Turnbull government abandons $8.2 billion Medicare levy increase



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Treasurer Scott Morrison will say in a speech on Thursday that with a stronger economy, the fiscal position has improved compared with a year ago.
AAP/Luis Ascui

Michelle Grattan, University of Canberra

The government is scrapping its $A8.2 billion planned increase in the Medicare levy, declaring a stronger budget outlook means it is not needed to fund the National Disability Insurance Scheme.

The levy, the biggest new revenue measure in last year’s budget, had no foreseeable prospect of passing the Senate in full, because Labor only supported a rise for those with incomes of more than $87,000.

Abandoning the measure will give more credibility to the budget numbers, which will be carefully scrutinised by the credit-rating agencies, and enable the government to sharpen its differences with Labor in the election battle on tax.

The increase in the levy – which would have taken it from 2% to 2.5% of taxable income – was due to start from July 1 next year. The $8.2 billion revenue was over the forward estimates.

The budget will include income tax cuts. But while it kept the levy rise on the books the government faced the criticism that it would be giving with one hand and taking with the other.

Treasurer Scott Morrison will say in a speech on Thursday that with a stronger economy, the fiscal position has improved compared with a year ago.

“That is why we are now in a position to give our guarantee to Australians living with a disability and their families and carers that all planned expenditure on the NDIS will be able to be met in this year’s budget and beyond without any longer having to increase the Medicare levy,” he will tell an Australian Business Economists function.

The government has not abandoned its argument that Labor left a gap in the funding of the NDIS – which the ALP flatly denies. Morrison will stress: “What I am announcing today is that gap can now be made up over time by continuing to deliver a stronger economy and by ensuring the government lives within its means”.

In an upbeat address just under two weeks out from the May 8 budget, Morrison will say that the economy “is finally shaking off the dulling effects of the downturn in the mining investment boom.”

“Naturally, a stronger economy provides for a stronger budget.”

He will say that company profits were “savaged” in the long come-down from the mining investment boom. This took a heavy toll including on government revenues.

“During this time, businesses put their hands in their own pockets to keep their employees in jobs and provide the modest wage increases they could.

“Since then, the clouds have been lifting. The tangible evidence of this is found in the increased tax receipts to the Commonwealth.

“Tax receipts up until February were running $4.8 billion higher than we estimated at MYEFO in December, including $1.2 billion in higher individual tax receipts and $3 billion in higher company tax receipts.”

Morrison will also emphasise the government’s action in controlling spending, and point out that it has not relied on commodity price assumptions to prop up the budget.

Outlining some themes for the budget, Morrison will say it will see the government “living within its means”. It will continue to give priority to strengthening the economy, and that will “enable us to shore up the nation’s finances and guarantee the essential services that Australians rely on both now and into the future.

“Only a stronger economy, backed up by a government that knows how to live within its means, can provide a real guarantee on these essential services – Medicare, schools, hospitals, aged care and disability services.”

Morrison will say Labor’s proposal to raise the Medicare levy for those earning more than $87,000 and to increase the top marginal tax rate were not to fund the NDIS, but “just another tax increase on working Australians”.

“This is in addition to Labor already boasting of and getting ready to hike more than $200 billion in additional new taxes on Australians if they win power.

“Taxes on small businesses, taxes on retirees and pensioners, taxes on family trusts, taxes on mums and dads who negatively gear their investment properties and taxes on workers.

He will say Labor plans for higher taxes will weaken the economy, ”‘putting at risk the benefits, the jobs, the wages, the incomes and the essential services that depend on a stronger economy. And we all know Labor can never live within their means”.

The ConversationLabor is now expected to abandon its commitment to a rise in the levy for higher income earners.

Michelle Grattan, Professorial Fellow, University of Canberra

This article was originally published on The Conversation. Read the original article.

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With health assuming its rightful place in planning, here are 3 key lessons from NSW



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Health objectives are at last being integrated into all levels of planning in New South Wales, from cities and towns to local places and buildings.
pisaphotography/Shutterstock

Patrick Harris, University of Sydney; Elizabeth Harris, UNSW; Emily Riley, University of Sydney; Jennifer Kent, University of Sydney, and Peter Sainsbury, South Western Sydney Local Health District

The way cities are designed and managed has big impacts on our health. While Australia is considered a world leader in research on health and cities, nationally our planning policies remain underdeveloped relative to our knowledge base. To remedy this, healthy planning advocates need to better understand how urban planning systems can be influenced.

Several recent, mostly positive, experiences in the New South Wales (NSW) planning system provide insights into this process. Each represents a milestone for land-use planning in this state given extensive reforms have been on and off the table for the past decade.




Read more:
The mysterious disappearance of health from New South Wales planning laws


The connections between city planning and health are many and varied. Key aspects include environmental sustainability, pollution risks and liveable places. Being liveable means having access to healthy food, nearby employment and services, and opportunities for active lifestyles.

These issues are increasingly important given projected population growth pressures on urban infrastructure. Other areas facing similar pressures, in Australia and overseas, might wish to take note of what has happened in NSW.

Since 2014 we have used political science to investigate attempts in NSW to include health in legislative reform, strategic city planning and major urban infrastructure assessments. As well as scrutinising relevant policies and associated documentation, we have interviewed more than 50 stakeholders. This has provided insights into how and why recent developments came about.

How has NSW brought health into planning?

Healthy planning has always had champions in NSW, but really hit its stride during a major legislative reform exercise that began in 2011. This came to a head in November 2017, when the state parliament passed amendments to the Environmental Planning and Assessment Act 1979.

This legislation now lists two objects of direct importance for health:

  • protection of the health and safety of occupants of buildings
  • promotion of good design and amenity of the built environment.

