable institutions. Links to peer-reviewed scientific journals are often helpful as those articles will also usually describe the limitations of the research presented.
up-to-date. Apps should be frequently updated. For websites, dates of update are usually found on the homepage or at the bottom of individual pages.

Check when information was last updated. fizkes/Shutterstock

Beware of red flags

Some things to watch out for are:

testimonials and anecdotes without evidence and scientific links to back the anecdotes up. If it sounds too good to be true, it probably is.
no information provided about conflicts of interest. Organisations gain when you click on their links or take their advice (financial, reputation and brand development). Think about what they gain when you use their information to help keep a balanced perspective.

Remember, the app’s star rating doesn’t mean it will contain factual information from a reliable source or be helpful for you and your child.

The role of digital tools

Digital tools won’t usually replace a health professional, but they can support care in many different ways. They may be used to help to educate and prepare for meetings, and to collaborate with health providers.

They may also be used to collect information about daily needs. Studies show reporting on sleep in children can be notoriously difficult, for example. But tracking sleep behaviour with actigraphy, where movement and activity patterns are measured using a wearable device, can provide information to support clinical care. With the promise of artificial intelligence, there will also be new opportunities to support daily living.

Our findings reflect a broader problem for digital health, however. Much investment is often made in developing products to drive use, with spurious claims of health benefits.

What’s needed is a system that prioritises the funding, implementation and evaluation of tools to demonstrate benefits for families. Only then may we realise the potential of digital tools to benefit those who use them.

Kelsie Boulton receives funding from the National Health and Medical Research Council and the Cerebral Palsy Alliance Research Foundation for research into neurodevelopmental conditions.

Adam Guastella receives funding from the National Health and Medical Research Council and Australian Research Council for research into neurodevelopmental conditions. He is director of the Clinic for Autism and Neurodevelopmental Research and scientific chair of Neurodevelopment Australia, a scientific group seeking to improve the knowledge and supports for all people with neurodevelopmental conditions.

Should I get a weighted vest to boost my fitness? And how heavy should it be?

2025-01-06T00:08:39Z

ZR10/Shutterstock

Exercise training while wearing a weighted vest is undergoing somewhat of a renaissance. Social media posts and trainers are promoting them as a potential strategy for improving fitness and health.

Exercising with additional weight attached to the body is nothing new. This idea has been used with soldiers for many centuries if not millennia – think long hikes with a heavy pack.

The modern weighted vest comes in a range of designs that are more comfortable and can be adjusted in terms of the weight added. But could one be helpful for you?

What the research says

One of the earliest research studies, reported in 1993, followed 36 older people wearing weighted vests during a weekly exercise class and at home over a 20-week period. Wear was associated with improvements in bone health, pain and physical function.

Since then, dozens of papers have evaluated the exercise effects of wearing a weighted vest, reporting a range of benefits.

Not surprisingly, exercise with a weighted vest increases physiological stress – or how hard the body has to work – as shown by increased oxygen uptake, heart rate, carbohydrate utilisation and energy expenditure.

Adding weight equal to 10% of body weight is effective. But it doesn’t appear the body works significantly harder when wearing 5% extra weight compared to body weight alone.

Does more load mean greater injury risk?

A small 2021 study suggested additional weights don’t alter the biomechanics of walking or running. These are important considerations for lower-limb injury risk.

The safety considerations of exercising with weighted vests have also been reported in a biomechanical study of treadmill running with added weight of 1% to 10% of body weight.

While physiological demand (indicated by heart rate) was higher with additional weight and the muscular forces greater, running motion was not negatively affected.

To date no research studies have reported increased injuries due to wearing weighted vests for recreational exercise. However a 2018 clinical study on weight loss in people with obesity found back pain in 25% of those wearing such vests. Whether this can be translated to recreational use in people who don’t have obesity is difficult to say. As always, if pain or discomfort is experienced then you should reduce the weight or stop vest training.

Better for weight loss or bone health?

While wearing a weighted vest increases the energy expenditure of aerobic and resistance exercise, research to show it leads to greater fat loss or retaining muscle mass is somewhat inconclusive.

One older study investigated treadmill walking for 30 minutes, three times a week in postmenopausal women with osteoporosis. The researchers found greater fat loss and muscle gain in the participants who wore a weighted vest (at 4–8% body weight). But subsequent research in obese older adults could not show greater fat loss in participants who wore weighted vests for an average of 6.7 hours per day.

There has been considerable interest in the use of weighted vests to improve bone health in older people. One 2003 study reported significant improvements in bone density in a group of older women over 32 weeks of weighted vest walking and strength training compared to a sedentary control group.

But a 2012 study found no difference in bone metabolism between groups of postmenopausal women with osteoporosis walking on a treadmill with or without a weighted vest.

Making progress

As with any exercise, there is a risk of injury if it is not done correctly. But the risk of weighted vest training appears low and can be managed with appropriate exercise progression and technique.

If you are new to training, then the priority should be to simply start exercising and not complicate it with wearing a weighted vest. The use of body weight alone will be sufficient to get you on the path to considerable gains in fitness.

Once you have a good foundation of strength, aerobic fitness and resilience for muscles, joints and bones, using a weighted vest could provide greater loading intensity as well as variation.

It is important to start with a lighter weight (such as 5% bodyweight) and build to no more than 10% body weight for ground impact exercises such as running, jogging or walking.

For resistance training such as squats, push-ups or chin-ups, progression can be achieved by increasing loads and adjusting the number of repetitions for each set to around 10 to 15. So, heavier loads but fewer repetitions, then building up to increase the load over time.

While weighted vests can be used for resistance training, it is probably easier and more convenient to use barbells, dumbbells, kettle bells or weighted bags.

The benefits of added weight can also be achieved by adding repetition or duration. Geert Pieters/Unsplash

The bottom line

Weighted vest training is just one tool in an absolute plethora of equipment, techniques and systems. Yes, walking or jogging with around 10% extra body weight increases energy expenditure and intensity. But training for a little bit longer or at a higher intensity can achieve similar results.

There may be benefits for bone health in wearing a weighted vest during ground-based exercise such as walking or jogging. But similar or greater stimulus to bone growth can be achieved by resistance training or even the introduction of impact training such as hopping, skipping or bounding.

Exercising with a weighted vest likely won’t increase your injury risk. But it must be approached intelligently considering fitness level, existing and previous injuries, and appropriate progression for intensity and repetition.

Rob Newton 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.

3 drugs that went from legal, to illegal, then back again

2025-01-05T19:05:42Z

Peruvian Syrup, containing cocaine, was used to 'cure' a range of diseases. Smithsonian Museum of American History/Flickr

Cannabis, cocaine and heroin have interesting life stories and long rap sheets. We might know them today as illicit drugs, but each was once legal.

Then things changed. Racism and politics played a part in how we viewed them. We also learned more about their impact on health. Over time, they were declared illegal.

But decades later, these drugs and their derivatives are being used legally, for medical purposes.

Here’s how we ended up outlawing cannabis, cocaine and heroin, and what happened next.

Cannabis, religion and racism

Cannabis plants originated in central Asia, spread to North Africa, and then to the Americas. People grew cannabis for its hemp fibre, used to make ropes and sacks. But it also had other properties. Like many other ancient medical discoveries, it all started with religion.

Cannabis is mentioned in the Hindu texts known as the Vedas (1700-1100 BCE) as a sacred, feel-good plant. Cannabis or bhang is still used ritually in India today during festivals such as Shivratri and Holi.

From the late 1700s, the British in India started taxing cannabis products. They also noticed a high rate of “Indian hemp insanity” – including what we’d now recognise as psychosis – in the colony. By the late 1800s, a British government investigation found only heavy cannabis use seemed to affect people’s mental health.

This drug bottle from the United States contains cannabis tincture. Wikimedia

In the 1880s, cannabis was used therapeutically in the United States to treat tetanus, migraine and “insane delirium”. But not everyone agreed on (or even knew) the best dose. Local producers simply mixed up what they had into a tincture – soaking cannabis leaves and buds in alcohol to extract essential oils – and hoped for the best.

So how did cannabis go from a slightly useless legal drug to a social menace?

Some of it was from genuine health concerns about what was added to people’s food, drink and medicine.

In 1908 in Australia, New South Wales listed cannabis as an ingredient that could “adulterate” food and drink (along with opium, cocaine and chloroform). To sell the product legally, you had to tell the customers it contained cannabis.

Some of it was international politics. Moves to control cannabis use began in 1912 with the world’s first treaty against drug trafficking. The US and Italy both wanted cannabis included, but this didn’t happen until until 1925.

Some of it was racism. The word marihuana is Spanish for cannabis (later Anglicised to marijuana) and the drug became associated with poor migrants. In 1915, El Paso, Texas, on the Mexican border, was the first US municipality to ban the non-medical cannabis trade.

By the late 1930s, cannabis was firmly entrenched as a public menace and drug laws had been introduced across much of the US, Europe and (less quickly) Australia to prohibit its use. Cannabis was now a “poison” regulated alongside cocaine and opiates.

The 1936 movie Reefer Madness fuelled cannabis paranoia. Motion Picture Ventures/Wikimedia Commons

The 1936 movie Reefer Madness was a high point of cannabis paranoia. Cannabis smoking was also part of other “suspect” new subcultures such as Black jazz, the 1950s Beatnik movement and US service personnel returning from Vietnam.

Today recreational cannabis use is associated with physical and mental harm. In the short term, it impairs your functioning, including your ability to learn, drive and pay attention. In the long term, harms include increasing the risk of psychosis.

But what about cannabis as a medicine? Since the 1980s there has been a change in mood towards experimenting with cannabis as a therapeutic drug. Medicinal cannabis products are those that contain cannabidiol (CBD) or tetrahydrocannabinol (THC). Today in Australia and some other countries, these can be prescribed by certain doctors to treat conditions when other medicines do not work.

Medicinal cannabis has been touted as a treatment for some chronic conditions such as cancer pain and multiple sclerosis. But it’s not clear yet whether it’s effective for the range of chronic diseases it’s prescribed for. However, it does seem to improve the quality of life for people with some serious or terminal illnesses who are using other prescription drugs.

