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Drugs like Ozempic won’t ‘cure’ obesity but they might make us more fat-phobic

<a href="https://theconversation.com/profiles/emma-beckett-22673">Emma Beckett</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Many have <a href="https://www.economist.com/leaders/2023/03/02/new-drugs-could-spell-an-end-to-the-worlds-obesity-epidemic">declared</a> drugs like Ozempic could “end obesity” by reducing the appetite and waistlines of millions of people around the world. When we look past the hype, this isn’t just untrue – it can also be harmful. The focus on weight, as opposed to health, is a feature of <a href="https://www.sciencedirect.com/science/article/abs/pii/S0277539521001217">diet culture</a>. This frames the pursuit of thinness as more important than other aspects of physical and cultural wellbeing. The Ozempic buzz isn’t just rooted in health and medicine but plays into ideas of <a href="https://butterfly.org.au/weight-bias-fatphobia-diet-culture/#:%7E:text=Weight%20bias%2C%20sometimes%20also%20called,or%20being%20around%20fat%20people.">fat stigma and fat phobia</a>. This can perpetuate fears of fatness and fat people, and the behaviours that <a href="https://link.springer.com/article/10.1186/S12916-018-1116-5">harm people who live in larger bodies</a>. <h2>Not the first ‘miracle’ weight-loss drug</h2> This isn’t the first time we have heard that weight-loss drugs will change the world. Ozempic and <a href="https://www.ncbi.nlm.nih.gov/books/NBK551568/">its family</a> of GLP-1-mimicking drugs are the <a href="https://theconversation.com/ozempic-is-in-the-spotlight-but-its-just-the-latest-in-a-long-and-strange-history-of-weight-loss-drugs-209324">latest in a long line of weight loss drugs</a>. Each looked promising at the time. But none have lived up to the hype in the long term. Some have even been withdrawn from sale due to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5126837/">severe side effects</a>. Science does improve <a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(20)30028-8/fulltext">incrementally</a>, but diet culture also keeps us on a cycle of hope for the next <a href="https://sahrc.org/2022/04/diet-culture-a-brief-history/">miracle cure</a>. So drugs like Ozempic might not deliver the results individuals expect, continuing the cycle of hope and shame. <h2>Ozempic doesn’t work the same for everyone</h2> When we talk about the results of studies using Ozempic, we often <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719041/">focus on the average</a> (also known as the mean) results or the maximum (or peak) results. So, studies might <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">show</a> those using the drug lost an average of 10.9% of their body weight, but some lost more than 20% and others less than 5% What we don’t talk about as much is that responses are variable. Some people are “<a href="https://www.sciencedirect.com/science/article/pii/S2212877820301769">non-responders</a>”. This means not everyone loses as much weight as the average, and some don’t lose weight at all. For some people, the side-effects will outweigh the benefits. When people are on drugs like Ozempic, their blood sugar is better controlled by enhancing the release of insulin and reducing the levels of another hormone called glucagon. But there is greater variability in the amount of <a href="https://www.sciencedirect.com/science/article/pii/S2212877820301769#bib88">weight lost</a> than the variability in blood sugar control. It isn’t clear why, but is likely due to differences in genetics and lifestyles, and weight being more complex to regulate. <h2>Treatment needs to be ongoing. What will this mean?</h2> When weight-loss drugs do work, they are only effective while they’re being taken. This means that to keep the weight off people need to keep taking them long term. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9542252/">One study found</a> an average weight loss of more than 17% after a year on Ozempic became an average net weight loss of 5.6% more than two years after stopping treatment. Short-term side effects of drugs like Ozempic include dizziness, nausea, vomiting and other gastrointestinal upsets. But because these are new drugs, we simply don’t have data to tell us if side effects will increase as people take them for longer periods. Nor do we know if <a href="https://www.medicalnewstoday.com/articles/why-weight-loss-drugs-stop-working-how-to-break-past-ozempic-plateau#:%7E:text=A%20lifetime%20commitment%20to%20Ozempic&text=By%20these%20standards%2C%20such%20drugs,long%2Dterm%20risk%20is%20unknown.">effectiveness will be reduced</a> in the long term. This is called <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/drug-tolerance#:%7E:text=A%20condition%20that%20occurs%20when,or%20different%20medicine%20is%20needed.">drug tolerance</a> and is documented for other long-term treatments such as antidepressants and chemotherapies. <h2>Biology is only part of the story</h2> For some people, using GLP-1-mimicking drugs like Ozempic will be validating and empowering. They will feel like their biology has been “normalised” in the same way that blood pressure or cholesterol medication can return people to the “normal” range of measures. But biologically, obesity <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202176/#:%7E:text=Obesity%20behaves%20as%20complex%20polygenic,about%2080%25%20(3).">isn’t solely about GLP-1 activity</a> with <a href="https://www.worldobesity.org/what-we-do/our-policy-priorities/the-roots-of-obesity">many other</a> hormones, physical activity, and even our gut microbes involved. Overall, <a href="https://www.ncbi.nlm.nih.gov/books/NBK278977/">obesity is complex and multifaceted</a>. Obesity isn’t just driven by personal biology and choice; it has social, cultural, political, environmental and economic determinants. <h2>A weight-centred approach misses the rest of the story</h2> The weight-centred approach <a href="https://butterfly.org.au/body-image/health-not-weight/#:%7E:text=Health%20and%20wellbeing%20are%20multi,on%20their%20size%20or%20appearance.">suggests that leading with thinness means health will follow</a>. But changing appetite is only part of the story when it comes to health. Obesity often <a href="https://www.sciencedirect.com/science/article/pii/S2667368123000335#:%7E:text=Obesity%20related%20malnutrition%20can%20also,%5D%2C%20%5B7%5D%5D.">co-exists with malnutrition</a>. We try to separate the effects in research using statistics, but focusing on the benefits of weight-loss drugs without addressing the underlying malnutrition means we aren’t likely to see the <a href="https://www.wsj.com/articles/ozempic-diet-exercise-healthy-43eee86c">improved health outcomes in everyone who loses weight</a>. <h2>Obesity isn’t an issue detached from people</h2> Even when it is well-intentioned, the rhetoric around the joy of “ending the obesity epidemic” can <a href="https://theconversation.com/ozempic-the-miracle-drug-and-the-harmful-idea-of-a-future-without-fat-211661">harm people</a>. Obesity doesn’t occur in isolation. It is people who are obese. And the celebration and hype of these weight-loss drugs can reinforce harmful fat stigma. The framing of these drugs as a “cure” exacerbates the binary view of thin versus fat, and healthy versus unhealthy. These are not binary outcomes that are good or bad. Weight and health exist on a spectrum. Ironically, while fat people are told they need to lose weight for their health, they are also <a href="https://www.dailytelegraph.com.au/news/nsw/ozempic-shame-why-users-are-embarrassed-to-admit-using-weight-loss-wonder-drug/news-story/ee52a819c69459afe6576d25988f9bd6">shamed for “cheating” or taking shortcuts</a> by using medication. <h2>Drugs are tools, not silver bullets</h2> The creation of these drugs is a start, but they remain expensive, and the hype has been followed by <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023#:%7E:text=Consumer%20Medicine%20Information%20.-,Why%20the%20Ozempic%20shortage%20happened,label%20prescribing%20for%20weight%20loss.">shortages</a>. Ultimately, complex challenges aren’t addressed with simple solutions. This is particularly true when people are involved, and even more so when there isn’t even an agreement on what the challenge is. Many organisations and individuals see obesity is a disease and believe this framing helps people to seek treatment. Others think it’s unnecessary to attach medical labels to body types and <a href="https://www.forbes.com/sites/geoffreykabat/2013/07/09/why-labeling-obesity-as-a-disease-is-a-big-mistake/?sh=5ca95cc2103b">argue</a> it confuses risk factors (things that are linked to increased risk of illness) with illness itself. Regardless, two things will always remain true. Drugs can only ever be tools, and those tools need to be applied in a context. To use these tools ethically, we need to remain mindful of who this application harms along the way. <hr /> Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-series-154673">Ozempic series</a> here.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/219309/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/emma-beckett-22673">Emma Beckett</a>, Adjunct Senior Lecturer, Nutrition, Dietetics & Food Innovation - School of Health Sciences, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/drugs-like-ozempic-wont-cure-obesity-but-they-might-make-us-more-fat-phobic-219309">original article</a>.