Also in 2017, the NSW Office of the Government Architect produced a policy of “design-led planning”. Known as “Better Placed”, this policy positions health as a top priority. It embeds health within design processes, methods and outcomes for different levels of planning from cities and towns to places and buildings.

In our view, Better Placed is an exemplary policy in demonstrating the importance of urban planning for health.

In another positive development, the Greater Sydney Commission recently released Metropolitan and District Plans that position health as a core objective (number 7). The plans consistently refer to health across the central themes of liveability, productivity and sustainability.

To their credit, the NSW government and the commission have developed plans concurrently with transport and infrastructure and released them together. The evidence suggests this integration should have public health benefits. The emphasis across the commission, transport and infrastructure plans on creating a liveable and accessible city increases our confidence in this outcome.




Read more:
A healthy approach: how to turn what we know about liveable cities into public policy


Three key factors in making health a priority

Our research suggests three crucial factors in elevating the status of health in planning.

1. A core group of non-government, government and academic representatives has led health advocacy for over a decade. The group’s messages and activities intentionally focused on collaboration across agencies in the public interest.

This advocacy has grown in sophistication since the early days of making submissions about “health” issues that risked being treated as peripheral to the main game of planning (infrastructure, for instance).

Within government, NSW Health (both state and local departments) has developed an increasingly effective response to urban planning opportunities for promoting and protecting health.

2. The previous minister for planning (Rob Stokes), the Office of the Government Architect and the Greater Sydney Commission have each provided vital policy mechanisms for including health. This illustrates the importance of particular agents in the right place at the right time.

The minister was essential in establishing the commission. This effectively created a respectful distance between strategic planning and the “economics trumps all” planning agenda seen in some policy environments.

The “design-led planning” emphasis came about when Stokes was planning minister. The starring role given to health in Better Placed gives healthy planning advocates, for the time being, unprecedented opportunity to influence strategies and plans.

3. Delivery now requires close attention, as these positive shifts alone have limited power. For instance, the commission’s plans emphasise collaborative infrastructure delivery to create an equitable city. Infrastructure has profound health impacts, costs and benefits.




Read more:
Transport access is good for new housing, but beware the pollution


Shifting infrastructure funding to benefit the city’s West will be the core fault line for delivering on promises of equitable infrastructure provision. However, infrastructure project funding and appraisal are crying out for reform. Better indicators, transparent analyses to inform options, improved governance arrangements and greater accountability have all been identified as required reforms.

The ConversationThe NSW planning system has begun to recognise the importance of urban planning for health. These developments present a tremendous opportunity to influence how healthy public policy can be delivered for the benefit of the whole city.

Patrick Harris, Senior Research Fellow, Menzies Centre for Health Policy, University of Sydney; Elizabeth Harris, Senior Research Fellow, UNSW; Emily Riley, Research Assistant, University of Sydney; Jennifer Kent, Research Fellow, University of Sydney, and Peter Sainsbury, Adjunct Associate Professor, South Western Sydney Local Health District

This article was originally published on The Conversation. Read the original article.

Legal highs: arguments for and against legalising cannabis in Australia



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Many of the harms associated with cannabis use are to do with its illegality.
from http://www.shutterstock.com

Nicole Lee, Curtin University and Jarryd Bartle, RMIT University

Greens leader Richard Di Natale wants Australia to legalise cannabis for personal use, regulated by a federal agency. This proposal is for legalisation of recreational use for relaxation and pleasure, not to treat a medical condition (which is already legal in Australia for some conditions).

According to the proposal, the government agency would licence, monitor and regulate production and sale, and regularly review the regulations. The agency would be the sole wholesaler, buying from producers and selling to retailers it licences.

The proposed policy includes some safeguards that reflect lessons we’ve learned from alcohol and tobacco. These include a ban on advertising, age restrictions, requiring plain packaging, and strict licensing controls. Under the proposal, tax revenues would be used to improve funding to the prevention and treatment sector, which is underfunded compared to law enforcement.




Read more:
Greens want cannabis to be made legal


Cannabis legislation around the world

In Australia, cannabis possession and use is currently illegal. But in several states and territories (South Australia, ACT and Northern Territory) a small amount for personal use is decriminalised. That means it’s illegal, but not a criminal offence. In all others it’s subject to discretionary or mandatory diversion usually by police (referred to as “depenalisation”).

Several jurisdictions around the world have now legalised cannabis, including Uruguay, Catalonia and nine states in the United States. Canada is well underway to legalising cannabis, with legislation expected some time this year, and the New Zealand prime minister has flagged a referendum on the issue.

In a recent opinion poll, around 30% of Australians thought cannabis should be legal. Teenagers 14-17 years old were least likely to support legalistaion (21% of that age group) and 18-24 year olds were most likely to support it (36% of that age group).




Read more:
Australia’s recreational drug policies aren’t working, so what are the options for reform?


In the latest National Drug Strategy Household Survey, around a quarter of respondents supported cannabis legalisation and around 15% approved of regular use by adults for non-medical purposes.

What are the concerns about legalisation?

Opponents of legalisation are concerned it will increase use, increase crime, increase risk of car accidents, and reduce public health – including mental health. Many are concerned cannabis is a “gateway” drug.

The “gateway drug” hypothesis was discounted decades ago. Although cannabis usually comes before other illegal drug use, the majority of people who use cannabis do not go on to use other drugs. In addition, alcohol and tobacco usually precede cannabis use, which if the theory were correct would make those drugs the “gateway”.




Read more:
Could a regulated cannabis market help curb Australia’s drinking problem?


There is also no evidence legalisation increases use. But, studies have shown a number of health risks, including:

  • around 10% of adults and one in six teens who use regularly will become dependent

  • regular cannabis use doubles the risk of psychotic symptoms and schizophrenia

  • teen cannabis use is associated with poorer school outcomes but causation has not been established

  • driving under the influence of cannabis doubles the risk of a car crash

  • smoking while pregnant affects a baby’s birth weight.