Cocaine, tonics and addiction

Several different species of the coca plant grow across Bolivia, Peru and Colombia. For centuries, local people chewed coca leaves or made them into a mildly stimulant tea. Coca and ayahuasca (a plant-based psychedelic) were also possibly used to sedate people before Inca human sacrifice.

In 1860, German scientist Albert Niemann (1834-1861) isolated the alkaloid we now call “cocaine” from coca leaves. Niemann noticed that applying it to the tongue made it feel numb.

But because effective anaesthetics such as ether and nitrous oxide had already been discovered, cocaine was mostly used instead in tonics and patent medicines.

Hall’s Coca Wine was made from the leaves of the coca plant. Stephen Smith & Co/Wellcome Collection, CC BY

Perhaps the most famous example was Coca-Cola, which contained cocaine when it was launched in 1886. But cocaine was used earlier, in 1860s Italy, in a drink called Vin Mariani – Pope Leo XIII was a fan.

With cocaine-based products easily available, it quickly became a drug of addiction.

Cocaine remained popular in the entertainment industry. Fictional detective Sherlock Holmes injected it, American actor Tallulah Bankhead swore by it, and novelist Agatha Christie used cocaine to kill off some of her characters.

In 1914, cocaine possession was made illegal in the US. After the hippy era of the 1960s and 1970s, cocaine became the “it” drug of the yuppie 1980s. “Crack” cocaine also destroyed mostly Black American urban communities.

Cocaine use is now associated with physical and mental harms. In the short and long term, it can cause problems with your heart and blood pressure and cause organ damage. At its worst, it can kill you. Right now, illegal cocaine production and use is also surging across the globe.

But cocaine was always legal for medical and surgical use, most commonly in the form of cocaine hydrochloride. As well as acting as a painkiller, it’s a vasoconstrictor – it tightens blood vessels and reduces bleeding. So it’s still used in some types of surgery.

Heroin, coughing and overdoses

Opium has been used for pain relief ever since people worked out how to harvest the sap of the opium poppy. By the 19th century, addictive and potentially lethal opium-based products such as laudanum were widely available across the United Kingdom, Europe and the US. Opium addiction was also a real problem.

Because of this, scientists were looking for safe and effective alternatives for pain relief and to help people cure their addictions.

In 1874, English chemist Charles Romley Alder Wright (1844-1894) created diacetylmorphine (also known as diamorphine). Drug firm Bayer thought it might be useful in cough medicines, gave it the brand name Heroin and put it on the market in 1898. It made chest infections worse.

Allenburys Throat Pastilles contained heroin and cocaine. Seth Anderson/Flickr, CC BY-NC

Although diamorphine was created with good intentions, this opiate was highly addictive. Shortly after it came on the market, it became clear that it was every bit as addictive as other opiates. This coincided with international moves to shut down the trade in non-medical opiates due to their devastating effect on China and other Asian countries.

Like cannabis, heroin quickly developed radical chic. The mafia trafficked into the US and it became popular in the Harlem jazz scene, beatniks embraced it and US servicemen came back from Vietnam addicted to it. Heroin also helped kill US singers Janis Joplin and Jim Morrison.

Today, we know heroin use and addiction contributes to a range of physical and mental health problems, as well as death from overdose.

However, heroin-related harm is now being outpaced by powerful synthetic opioids such as oxycodone, fentanyl, and the nitazene group of drugs. In Australia, there were more deaths and hospital admissions from prescription opiate overdoses than from heroin overdoses.

In a nutshell

Not all medicines have a squeaky-clean history. And not all illicit drugs have always been illegal.

Drugs’ legal status and how they’re used are shaped by factors such as politics, racism and social norms of the day, as well as their impact on health.

Philippa Martyr 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.

The elimination of cervical cancer in NZ is within reach in our lifetime – but not without funding and a plan

2025-01-02T19:06:41Z

After committing to a global plan to eliminate cervical cancer, New Zealand is lagging behind Australia and other countries in how it manages this preventable disease.

Each year approximately 175 New Zealanders are diagnosed with cervical cancer and 55 people die from it.

Human papillomavirus (HPV) is the cause of 95% of cervical cancers and some throat and anal cancers. New Zealand has a very effective vaccine against this cancer. And HPV screening can detect changes on the cervix before cancer occurs.

With vaccination and screening it is now realistic to aim to eliminate cervical cancer in our lifetime – but it requires a strategy and investment.

Global goals

The World Health Organization’s global elimination strategy for cervical cancer rests on three _targets:

90% of girls fully vaccinated with the HPV vaccine by the age of 15
70% of women screened using a high-performance test (for example, HPV testing) by the age of 35 and again by the age of 45
90% of women with pre-cancer treated and 90% of women with invasive cancer managed.

But to achieve this in Aotearoa New Zealand, there needs to be a commitment from the government to develop and resource an elimination strategy.

This is not currently happening. And, despite some advances, women continue to die.

The rise in self-testing

HPV self-testing was introduced as part of the national screening programme in September 2023. Testing for the virus provides 60-70% greater protection against developing invasive cervical cancers compared with cervical cytology (the “smear” – involving a speculum examination by a trained provider).

It is such good a test that following a negative result (and no symptoms) another test is not needed for five years.

Switching to HPV-testing has potential to reduce the annual number of cervical cancers by 15%. Women can do the test themselves and, under the new scheme, 80% are choosing self-testing.

There has also been a high uptake from never-screened or under-screened women. This is important because more than 85% of our cervical cancers occurred in those not regularly screened.

Before the introduction of the HPV self-test, just 67.1% of eligible people were up to date with their screening. Over the past year this has increased to 70.8% – reaching the WHO _target. However, coverage for Māori remains below – increasing from 56.3% to just 61.9%.

Low vaccination rates

While screening coverage has increased to 70.8% overall, New Zealand’s HPV vaccination coverage is low (45-60%) – nowhere near the 90% _target, which Australia is close to.

Australia is set to become the first to achieve elimination, after the government committed A$48.2 million to support their national elimination strategy and its implementation.

HPV vaccination is an essential pillar of cervical cancer prevention.

A recent study found no cases of cervical cancer in a cohort of girls immunised between the age of 12 and 13 (born between 1996 and 1998) in Scotland’s school-based vaccination programme. But there were cases of cervical cancer in the unvaccinated group.

More work needed

Champions, researchers, clinicians and whānau campaigned and contributed to our new (albeit overdue) HPV cervical screening programme. But more action is needed.

This is particularly the case as funding for healthcare is cut back.

To achieve the elimination goals we have committed to, three things need to happen:

Free cervical screening (unlike breast and bowel screening, New Zealand’s cervical screening programme not fully-funded).
A cervical cancer elimination strategy with dedicated funding.
Boosting HPV vaccination uptake.

It’s essential everyone is included to achieve elimination. The WHO global _targets – set to address the differential burden of cervical cancer between countries – fail to address the rights of Indigenous peoples to be counted within the elimination _targets. Within-country inequities may remain hidden as a country can claim elimination based on data that doesn’t separate different ethnic groups.

Countries, including Aotearoa New Zealand, need to meet elimination _targets for all women.

Aotearoa has the tools (HPV self-testing, vaccination and treatment for cell changes) to make elimination for all a reality. But without an equitable strategy or funding to drive progress, the end of cervical cancer for New Zealanders will not be as close or as equitable as it should be.

Bev Lawton receives funding from The Health Research Council of New Zealand and the Ministry of Health. She is a member of the National Cervical Screening Programme Clinical Practice Guidelines Committee and a member of the National Cervical Screening Programme Advisory and Action Group.

Francesca Storey 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.

Why do some people’s hair and nails grow quicker than mine?

2025-01-02T19:05:52Z

Jari Lobo/Pexels

Throughout recorded history, our hair and nails played an important role in signifying who we are and our social status. You could say, they separate the caveman from businessman.

It was no surprise then that many of us found a new level of appreciation for our hairdressers and nail artists during the COVID lockdowns. Even Taylor Swift reported she cut her own hair during lockdown.

So, what would happen if all this hair and nail grooming got too much for us and we decided to give it all up. Would our hair and nails just keep on growing?

The answer is yes. The hair on our head grows, on average, 1 centimeter per month, while our fingernails grow an average of just over 3 millimetres.

When left unchecked, our hair and nails can grow to impressive lengths. Aliia Nasyrova, known as the Ukrainian Rapunzel, holds the world record for the longest locks on a living woman, which measure an impressive 257.33 cm.

When it comes to record-breaking fingernails, Diana Armstrong from the United States holds that record at 1,306.58 cm.

Most of us, however, get regular haircuts and trim our nails – some with greater frequency than others. So why do some people’s hair and nails grow more quickly?

Remind me, what are they made out of?

Hair and nails are made mostly from keratin. Both grow from matrix cells below the skin and grow through different patterns of cell division.

Nails grow steadily from the matrix cells, which sit under the skin at the base of the nail. These cells divide, pushing the older cells forward. As they grow, the new cells slide along the nail bed – the flat area under the fingernail which looks pink because of its rich blood supply.

Nails, like hair, are made mostly of keratin. Scott Gruber/Unsplash

A hair also starts growing from the matrix cells, eventually forming the visible part of the hair – the shaft. The hair shaft grows from a root that sits under the skin and is wrapped in a sac known as the hair follicle.

This sac has a nerve supply (which is why it hurts to pull out a hair), oil-producing glands that lubricate the hair and a tiny muscle that makes your hair stand up when it’s cold.

At the follicle’s base is the hair bulb, which contains the all-important hair papilla that supplies blood to the follicle.

Matrix cells near the papilla divide to produce new hair cells, which then harden and form the hair shaft. As the new hair cells are made, the hair is pushed up above the skin and the hair grows.

But the papilla also plays an integral part in regulating hair growth cycles, as it sends signals to the stem cells to move to the base of the follicle and form a hair matrix. Matrix cells then get signals to divide and start a new growth phase.