Body

What’s the difference between autism and Asperger’s disorder?

<a href="https://theconversation.com/profiles/andrew-cashin-458270">Andrew Cashin</a>, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a> Swedish climate activist Greta Thunberg describes herself as having <a href="https://www.theguardian.com/environment/2019/sep/02/greta-thunberg-responds-to-aspergers-critics-its-a-superpower">Asperger’s</a> while others on the autism spectrum, such as Australian comedian Hannah Gatsby, <a href="https://www.theguardian.com/stage/2022/mar/19/hannah-gadsby-autism-diagnosis-little-out-of-whack">describe</a> themselves as “autistic”. But what’s the difference? Today, the previous diagnoses of “Asperger’s disorder” and “autistic disorder” both fall within the diagnosis of autism spectrum disorder, or ASD. Autism describes a “neurotype” – a person’s thinking and information-processing style. Autism is one of the forms of diversity in human thinking, which comes with strengths and challenges. When these challenges become overwhelming and impact how a person learns, plays, works or socialises, a diagnosis of <a href="https://www.psychiatry.org/patients-families/autism/what-is-autism-spectrum-disorder">autism spectrum disorder</a> is made. <h2>Where do the definitions come from?</h2> The Diagnostic and Statistical Manual of Mental Disorders (DSM) outlines the criteria clinicians use to diagnose mental illnesses and behavioural disorders. Between 1994 and 2013, autistic disorder and Asperger’s disorder were the two primary diagnoses related to autism in the fourth edition of the manual, the DSM-4. In 2013, the DSM-5 collapsed both diagnoses into one <a href="https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596">autism spectrum disorder</a>. <h2>How did we used to think about autism?</h2> The two thinkers behind the DSM-4 diagnostic categories were Baltimore psychiatrist Leo Kanner and Viennese paediatrician Hans Asperger. They described the challenges faced by people who were later diagnosed with autistic disorder and Asperger’s disorder. Kanner and Asperger observed patterns of behaviour that differed to typical thinkers in the domains of communication, social interaction and flexibility of behaviour and thinking. The variance was associated with challenges in adaptation and distress. Between the 1940s and 1994, the majority of those diagnosed with autism also had an intellectual disability. Clinicians became focused on the accompanying intellectual disability as a necessary part of autism. The introduction of Asperger’s disorder shifted this focus and acknowledged the diversity in autism. In the DSM-4 it superficially looked like autistic disorder and Asperger’s disorder were different things, with the Asperger’s criteria stating there could be no intellectual disability or delay in the development of speech. Today, as a legacy of the recognition of the autism itself, the <a href="https://www.aihw.gov.au/reports/disability/autism-in-australia/contents/autism">majority of people</a> diagnosed with autism spectrum disorder – the new term from the DSM-5 – don’t a have an accompanying intellectual disability. <h2>What changed with ‘autism spectrum disorder’?</h2> The move to autism spectrum disorder brought the previously diagnosed autistic disorder and Asperger’s disorder under the one new diagnostic umbrella term. It made clear that other diagnostic groups – such as intellectual disability – can co-exist with autism, but are separate things. The other major change was acknowledging communication and social skills are intimately linked and not separable. Rather than separating “impaired communication” and “impaired social skills”, the diagnostic criteria changed to “impaired social communication”. The introduction of the spectrum in the diagnostic term further clarified that people have varied capabilities in the flexibility of their thinking, behaviour and social communication – and this can change in response to the context the person is in. <h2>Why do some people prefer the old terminology?</h2> Some people feel the clinical label of Asperger’s allowed a much more refined understanding of autism. This included recognising the achievements and great societal contributions of people with known or presumed autism. The contraction “Aspie” played an enormous part in the shift to positive identity formation. In the time up to the release of the DSM-5, <a href="https://xminds.org/resources/Documents/Web%20files/Aspie%20Criteria%20by%20Attwood.pdf">Tony Attwood and Carol Gray</a>, two well known thinkers in the area of autism, highlighted the strengths associated with “being Aspie” as something to be proud of. But they also raised awareness of the challenges. <h2>What about identity-based language?</h2> A more recent shift in language has been the reclamation of what was once viewed as a slur – “autistic”. This was a shift from person-first language to identity-based language, from “person with autism spectrum disorder” to “autistic”. The neurodiversity rights movement describes its aim to <a href="https://researchonline.jcu.edu.au/71531/1/JCU_71531_AAM.pdf">push back</a> against a breach of human rights resulting from the wish to cure, or fundamentally change, people with autism. The movement uses a “social model of disability”. This views disability as arising from societies’ response to individuals and the failure to adjust to enable full participation. The inherent challenges in autism are seen as only a problem if not accommodated through reasonable adjustments. However the social model contrasts itself against a very outdated medical or clinical model. Current clinical thinking and practice focuses on <a href="https://www.collegianjournal.com/article/S1322-7696(22)00122-6/fulltext">targeted</a> supports to reduce distress, promote thriving and enable optimum individual participation in school, work, community and social activities. It doesn’t aim to cure or fundamentally change people with autism. A diagnosis of autism spectrum disorder signals there are challenges beyond what will be solved by adjustments alone; individual supports are also needed. So it’s important to combine the best of the social model and contemporary clinical model.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/223643/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/andrew-cashin-458270">Andrew Cashin</a>, Professor of Nursing, School of Health and Human Sciences, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/whats-the-difference-between-autism-and-aspergers-disorder-223643">original article</a>.

Mind

Kate Winslet reveals secret health battle

Kate Winslet has opened up about a secret health battle that she faced following the success of Titanic in the late 1990s. The British actress shared how the global success of the film propelled her into stardom, which welcomed a whole new level of scrutiny about her image. Now, the 48-year-old has spoken candidly about her battles with an eating disorder during the height of her fame. "I never told anyone about it," Winslet told the <a href="https://www.nytimes.com/2024/03/03/magazine/kate-winslet-the-regime.html" target="_blank" rel="noopener">New York Times</a>. "Because guess what – people in the world around you go: 'Hey, you look great! You lost weight!'" Now, even 26 years after the peak of the attention, Winslet says that "even the compliment about looking good is connected to weight. And that is one thing I will not let people talk about." "If they do, I pull them up straight away." While this is the first time Winslet admitted to having an eating disorder, it is not the first time she has addressed unwelcome comments over her appearance. On a podcast in 2022, the actress said she wished she had hit back at critics of her body at the time instead of remaining silent. "I would have said, 'Don't you dare treat me like this. I'm a young woman, my body is changing, I'm figuring it out, I'm deeply insecure, I'm terrified, don't make this any harder than it already is'," Winslet said on the Happy Sad Confused podcast. She continued, "It can be extremely negative. People are subject to scrutiny that is more than a young, vulnerable person can cope with. But in the film industry, it is really changing." "When I was younger my agent would get calls saying, 'How's her weight?' I kid you not. So it's heartwarming that this has started to change." Image credits: Getty Images