What are the arguments for legalisation?

Reducing harms

Australia’s official drug strategy is based on a platform of harm minimisation, including supply reduction, demand reduction (prevention and treatment) and harm reduction. Arguably, policies should therefore have a net reduction in harm.

But some of the major harms from using illicit drugs are precisely because they are illegal. A significant harm is having a criminal record for possessing drugs that are for personal use. This can negatively impact a person’s future, including careers and travel. Decriminalisation of cannabis would also reduce these harms without requiring full legalisation.

Reducing crime and social costs

A large proportion of the work of the justice system (police, courts and prisons) is spent on drug-related offences. Yet, as Mick Palmer, former AFP Commissioner, notes “drug law enforcement has had little impact on the Australian drug market”.

Decriminalisation may reduce the burden on the justice system, but probably not as much as full legalisation because police and court resources would still be used for cautioning, issuing fines, or diversion to education or treatment. Decriminalisation and legalistaion both potentially reduce the involvement of the justice system and also of the black market growing and selling of cannabis.




Read more:
Assessing the costs and benefits of legalising cannabis


Raising tax revenue

Economic analysis of the impact of cannabis legalisation calculate the net social benefit of legalisation at A$727.5 million per year. This is significantly higher than the status quo at around A$295 million (for example from fines generating revenue, as well as perceived benefits of criminalisation deterring use). The Parliamentary Budget Office estimates tax revenue from cannabis legalisation at around A$259 million.

Civil liberties

Many see cannabis prohibition as an infringement on civil rights, citing the limited harms associated with cannabis use. This includes the relatively low rate of dependence and very low likelihood of overdosing on cannabis, as well as the low risk of harms to people using or others.

Many activities that are legal are potentially harmful: driving a car, drinking alcohol, bungee jumping. Rather than making them illegal, there are guidelines, laws and education to make them safer that creates a balance between civil liberties and safety.

What has happened in places where cannabis is legal?

Legalisation of cannabis is relatively recent in most jurisdictions so the long-term benefits or problems of legalisation are not yet known.

But one study found little effect of legalisation on drug use or other outcomes, providing support for neither opponents nor advocates of legalisation. Other studies have shown no increase in use, even among teens.

The ConversationThe research to date suggests there is no significant increase (or decrease) in use or other outcomes where cannabis legalisation has occurred. It’s possible the harm may shift, for example from legal harms to other types of harms. We don’t have data to support or dispel that possibility.

Nicole Lee, Professor at the National Drug Research Institute, Curtin University and Jarryd Bartle, Sessional Lecturer in Criminal Law, RMIT University

This article was originally published on The Conversation. Read the original article.

Explainer: what’s new about the 2018 flu vaccines, and who should get one?


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The flu shot is free for at-risk groups, and available to others for around $10-$25.
Shutterstock

Kanta Subbarao, The Peter Doherty Institute for Infection and Immunity

As winter draws closer, many Australians are wondering whether this year’s influenza season will be as bad as the last, and whether they should get vaccinated.

For most of us, influenza (the flu) is a mild illness, causing fever, chills, a cough, sore throat and body aches, that lasts several days. But some people – especially the elderly, young children and those with chronic diseases – are at risk of serious and potentially deadly complications.

While not perfect, the seasonal influenza vaccine is the best way to protect against influenza viruses. It’s free for at-risk groups, and available to others for around A$10A$25 (plus a consultation fee if your GP doesn’t bulk bill). In some states people can also get influenza vaccines from pharmacies.

Different viruses

There are four influenza viruses that cause epidemics: two type A viruses, called A/H1N1 and A/H3N2 and two type B influenza viruses, called B/Yamagata and B/Victoria viruses. All four cause a similar illness called influenza.

In any season, one of the viruses may dominate, or two or even three viruses could circulate.




Read more:
Influenza: The search for a universal vaccine


Last year’s influenza seasons in Australia and the United States were caused by A/H3N2, while B/Yamagata viruses predominated in Asia, and a mix occurred in Europe.

Influenza A/H3N2 viruses cause more severe epidemics that affect the entire population, from the very young to the very old.

In contrast, influenza B and A/H1N1 viruses tend to cause disease in children and young adults, respectively, sparing the elderly.

Developing the vaccine

Although influenza activity around the world is monitored throughout the year, influenza viruses mutate continuously and we can’t predict which virus will dominate. For this reason, the influenza vaccine includes components that are updated to protect against all four influenza A and B viruses.

Vaccination is the best option to prevent influenza and is offered in the autumn, in anticipation of influenza season in the winter. Typically, the influenza season begins in June, peaks by September and can last until November.

For best protection, you need a flu vaccine each year. Roberty Booy, Head of the Clinical Research team at the National Centre for Immunisation Research and Surveillance, explains why (via the Australian Academy of Science).

It takes about two weeks for the vaccine to induce immunity and the resulting protection lasts about six months.

The 2017 influenza season was severe in all states except WA. The epidemic began earlier than usual, there were more reported cases than in previous years, and there were a large number of outbreaks in residential care facilities in several jurisdictions.




Read more:
Here’s why the 2017 flu season was so bad


Who is most affected?

People of all ages can get influenza but some people are at greater risk of severe illness and complications that require hospitalisation. These groups include:

  • older adults who are over 65 years of age
  • children aged under five years and especially children under one
  • pregnant women
  • Aboriginal and Torres Strait Islander persons
  • people with severe asthma or underlying health conditions such as heart or lung disease, low immunity or diabetes.
Anyone can get a flu vaccine but some people have to pay for it.
Shutterstock

While the National Immunisation Program provides vaccines free of charge for the groups listed above, anyone who wants to reduce their risk of influenza can get vaccinated.

What’s new this year?

There are two notable changes.