Unlike nails, our hair grows in cycles

Scientists have identified four phases of hair growth, the:

anagen or growth phase, which lasts between two and eight years
catagen or transition phase, when growth slows down, lasting around two weeks
telogen or resting phase, when there is no growth at all. This usually lasts two to three months
exogen or shedding phase, when the hair falls out and is replaced by the new hair growing from the same follicle. This starts the process all over again.

Hair follicles enter these phases at different times so we’re not left bald. Mosterpiece/Shutterstock

Each follicle goes through this cycle 10–30 times in its lifespan.

If all of our hair follicles grew at the same rate and entered the same phases simultaneously, there would be times when we would all be bald. That doesn’t usually happen: at any given time, only one in ten hairs is in the resting phase.

While we lose about 100–150 hairs daily, the average person has 100,000 hairs on their head, so we barely notice this natural shedding.

So what affects the speed of growth?

Genetics is the most significant factor. While hair growth rates vary between individuals, they tend to be consistent among family members.

Nails are also influenced by genetics, as siblings, especially identical twins, tend to have similar nail growth rates.

Genetics have the biggest impact on growth speed. Cottonbro Studio/Pexels

But there are also other influences.

Age makes a difference to hair and nail growth, even in healthy people. Younger people generally have faster growth rates because of the slowing metabolism and cell division that comes with ageing.

Hormonal changes can have an impact. Pregnancy often accelerates hair and nail growth rates, while menopause and high levels of the stress hormone cortisol can slow growth rates.

Nutrition also changes hair and nail strength and growth rate. While hair and nails are made mostly of keratin, they also contain water, fats and various minerals. As hair and nails keep growing, these minerals need to be replaced.

That’s why a balanced diet that includes sufficient nutrients to support your hair and nails is essential for maintaining their health.

Nutrition can impact hair and nail growth. Cottonbro Studio/Pexels

Nutrient deficiencies may contribute to hair loss and nail breakage by disrupting their growth cycle or weakening their structure. Iron and zinc deficiencies, for example, have both been linked to hair loss and brittle nails.

This may explain why thick hair and strong, well-groomed nails have long been associated with perception of good health and high status.

However, not all perceptions are true.

No, hair and nails don’t grow after death

A persistent myth that may relate to the legends of vampires is that hair and nails continue to grow after we die.

In reality, they only appear to do so. As the body dehydrates after death, the skin shrinks, making hair and nails seem longer.

Morticians are well aware of this phenomenon and some inject tissue filler into the deceased’s fingertips to minimise this effect.

So, it seems that living or dead, there is no escape from the never-ending task of caring for our hair and nails.

Michelle Moscova receives funding from NHMRC, but this funding is not related to the topic of this article.

Most adults will gain half a kilo this year – and every year. Here’s how to stop ‘weight creep’

2025-01-01T19:02:03Z

Allgo/Unsplash

As we enter a new year armed with resolutions to improve our lives, there’s a good chance we’ll also be carrying something less helpful: extra kilos. At least half a kilogram, to be precise.

“Weight creep” doesn’t have to be inevitable. Here’s what’s behind this sneaky annual occurrence and some practical steps to prevent it.

Small gains add up

Adults tend to gain weight progressively as they age and typically gain an average of 0.5 to 1kg every year.

While this doesn’t seem like much each year, it amounts to 5kg over a decade. The slow-but-steady nature of weight creep is why many of us won’t notice the extra weight gained until we’re in our fifties.

Why do we gain weight?

Subtle, gradual lifestyle shifts as we progress through life and age-related biological changes cause us to gain weight. Our:

activity levels decline. Longer work hours and family commitments can see us become more sedentary and have less time for exercise, which means we burn fewer calories
diets worsen. With frenetic work and family schedules, we sometimes turn to pre-packaged and fast foods. These processed and discretionary foods are loaded with hidden sugars, salts and unhealthy fats. A better financial position later in life can also result in more dining out, which is associated with a higher total energy intake
sleep decreases. Busy lives and screen use can mean we don’t get enough sleep. This disturbs our body’s energy balance, increasing our feelings of hunger, triggering cravings and decreasing our energy

Insufficient sleep can increase our appetite. Craig Adderley/Pexels

stress increases. Financial, relationship and work-related stress increases our body’s production of cortisol, triggering food cravings and promoting fat storage
metabolism slows. Around the age of 40, our muscle mass naturally declines, and our body fat starts increasing. Muscle mass helps determine our metabolic rate, so when our muscle mass decreases, our bodies start to burn fewer calories at rest.

We also tend to gain a small amount of weight during festive periods – times filled with calorie-rich foods and drinks, when exercise and sleep are often overlooked. One study of Australian adults found participants gained 0.5 kilograms on average over the Christmas/New Year period and an average of 0.25 kilograms around Easter.

Why we need to prevent weight creep

It’s important to prevent weight creep for two key reasons:

1. Weight creep resets our body’s set point

Set-point theory suggests we each have a predetermined weight or set point. Our body works to keep our weight around this set point, adjusting our biological systems to regulate how much we eat, how we store fat and expend energy.

When we gain weight, our set point resets to the new, higher weight. Our body adapts to protect this new weight, making it challenging to lose the weight we’ve gained.

But it’s also possible to lower your set point if you lose weight gradually and with an interval weight loss approach. Specifically, losing weight in small manageable chunks you can sustain – periods of weight loss, followed by periods of weight maintenance, and so on, until you achieve your goal weight.

Holidays can also come with weight gain. Zan Lazarevic/Unsplash

2. Weight creep can lead to obesity and health issues

Undetected and unmanaged weight creep can result in obesity which can increase our risk of heart disease, strokes, type 2 diabetes, osteoporosis and several types of cancers (including breast, colorectal, oesophageal, kidney, gallbladder, uterine, pancreatic and liver).

A large study examined the link between weight gain from early to middle adulthood and health outcomes later in life, following people for around 15 years. It found those who gained 2.5 to 10kg over this period had an increased incidence of type 2 diabetes, heart disease, strokes, obesity-related cancer and death compared to participants who had maintained a stable weight.

Fortunately, there are steps we can take to build lasting habits that will make weight creep a thing of the past.

7 practical steps to prevent weight creep

1. Eat from big to small

Aim to consume most of your food earlier in the day and taper your meal sizes to ensure dinner is the smallest meal you eat.

A low-calorie or small breakfast leads to increased feelings of hunger, specifically appetite for sweets, across the course of the day.

We burn the calories from a meal 2.5 times more efficiently in the morning than in the evening. So emphasising breakfast over dinner is also good for weight management.

Aim to consume bigger breakfasts and smaller dinners. Michael Burrows/Pexels

2. Use chopsticks, a teaspoon or an oyster fork

Sit at the table for dinner and use different utensils to encourage eating more slowly.

This gives your brain time to recognise and adapt to signals from your stomach telling you you’re full.

3. Eat the full rainbow

Fill your plate with vegetables and fruits of different colours first to support eating a high-fibre, nutrient-dense diet that will keep you feeling full and satisfied.

Meals also need to be balanced and include a source of protein, wholegrain carbohydrates and healthy fat to meet our dietary needs – for example, eggs on wholegrain toast with avocado.

4. Reach for nature first

Retrain your brain to rely on nature’s treats – fresh vegetables, fruit, honey, nuts and seeds. In their natural state, these foods release the same pleasure response in the brain as ultra-processed and fast foods, helping you avoid unnecessary calories, sugar, salt and unhealthy fats.

5. Choose to move

Look for ways to incorporate incidental activity into your daily routine – such as taking the stairs instead of the lift – and boost your exercise by challenging yourself to try a new activity.

Just be sure to include variety, as doing the same activities every day often results in boredom and avoidance.

Try new activities or sports to keep your interest up. Cottonbro Studio/Pexels

6. Prioritise sleep

Set yourself a goal of getting a minimum of seven hours of uninterrupted sleep each night, and help yourself achieve it by avoiding screens for an hour or two before bed.

7. Weigh yourself regularly

Getting into the habit of weighing yourself weekly is a guaranteed way to help avoid the kilos creeping up on us. Aim to weigh yourself on the same day, at the same time and in the same environment each week and use the best quality scales you can afford.

At the Boden Group, Charles Perkins Centre, we are studying the science of obesity and running clinical trials for weight loss. You can register here to express your interest.

A/Prof Nick Fuller works for the University of Sydney and RPA Hospital and has received external funding for projects relating to the treatment of overweight and obesity. He is the author and founder of the Interval Weight Loss program, and the author of Healthy Parents, Healthy Kids with Penguin Books.

The surprising ways ‘swimming off’ a hangover can be risky, even if alcohol has left your system

2024-12-31T19:33:45Z

Wanderlust Media/Shutterstock

It’s the morning after a big night and you’re feeling the effects of too much alcohol.

So it can be tempting to “refresh” and take the edge off a hangover with a swim at the beach, or a dip in the cool waters of your local river or pool.

But you might want to think twice.

The day after heavy drinking can affect your body, energy levels and perception of risk in many ways. This means you’re more likely to drown or make careless decisions – even without high levels of alcohol in your blood.

Alcohol + water + summer = drowning

Alcohol is one of the main reasons why someone’s more likely to die due to drowning. And Australians consume a lot of it, including around the water.

The risk of drowning, and injury, including incidents involving alcohol, dramatically increases over the summer festive period – in particular on public holidays and long weekends.

Among people aged 18 and over who drowned in rivers where alcohol was involved, we found some 40% had a blood alcohol concentration of at least 0.20%. That’s four times the upper legal limit of 0.05% when driving a car on a full licence.

When we breathalysed people at four Australian rivers, we found higher levels of blood alcohol with higher temperatures, and particularly on public holidays.

At the beach, intoxication due to alcohol and/or drugs is involved in 23% of drowning deaths with an average blood alcohol concentration of 0.19%.

How about if you’re hungover?

Getting alcohol out of your body is a relatively slow process. On average, alcohol is metabolised at a rate of 0.015% per hour. So if someone stops drinking at 2am with a blood alcohol concentration of 0.20%, their alcohol levels don’t drop to zero until 4pm the next day.