Caring

Leap of imagination: how February 29 reminds us of our mysterious relationship with time and space

<a href="https://theconversation.com/profiles/emily-ohara-874665">Emily O'Hara</a>, <a href="https://theconversation.com/institutions/auckland-university-of-technology-1137">Auckland University of Technology</a> If you find it intriguing that February 28 will be followed this week by February 29, rather than March 1 as it usually is, spare a thought for those alive in 1582. Back then, Thursday October 4 was followed by Friday October 15. Ten whole days were snatched from the present when Pope Gregory XIII issued a papal bull to “restore” the calendar from discrepancies that had crept into the Julian calendar, introduced by Julius Caesar in 45 BCE. The new Gregorian calendar returned the northern hemisphere’s vernal equinox to its “proper” place, around March 21. (The equinox is when the Earth’s axis is tilted neither toward nor away from the sun, and is used to determine the date of Easter.) The Julian calendar had observed a leap year every four years, but this meant time had drifted out of alignment with the dates of celestial events and astronomical seasons. In the Gregorian calendar, leap days were added only to years that were a multiple of four – like 2024 – with an exception for years that were evenly divisible by 100, but not 400 – like 1700. Simply put, leap days exist because it doesn’t take a neat 365 days for Earth to orbit the Sun. It takes 365.2422 days. Tracking the movement of celestial objects through space in an orderly pattern doesn’t quite work, which is why we have February – time’s great mop. <h2>Time and space</h2> This is just part of the history of how February – the shortest month, and originally the last month in the Roman calendar – came to have the job of absorbing those inconsistencies in the temporal calculations of the world’s most commonly used calendar. There is plenty of <a href="https://theconversation.com/leap-day-fixing-the-faults-in-our-stars-54032">science</a>, <a href="https://theconversation.com/explainer-the-science-behind-leap-years-and-how-they-work-54788">maths</a> and <a href="https://theconversation.com/how-a-seasonal-snarl-up-in-the-mid-1500s-gave-us-our-strange-rules-for-leap-years-132659">astrophysics</a> explaining the relationship between time and the planet we live on. But I like to think leap years and days offer something even more interesting to consider: why do we have calendars anyway? And what have they got to do with how we understand the wonder and strangeness of our existence in the universe? Because calendars tell a story, not just about time, but also about space. Our reckoning of time on Earth is through our spatial relationship to the Sun, Moon and stars. Time, and its place in our lives, sits somewhere between the scientific, the celestial and the spiritual. It is <a href="https://shop.whitechapelgallery.org/products/time">notoriously slippery, subjective and experiential</a>. It is also marked, tracked and determined in myriad ways across different cultures, from tropical to solar to <a href="https://www.stuff.co.nz/pou-tiaki/300062097/matariki-and-the-maramataka-the-mori-lunar-calendar">lunar</a> calendars. It is the Sun that measures a day and gives us our first reference point for understanding time. But it is the <a href="https://librarysearch.aut.ac.nz/vufind/Record/1145999?sid=25214690">Moon</a>, as a major celestial body, that extends our perception of time. By stretching a span of one day into something longer, it offers us a chance for philosophical reflection. The Sun (or its effect at least) is either present or not present. The Moon, however, goes through phases of transformation. It appears and disappears, changing shape and hinting that one night is not exactly like the one before or after. The Moon also has a distinct rhythm that can be tracked and understood as a pattern, giving us another sense of duration. Time is just that – overlapping durations: instants, seconds, minutes, hours, days, weeks, months, years, decades, lifetimes, centuries, ages. <h2>The elusive Moon</h2> It is almost impossible to imagine how time might feel in the absence of all the tools and gadgets we use to track, control and corral it. But it’s also hard to know what we might do in the absence of time as a unit of productivity – a measurable, dispensable resource. The closest we might come is simply to imagine what life might feel like in the absence of the Moon. Each day would rise and fall, in a rhythm of its own, but without visible reference to anything else. Just endless shifts from light to dark. Nights would be almost completely dark without the light of the Moon. Only stars at a much further distance would puncture the inky sky. The world around us would change – trees would grow, mammals would age and die, land masses would shift and change – but all would happen in an endless cycle of sunrise to sunset. The light from the Sun takes <a href="https://www.skyatnightmagazine.com/space-science/how-take-light-from-sun-reach-earth">eight minutes</a> to reach Earth, so the sunlight we see is always eight minutes in the past. I remember sitting outside when I first learned this, and wondering what the temporal delay might be between me and other objects: a plum tree, trees at the end of the street, hills in the distance, light on the horizon when looking out over the ocean, stars in the night sky. Moonlight, for reference, takes about <a href="https://www.pbs.org/seeinginthedark/astronomy-topics/light-as-a-cosmic-time-machine.html">1.3 seconds</a> to get to Earth. Light always travels at the same speed, it is entirely constant. The differing duration between how long it takes for sunlight or moonlight to reach the Earth is determined by the space in between. Time on the other hand, is anything but constant. There are countless ways we characterise it. The mere fact we have so many calendars and ways of describing perceptual time hints at our inability to pin it down. Calendars give us the impression we can, and have, made time predictable and understandable. Leap years, days and seconds serve as a periodic reminder that we haven’t.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/224503/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/emily-ohara-874665">Emily O'Hara</a>, Senior Lecturer, Spatial Design + Temporary Practices, <a href="https://theconversation.com/institutions/auckland-university-of-technology-1137">Auckland University of Technology</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/leap-of-imagination-how-february-29-reminds-us-of-our-mysterious-relationship-with-time-and-space-224503">original article</a>.

Technology

The US just returned to the Moon after more than 50 years. How big a deal is it, really?