One change is that several states (Tasmania, Victoria, New South Wales, Queensland, Western Australia and the ACT) are now offering free vaccination for children under five years of age.




Read more:
Thinking about getting your child the flu vaccine? Here’s what you need to know


This is important because children are prone to severe illness and they spread the virus to their contacts, at home and in daycare. Previously, only WA offered children the influenza vaccine free of charge.

The second change is “enhanced” vaccines are available for adults over the age of 65. The standard influenza vaccine is not optimally effective in older adults.

Two products have been developed to improve the immunity offered by the vaccine: one is a high-dose vaccine four times the strength of the standard vaccine and the second is an “adjuvanted” vaccine, that contains an additive that boosts the immune response to the vaccine.




Read more:
Here’s what you need to know about the new flu vaccines for over-65s


These vaccines have been available in other countries for many years but are being introduced in Australia for the first time in 2018. Older adults will be offered one of the two enhanced vaccines for free.

What happens if you still get influenza?

Even if you’re vaccinated, you can still get influenza.

The effectiveness of the seasonal influenza vaccine varies and is usually around 40-50%. But last year’s vaccine was only around 33% effective overall, because it was not effective against the A/H3N2 virus though it was effective against the A/H1N1 and influenza B viruses.

While vaccines are given ahead of time to prevent influenza, antiviral drugs are available via GP prescription for people who get infected.

The antiviral drugs for influenza are most effective when taken within two days of illness and are only effective against influenza viruses. But they’re not effective against other respiratory viruses that cause colds and respiratory symptoms.

Influenza is a contagious virus that spreads through contact with respiratory secretions that are airborne (such as coughs and sneezes) or that contaminate surfaces (after wiping a runny nose, for instance). If you have influenza, stay home to avoid spreading the virus.

The ConversationUnfortunately, we can’t predict whether the 2018 influenza season will be mild or severe. Once we know which virus or viruses are circulating, we may be in a better position to predict how severe the season will be for older adults.

Kanta Subbarao, Professor, The Peter Doherty Institute for Infection and Immunity

This article was originally published on The Conversation. Read the original article.

Mood and personality disorders are often misconceived: here’s what you need to know


Kathryn Fletcher, Swinburne University of Technology and Kristi-Ann Villagonzalo, Swinburne University of Technology

With each new version of the widely-used manual of mental disorders, the number of mental health conditions increases. The latest version (DSM-5) lists around 300 disorders. To complicate things, many share common features, such as depression and anxiety.

The manual is a useful guide for doctors and researchers, but making a diagnosis is not a precise science. So if the “experts” are still debating what’s what when it comes to categorising disorders, it’s not surprising misconceptions abound in the community about certain mental health conditions.

We learn about mental health conditions in a number of ways. Either we know someone who has experienced it, we’ve experienced it ourselves, read about it or seen something on TV. Movies and TV series commonly portray people with mental illness as dangerous, scary and unpredictable. The most popular (mis)representations are of characters with multiple personalities, personality disorders, schizophrenia and bipolar disorder.




Read more:
The emotion centre is the oldest part of the human brain: why is mood so important?


While the media is an important source of information about mental illness, it can misinform the public if reported inaccurately, promoting stigma and perpetuating myths. And research shows negative images of mental illness in the media (fictional and non-fictional) results in negative and inaccurate beliefs about mental illness.

Dissociative identity disorder

“Multiple personality disorder” or “split personality disorder” are colloquial terms for dissociative identity disorder. Despite being colloquially named a personality disorder, it’s actually a dissociative disorder.

A personality disorder is a long-term way of thinking, feeling and behaving that deviates from the expectations of culture. Whereas in dissociative identity disorder, at least two alternate personalities (alters) routinely take control of the individual’s behaviour. The individual is usually unable to remember what happened when an alter takes over: there are noticeble gaps in their memory, which can be extremely distressing.




Read more:
Dissociative identity disorder exists and is the result of childhood trauma


The popular TV series “The United States of Tara” actually does a pretty good job of portraying dissociative identity disorder. The main character has a series of alters and experiences recurrent gaps in her memory.

While it used to be considered rare, dissociative identity disorder is estimated to affect 1% of the general population, and is typically related to early trauma (such as childhood abuse). People commonly confuse dissociative identity disorder with schizophrenia. Unlike schizophrenia, the individual is not imagining external voices or experiencing visual hallucinations: one personality literally “checks out” and another appears in their place.

Borderline personality disorder

Borderline personality disorder is often misconstrued. People with this condition are often portrayed as manipulative, destructive and violent. In reality, these behaviours are driven by emotional pain: the person has never learned to ask effectively for what they need or want.

It is also often assumed “borderline” means the person almost has a personality disorder. The term “borderline” here creates some confusion. First introduced in the United States in 1938, the term was used by psychiatrists to describe patients who were thought to be on the “border” between diagnoses (mostly psychosis and neurosis). The term “borderline” has stuck in the diagnosis, but there is now a much better understanding of the causes, symptoms and treatment.




Read more:
Borderline personality disorder is a hurtful label for real suffering – time we changed it


Those with borderline personality disorder have difficulties regulating their emotions. This contributes to angry outbursts, anxiety and depression, and relationships fraught with difficulties. It’s also commonly associated with trauma (such as childhood abuse or neglect).

Many actions of a person with borderline personality disorder (such as self-harm and overdose) are done out of desperation in an attempt to manage difficult and intense emotions.




Read more:
Explainer: what is borderline personality disorder?


Bipolar disorder

While borderline personality disorder and bipolar disorder can look similar (mood problems, impulsive behaviour and suicidal thinking), there are several key differences.

Bipolar disorder is characterised by extreme mood swings – from severe lows (depression) to periods of high activity, energy and euphoria. The different mood states can seem like a personality change, but a return to the “usual self” occurs once mood stabilises.