Although hangovers can vary from person to person, typical symptoms include headache, muscle aches, fatigue, weakness, thirst, nausea, stomach pain, vertigo, irritability, sensitivity to light and sound, anxiety, sweating and increased blood pressure.

As well as feeling a bit dusty, the day after an evening of heavy drinking, you’re not so good at identifying risks and reacting to them.

In a pool, this might mean not noticing it’s too shallow to dive safely. In natural waterways, this might mean not noticing a strong river current or a rip current at the beach. Or someone might notice these hazards but swim or dive in anyway.

You don’t have to have alcohol in your blood to be affected. Fatigue can set in, leading you to make careless decisions. tismaja/Shutterstock

In one study, we found that after a four-day Australian music festival where people drank heavily, even people who were sober (no longer had alcohol in their blood) were still affected.

Compared to baseline tests in the lab we ran three weeks before the festival, people who were sober the day after the festival had faster reaction times in a test to gauge their attention. But they made more mistakes. This suggests hangovers coupled with fatigue lead to quicker but more careless behaviour.

In and around water this could be the difference between life and death.

Positive blood alcohol readings, including of alcohol from the night before, are commonly implicated in drowning deaths as a result of risky behaviours such as jumping into the water, both at a river and along the coast. Jumping can cause physical injury or render you unconscious, leading to drowning.

Alcohol, including the day after drinking, can also make drowning more likely for a number of other reasons. It also reduces people’s coordination and reaction times.

What else is going on?

Alcohol makes the blood vessels near your skin open up (dilate). So more blood flows into them, making you feel hot. This means you may stay in colder water for longer, increasing your risk of hypothermia.

Alcohol can even make CPR (cardiopulmonary resuscitation) less effective, should you need to be resuscitated.

Normally, your body controls levels of certain minerals (or electrolytes) in the blood. But electrolyte imbalance is common after heavy drinking, including the day after. It’s the reason why hangover symptoms such as muscle pain can lead to cramps in your arms or legs. This can become dangerous when being in or on the water.

Low blood sugar levels the day after drinking is also common. This can lead to people becoming exhausted more quickly when doing physical activities, including swimming.

Other hazards include cold water, high waves and deep water, all of which your body may not be capable of dealing with if you’re feeling the effects of a big night.

What can we do about it?

Authorities regularly warn about the dangers of alcohol intoxication and being near the water. Young people and men are often _targeted because these are the groups more likely to drown where alcohol is involved.

Beaches may have alcohol-free zones. Rivers rarely have the same rules, despite similar dangers.

Royal Life Saving urges men to ‘make the right call’ and avoid alcohol around the water.

How to stay safe around water if you’re drinking

So take care this summer and stay out of the water if you’re not feeling your best:

do your swimming before your drinking
look out for your mates, especially ones who may have had a few too many or are hungover
avoid getting back into the water after you’ve drunk alcohol or if you’re not feeling your best the next day.

Over the past five years, Amy Peden has received funding from the National Health and Medical Research Council, Meta, Surf Life Saving Australia. the Department of Agriculture, Fisheries and Forestry and the NSW Government Office of Sport. Dr Peden is affiliated with Royal Life Saving Society - Australia as an honorary senior research fellow.

In the past five years, Emmanuel Kuntsche has received funding from La Trobe University, National Health and Medical Research Council, Australian Research Council, Victorian Health Promotion Foundation, University of Bayreuth Centre of International Excellence 'Alexander von Humboldt', Veski Foundation, the University of New South Wales, Foundation for Alcohol Research and Education, Healthy Canberra, Swiss National Science Foundation, Queensland Mental Health Commission, and New South Wales Department of Family and Community Services.

Jasmin C. Lawes is the National Research Manager at Surf Life Saving Australia. Over the past five years, Jaz has received funding from the Australian government and the Australian Research Council. Jaz is a co-founder of the UNSW Beach Safety Research Group and is also an invited member of the International Lifesaving Federation's drowning prevention commission.

How to stay safe in a New Year’s Eve crowd

2024-12-30T19:04:09Z

Elias Bitar/Shutterstock

December 31 brings masses of people together to usher in the new year.

But when massive crowds gather to party, certain risks – such as overcrowding or alcohol-related violence – may increase.

Here are some tips to stay safe in packed public spaces, so your end-of-year celebration can be a happy one.

A surge of people in the city centre

New Year’s Eve celebrations are usually unticketed and free to attend. This can make it difficult to estimate how many people will show up.

But public events to watch midnight fireworks often attract hundreds of thousands of people in large city centres.

Revellers are spread over open public areas rather than within a structured venue, and there’s typically no formal security screening or restricted entry.

The risk of overcrowding often peaks shortly after midnight. During the night, the crowd usually builds up gradually over several hours. Then, after the fireworks display, everyone rushes to nearby transport hubs to get home.

This surge in movement – where people pour into stations and areas with limited capacity – increases the risk of a crowd crush.

How does a crowd crush happen?

A crowd crush is not necessarily the result of a “stampede”, although it’s a common misconception this is what causes death and injury in crowds.

In fact, a crowd crush, or surge, is a problem of extreme density.

A crowd crush usually happens when there are more than seven or eight people per square metre. ausnewsde/Shutterstock

In a crowd crush, you will start to feel pushed forward, often against your will, and this pushes others forward in a dangerous chain reaction.

In these situations, you lose the ability to move on your own accord. The crowd begins to behave more like a fluid.

This turbulence only happens in very dense crowds — usually when there are more than seven or eight people per square metre.

The danger escalates if the pressure on a person’s chest and lungs from overcrowding becomes too intense. This can lead to compressive asphyxia — when a person can’t breathe due to immense pressure on their chest.

A progressive crowd collapse can also occur. If someone falls, it can trigger a domino effect.

What can I do?

There are some things you can do to help lessen your risk of being involved in a crowd crush.

1. Plan your journey ahead: avoid areas likely to experience bottlenecks. Local authorities often plan how to spread crowds and avoid congestion, for example by setting up several celebration sites. Know where you’re going ahead of time.

2. Delay your departure: if possible, wait a little after the fireworks display ends to avoid the surge of movement towards public transport.

3. Monitor for overcrowding: look for early signs of a crush, such as movement slowing or stopping. Try to avoid packed areas and move towards less crowded spaces (for example, to the sides). Listen for signals of distress from people around you or downstream in the crowd. And if you can, pass this information further upstream – for example, by saying “stop moving” or “slow down”, which can lessen the pressure.

People who are shorter or have mobility issues or crowd anxiety (agoraphobia) may be more at risk – so take extra care if this applies to you or someone you’re with.

What about other risks?

Severe heat

New Year’s Eve in Australia is often hit with extreme heat. The good news is severe weather alerts are usually issued well in advance, so you can be prepared. Check the forecast, dress appropriately and carry water with you.

If you’re in an at risk group (including older people, very young children and people with chronic conditions) be prepared to make the choice not to go, if unfavourable weather is predicted.

Fireworks

Fireworks are an iconic part of New Year’s Eve. There can be safety risks, but these come from private fireworks that are prone to misfire and cause accidents.

Public fireworks displays today are incredibly safe compared to private fireworks. Public displays are licensed by experts who follow strict regulations.

People gather to watch fireworks in the centre of Adelaide. myphotobank.com.au/Shutterstock

Alcohol

For many people, a cheeky champagne is a must on December 31.

Unfortunately where excessive drinking is involved, risks increase – including violent behaviour in public or drink driving incidents.

A Victorian Health Promotion Foundation study found ambulance call-outs and emergency department presentations increase six-fold on New Year’s Eve.

Hospital admissions related to alcohol intoxication increase five-fold.

Emergency department visits for assault more than triple during this time.

But you can drink, party and travel responsibly. Pace yourself, and always have a safe way to get home. Designate a driver, use public transport, or call a ride-share or taxi.

Terrorism

For the first time in a decade, Australia will be celebrating New Year’s Eve at a “probable” terror threat level. This means the possibility of an attack — though not imminent — remains significant enough to warrant vigilance.

If you notice any suspicious activity, report it immediately to your local designated hotline.

In an emergency, follow instructions from authorities and be aware of your surroundings. Avoid filming incidents as they unfold – prioritise your safety and that of others over documentation.

The likelihood of something going wrong is generally quite low. But with millions of people participating in many events across the globe, it’s good to be aware of what the risks might be.

Being prepared means you can enjoy the festivities more safely.

Why do disinfectants only kill 99.9% of germs? Here’s the science

2024-12-29T19:06:25Z

Davor Geber/Shutterstock

Have you ever wondered why most disinfectants indicate they kill 99.9% or 99.99% of germs, but never promise to wipe out all of them? Perhaps the thought has crossed your mind mid-way through cleaning your kitchen or bathroom.

Surely, in a world where science is able to do all sorts of amazing things, someone would have invented a disinfectant that is 100% effective?

The answer to this conundrum requires understanding a bit of microbiology and a bit of mathematics.

What is a disinfectant?

A disinfectant is a substance used to kill or inactivate bacteria, viruses and other microbes on inanimate objects.

There are literally millions of microbes on surfaces and objects in our domestic environment. While most microbes are not harmful (and some are even good for us) a small proportion can make us sick.

Although disinfection can include physical interventions such as heat treatment or the use of UV light, typically when we think of disinfectants we are referring to the use of chemicals to kill microbes on surfaces or objects.

Chemical disinfectants often contain active ingredients such as alcohols, chlorine compounds and hydrogen peroxide which can _target vital components of different microbes to kill them.

Diseinfectants can contain a range of ingredients. Maridav/Shutterstock

The maths of microbial elimination

In the past few years we’ve all become familiar with the concept of exponential growth in the context of the spread of COVID cases.

This is where numbers grow at an ever-accelerating rate, which can lead to an explosion in the size of something very quickly. For example, if a colony of 100 bacteria doubles every hour, in 24 hours’ time the population of bacteria would be more than 1.5 billion.

Conversely, the killing or inactivating of microbes follows a logarithmic decay pattern, which is essentially the opposite of exponential growth. Here, while the number of microbes decreases over time, the rate of death becomes slower as the number of microbes becomes smaller.