<a href="https://theconversation.com/profiles/david-flannery-3906">David Flannery</a>, <a href="https://theconversation.com/institutions/queensland-university-of-technology-847">Queensland University of Technology</a> In the few short years since the COVID pandemic changed our world, China, Japan and India have all successfully landed on the Moon. Many more robotic missions have flown past the Moon, entered lunar orbit, or crashed into it in the past five years. This includes <a href="https://www.planetary.org/space-missions/kplo">spacecraft developed by South Korea</a>, <a href="https://english.alarabiya.net/News/gulf/2023/04/27/Dubai-s-ruler-announces-new-moon-mission-after-UAE-s-Rashid-Rover-lunar-crash-">the United Arab Emirates</a>, and an <a href="https://www.spaceil.com/">Israeli not-for-profit organisation</a>. Late last week, the American company <a href="https://www.intuitivemachines.com/">Intuitive Machines</a>, in collaboration with NASA, celebrated “America’s return to the Moon” with a successful landing of its Odysseus spacecraft. Recent <a href="https://theconversation.com/change-5-china-launches-sample-return-mission-to-the-moon-is-it-winning-the-new-space-race-150665">Chinese-built sample return missions</a> are far more complex than this project. And didn’t NASA ferry a dozen humans to the Moon back when microwaves were cutting-edge technology? So what is different about this mission developed by a US company? <h2>Back to the Moon</h2> The recent Odysseus landing stands out for two reasons. For starters, this is the first time a US-built spacecraft has landed – not crashed – on the Moon for over 50 years. Secondly, and far more significantly, this is the first time a private company has pulled off a successful delivery of cargo to the Moon’s surface. NASA has lately focused on destinations beyond the Earth–Moon system, including Mars. But with its <a href="https://www.nasa.gov/commercial-lunar-payload-services/">Commercial Lunar Payload Services</a> (CLPS) program, it has also funded US private industry to develop Moon landing concepts, hoping to reduce the delivery costs of lunar payloads and allow NASA engineers to focus on other challenges. Working with NASA, Intuitive Machines selected a <a href="https://en.wikipedia.org/wiki/Malapert_(crater)">landing site</a> about 300 kilometres from the lunar south pole. Among other challenges, landing here requires entering a polar orbit around the Moon, which consumes additional fuel. At this latitude, the land is heavily cratered and dotted with long shadows. This makes it challenging for autonomous landing systems to find a safe spot for a touchdown. NASA spent about US$118 million (A$180 million) to land six scientific <a href="https://www.esa.int/Enabling_Support/Space_Engineering_Technology/About_Payload_Systems">payloads</a> on Odysseus. This is relatively cheap. Using low-cost lunar landers, NASA will have an efficient way to test new space hardware that may then be flown on other Moon missions or farther afield. <h2>Ten minutes of silence</h2> One of the technology tests on the Odysseus lander, NASA’s <a href="https://www.nasa.gov/directorates/stmd/impact-story-navigation-doppler-lidar/">Navigation Doppler Lidar experiment</a> or NDL, appears to have proved crucial to the lander’s success. As the lander neared the surface, the company realised its navigation systems had a problem. NASA’s NDL experiment is serendipitously designed to test precision landing techniques for future missions. It seems that at the last second, engineers bodged together a solution that involved feeding necessary data from NDL to the lander. Ten minutes of silence followed before a <a href="https://twitter.com/Int_Machines/status/1760838333851148442">weak signal was detected</a> from Odysseus. Applause thundered through the mission control room. NASA’s administrator released a video congratulating everyone for returning America to the Moon. It has since become clear the lander is not oriented perfectly upright. The solar panels are generating sufficient power and the team is slowly receiving the first images from the surface. However, it’s likely Odysseus <a href="https://www.universetoday.com/165864/odysseus-moon-lander-is-tipped-over-but-still-sending-data/">partially toppled over</a> upon landing. Fortunately, at the time of writing, it seems most of the science payload may yet be deployed as it’s on the side of the lander facing upwards. The unlucky payload element facing downwards <a href="https://edition.cnn.com/2024/02/23/world/odysseus-lunar-landing-sideways-scn/index.html">is a privately contributed artwork</a> connected <a href="https://edition.cnn.com/2024/02/22/style/jeff-koons-moon-phases-odysseus-landing/index.html">to NFTs</a>. The lander is now likely to survive for at least a week before the Sun sets on the landing site and a dark, frigid lunar night turns it into another museum piece of human technology frozen in the lunar <a href="https://www.britannica.com/science/regolith">regolith</a>. <h2>Win some, lose some</h2> NASA’s commercial approach to stimulating low-cost payload services all but guarantees some failures. But eventually NASA hopes that several commercial launch and landing providers will emerge from the program, along with a few learning experiences. The know-how accumulated at organisations operating hardware in space is at least as important as the development of the hardware itself. The market for commercial lunar payloads remains unclear. Possibly, once the novelty wears off and brands are no longer able to generate buzz by, for example, <a href="https://www.columbia.com/omni-heat-infinity/moon-mission/">sending a piece of outdoor clothing to the Moon</a>, this source of funding may dwindle. However, just as today, civil space agencies and taxpayers will continue to fund space exploration to address shared science goals. Ideally, commercial providers will offer NASA an efficient method for testing key technologies needed for its schedule of upcoming scientific robotic missions, as well as <a href="https://www.nasa.gov/specials/artemis/">human spaceflight in the Artemis program</a>. Australia would also have the opportunity to test hardware at a reduced price. It’s worth noting that US budgetary issues, <a href="https://spacenews.com/nasa-warns-of-very-problematic-space-technology-budget-cuts/">funding cuts</a> and <a href="https://www.jpl.nasa.gov/news/jpl-workforce-update">subsequent lay-offs</a> do threaten these ambitions. Meanwhile, in Australia, we may have nothing to launch anyway. We continue to spend less <a href="https://www.aph.gov.au/About_Parliament/Parliamentary_departments/Parliamentary_Library/Budget/reviews/2023-24/ScienceResearch">than the OECD average on scientific research</a>, and only a few Australian universities – who traditionally lead such efforts – <a href="https://business.gov.au/grants-and-programs/moon-to-mars-initiative-demonstrator-mission-grants/grant-recipients">have received funding</a> provided by the Australian Space Agency. If we do support planetary science and space exploration in the future, Australians will need to decide if we want to allocate our limited resources, competing with NASA and US private industry, to supply launch, landing and robotic services to the global space industry. Alternatively, we could leverage these lower-cost payload providers to develop our own scientific space program, and locally developed space technologies associated with benefits to the knowledge economy, education and national security.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/224276/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/david-flannery-3906">David Flannery</a>, Planetary Scientist, <a href="https://theconversation.com/institutions/queensland-university-of-technology-847">Queensland University of Technology</a> Image credits: Intuitive Machines This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/the-us-just-returned-to-the-moon-after-more-than-50-years-how-big-a-deal-is-it-really-224276">original article</a>.

International Travel

What ‘psychological warfare’ tactics do scammers use, and how can you protect yourself?