While depression is part of borderline personality disorder and bipolar disorder, those with bipolar disorder experience significant “up” mood swings. This is known as mania in bipolar I disorder and hypomania (less intense mania) in bipolar II disorder.




Read more:
Explainer: what is bipolar disorder?


Bipolar mood episodes last longer (four days or longer for “ups” and two weeks or longer for “downs”), with periods of wellness in between, and are less likely to be triggered by external events. And bipolar disorder is more likely to run in families, disrupt sleep patterns, and psychotic symptoms (delusions, hallucinations) can occur during mood episodes.

We all have ups and downs, but bipolar disorder is much more than that with extreme, recurrent mood episodes that are not only distressing, but have a significant long-term impact on key areas of a persons’s life. Positively, with the right treatment, good quality of life is entirely possible despite ongoing symptoms.

Schizophrenia

Schizophrenia, meaning “split mind” in Greek, is often confused with dissociative identity disorder. However, the “split” refers not to multiple personalities, but to a “split” from reality. People with schizophrenia may find it difficult to discern whether their perceptions, thoughts, and emotions are based in reality or not.

Hearing voices (auditory hallucinations) is a common symptom, along with seeing, smelling, feeling, or tasting things others can’t. Unusual beliefs (delusions), including some that cannot possibly be true (such as a belief that one has special powers) are also common. So too is disordered thinking, where the person jumps from one topic to another at random, or makes strange associations to things that don’t make sense. They may also exhibit bizarre behaviour including socially inappropriate outbursts or wearing odd clothing that is inappropriate to the circumstances.

Other symptoms of schizophrenia look a lot like depression, such as an inability to experience pleasure, social withdrawal and low motivation. Depressive symptoms are also present in schizophrenia, but are slightly different in that emotion is diminished altogether, rather than a depressed mood per se.




Read more:
Either mad and bad or Jekyll and Hyde: media portrayals of schizophrenia


Mental health conditions don’t come in neat packages

Unlike physical conditions, we don’t have a biological test that can magically tell us what mental condition we’re dealing with. Mental health practitioners are carefully trained to observe symptom patterns: the right diagnosis guides the appropriate treatment.

For example, first-line treatment of schizophrenia and bipolar disorder often focuses on medication. While dissociative identity disorder and borderline personality disorders are treated primarily with psychological therapy.

The ConversationMental health conditions are serious – whether disorders of personality, mood or somewhere in between. Improved understanding and balanced representation of these conditions is needed to shift stigmas and misconceptions in the community.

Kathryn Fletcher, Postdoctoral Research Fellow, Swinburne University of Technology and Kristi-Ann Villagonzalo, Postdoctoral Research Fellow, Swinburne University of Technology

This article was originally published on The Conversation. Read the original article.

We asked five experts: do I have to drink eight glasses of water per day?



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Eight seems like a lot…
from http://www.shutterstock.com

Alexandra Hansen, The Conversation

Everyone knows humans need water and we can’t survive without it. We’ve all heard we should be aiming for eight glasses, or two litres of water per day.

This target seems pretty steep when you think about how much water that actually is, and don’t we also get some water from the food we eat?

We asked five medical and sports science experts if we really need to drink eight glasses of water per day.

All five experts said no

Here are their detailed responses:

https://cdn.theconversation.com/infographics/248/5569e2081efba668022eb859f9f36a24735d7625/site/index.html


If you have a “yes or no” health question you’d like posed to Five Experts, email your suggestion to: alexandra.hansen@theconversation.edu.au


The ConversationDisclosure statements: Toby Mündel has received research funding from the Gatorade Sport Science Institute and Neurological Foundation of New Zealand, which has included research on hydration.

Alexandra Hansen, Section Editor: Health + Medicine, The Conversation

This article was originally published on The Conversation. Read the original article.

Health check: why do we get muscle cramps?



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Some people experience cramps frequently after vigorous, high-intensity exercise.
from shutterstock.com

Alan Hayes, Victoria University

Many of us know the feeling of a cramp – whether you’ve been struck down on the sports field or woken with a start in excruciating pain in the middle of the night. A cramp is the involuntary contraction of our skeletal muscle, and it hurts.

Some people often experience cramps after vigorous, high-intensity exercise, but there are also many who experience them with no exercise at all – mostly at night. These “nocturnal” cramps occur with increasing frequency as we age, and are common in pregnancy.

Interestingly, these cramps are usually restricted to the lower limb. This is generally the same as athletes experiencing exercise-associated muscle cramps. So, are the causes the same?

What causes cramps?

Actually, we don’t really know, but there are several theories.

We know cramps are rarely seen at the start of a sporting contest, but regularly seen at the end. So fatigue seems to be the defining factor in exercise. Some researchers have long suggested dehydration and electrolyte imbalance (such as decreased salt content) as a cause.

But recent reviews have downplayed this theory, as the evidence is mostly observational. This means while there may be an association between dehydration, salt depletion and cramps, we can’t prove one caused the other.

Also, in these studies, people who were prone to cramps didn’t have differences in hydration or electrolyte content compared to people who were not prone to cramps.




Read more:
Health Check: what happens to your body when you’re dehydrated?


And if electrolyte imbalance was implicated, then all the muscles in the body would be affected. But only muscles actively being used tend to cramp, particularly those that cross more than one joint, such as the calf muscle and hamstrings. These may be contracting from a shortened position when the knee is bent.

Mismatched reflexes

Muscles have an inbuilt reflex mechanism. When the muscle is tensed, or contracts, a reflexive message is sent to the spinal cord for the muscle to lengthen and relax. This protects the muscle from injury.

The recent reviews suggest what is called the altered neuromuscular control hypothesis to explain cramps. Here, the protective reflex action is disrupted, which usually happens when the muscle is tired. So, in this instance, the muscle contracts, but the usual signal to the spinal cord for it to relax is inhibited. There is now no protective relaxing of the muscle that follows, meaning it contracts for longer than you want it to.