For example, if a particular disinfectant kills 90% of bacteria every minute, after one minute, only 10% of the original bacteria will remain. After the next minute, 10% of that remaining 10% (or 1% of the original amount) will remain, and so on.

Because of this logarithmic decay pattern, it’s not possible to ever claim you can kill 100% of any microbial population. You can only ever scientifically say that you are able to reduce the microbial load by a proportion of the initial population. This is why most disinfectants sold for domestic use indicate they kill 99.9% of germs.

Other products such as hand sanitisers and disinfectant wipes, which also often purport to kill 99.9% of germs, follow the same principle.

You might have noticed none of the cleaning products in your laundry cupboard kill 100% of germs. Africa Studio/Shutterstock

Real-world implications

As with a lot of science, things get a bit more complicated in the real world than they are in the laboratory. There are a number of other factors to consider when assessing how well a disinfectant is likely to remove microbes from a surface.

One of these factors is the size of the initial microbial population that you’re trying to get rid of. That is, the more contaminated a surface is, the harder the disinfectant needs to work to eliminate the microbes.

If for example you were to start off with only 100 microbes on a surface or object, and you removed 99.9% of these using a disinfectant, you could have a lot of confidence that you have effectively removed all the microbes from that surface or object (called sterilisation).

In contrast, if you have a large initial microbial population of hundreds of millions or billions of microbes contaminating a surface, even reducing the microbial load by 99.9% may still mean there are potentially millions of microbes remaining on the surface.

Time is is a key factor that determines how effectively microbes are killed. So exposing a highly contaminated surface to disinfectant for a longer period is one way to ensure you kill more of the microbial population.

This is why if you look closely at the labels of many common household disinfectants, they will often suggest that to disinfect you should apply the product then wait a specified time before wiping clean. So always consult the label on the product you’re using.

Disinfectants won’t necessarily work in your kitchen exactly like they work in a lab. Ground Picture/Shutterstock

Other factors such as temperature, humidity and the type of surface also influence how well a disinfectant works outside the lab.

Similarly, microbes in the real world may be either more or less sensitive to disinfection than those used for testing in the lab.

Disinfectants are one part infection control

The sensible use of disinfectants plays an important role in our daily lives in reducing our exposure to pathogens (microbes that cause illness). They can therefore reduce our chances of getting sick.

The fact disinfectants can’t be shown to be 100% effective from a scientific perspective in no way detracts from their importance in infection control. But their use should always be complemented by other infection control practices, such as hand washing, to reduce the risk of infection.

Hassan Vally 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.

We don’t all need regular skin cancer screening – but you can know your risk and check yourself

2024-12-26T19:15:34Z

Pixel-Shot/Shutterstock

Australia has one of the highest skin cancer rates globally, with nearly 19,000 Australians diagnosed with invasive melanoma – the most lethal type of skin cancer – each year.

While advanced melanoma can be fatal, it is highly treatable when detected early.

But Australian clinical practice guidelines and health authorities do not recommend screening for melanoma in the general population.

Given our reputation as the skin cancer capital of the world, why isn’t there a national screening program? Australia currently screens for breast, cervical and bowel cancer and will begin lung cancer screening in 2025.

It turns out the question of whether to screen everyone for melanoma and other skin cancers is complex. Here’s why.

The current approach

On top of the 19,000 invasive melanoma diagnoses each year, around 28,000 people are diagnosed with in-situ melanoma.

In-situ melanoma refers to a very early stage melanoma where the cancerous cells are confined to the outer layer of the skin (the epidermis).

Instead of a blanket screening program, Australia promotes skin protection, skin awareness and regular skin checks (at least annually) for those at high risk.

About one in three Australian adults have had a clinical skin check within the past year.

Those with fairer skin or a family history may be at greater risk of skin cancer. Halfpoint/Shutterstock

Why not just do skin checks for everyone?

The goal of screening is to find disease early, before symptoms appear, which helps save lives and reduce morbidity.

But there are a couple of reasons a national screening program is not yet in place.

We need to ask:

1. Does it save lives?

Many researchers would argue this is the goal of universal screening. But while universal skin cancer screening would likely lead to more melanoma diagnoses, this might not necessarily save lives. It could result in indolent (slow-growing) cancers being diagnosed that might have never caused harm. This is known as “overdiagnosis”.

Screening will pick up some cancers people could have safely lived with, if they didn’t know about them. The difficulty is in recognising which cancers are slow-growing and can be safely left alone.

Receiving a diagnosis causes stress and is more likely to lead to additional medical procedures (such as surgeries), which carry their own risks.

2. Is it value for money?

Implementing a nationwide screening program involves significant investment and resources. Its value to the health system would need to be calculated, to ensure this is the best use of resources.

Narrower _targets for better results

Instead of screening everyone, _targeting high-risk groups has shown better results. This focuses efforts where they’re needed most. Risk factors for skin cancer include fair skin, red hair, a history of sunburns, many moles and/or a family history.

Research has shown the public would be mostly accepting of a risk-tailored approach to screening for melanoma.

There are moves underway to establish a national _targeted skin cancer screening program in Australia, with the government recently pledging $10.3 million to help tackle “the most common cancer in our sunburnt country, skin cancer” by focusing on those at greater risk.

Currently, Australian clinical practice guidelines recommend doctors properly evaluate all patients for their future risk of melanoma.

Looking with new technological eyes

Technological advances are improving the accuracy of skin cancer diagnosis and risk assessment.

For example, researchers are investigating 3D total body skin imaging to monitor changes to spots and moles over time.

Artificial intelligence (AI) algorithms can analyse images of skin lesions, and support doctors’ decision making.

Genetic testing can now identify risk markers for more personalised screening.

And telehealth has made remote consultations possible, increasing access to specialists, particularly in rural areas.

Check yourself – 4 things to look for

Skin cancer can affect all skin types, so it’s a good idea to become familiar with your own skin. The Skin Cancer College Australasia has introduced a guide called SCAN your skin, which tells people to look for skin spots or areas that are:

1. sore (scaly, itchy, bleeding, tender) and don’t heal within six weeks

2. changing in size, shape, colour or texture

3. abnormal for you and look different or feel different, or stand out when compared to your other spots and moles

4. new and have appeared on your skin recently. Any new moles or spots should be checked, especially if you are over 40.

If something seems different, make an appointment with your doctor.

You can self-assess your melanoma risk online via the Melanoma Institute Australia or QIMR Berghofer Medical Research Institute.

H. Peter Soyer is a shareholder of MoleMap NZ Limited and e-derm consult GmbH and undertakes regular teledermatological reporting for both companies. He is a Medical Consultant for Canfield Scientific Inc. He receives funding from the National Health and Medical Research Council and The Medical Research Future Fund.

Anne Cust receives funding from the National Health and Medical Research Council.

Monika Janda receives project and fellowship funding from the National Health and Medical Research Council and The Medical Research Future Fund. She serves on the scientific advisory committee for Melanoma and Skin Cancer Advocacy Group.

Caitlin Horsham 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.

Children can be more vulnerable in the heat. Here’s how to protect them this summer

2024-12-26T19:14:04Z

maxim ibragimov/Shutterstock

Extreme heat is increasingly common in Australia and around the world and besides making us uncomfortable, it can harm our health. For example, exposure to extreme heat can exacerbate existing medical conditions, or cause problems such as heat stroke.

Due to a combination of physiology and behaviour, children are potentially more vulnerable to severe heat-related illness such as heat stroke or heat exhaustion.

But these are not the only heat-related health issues children might experience on a very hot day. In a new study, we looked at emergency department (ED) visits and unplanned hospital admissions among children in New South Wales on heatwave days.

We found a significant increase in children attending hospital compared to milder days – with a range of health issues.

Why are children more vulnerable in the heat?

Sweating is the main way we lose heat from our bodies and cool down.

Children have a greater skin surface area to body mass ratio, which can be an advantage for sweating – they can lose more heat through evaporation for a given body mass. But this also means children can lose fluids and electrolytes faster through sweating, theoretically making them more susceptible to dehydration.

Meanwhile, younger children, particularly babies, can’t sweat as much as older children and adults. This means they can’t cool down as effectively.

Children in general also tend to engage in more outdoor physical activity, which might see them more exposed to very hot temperatures.

Further, children may be less in-tune to the signals their body is giving them that they’re overheating, such as excessive sweating or red skin. So they might not stop and cool down when they need to. Young children especially may not recognise the early signs of heat stress or be able to express discomfort.

Children may not easily be able to communicate that they’re hot and bothered. christinarosepix/Shutterstock

Our study

We wanted to examine children’s exposure to extreme heat stress and the associated risks to their health.

We measured extreme heat as “heatwave days”, at least two consecutive days with a daily maximum temperature above the 95th percentile for the relevant area on a universal thermal climate index. This ranged from 27°C to 45°C depending on the area.

We assessed health outcomes by looking at ED visits and unplanned hospital admissions among children aged 0–18 years from NSW between 2000 and 2020. This totalled around 8.2 million ED visits and 1.4 million hospital admissions.

We found hospital admissions for heat-related illness were 104% more likely on heatwave days compared to non-heatwave days, and ED visits were 78% more likely. Heat-related illness includes a spectrum of disorders from minor conditions such as dehydration to life-threatening conditions such as heat stroke.

But heat-related illness wasn’t the only condition that increased on heatwave days. There was also an increase in childhood infections, particularly infectious enteritis possibly related to food poisoning (up 6% for ED visits and 17% for hospital admissions), ear infections (up 30% for ED visits and 3% for hospital admissions), and skin and soft tissue infections (up 6% for ED visits and 4% for hospital admissions).

Kids can be more vulnerable in the heat because of their behaviour and physiology. K-FK/Shutterstock

We know many infectious diseases are highly seasonal. Some, like the flu, peak in winter. But heat and humidity increase the risk of certain infections caused by bacterial, viral and fungal pathogens.

For example, warmer weather and higher humidity can increase the survival of bacteria, such as Salmonella, on foods, which increases the risk of food poisoning.