<a href="https://theconversation.com/profiles/mike-johnstone-106590">Mike Johnstone</a>, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a> and <a href="https://theconversation.com/profiles/georgia-psaroulis-1513050">Georgia Psaroulis</a>, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a> Not a day goes by without a headline <a href="https://www.vice.com/en/article/qjvaym/people-share-worst-scam-stories">about a victim being scammed</a> and losing money. We are constantly warned about new scams and staying safe from cybercriminals. Scamwatch has <a href="https://www.scamwatch.gov.au/research-and-resources/tools-resources/online-resources/spot-the-scam-signs">no shortage of resources</a>, too. So why are people still getting scammed, and sometimes spectacularly so? Scammers use sophisticated psychological techniques. They exploit our deepest human vulnerabilities and bypass rational thought to tap into our emotional responses. This “<a href="https://www.thecut.com/article/amazon-scam-call-ftc-arrest-warrants.html">psychological warfare</a>” coerces victims into making impulsive decisions. Sometimes scammers spread their methods around many potential victims to see who is vulnerable. Other times, criminals focus on a specific person. Let’s unpack some of these psychological techniques, and how you can defend against them. <h2>1. Random phone calls</h2> Scammers start with small requests to establish a sense of commitment. After agreeing to these minor requests, we are more likely to comply with larger demands, driven by a desire to act consistently. The call won’t come from a number in your contacts or one you recognise, but the scammer may pretend to be someone you’ve engaged to work on your house, or perhaps one of your children using a friend’s phone to call you. If it is a scammer, maybe keeping you on the phone for a long time gives them an opportunity to find out things about you or people you know. They can use this info either immediately or at a later date. <h2>2. Creating a sense of urgency</h2> Scammers fabricate scenarios that require immediate action, like claiming a bank account is at risk of closure or an offer is about to expire. This tactic aims to prevent victims from assessing the situation logically or seeking advice, pressuring them into rushed decisions. The scammer creates an artificial situation in which you are frightened into doing something you wouldn’t ordinarily do. Scam calls <a href="https://theconversation.com/we-have-filed-a-case-under-your-name-beware-of-tax-scams-theyll-be-everywhere-this-eofy-162171">alleging to be from the Australian Tax Office</a> (ATO) are a great example. You have a debt to pay (apparently) and things will go badly if you don’t pay right now. Scammers play on your emotions to provoke reactions that cloud judgement. They may threaten legal trouble to instil fear, promise high investment returns to exploit greed, or share fabricated distressing stories to elicit sympathy and financial assistance. <h2>3. Building rapport with casual talk</h2> Through extended conversation, scammers build a psychological commitment to their scheme. No one gets very far by just demanding your password, but it’s natural to be friendly with people who are friendly towards us. After staying on the line for long periods of time, the victim also becomes cognitively fatigued. This not only makes the victim more open to suggestions, but also isolates them from friends or family who might recognise and counteract the scam. <h2>4. Help me to help you</h2> In this case, the scammer creates a situation where they help you to solve a real or imaginary problem (that they actually created). They work their “IT magic” and the problem goes away. Later, they ask you for something you wouldn’t normally do, and you do it because of the “social debt”: they helped you first. For example, a hacker might attack a corporate network, causing it to slow down. Then they call you, pretending to be from your organisation, perhaps as a recent hire not yet on the company’s contact list. They “help” you by turning off the attack, leaving you suitably grateful. Perhaps a week later, they call again and ask for sensitive information, such as the CEO’s password. You know company policy is to not divulge it, but the scammer will ask if you remember them (of course you do) and come up with an excuse for why they really need this password. The balance of the social debt says you will help them. <h2>5. Appealing to authority</h2> By posing as line managers, officials from government agencies, banks, or other authoritative bodies, scammers exploit our natural tendency to obey authority. Such scams operate at varying levels of sophistication. The simple version: your manager messages you with an urgent request to purchase some gift cards and send through their numbers. The complex version: your manager calls and asks to urgently transfer a large sum of money to an account you don’t recognise. You do this because <a href="https://www.wsj.com/articles/fraudsters-use-ai-to-mimic-ceos-voice-in-unusual-cybercrime-case-11567157402">it sounds exactly</a> like your manager on the phone – but the scammer <a href="https://www.forbes.com/sites/thomasbrewster/2021/10/14/huge-bank-fraud-uses-deep-fake-voice-tech-to-steal-millions/?sh=1329b80e7559">is using a voice deepfake</a>. In a recent major case in Hong Kong, such a scam even involved a <a href="https://edition.cnn.com/2024/02/04/asia/deepfake-cfo-scam-hong-kong-intl-hnk/index.html">deepfake video call</a>. This is deeply challenging because artificial intelligence tools, such as Microsoft’s VALL-E, can create <a href="https://arstechnica.com/information-technology/2023/01/microsofts-new-ai-can-simulate-anyones-voice-with-3-seconds-of-audio/">a voice deepfake</a> using just three seconds of sampled audio from a real person. <h2>How can you defend against a scam?</h2> First and foremost, verify identity. Find another way to contact the person to verify who they are. For example, you can call a generic number for the business and ask to be connected. In the face of rampant voice deepfakes, it can be helpful to agree on a “safe word” with your family members. If they call from an unrecognised number and you don’t hear the safe word just hang up. Watch out for pressure tactics. If the conversation is moving too fast, remember that someone else’s problem is not yours to solve. Stop and run the problem past a colleague or family member for a sanity check. A legitimate business will have no problem with you doing this. Lastly, if you are not sure about even the slightest detail, the simplest thing is to hang up or not respond. If you really owe a tax debt, the ATO will write to you.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/223959/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/mike-johnstone-106590">Mike Johnstone</a>, Security Researcher, Associate Professor in Resilient Systems, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a> and <a href="https://theconversation.com/profiles/georgia-psaroulis-1513050">Georgia Psaroulis</a>, Postdoctoral research fellow, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-psychological-warfare-tactics-do-scammers-use-and-how-can-you-protect-yourself-223959">original article</a>.

Money & Banking

Why it’s a bad idea to mix alcohol with some medications

<a href="https://theconversation.com/profiles/nial-wheate-96839">Nial Wheate</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/jasmine-lee-1507733">Jasmine Lee</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/kellie-charles-1309061">Kellie Charles</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/tina-hinton-329706">Tina Hinton</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Anyone who has drunk alcohol will be familiar with how easily it can lower your social inhibitions and let you do things you wouldn’t normally do. But you may not be aware that mixing certain medicines with alcohol can increase the effects and put you at risk. When you mix alcohol with medicines, whether prescription or over-the-counter, the medicines can increase the effects of the alcohol or the alcohol can increase the side-effects of the drug. Sometimes it can also result in all new side-effects. <h2>How alcohol and medicines interact</h2> The chemicals in your brain maintain a delicate balance between excitation and inhibition. Too much excitation can lead to <a href="https://www.medicalnewstoday.com/articles/324330">convulsions</a>. Too much inhibition and you will experience effects like sedation and depression. <iframe id="JCh01" class="tc-infographic-datawrapper" style="border: none;" src="https://datawrapper.dwcdn.net/JCh01/1/" width="100%" height="400px" frameborder="0"></iframe> Alcohol works by increasing the amount of inhibition in the brain. You might recognise this as a sense of relaxation and a lowering of social inhibitions when you’ve had a couple of alcoholic drinks. With even more alcohol, you will notice you can’t coordinate your muscles as well, you might slur your speech, become dizzy, forget things that have happened, and even fall asleep. Medications can interact with alcohol to <a href="https://awspntest.apa.org/record/2022-33281-033">produce different or increased effects</a>. Alcohol can interfere with the way a medicine works in the body, or it can interfere with the way a medicine is absorbed from the stomach. If your medicine has similar side-effects as being drunk, those <a href="https://www.drugs.com/article/medications-and-alcohol.html#:%7E:text=Additive%20effects%20of%20alcohol%20and,of%20drug%20in%20the%20bloodstream.">effects can be compounded</a>. Not all the side-effects need to be alcohol-like. Mixing alcohol with the ADHD medicine ritalin, for example, can <a href="https://www.healthline.com/health/adhd/ritalin-and-alcohol#side-effects">increase the drug’s effect on the heart</a>, increasing your heart rate and the risk of a heart attack. Combining alcohol with ibuprofen can lead to a higher risk of stomach upsets and stomach bleeds. Alcohol can increase the break-down of certain medicines, such as <a href="https://www.sciencedirect.com/science/article/abs/pii/S0149763421005121?via%3Dihub">opioids, cannabis, seizures, and even ritalin</a>. This can make the medicine less effective. Alcohol can also alter the pathway of how a medicine is broken down, potentially creating toxic chemicals that can cause serious liver complications. This is a particular problem with <a href="https://australianprescriber.tg.org.au/articles/alcohol-and-paracetamol.html">paracetamol</a>. At its worst, the consequences of mixing alcohol and medicines can be fatal. Combining a medicine that acts on the brain with alcohol may make driving a car or operating heavy machinery difficult and lead to a serious accident. <h2>Who is at most risk?</h2> The effects of mixing alcohol and medicine are not the same for everyone. Those most at risk of an interaction are older people, women and people with a smaller body size. Older people do not break down medicines as quickly as younger people, and are often on <a href="https://www.safetyandquality.gov.au/our-work/healthcare-variation/fourth-atlas-2021/medicines-use-older-people/61-polypharmacy-75-years-and-over#:%7E:text=is%20this%20important%3F-,Polypharmacy%20is%20when%20people%20are%20using%20five%20or%20more%20medicines,take%20five%20or%20more%20medicines.">more than one medication</a>. Older people also are more sensitive to the effects of medications acting on the brain and will experience more side-effects, such as dizziness and falls. Women and people with smaller body size tend to have a higher blood alcohol concentration when they consume the same amount of alcohol as someone larger. This is because there is less water in their bodies that can mix with the alcohol. <h2>What drugs can’t you mix with alcohol?</h2> You’ll know if you can’t take alcohol because there will be a prominent warning on the box. Your pharmacist should also counsel you on your medicine when you pick up your script. The most common <a href="https://adf.org.au/insights/prescription-meds-alcohol/">alcohol-interacting prescription medicines</a> are benzodiazepines (for anxiety, insomnia, or seizures), opioids for pain, antidepressants, antipsychotics, and some antibiotics, like metronidazole and tinidazole. It’s not just prescription medicines that shouldn’t be mixed with alcohol. Some over-the-counter medicines that you shouldn’t combine with alcohol include medicines for sleeping, travel sickness, cold and flu, allergy, and pain. Next time you pick up a medicine from your pharmacist or buy one from the local supermarket, check the packaging and ask for advice about whether you can consume alcohol while taking it. If you do want to drink alcohol while being on medication, discuss it with your doctor or pharmacist first.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/223293/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/nial-wheate-96839">Nial Wheate</a>, Associate Professor of the School of Pharmacy, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/jasmine-lee-1507733">Jasmine Lee</a>, Pharmacist and PhD Candidate, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/kellie-charles-1309061">Kellie Charles</a>, Associate Professor in Pharmacology, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/tina-hinton-329706">Tina Hinton</a>, Associate Professor of Pharmacology, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/why-its-a-bad-idea-to-mix-alcohol-with-some-medications-223293">original article</a>.