When we tense our muscles a message is sent to the spinal cord for the muscles to relax.
From shutterstock.com

But the reason for neuromuscular fatigue, and why this inhibits the reflex, is not well understood. Cramps are also more common at the start of a sports season, when muscles are less conditioned. This is most likely due to higher levels of fatigue occurring in less trained muscles.

The altered neuromuscular control could also explain nocturnal cramps, as older muscles of inactive people are generally shorter. Whether this is the case in pregnancy is still debated.

Hot conditions have also been associated with increased cramping, but this likely relates to higher rates of fatigue when it’s hot. Despite what people may think, cold doesn’t increase the incidence of cramps, but may be likely to make the severity of cramps worse as reflexes are stronger in cold, stiff muscles.




Read more:
Health Check: how to exercise safely in the heat


Are certain people more susceptible?

Some people seem to experience cramps more often than others, which may be related to the sensitivity of their muscle reflexes.

Fatigue is a clear risk factor, both in long-term endurance athletes and in those participating in high-intensity activities. This is because high-intensity activities require the use of our powerful, fast-contracting fibres (fast fibres), as opposed to lower-intensity activities that use our slower fibres. Fast fibres are more susceptible to fatigue.

Cramps are more prevalent in males, which may be because males have more fast fibres, or because females demonstrate less fatigue when exercising at similar relative intensities.

Cramps may occur during the night, including commonly in pregnant women.
from shutterstock.com

Nocturnal cramps are more commonly reported in older age. There is also a particularly high prevalence of cramps in pregnancy, generally beginning in the second trimester and often worsening in the third.

No one really knows exactly why this occurs. It may be due to increased fatigue from carrying the extra body weight, or increased pressure on the leg muscles due to slowed return of blood to the heart.

Hormones could play a role too, and there have been suggestions that women taking the contraceptive pill could be more prone to cramping. Connective tissue stiffness is altered by sex hormones.

But, while reflex sensitivity does change with the phases of the menstrual cycle, the muscle stretch reflex is actually lowest at ovulation, and there is limited evidence that the pill affects this.




Read more:
Chemical messengers: how hormones change through menopause


How do we treat cramps?

Salt tablets and magnesium have been commonly used for cramps, but because electrolyte imbalance and dehydration don’t appear to be the cause, their usefulness is debatable.

Stretching is generally the best way to get rid of a cramp.
From shutterstock.com

The best way to get rid of a cramp is by stretching the muscle, since the reflex to do this is likely being inhibited. However, stretching a severely cramping muscle might cause a degree of damage to the muscle.

So, contracting the opposite muscle in the muscle pair (usually on the other side) may be a better approach. This involves, for example, contracting the quadriceps (at the front of the leg) when the hamstrings (at the back of the leg) are cramping.




Read more:
Health Check: do you need to stretch before and after exercise?


Given the overall lack of understanding of exactly how cramps occur, evidence-based prevention strategies are few and far between. If fatigue is one of the main causes of increased susceptibility to cramps, then methods to delay fatigue – such as fluid intake and salt replacement during exercise – may help prevent them. This can also aid performance.

The ConversationMassage (due to reduced nerve sensitivity) and stretching may also help decrease the incidence of cramps in older people and during pregnancy.

Alan Hayes, Assistant Dean, Western Centre for Health Research and Education, Victoria University

This article was originally published on The Conversation. Read the original article.

Flesh-eating bacteria cases on the rise and we need an urgent response


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In Australia, cases of Buruli ulcer have been associated with coastal areas – like Victoria’s Bellarine Peninsula.
Bernard Spragg. NZ/Flickr, CC BY

Daniel O’Brien, University of Melbourne

Victoria is facing a worsening epidemic of flesh-eating bacteria that cause a disease known internationally as Buruli ulcer – and we don’t know how to prevent it. Also called Bairnsdale ulcer or Daintree ulcer, this disease causes destructive skin lesions that can lead to severe illness and occasionally even death.

Buruli ulcer is caused by the bacteria Mycobacterium ulcerans (M. ulcerans) and often results in long-term disability and cosmetic deformity.

An epidemic, or an outbreak, is when cases of a disease occur more often than expected in a given area over a particular period of time.

In 2016, there were 182 new cases in Victoria, which, at the time was the highest number ever reported. But the number of casesreported in 2017 (275) have further increased by 51%, compared with 2016 (182). The cases are also becoming more severe in nature and occurring in new geographical areas.

In Australia, Buruli ulcer is frequently reported from the Daintree region, and less commonly the Capricorn coast, of Queensland. Occasionally we’ve heard of cases from the NT, NSW and WA. But most reports come from Victoria, where the disease has been recognised since 1948.

Despite this, we still don’t know the exact environmental niche where the organism lives and how it is transmitted to humans.

Our article, published today in the Medical Journal of Australia, calls for an urgent investigation to answer some critical questions. These include finding out the natural source of M. ulcerans; how the infection is transmitted to humans; what role possums, mosquitoes and other species play in transmission; why the disease incidence is increasing and spreading into new areas in Victoria; and why cases are becoming more severe.

Why is Buruli ulcer such a problem?

Buruli ulcer occurs most commonly in the tropical regions of West or Central Africa, and is a significant public health problem there.

Ulcers are the most common form of this disease. But it can also manifest as a small swelling or lump below the skin, a plaque or as a cellulitic form, and can be complicated by bone or joint infection. The disease can affect all age-groups, including young children.




Read more:
Explainer: what is the flesh-eating bacterium that causes Buruli ulcer and how can I avoid it?