Hot weather can also increase the risk of ear infections. Children may be at greater risk during hot weather because they often swim or play at the beach or pool. Water can stay in the ear after swimming and a moist environment in the ear canal can cause growth of pathogens leading to ear infections.

Which children are most vulnerable?

During heatwaves, we found infants aged under one were at increased risk of ED visits and hospital admission for any reason compared to older children. This is not surprising, because babies can’t regulate their body temperature effectively and are reliant on their caregivers to keep them cool.

Our study also found children from the most disadvantaged areas were more vulnerable to heat-related illness on heatwave days. Although we don’t know exactly why, we hypothesised families from poorer areas might have limited access to air-conditioning and could be more likely to live in hotter neighbourhoods.

Keeping kids cool: tips for parents

The highest levels of heat exposure on hot days for young children is usually when they’re taken outside in prams and strollers. To protect their children from direct sunlight, parents often instinctively cover their stroller with a cloth such as a muslin.

However, a recent study from our group showed this actually increases temperatures inside a stroller to as much as 3–4˚C higher than outside.

But if the cloth is wet with water, and a small fan is used to circulate the air close to the child, stroller temperatures can be 4–5˚C lower than outside. Wetting the cloth every 15–20 minutes (for example, with a spray bottle) maintains the cooling effect.

When young children are not in a stroller, and for older children, there are a few things to consider to keep them cool and safe.

Remember temperatures reported on weather forecasts are measured in the shade, and temperatures in the sun can be up to 15˚C higher. So sticking to the shade as much as possible is important.

Exercise generates heat inside the body, so activities should be shortened, or rescheduled to cooler times of the day.

Sunscreen and hats are important when outdoors, but neither are especially effective for keeping cool. Spraying water on the child’s skin – not just the face but arms, legs and even the torso if possible – can help. Wetting their hats is another idea.

Proper hydration on hot days is also essential. Regular water breaks, including offering water before, during and after activity, is important. Offering foods with high water content such as watermelon and orange can help with hydration too.

James Smallcombe receives funding from NHMRC

Natasha Nassar receives funding from NHMRC

Ollie Jay receives funding from National Health and Medical Research Council (NHMRC) and Wellcome Trust (UK).

Wen-Qiang He 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.

Hitting the beach? Here are some dangers to watch out for – plus 10 essentials for your first aid kit

2024-12-22T19:06:52Z

FTiare/Shutterstock

Summer is here and for many that means going to the beach. You grab your swimmers, beach towel and sunscreen then maybe check the weather forecast. Did you think to grab a first aid kit?

The vast majority of trips to the beach will be uneventful. However, if trouble strikes, being prepared can make a huge difference to you, a loved one or a stranger.

So, what exactly should you be prepared for?

Knowing the dangers

The first step in being prepared for the beach is to learn about where you are going and associated levels of risk.

In Broome, you are more likely to be bitten by a dog at the beach than stung by an Irukandji jellyfish.

In Byron Bay, you are more likely to come across a brown snake than a shark.

In the summer of 2023–24, Surf Life Saving Australia reported more than 14 million Australian adults visited beaches. Surf lifesavers, lifeguards and lifesaving services performed 49,331 first aid treatments across 117 local government areas around Australia. Surveys of beach goers found perceptions of common beach hazards include rips, tropical stingers, sun exposure, crocodiles, sharks, rocky platforms and waves.

Sun and heat exposure are likely the most common beach hazard. The Cancer Council has reported that almost 1.5 million Australians surveyed during summer had experienced sunburn during the previous week. Without adequate fluid intake, heat stroke can also occur.

Lacerations and abrasions are a further common hazard. While surfboards, rocks, shells and litter might seem more dangerous, the humble beach umbrella has been implicated in thousands of injuries.

Sprains and fractures are also associated with beach activities. A 2022 study linked data from hospital, ambulance and Surf Life Saving cases on the Sunshine Coast over six years and found 79 of 574 (13.8%) cervical spine injuries occurred at the beach. Surfing, smaller wave heights and shallow water diving were the main risks.

Rips and rough waves present a higher risk at areas of unpatrolled beach, including away from surf lifesaving flags. Out of 150 coastal drowning deaths around Australia in 2023–24, nearly half were during summer. Of those deaths:

56% occurred at the beach
31% were rip-related
86% were male, and
100% occurred away from patrolled areas.

People who had lived in Australia for less than two years were more worried about the dangers, but also more likely to be caught in a rip.

Safety Beach on Victoria’s Mornington Peninsula. Still bring your first aid essentials though. Julia Kuleshova/Shutterstock

Knowing your DR ABCs

So, beach accidents can vary by type, severity and impact. How you respond will depend on your level of first aid knowledge, ability and what’s in your first aid kit.

A first aid training company survey of just over 1,000 Australians indicated 80% of people agree cardiopulmonary resuscitation (CPR) is the most important skill to learn, but nearly half reported feeling intimidated by the prospect.

CPR training covers an established checklist for emergency situations. Using the acronym “DR ABC” means checking for:

Danger
Response
Airway
Breathing
Circulation

A complete first aid course will provide a range of skills to build confidence and be accredited by the national regulator, the Australian Skills Quality Authority.

What to bring – 10 first aid essentials

Whether you buy a first aid kit or put together you own, it should include ten essential items in a watertight, sealable container:

Band-Aids for small cuts and abrasions
sterile gauze pads
bandages (one small one for children, one medium crepe to hold on a dressing or support strains or sprains, and one large compression bandage for a limb)
large fabric for sling
a tourniquet bandage or belt to restrict blood flow
non-latex disposable gloves
scissors and tweezers
medical tape
thermal or foil blanket
CPR shield or breathing mask.

Before you leave for the beach, check the expiry dates of any sunscreen, solutions or potions you choose to add.

If you’re further from help

If you are travelling to a remote or unpatrolled beach, your kit should also contain:

sterile saline solution to flush wounds or rinse eyes
hydrogel or sunburn gel
an instant cool pack
paracetamol and antihistamine medication
insect repellent.

Make sure you carry any “as-required” medications, such as a Ventolin puffer for asthma or an EpiPen for severe allergy.

Vinegar is no longer recommended for most jellyfish stings, including Blue Bottles. Hot water is advised instead.

In remote areas, also look out for Emergency Response Beacons. Located in high-risk spots, these allow bystanders to instantly activate the surf emergency response system.

If you have your mobile phone or a smart watch with GPS function, make sure it is charged and switched on and that you know how to use it to make emergency calls.

First aid kits suitable for the beach range in price from $35 to over $120. Buy these from certified first aid organisations such as Surf Lifesaving Australia, Australian Red Cross, St John Ambulance or Royal Life Saving. Kits that come with a waterproof sealable bag are recommended.

Be prepared this summer for your trip to the beach and pack your first aid kit. Take care and have fun in the sun.

You could be stress eating these holidays – or eating your way to stress. 5 tips for the table

2024-12-22T19:06:16Z

Dean Clarke/Shutterstock

The holiday season can be a time of joy, celebration, and indulgence in delicious foods and meals. However, for many, it can also be an emotional and stressful period.

This stress can manifest in our eating habits, leading to what is known as emotional or stress eating.

There are certain foods we tend to eat more of when we’re stressed, and these can affect our health. What’s more, our food choices can influence our stress levels and make us feel worse. Here’s how.

Why we might eat more when stressed

The human stress response is a complex signalling network across the body and brain. Our nervous system then responds to physical and psychological events to maintain our health. Our stress response – which can be subtle or trigger a fight-or-flight response – is essential and part of daily life.

The stress response increases production of the hormones cortisol and insulin and the release of glucose (blood sugars) and brain chemicals to meet demand. Eating when we experience stress is a normal behaviour to meet a spike in energy needs.

But sometimes our relationship with food becomes strained in response to different types of stress. We might attach shame or guilt to overeating. And anxiety or insecurity can mean some people under-eat in stressful times.

Over time, people can start to associate eating with negative emotions – such as anger, sadness, fear or worry. This link can create behavioural cycles of emotional eating. “Emotional eaters” may go on to develop altered brain responses to the sight or smell of food.

What stress eating can do to the body

Stress eating can include binge eating, grazing, eating late at night, eating quickly or eating past the feeling of fullness. It can also involve craving or eating foods we don’t normally choose. For example, stressed people often reach for ultra-processed foods. While eating these foods is not necessarily a sign of stress, having them can activate the reward system in our brain to alleviate stress and create a pattern.

Short-term stress eating, such as across the holiday period, can lead to symptoms such as acid reflux and poor sleep – particularly when combined with drinking alcohol.

In the longer term, stress eating can lead to weight gain and obesity, increasing the risks of cancer, heart diseases and diabetes.

While stress eating may help reduce stress in the moment, long-term stress eating is linked with an increase in depressive symptoms and poor mental health.

If you do over eat at a big gathering, don’t try and compensate by eating very little the next day. Peopleimage.com - Yuri A/Shutterstock

What we eat can make us more or less stressed

The foods we choose can also influence our stress levels.

Diets high in refined carbohydrates and sugar (such as sugary drinks, sweets, crackers, cakes and most chocolates) can make blood sugar levels spike and then crash.

Diets high in unhealthy saturated and trans fats (processed foods, animal fats and commercially fried foods) can increase inflammatory responses.

Rapid changes in blood sugar and inflammation can increase anxiety and can change our mood.

Meanwhile, certain foods can improve the balance of neurotransmitters in the brain that regulate stress and mood.

Omega-3 fatty acids, found in fish and flaxseeds, are known to reduce inflammation and support brain health. Magnesium, found in leafy greens and nuts, helps regulate cortisol levels and the body’s stress response.

Vitamin Bs, found in whole grains, nuts, seeds, beans and animal products (mostly B12), help maintain a healthy nervous system and energy metabolism, improving mood and cognitive performance.