Body

Anger, sadness, boredom, anxiety – emotions that feel bad can be useful

<a href="https://theconversation.com/profiles/heather-lench-1349234">Heather Lench</a>, <a href="https://theconversation.com/institutions/texas-aandm-university-1672">Texas A&M University</a> Remember the sadness that came with the last time you failed miserably at something? Or the last time you were so anxious about an upcoming event that you couldn’t concentrate for days? These types of emotions are unpleasant to experience and can even feel overwhelming. People often try to avoid them, suppress them or ignore them. In fact, in psychology experiments, people will <a href="https://doi.org/10.1007/s10902-012-9394-7">pay money to not feel many negative emotions</a>. But recent research is revealing that emotions can be useful, and even negative emotions can bring benefits. <a href="https://scholar.google.com/citations?user=fzHtrJIAAAAJ&hl=en&oi=ao">In my</a> <a href="https://emotionsciencelab.com">emotion science lab</a> at Texas A&M University, we study how emotions like anger and boredom affect people, and we explore ways that these feelings can be beneficial. We share the results so people can learn how to use their emotions to build the lives they want. Our studies and many others have shown that emotions aren’t uniformly good or bad for people. Instead, different emotions can result in better outcomes in particular types of situations. Emotions seem to function like a Swiss army knife – different emotional tools are helpful in specific situations. <h2>Sadness can help you recover from a failure</h2> Sadness occurs when people perceive that they’ve lost a goal or a desired outcome, and there’s nothing they can do to improve the situation. It could be getting creamed in a game or failing a class or work project, or it can be losing a relationship with a family member. Once evoked, sadness is associated with what psychologists call a deactivation state of doing little, without much behavior or <a href="https://dictionary.apa.org/arousal">physical arousal</a>. Sadness also brings <a href="https://doi.org/10.1111/ap.12232">thinking that is more detailed and analytical</a>. It makes you stop <a href="https://doi.org/10.1177/0963721412474458">and think</a>. The benefit of the stopping and thinking that comes with sadness is that it <a href="https://doi.org/10.1007/978-3-319-77619-4_4">helps people recover from failure</a>. When you fail, that typically means the situation you’re in is not conducive to success. Instead of just charging ahead in this type of scenario, sadness prompts people to step back and <a href="https://doi.org/10.1037/a0016242">evaluate what is happening</a>. When people are sad, they process information in a deliberative, analytical way and want to avoid risk. This mode comes with <a href="https://doi.org/10.1037/0022-3514.75.2.318">more accurate memory</a>, <a href="https://doi.org/10.1080/02699939108411048">judgment that is less influenced</a> <a href="https://doi.org/10.1016/j.jesp.2004.11.005">by irrelevant assumptions or information</a>, and <a href="https://doi.org/10.1016/j.jesp.2008.04.010">better detection of other people lying</a>. These cognitive changes can encourage people to understand past failures and possibly prevent future ones. Sadness can function differently when there’s the possibility that the failure could be avoided if other people help. In these situations, people tend to <a href="https://doi.org/10.1111/j.1469-8986.1994.tb01049.x">cry and can experience</a> <a href="https://doi.org/10.1007/s10286-018-0526-y">increased physiological arousal</a>, such as quicker heart and breathing rates. Expressing sadness, through tears or verbally, has the benefit of <a href="https://doi.org/10.1177/147470491301100114">potentially recruiting other people to help you</a> achieve your goals. This behavior appears to start in infants, with <a href="https://doi.org/10.2307/1127506">tears and cries signaling caregivers to help</a>. <h2>Anger prepares you to overcome an obstacle</h2> Anger occurs when people perceive they’re losing a goal or desired outcome, but that they could improve the situation by removing something that’s in their way. The obstacle could be an injustice committed by another person, or it could be a computer that repeatedly crashes while you’re trying to get work done. Once evoked, <a href="https://doi.org/10.1037/a0024244">anger is associated with a “readiness for action,”</a> and your <a href="https://doi.org/10.1016/S0191-8869(02)00313-6">thinking focuses on the obstacle</a>. The benefit of being prepared for action and focused on what’s in your way is that it motivates you to overcome what’s standing between you and your goal. <a href="https://doi.org/10.1177/1754073913512003">When people are angry</a>, they <a href="https://doi.org/10.1002/ejsp.2420240104">process information and make judgments rapidly</a>, want to take action, and are <a href="https://doi.org/10.1016/j.biopsycho.2010.03.010">physiologically aroused</a>. In experiments, <a href="https://doi.org/10.1016/j.paid.2010.04.017">anger actually increases the force of people’s kicks</a>, which can be helpful in physical encounters. Anger results in better outcomes in situations that involve challenges to goals, including confrontational games, <a href="https://doi.org/10.1037/pspa0000350">tricky puzzles</a>, video games with obstacles, and responding quickly on tasks. Expressing anger, facially or verbally, has the benefit of <a href="http://dx.doi.org/10.1037/pspp0000292">prompting other people to clear the way</a>. People are <a href="https://doi.org/10.1037/0022-3514.86.1.57">more likely to concede in negotiations</a> and <a href="https://doi.org/10.1016/j.jesp.2012.12.015">give in on issues</a> when their adversary looks or says they are angry. <h2>Anxiety helps you prepare for danger</h2> Anxiety occurs when people <a href="https://doi.org/10.1177/070674371105601202">perceive a potential threat</a>. This could be giving a speech to a large audience where failure would put your self-esteem on the line, or it could be a physical threat to yourself or loved ones. Once evoked, anxiety is associated with being prepared to respond to danger, including increased physical arousal and <a href="https://doi.org/10.1111/j.1467-9280.2006.01701.x">attention to threats and risk</a>. Being prepared for danger means that if trouble brews, you can respond quickly to prevent or avoid it. When anxious, people detect threats rapidly, have fast reaction times and <a href="https://doi.org/10.1111/j.1467-9280.2006.01701.x">are on heightened alert</a>. The eye-widening that often comes with fear and anxiety even <a href="https://doi.org/10.1038/nn.2138">gives people a wider field of vision</a> and improves threat detection. Anxiety prepares the body for action, which improves performance on a number of tasks that involve motivation and attention. It motivates people to prepare for upcoming events, such as devoting time to study for an exam. Anxiety also prompts protective behavior, which can help prevent the potential threat from becoming a reality. <h2>Boredom can jolt you out of a rut</h2> There is less research on boredom than many other emotions, so it is not as well understood. Researchers debate <a href="https://doi.org/10.1016/j.tics.2023.02.002">what it is</a> and <a href="https://doi.org/10.3390/bs3030459">what it does</a>. Boredom appears to occur when someone’s current situation is <a href="https://doi.org/10.3390/bs3030459">not causing any other emotional response</a>. There are three situations <a href="https://doi.org/10.1007/s11031-011-9234-9">where this lack can occur</a>: when emotions fade, such as the happiness of a new car fading to neutral; when people don’t care about anything in their current situation, such as being at a large party where nothing interesting is happening; or when people have no goals. Boredom does not necessarily set in just because nothing is happening – someone with a goal of relaxation might feel quite content sitting quietly with no stimulation. Psychology researchers think that the benefit of boredom in situations where people are not responding emotionally is that it <a href="http://dx.doi.org/10.1037/emo0000433">prompts making a change</a>. If nothing in your current situation is worth responding to, the <a href="https://doi.org/10.1002/jocb.154">aversive experience of boredom can motivate you</a> to seek new situations or change the way you’re thinking. Boredom has been related to more risk seeking, a desire for novelty, and creative thinking. It seems to function like an emotional stick, nudging people out of their current situation to explore and create. <h2>Using the toolkit of emotion</h2> People want to be happy. But research is finding that a satisfying and productive life includes a <a href="http://dx.doi.org/10.1037/pspp0000292">mix of positive and negative emotions</a>. Negative emotions, even though they feel bad to experience, can motivate and prepare people for failure, challenges, threats and exploration. Pleasant or not, your emotions can help guide you toward better outcomes. Maybe understanding how they prepare you to handle various situations will help you feel better about feeling bad.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/217654/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/heather-lench-1349234">Heather Lench</a>, Professor of Psychological and Brain Sciences, <a href="https://theconversation.com/institutions/texas-aandm-university-1672">Texas A&M University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/anger-sadness-boredom-anxiety-emotions-that-feel-bad-can-be-useful-217654">original article</a>.