Treatment effectiveness has improved in recent years and cure rates have approached 100% with the use of combination antibiotics (rifampicin and clarithromycin). But these are expensive and not subsidised under Australia’s Pharmaceutical Benefits Scheme (PBS).

The treatments are also powerful and about one-quarter of people have severe side-effects including hepatitis, allergy or a destabilisation of other medical conditions such as heart disease or mental illness.

Buruli ulcer usually requires reconstructive surgery, like in the case of this 76-year-old man.
Author provided

Many people require reconstructive plastic surgery – sometimes with prolonged hospital admissions. On average it takes four to five months for the disease to heal, and sometimes a year or more.

All of this results in substantial costs through such things as wound dressings, medical visits, surgery, hospitalisation, and time off work or school.

What do we know about the bacteria?

M. ulcerans disease is concentrated in particular sites, and endemic and non-endemic areas are separated by only a few kilometres. In Africa it’s usually associated with wetlands, especially those with slow-flowing or stagnant waters. But in Australia it’s found mostly in coastal regions, like Victoria’s Mornington Peninsula.

We know the risk of infection is seasonal, with an increased risk in the warmer months. Lesions most commonly occur on areas of the body that have been exposed. This suggests bites, environmental contamination or trauma may play a role in infection, and that clothing is protective.

Human-to-human transmission does not seem to occur, although cases are commonly clustered in families, presumably as a result of similar environmental exposure.

The rest is unclear. Possible sources of infection in the environment include the soil, or dead plant material in water bodies such as lakes or ponds.

It may be transmitted to humans though contamination of skin lesions and minor abrasions – through trauma or via the bite of insects such as mosquitoes.

In Victoria, some possums in Point Lonsdale on the Bellarine Peninsula (an endemic area) were found to have Buruli ulcers and have high levels of M. ulcerans in their faeces. The location, proportion and concentration of M. ulcerans in possum faeces was also strongly correlated with human cases. But no M. ulcerans was found in possum faeces in nearby areas with no human cases.

So, it’s thought possum faeces might increase the risk of infection to humans in contact with that environment, or infection could be potentially transmitted by insects biting possums and then humans.




Read more:
Are mosquitoes to blame for the spread of ‘flesh-eating’ bacteria?


What should we do?

We need to understand the risk factors for M. ulcerans disease by comprehensively analysing human behaviour and environmental characteristics, combined with information on climate and geography.

It’s especially relevant that over the last two years, the number of cases have been increasing in the Mornington Peninsula, while decreasing in the adjacent Bellarine Peninsula. Studying this could allow us to pinpoint the risk factors that underlie the differing incidence patterns.

Once identified, more specific analysis can be performed to further assess the role of these risk factors. We can then explore targeted interventions such as modifying human behaviour, insect control, changes to water use and informed urban planning. Through this we have the best chance to develop effective public health interventions to prevent the disease, and promote more community education and awareness campaigns to help people protect themselves.

It will also facilitate the development of predictive models for non-affected areas that closely monitor these areas for the emergence of the organism. This knowledge can hopefully also be applied globally to benefit those affected overseas.

The ConversationWe need an urgent response based on robust scientific knowledge. Only then can we hope to halt the devastating impact of this disease. We advocate for local, regional and national governments to urgently commit to funding the research needed to help stop Buruli ulcer.

Daniel O’Brien, Associate Professor, University of Melbourne

This article was originally published on The Conversation. Read the original article.

Cancer costs Australia nearly $2 billion per year in lost labour



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A new study calls for additional support from government, employers and the medical profession for cancer survivors wanting to return to work.
from shutterstock.com

Antolin Bonnett, The Conversation

Australia loses nearly A$2 billion of GDP every year due to people with cancer leaving the workforce.

A study published today in BMC Public Health showed that 67% of Australians of working age (25-64) diagnosed with cancer reported changes to their employment in 2015, such as reduced hours and stopping work. Around 50,000 people with cancer weren’t working at all.

The authors calculated this equated to a loss of A$1.7 billion in GDP.

Compared to the workforce rates of other long-term health conditions, such as chronic epilepsy, heart disease and diabetes, those with cancer were almost twice as likely to not be in the workforce.

A previous report showed loss of productivity due to cancer diagnosis accounts for around 54% of the total lifetime cost of cancer. This is compared to only 29% in direct costs, such as medical treatment.

Previous studies show around 40% of cancer survivors will return to work after treatment at six months following a diagnosis, and 89% after two years.

The authors called for additional support from government, employers and the medical profession for cancer survivors wanting to return to work.

Lead author and lecturer at James Cook University, Nicole Bates, said returning to work was “an important milestone, both financially and emotionally”.

Australians with a cancer diagnosis who didn’t have a tertiary qualification were nearly four times as likely to not be working as those who did. Other factors affecting work status included having a manual labour job, less flexible working arrangement, and the type of cancer and treatment.




Read more:
We need more support systems for people who want to work during and after cancer treatment


Professor and medical oncologist at Flinders University, Bogda Koczwara, said lack of flexible employment was a significant roadblock to cancer survivors re-entering the workforce. She added Australian systems only allowed people to be either “on or off”.

“In Australia, there isn’t a lot of room for return to employment. Sometimes a person may be willing to return to work but not capable of doing so at full capacity. But they’re better off staying at home and claiming full insurance than going back to work partially because that way they lose their payments,” she said.

Professor Koczwara, who was not involved in the study, also said it was important to not only consider medical ways to assist cancer patients returning to work.

Miss Bates said employers could work with the cancer survivor and their medical professionals to “enable returning to work within their capabilities”.

Director of the Australian Healthy Policy Collaboration at Victoria University, Rosemary Calder, said it would be useful to explore how cancers that shared common risk factors with preventable chronic diseases contributed to the productivity impact.

“Given what we know about the shared risk factors for some cancers and other chronic diseases, if we invested in prevention of these risk factors, we potentially could reduce the productivity impact of cancers related to those risk factors,” she said.