5 tips for the holiday table and beyond

Food is a big part of the festive season, and treating yourself to delicious treats can be part of the fun. Here are some tips for enjoying festive foods, while avoiding stress eating:

1. slow down: be mindful about the speed of your eating. Slow down, chew food well and put down your utensils after each bite

2. watch the clock: even if you’re eating more food than you normally would, sticking to the same timing of eating can help maintain your body’s response to the food. If you normally have an eight-hour eating window (the time between your first meal and last meal of the day) then stick to this even if you’re eating more

3. continue other health behaviours: even if we are eating more food or different food during the festive season, try to keep up other healthy behaviours, such as sleep and exercise

4. stay hydrated: make sure to drink plenty of fluids, especially water. This helps our body function and can help with feelings of hunger. When our brain gets the message something has entered the stomach (what we drink) this can provide a temporary reduction in feelings of hunger

5. don’t restrict: if we have a big day of eating, it can be tempting to restrict eating in the days before or after. But it is never a good idea to overly constrain food intake. It can lead to more overeating and worsen stress.

Reaching for cookies late at night can be characteristic of stress eating. Stokkete/Shutterstock

Plus 3 bonus tips to manage holiday stress

1. shift your thinking: try reframing festive stress. Instead of viewing it as “something bad”, see it as “providing the energy” to reach your goals, such as a family gathering or present shopping

2. be kind to yourself and others: practise an act of compassion for someone else or try talking to yourself as you would a friend. These actions can stimulate our brains and improve wellbeing

3. do something enjoyable: being absorbed in enjoyable activities – such as crafting, movement or even breathing exercises – can help our brains and bodies to return to a more relaxed state, feel steady and connected.

For support and more information about eating disorders, contact the Butterfly Foundation on 1800 33 4673 or Kids Helpline on 1800 551 800. If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14. In an emergency, call 000.

Saman Khalesi was previously supported by a Postdoctoral Fellowship (Award No. 102584) from the National Heart Foundation of Australia.

Talitha Best is affiliated with Australian Psychological Society.

Charlotte Gupta 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.

Sunglasses don’t just look good – they’re good for you too. Here’s how to choose the right pair

2024-12-20T00:06:14Z

Versta/Shutterstock

Australians are exposed to some of the highest levels of solar ultraviolet (UV) radiation in the world.

While we tend to focus on avoiding UV damage to our skin, it’s important to remember our eyes as well.

Last summer, only six in ten Australians who spent time outside during peak UV exposure times said they wore sunglasses.

But sunglasses are much more than a fashion statement. Here’s why they’re important for our eye health (and our skin) – and some tips on how to choose a pair that works.

What is UV radiation?

UV radiation is a type of energy produced by sources like the sun. There are three types: UVA, UVB, UVC. UVA and UVB are responsible for the sun-related damage to our skin and eyes.

UV can be direct, scattered or reflected, bouncing off surfaces such as water, sand and snow. But unlike the other types of energy the sun makes (visible light and infrared radiation), we can’t see or feel UV radiation.

This is why we can’t rely on clear skies or hot temperatures to work out if UV levels are high.

Instead, we use the UV Index, a scale from low (1–2) to extreme (11+).

Official guidelines recommend sun protection when the UV index is 3 or higher. This includes protecting our eyes.

How does UV light affect our eyes?

Excessive UV radiation can have both short and long-term effects on our eyes and surrounding skin.

In the short term, you might become sensitive to light or develop photokeratitis, sometimes known as “snow blindness”.

Photokeratitis is like a sunburn to the cornea (the clear, dome-shaped part at the front of the eye that lets light in) and makes the eyes sore, red and sensitive to light. Photokeratitis usually resolves with rest from light and eyedrops.

But the long-term effects of chronic UV exposure can be more severe.

It can lead to a fleshy growth on the eye called a pterygium, also known as “surfer’s eye”. This growth can obstruct vision if it grows over the cornea, requiring surgical removal.

Excessive UV exposure can also speed up the development of cataracts (where the lens inside the eye becomes cloudy and blurs the vision) or lead to skin cancers on the eye and eyelid.

Excessive UV exposure can be particularly harmful to children as the lens in their eyes aren’t able to filter UV light as well as adults – so it’s important for children to wear sunglasses too.

What about the skin?

UV radiation can also accelerate skin ageing.

It breaks down proteins in the skin which keep it elastic, such as elastin and collagen, and can trigger low-grade inflammation.

Without sunglasses, we also tend to squint more to try and reduce the amount of light entering our eyes. These repeated movements can contribute to the development of wrinkles and “crow’s feet” around the eyes.

What sunglasses should I choose?

In Australia and New Zealand, every pair of spectacles with tinted lenses must be be labelled to show the category of protection they offer. They are regulated by Australian/New Zealand Standards.

There are five categories for lenses:

categories 0–1 are “fashion spectacles”. They look like sunglasses but in fact offer little or no UV protection
category 2 provide a medium level of sun glare reduction and good UV protection
category 3 provide a high level of sun glare reduction and good UV protection
category 4 lenses are very dark and only recommended for use in extreme levels of glare, such as mountaineering, or at sea. These lenses are too dark to be used for driving.

Children should wear sunglasses too. rosntik/Shutterstock

What else should I know?

Good sunglasses don’t have to be expensive. The category of protection is more important than the price tag – so always check the label to see how well they block UV radiation.

Sunglasses that fit close to eyes, with good wrap around the face, provide the best protection in reducing both direct and reflected UV radiation.

Lenses can also be polarised, blocking any light waves coming from a horizontal direction. This reduces glare from reflective surfaces while increasing contrast – especially useful for water activities such as fishing.

Some sunglasses may also use the term “eye protection factor” (EPF). The EPF rating is based on how well a pair of sunglasses can protect your eyes from UVA and UVB based on the lenses and frame design. Look for an EPF of 9 or 10.

The label “UV400” is also useful, as it means the lenses block almost 100% of UV.

Protecting your eyes year round

Sunlight can also be beneficial to our eyes.

For example, morning sunlight can help us reset our body clocks and promote proper eye development in children to prevent shortsightedness. It is also important for the body’s production of vitamin D.

But moderation is key. The safest way to get the benefits of sunlight during summer is a few minutes of mid-morning or mid-afternoon sunlight. In late autumn and winter when the UV index is below 3, spending time outdoors during midday is beneficial.

As we’re exposed to UV radiation all year round, sunglasses are a good idea in any season. In summer, wearing a wide-brimmed hat and sunscreen, and limiting outdoor time during peak UV exposure, will also help protect your eyes and skin.

Flora Hui 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.

Without clean water, Pacific Islanders turn to sugary drinks. Tackling this could reduce obesity

2024-12-19T21:58:42Z

Kara Math/Shutterstock

One in two people in the Pacific Islands is classified as overweight (with a body mass index of 25–29) or obese (a BMI 30 or above). This is a problem because obesity increases the risk of health conditions such as diabetes, heart disease, strokes and some cancers.

While various factors contribute to obesity, limited access to clean drinking water plays an overlooked role. Without a safe drinking water supply, many households may turn to sugary drinks as an alternative. This type of substitution increases the risk of obesity.

Our new research explored how water insecurity in the Pacific island nation of Kiribati correlates with sugary drink consumption. We used survey data, including more than 2,000 of households spread over 21 rural and urban islands, to track locals’ water supply and their consumption of sugary drinks such as soft drinks and juice.

Water insecurity is a big issue in Kiribati, with households relying mainly on unprotected groundwater (40%) and rainwater (28%) for drinking.

We found households that relied on unprotected groundwater and rainwater drank 381–406 grams more sugary drinks per week than those with access to a piped water system. For households with water insecurity, this brings their weekly consumption to more than 1.7 litres.

Dietary drivers of obesity

Located in the middle of the Pacific Ocean, the Republic of Kiribati comprises 33 low-lying islands (with an average height of 3 metres above sea level) and a population of 133,000.

The Kiribati archipelago is spread across a wide maritime territory, neighbouring other Pacific countries such as Marshall Islands and Tuvalu. This makes our results relatively generalisable to other enclaved countries and small island developing states in Micronesia.

Not all residents have access to safe drinking water. Department of Foreign Affairs and Trade, CC BY

Households in the Pacific Islands are already grappling with the dietary changes globalisation and urbanisation have brought. Traditional diets of fresh fish, root vegetables and local fruits have been partially replaced by processed foods and sugary drinks. These are high in calories and low in nutrition.

These dietary shifts, combined with water insecurity, create an environment that exacerbates health challenges and contributes to obesity.

What can be done about it?

Only one-third of the population in Kiribati has access to a safe piped water system for drinking.

The rest of the population use unprotected groundwater and rainwater. But they cannot afford expensive tank kits, filters and treatment systems to remove harmful contaminants in water such as animal waste and chemicals. Locals are aware of these risks and therefore look to other options.

Improving access to clean, safe drinking water can be a cost-effective public policy that reduces sugary drink consumption and addresses the broader public health challenge of obesity.

To achieve this goal, a number of interventions are needed, such as:

ensuring households that rely on rainwater harvesting have access to tank kits, filters and treatment systems to remove harmful contaminants
developing seawater desalination plants that rely on clean energy sources. This would improve access to clean, piped water but comes at a significant cost
taxing sugary drinks to reduce consumption. In Mexico, a 10% increase in the price of sugary drinks led to an 11.6% decrease in their consumption.

Kiribati diets have changed dramatically with globalisation. maloff/Shutterstock

Climate change will compound the problem

Water insecurity in small island developing nations such as Kiribati are exacerbated by climate change. Rising sea levels are contaminating freshwater sources with salt, while more frequent and severe droughts are straining already limited resources.

These climate-related pressures make it increasingly difficult for communities to access clean drinking water, entrenching reliance on sugary drinks.

This phenomenon is similar in countries characterised by higher levels of sugary drinks imports and intakes such as in Niue, Cook Islands, Tonga, Tuvalu and Palau, but also for Australia’s remote Indigenous communities for whom access to safe drinking water isn’t guaranteed and sugary drink consumption is high.

Addressing water insecurity and obesity in tandem offers an opportunity to create sustainable solutions and build resilience against some of the adverse effects climate change can have on public health.

This research benefited from financial support from the Australian Academy of Social Sciences and the Embassy of France in Australia.