Mind

Parents busted for making their healthy child use a wheelchair to claim benefits

A cruel mother and father have been jailed for over six years for forcing their healthy child to use a wheelchair in order to claim benefit payments. In 2012, Louise Law and her ex-husband Martin forced their then seven-year-old daughter into the wheelchair, as a ploy to gain a mobility car and disability allowance payments despite their being nothing wrong with her. The parents carried on with the scam for four years while they "fabricated illnesses and exaggerated symptoms" to teachers and NHS workers, all while raking in the extensive payments. The crown court in East Yorkshire, England, heard that the child suffered "gratuitous degradation" at being forced to use the wheelchair, as they were bullied at school and deprived of an ordinary childhood. In court, Louise Law admitted an offence of child cruelty, however she changed her plea on the day of a scheduled trial and was jailed for six years and nine months. Martin Law, now split from his wife, is now a long-term resident of a care home and was ruled unfit to enter a plea - although a jury convicted him of child cruelty, and was made subject of a guardianship order. Passing sentence, Judge Kate Rayfield told Mrs Law, "She missed out on so much of her childhood because of what you put her through." "Despite all of her tests revealing nothing wrong, you continued to subject her to appointments and investigations. You did the talking yourselves, telling the doctors lies." "This was a scam... You were telling her to report symptoms that she never said that she had." When the child reached the age of 18 in 2022, she was interviewed by police as she said the faux medical treatment from her parents began when she was six years old. A few initial medical appointments progressed to around 30 hospital appointments, including overnight stays. Prosecutor Louise Reevell told the court, "Her parents made her think that she could not walk properly. She would go to school in a wheelchair but she didn't really need it." Despite medical professionals proving that the child did not need the extensive medical treatment, her parents still claimed that the illnesses and symptoms of their daughter were genuine. Image credits: Getty Images