Read more:
Interactive body map: what really gives you cancer?


The researchers analysed data from the 2015 Australian Bureau of Statistics Survey of Disability, Ageing and Carers according to education, health condition, and employment status.

The study was limited by its inability to differentiate the rates of workforce participation of those currently undergoing treatment compared to those in remission.

The ConversationThis article has been updated to include other long-term health conditions that affected return to work, and clarify that the estimated loss of productivity due to cancer compared to direct medical costs was from a previous report.

Antolin Bonnett, Editorial Intern, The Conversation

This article was originally published on The Conversation. Read the original article.

Six things you can do to reduce your risk of dementia



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Challenging and training your brain is important to prevent dementia risk.
Photo by rawpixel.com on Unsplash

Helen Macpherson, Deakin University

An ageing population is leading to a growing number of people living with dementia. Dementia is an umbrella term for a group of symptoms including memory impairment, confusion, and loss of ability to carry out everyday activities.

Alzheimer’s disease is the most common form of dementia, and causes a progressive decline in brain health.

Dementia affects more than 425,000 Australians. It is the second-ranked cause of death overall, and the leading cause in women.

The main risk factor for dementia is older age. Around 30% of people aged over 85 live with dementia. Genetic influences also play a role in the onset of the disease, but these are stronger for rarer types of dementia such as early-onset Alzheimer’s disease.




Read more:
What causes Alzheimer’s disease? What we know, don’t know and suspect


Although we can’t change our age or genetic profile, there are nevertheless several lifestyle changes we can make that will reduce our dementia risk.

1. Engage in mentally stimulating activities

Education is an important determinant of dementia risk. Having less than ten years of formal education can increase the chances of developing dementia. People who don’t complete any secondary school have the greatest risk.

The good news is that we can still strengthen our brain at any age, through workplace achievement and leisure activities such as reading newspapers, playing card games, or learning a new language or skill.

Even playing cards can strengthen your brain.
Photo by Inês Ferreira on Unsplash

The evidence suggests that group-based training for memory and problem-solving strategies could improve long-term cognitive function. But this evidence can’t be generalised to computerised “brain training” programs. Engaging in mentally stimulating activities in a social setting may also contribute to the success of cognitive training.




Read more:
What is ‘cognitive reserve’? How we can protect our brains from memory loss and dementia


2. Maintain social contact

More frequent social contact (such as visiting friends and relatives or talking on the phone) has been linked to lower risk of dementia, while loneliness may increase it.

Greater involvement in group or community activities is associated with a lower risk. Interestingly, size of friendship group appears less relevant than having regular contact with others.

3. Manage weight and heart health

There is a strong link between heart and brain health. High blood pressure and obesity, particularly during mid-life, increase the risk of dementia. Combined, these conditions may contribute to more than 12% of dementia cases.

In an analysis of data from more than 40,000 people, those who had type 2 diabetes were up to twice as likely to develop dementia as healthy people.

Managing or reversing these conditions through the use of medication and/or diet and exercise is crucial to reducing dementia risk.

Exercise is protective for heart health and diabetes, as well as against cognitive decline.
Photo by chuttersnap on Unsplash

4. Get more exercise

Physical activity has been shown to protect against cognitive decline. In data combined from more than 33,000 people, those who were highly physically active had a 38% lower risk of cognitive decline compared with those who were inactive.

Precisely how much exercise is enough to maintain cognition is still under debate. But a recent review of studies looking at the effects of taking exercise for a minimum of four weeks suggested that sessions should last at least 45 minutes and be of moderate to high intensity. This means huffing and puffing and finding it difficult to maintain a conversation.




Read more:
Could too much sitting be bad for our brains?


Australians generally don’t meet the target of 150 minutes of physical activity per week.

5. Don’t smoke

Cigarette smoking is harmful to heart health, and the chemicals found in cigarettes trigger inflammation and vascular changes in the brain. They can also trigger oxidative stress, in which chemicals called free radicals can cause damage to our cells. These processes may contribute to the development of dementia.

The good news is that smoking rates in Australia have dropped from 28% to 16% since 2001.

As dementia risk is higher in current smokers compared with past smokers and non-smokers, this provides yet another incentive to quit once and for all.

6. Seek help for depression

Around one million Australian adults are currently living with depression. In depression, some changes occur in the brain that may affect dementia risk. High levels of the stress hormone cortisol have been linked to shrinkage of brain regions that are important for memory.

High blood pressure can increase the risk of dementia.
Photo by rawpixel.com on Unsplash

Vascular disease, which causes damage to blood vessels, has also been observed in both depression and dementia. Researchers suggests that long-term oxidative stress and inflammation may also contribute to both conditions.




Read more:
You’ve been diagnosed with depression, now what?


A 28-year study of more than 10,000 people found that dementia risk was only increased in those who had depression in the ten years before diagnosis. One possibility is that late-life depression can reflect an early symptom of dementia.

Other studies have shown that having depression before the age of 60 still increases dementia risk, so seeking treatment for depression is encouraged.

Other things to consider

Reducing dementia risk factors doesn’t guarantee that you will never develop dementia. But it does mean that, at a population level, fewer people will be affected. Recent estimates suggest that up to 35% of all dementia cases may be due to the risk factors outlined above.

This figure also includes management of hearing loss, although the evidence for this is less well established.

The contribution of sleep disturbances and diet to dementia risk are emerging as important, and will likely receive more consideration as the evidence base grows.

The ConversationEven though dementia may be seen as an older person’s disease, harmful processes can occur in the brain for several decades before dementia appears. This means that now is the best time to take action to reduce your risk.

Helen Macpherson, Research Fellow, Institute for Physical Activity and Nutrition, Deakin University

This article was originally published on The Conversation. Read the original article.