Almost 1 million Australians are LGBTQIA+ – and for the first time, there’s a new national health plan for them

2024-12-19T19:09:00Z

Lomb/Shutterstock

New data released by the Australian Bureau of Statistics (ABS) this week shows one in 20 (4.5%) Australians over 16 are LGBTQIA+.

For perspective: at around 900,000 people, that’s similar to the population of Tasmania and the Australian Capital Territory combined.

Yet in health and wellbeing outcomes – particularly mental health – this population drags far behind the rest of the country.

Last week the government released a landmark ten-year national action plan to address these health disparities for LGBTQIA+ people. Here’s why it’s needed – and what it hopes to achieve.

How many Australians are LGBTQIA+?

An accurate assessment of the number of LGBTQIA+ people in Australia has long been a critical gap in research due to limited reliable, population-level data.

This has meant LGBTQIA+ people, and their health needs, have often not been visible, particularly in outer suburbs and regional or rural areas. Services and supports can be inadequate as a result.

We don’t yet have census data about the LGBTQIA+ population. After years of community advocacy (and controversy over the government’s reversal and reinstatement of the questions) the 2026 census will be the first to ask Australians about their sexual orientation.

But this week the Australian Bureau of Statistics (ABS) released its first report on estimates and characteristics of LGBTQIA+ populations in Australia. These data were combined from four recent ABS health surveys.

The new data show 4.5% of Australians are LGBTQIA+. The percentage was higher among younger people – almost one in ten (9.5%) 16- to 24-year-olds, who are also at higher risk of poor mental health outcomes.

Why do we need a dedicated action plan?

While LGBTQIA+ people have been included as a priority population in other Australian health strategies, the new action plan is the first focused specifically on them.

The report highlights poorer self-rated health for LGBTQIA+ people as a key concern, as well as mental health and suicide outcomes, when compared to the population as a whole.

One in three (31%) LGBTQIA+ people self-rate their health as only “fair” or “poor” – double the general population (15%). This subjective assessment of health is recognised as a reliable predictor of future health.

Recent Australian data shows LGBTQIA+ people are more likely to be diagnosed with anxiety, depression or post-traumatic stress disorder. They have higher rates of self-harm and homelessness and are more likely to experience suicidal thoughts and behaviours.

For example, LGBTQIA+ adults have attempted suicide at over 17 times the rate of the general population (5.2% compared to 0.3% over a 12-month period).

A smaller body of data shows these mental health impacts are heightened for some sections of the LGBTQIA+ community. These include people with intersex variations, trans and gender diverse people, people living with disability, and Aboriginal and Torres Strait Islander people.

Why do LBTQIA+ people have poorer health?

These health disparities are not inherent to being LGBTQIA+. The evidence shows they are instead driven by social factors, such as rejection from families, experiences of harassment and discrimination, and lack of support within schools and communities.

When accessing health care and other support services, LGBTQIA+ people face multiple barriers which may further exacerbate gaps in health and wellbeing.

This may include a lack of LGBTQIA+ affirming care options. For example, health services may not ask about sexuality or gender identity on intake forms. This places the onus on LGBTQIA+ people to “out” themselves, which can be stressful and lead people to avoid health care.

Or it might involve accidental or overt discrimination, such as deliberate misgendering (referring to someone in a way that doesn’t reflect their gender identity) or outright refusal of service.

In some cases, health-care providers may draw on harmful stereotypes, such as negative ideas about LGBTQIA+ people and promiscuity, rather than focusing on the presenting needs of individual patients.

What will the action plan do?

Reducing stigma and discrimination requires changes in organisational culture and processes in health systems.

The National Action Plan acknowledges this requires considered action and investment to improve outcomes over the longer term. It aims to enhance access to inclusive health care and improve health literacy for LGBTQIA+ people.

For example, this will include ensuring LGBTQIA+ people are included in policy development and service planning across a range of health areas. It will also involve health education campaigns for LGBTQIA+ communities to encourage engagement in preventative health care.

The strategy prioritises workforce training and expanding research to address gaps in knowledge about this population.

LGBTQI+ people report better health in places where they have greater legal protections. Belarmino Essado/Shutterstock

Has LGBTQIA+ health improved with law reform?

LGBTQIA+ people report better health in jurisdictions where they receive greater legal protections and stigma is lower.

In recent decades, Australia has seen significant legal and cultural reforms to ensure recognition and equal rights are afforded to LGBTQIA+ people.

However, discrimination and stigma against sexual and gender minorities is far from eradicated. We are currently witnessing a global backlash against LGBTQIA+ rights.

In the United States in 2023, there were 75 instances of law change enacted to redact or remove LGBTQIA+ rights or visibility. This included banning classroom teaching on gender and sexual diversity and restricting access to public bathrooms for trans people.

Australia has also felt the impact of this backlash.

In 2023, “drag story time” events encountered threats of violence. In this same year a formal ball for young LGBTQIA+ people in Wangaratta was cancelled due to fears for participants’ safety.

Gains made toward greater equity in health outcomes for LGBTQIA+ people can be undermined or reversed with shifts in political culture or pressure from conservative forces.

Australia’s national action plan goes a long way toward protecting and advancing LGBTQIA+ people’s health in a way that is sustainable. However, there is still a long way to go and ongoing political support for the plan will be fundamental to its success.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.

13YARN is a free and confidential 24/7 national crisis support line for Aboriginal and Torres Strait Islander people who are feeling overwhelmed or having difficulty coping. Call 13 92 76.

Jennifer Power receives funding from the Australian Research Council and the Australian Department of Health and Aged care.

Joel Anderson receives funding from the Australian Research Council and the Medical Research Futures Fund.

Natalie Amos receives funding from the Australian Department of Health and Aged Care, the Medical Research Future Fund and Thorne Harbour Health.

Ruby Grant has previously received funding from Thorne Harbour Health and the Tasmanian Government.

The Essure contraceptive device left some women with chronic pelvic pain. Why did their class action fail?

2024-12-19T02:17:46Z

ben bryant/Shutterstock

The Victorian Supreme Court recently dismissed a class action on behalf of more than 1,400 women who received Bayer’s Essure contraceptive device.

The decision attracted significant publicity, including criticism from the Victorian Premier.

It left the women shocked and disappointed, particularly since Bayer had settled a similar claim in the United States for US$1.6 billion.

So why did the Victorian class action fail?

What’s Essure?

Essure offered an alternative to more invasive permanent contraceptive procedures such as tubal ligation.

The device was implanted into the fallopian tubes. This triggered an intended inflammatory response that blocked the tubes, preventing passage of sperm and ova.

In Australia, the device was implanted by gynaecologists. More than 3,000 devices are thought to have been implanted into Australian women.

In 2017, Essure was voluntarily withdrawn from our market after increasingly publicised concerns regarding safety, including in the US.

The US class action was settled out of court, enabling Bayer to avoid setting a legal precedent for similar claims in other jurisdictions.

Relevant US laws are different from those in Australia. Consequently, settlement of the US claim has only limited value in determining the likely outcome of litigation in Australian courts.

What went wrong with the device?

Lead plaintiff Patrice Turner began experiencing abnormal uterine bleeding, heavy periods and pelvic pain within a few years of using Essure.

She ultimately required a hysterectomy, which removed the Essure devices and resolved her symptoms.

Other class members experienced similar symptoms, with many also requiring hysterectomies.

The claim relied on three causes of action:

Essure had a safety defect which caused the plaintiff’s injury
Essure wasn’t of the quality consumers would reasonably expect
the defendants were negligent in Essure’s design, manufacturing and distribution. The alleged negligence included inadequately disclosing risks to patients considering Essure or who had already received Essure.

All causes of action required the plaintiff to prove a causal connection between her harm and the device.

What did the court find?

Proving causation in legal disputes is often complex and technical. That is particularly so in cases where medical or other interventions allegedly cause or exacerbate injury or disability, where harms can also potentially be caused by other factors.

In dismissing the class action, Justice Andrew Keogh found the extensive expert evidence did not demonstrate that Essure caused either the harms experienced by the class members generally, or by the plaintiff specifically. That evidence drew on a wide range of medical and scientific disciplines.

Justice Keogh found for Bayer, noting pelvic pain and abnormal uterine bleeding are common in pre-menopausal women, and there is a range of potential causes of each.

The 827-page judgment emphasised that medical devices, which are “inherently dangerous or known to carry a risk of harm”, cannot be expected to be “risk-free”. A device does not have a “safety defect”, nor is it of unacceptable quality, simply because it poses a risk to consumers.

Doctors explain the risks of medical devices to their patients. Tyler Olson/Shutterstock

Similarly, in considering the negligence claim, the critical consideration was not whether the defendants shouldn’t have produced Essure when there was a foreseeable risk it could cause harm.

Rather, it was about whether the defendants acted reasonably in managing that risk, including providing sufficient information about the risks associated with Essure.

Justice Keogh found the defendants did act reasonably, providing:

adequate warnings of the established Essure risks in the PTMs [physician training manuals] and IFUs [instructions for use]. It was reasonable to expect that treating gynaecologists would provide information and warnings about the established risks to their patients based upon their own specialist skill, expertise and experience and the information provided by the defendants.

So what happens now?

The plaintiff has until early 2025 to appeal the decision.

An appeal would require establishing that the judge erred in his interpretation and application of the law, rather than simply arguing that the outcome is wrong.

Significantly, health professionals should give Justice Keogh’s findings on warnings much thought.

Doctors potentially face more litigation related to medical devices if they do not appropriately provide patients with more extensive and customised warnings than the standard warnings by the manufacturer about risks associated with particular devices.

Could something like this happen again?

Regulatory frameworks governing medical devices have been significantly strengthened since Australia’s Therapeutic Goods Administration first approved Essure in the 1990s.

Increased publicity and successful class actions related to other problematic medical devices have resulted in significant reforms designed to reduce large-scale patient harms.

Medical devices carry inherent risks. These can only be managed rather than eliminated entirely without limiting access to devices and other interventions which may benefit significant numbers of patients.

However, given the court’s findings that the evidence did not indicate Essure caused the plaintiff’s harms, under the strengthened regulations for medical devices, a product like Essure could potentially meet the current requirements for sale in Australia.

Wendy Bonython 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.