Legal

Eating leafy greens could be better for oral health than using mouthwash

<a href="https://theconversation.com/profiles/mia-cousins-burleigh-1201153">Mia Cousins Burleigh</a>, <a href="https://theconversation.com/institutions/university-of-the-west-of-scotland-1385">University of the West of Scotland</a> and <a href="https://theconversation.com/profiles/siobhan-paula-moran-1506183">Siobhan Paula Moran</a>, <a href="https://theconversation.com/institutions/university-of-the-west-of-scotland-1385">University of the West of Scotland</a> Over half the adult population in the <a href="https://pubmed.ncbi.nlm.nih.gov/26052472">UK and US</a> have gum disease. Typical treatments include <a href="https://www.nature.com/articles/s41598-020-61912-4">mouthwash</a> and in severe cases, <a href="https://www.magonlinelibrary.com/doi/abs/10.12968/vetn.2017.8.10.542">antibiotics</a>. These treatments have side effects, such as dry mouth, the development of <a href="https://pubmed.ncbi.nlm.nih.gov/30967854/">antimicrobial resistance</a> and increased <a href="https://www.nature.com/articles/s41598-020-61912-4">blood pressure</a>. But research has indicated that a molecule called <a href="https://www.nature.com/articles/s41598-020-69931-x">nitrate</a>, which is found in leafy green vegetables, has fewer side effects and offers greater benefits for oral health. And it could be used as a natural alternative for treating oral disease. Inadequate brushing and flossing leads to the build up of <a href="https://www.nature.com/articles/s41598-020-69931-x">dental plaque</a>, a sticky layer of bacteria, on the surface of teeth and gums. Plaque causes tooth decay and gum disease. Sugary and acidic foods, dry mouth, and smoking can also contribute to bad breath, tooth decay, and gum infections. The two main types of gum disease are gingivitis and periodontitis. <a href="https://www.spandidos-publications.com/10.3892/etm.2019.8381">Gingivitis</a> causes redness, swelling and bleeding of the gums. <a href="https://www.spandidos-publications.com/10.3892/etm.2019.8381">Periodontitis</a> is a more advanced form of gum disease, causing damage to the soft tissues and bones supporting the teeth. Periodontal disease can therefore, lead to tooth loss and, when bacteria from the mouth enter the bloodstream, can also contribute to the development of <a href="https://www.nature.com/articles/bdjteam2015163">systemic disorders</a> such as cardiovascular disease, dementia, diabetes and rheumatoid arthritis. <h2>Leafy greens may be the secret</h2> Leafy greens and root vegetables are bursting with <a href="https://www.sciencedirect.com/science/article/pii/S2666149723000312">vitamins, minerals, and antioxidants</a> – and it’s no secret that a diet consisting of these vegetables is crucial for maintaining a healthy weight, boosting the immune system, and preventing <a href="https://journals.sagepub.com/doi/10.1177/2048004016661435">heart disease, cancer and diabetes.</a> The multiple health benefits of leafy greens are partly because spinach, lettuce and beetroots are brimming with <a href="https://www.nature.com/articles/s41598-020-69931-x">nitrate</a>, which can be reduced to nitric oxide by nitrate-reducing bacteria inside the mouth. <figure><iframe src="https://www.youtube.com/embed/7zrRlMGeBes?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>Popeye knew a thing or two about the health benefits of eating leafy greens. Boomerang Official, 2017.</figcaption></figure> Nitric oxide is known to <a href="https://www.sciencedirect.com/science/article/abs/pii/S0006295222004191">lower blood pressure</a> and improve <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0243755#:%7E:text=Nitrate%2Drich%20beetroot%20juice%20offsets,healthy%20male%20runners%20%7C%20PLOS%20ONE">exercise performance</a>. However, in the mouth, it helps to prevent the overgrowth of bad bacteria and reduces <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0243755#:%7E:text=Nitrate%2Drich%20beetroot%20juice%20offsets,healthy%20male%20runners%20%7C%20PLOS%20ONE">oral acidity</a>, both of which can cause gum disease and tooth decay. As part of our research on nitrate and oral health, <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0243755#:%7E:text=Nitrate%2Drich%20beetroot%20juice%20offsets,healthy%20male%20runners%20%7C%20PLOS%20ONE">we studied competitive athletes</a>. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9839431/">Athletes are prone to gum disease</a> due to high intake of carbohydrates – which can cause inflammation of the gum tissues – stress, and dry mouth from breathing hard during training. Our study showed that beetroot juice (containing approximately 12 <a href="https://www.nursingtimes.net/students/an-easy-guide-to-mmols-09-02-2012/">millimole</a> of nitrate) protected their teeth from acidic sports drinks and carbohydrate gels during exercise – suggesting that nitrate could be used as a prebiotic by athletes to reduce the risk of tooth decay. Nitrate offers a lot of promise as an oral health <a href="https://www.nature.com/articles/s41598-020-69931-x">prebiotic</a>. Good oral hygiene and a nitrate rich diet could be the key to a healthier body, a vibrant smile and disease-free gums. This is good news for those most at risk of oral health deterioration such as <a href="https://www.news-medical.net/health/Periodontitis-and-Pregnancy.aspx">pregnant women</a>, and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8771712/">the elderly</a>. In the UK, antiseptic mouthwashes containing <a href="https://www.nature.com/articles/s41598-020-61912-4">chlorhexidine</a> are commonly used to treat dental plaque and gum disease. Unfortunately, these mouthwashes are a blunderbuss approach to oral health, as they indiscriminately remove both good and bad bacteria and increase oral acidity, which can cause disease. Worryingly, early research also indicates that chlorhexidine may contribute to <a href="https://pubmed.ncbi.nlm.nih.gov/30967854/">antimicrobial resistance</a>. Resistance occurs when bacteria and fungi survive the effects of one or more <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4768623/">antimicrobial drugs</a> due to repeated exposure to these treatments. Antimicrobial resistance is a <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02724-0/fulltext">global health concern</a>, predicted to cause 10 million deaths yearly by the year 2050. In contrast, dietary nitrate is more targeted. Nitrate eliminates disease-associated bacteria, reduces oral acidity and creates a balanced <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2944498/">oral microbiome</a>. The oral microbiome refers to all the microorganisms in the mouth. Nitrate offers exciting potential as an <a href="https://www.nature.com/articles/s41598-020-69931-x">oral health prebiotic</a>, which can be used to prevent disease onset or limit disease progression. <h2>How many leafy greens for pearly whites?</h2> So how much should we consume daily? As a rule of thumb, a generous helping of spinach, kale or beetroot at mealtimes contains about 6-10 mmol of nitrate and offers immediate health benefits. Work we have done with our collaborators has shown that treating <a href="https://www.nature.com/articles/s41598-020-69931-x">plaque samples</a> from periodontal disease patients with 6.5 mmol of nitrate increased healthy bacteria levels and reduced acidity. For example, consuming <a href="https://aap.onlinelibrary.wiley.com/doi/full/10.1002/JPER.20-0778">lettuce juice</a> for two weeks reduced gum inflammation and increased healthy bacteria levels in patients with gum disease. Growing evidence suggests that nitrate is a cornerstone of oral health. Crunching on a portion of vegetables at mealtimes can help to prevent or treat oral disease and keeps the mouth fresh and healthy.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/221181/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/mia-cousins-burleigh-1201153">Mia Cousins Burleigh</a>, Lecturer, School of Health and Life Sciences, <a href="https://theconversation.com/institutions/university-of-the-west-of-scotland-1385">University of the West of Scotland</a> and <a href="https://theconversation.com/profiles/siobhan-paula-moran-1506183">Siobhan Paula Moran</a>, PhD candidate, School of Health and Life Sciences, <a href="https://theconversation.com/institutions/university-of-the-west-of-scotland-1385">University of the West of Scotland</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/eating-leafy-greens-could-be-better-for-oral-health-than-using-mouthwash-221181">original article</a>.

Body

“So tacky”: Bride slammed for using GoFundMe to pay for wedding

A cash-strapped bride has been slammed for considering using GoFundMe to help pay for her wedding. Taking to a wedding page on Facebook, the bride explained that she and her partner had been saving as much money as possible for their wedding, but were struggling with their finances. “Our wedding is next year but I'm still so stressed that we won't be able to pay for the things that we need let alone actual decorations,” the bride began. Given the large expense of a wedding, the bride questioned if it was “tacky” to use GoFundMe, a crowd-funding website used for emergencies, to fund her big day. People were quick to chime in on the idea, with many people labelling it as “inappropriate” to use such a site for wedding expenses. The bride didn't share how much extra money she needs to fund the wedding, but many said she should continue to save rather than rely on others. “Have the wedding you can afford, or wait and save,” one said bluntly. “Personally I think it is [tacky]. If you want to have a wedding you should be funding it yourself. If you can't afford all the things you want, then I guess you have to decide if you would rather go without or postpone until it's in your budget,” another wrote. One woman said it's “insensitive” since GoFundMe pages are for emergencies only, such as medical situations. “If you can't afford to have the wedding you want you really have two choices - postpone until in a better position financially or scale back your plans to fit within your means,” she said. Image credits: Getty Images

Money & Banking

How dieting, weight suppression and even misuse of drugs like Ozempic can contribute to eating disorders

<a href="https://theconversation.com/profiles/samantha-withnell-1504436">Samantha Withnell</a>, <a href="https://theconversation.com/institutions/western-university-882">Western University</a> and <a href="https://theconversation.com/profiles/lindsay-bodell-1504260">Lindsay Bodell</a>, <a href="https://theconversation.com/institutions/western-university-882">Western University</a> Up to 72 per cent of women and 61 per cent of men are dissatisfied with their weight or <a href="https://doi.org/10.1016/j.eatbeh.2014.04.010">body image</a>, according to a U.S. study. Globally, millions of people <a href="https://doi.org/10.1111%2Fobr.12466">attempt to lose weight</a> every year with the hope that weight loss will have positive effects on their body image, health and quality of life. However, these motivated individuals often struggle to maintain new diets or exercise regimens. The rise of medications such as semaglutides, like <a href="https://dhpp.hpfb-dgpsa.ca/dhpp/resource/101298">Ozempic</a> or <a href="https://dhpp.hpfb-dgpsa.ca/dhpp/resource/101765">Wegovy</a>, <a href="https://www.cbc.ca/news/health/ozempic-weight-loss-1.6772021">might be viewed as an appealing “quick fix”</a> alternative to meet weight loss goals. Research led by our team and others suggests that such attempts to lose weight often do more harm than good, and even increase the risk of <a href="https://osf.io/9stq2">developing an eating disorder</a>. <h2>Weight loss and eating disorders</h2> Eating disorders are <a href="https://doi.org/10.1002/eat.20589">serious mental health conditions</a> primarily characterized by extreme patterns of under- or over-eating, concerns about one’s shape or body weight or other behaviours intended to influence body shape or weight such as exercising excessively or self-inducing vomiting. Although once thought to only affect young, white adolescent girls, eating disorders do not discriminate; eating disorders can develop in people of <a href="https://doi.org/10.1002/erv.2553">any age, sex, gender or racial/ethnic background</a>, with an estimated <a href="https://nedic.ca/general-information/">one million Canadians</a> suffering from an eating disorder at any given time. Feb. 1 to 7 is <a href="https://nedic.ca/edaw/">National Eating Disorders Awareness Week</a>. As a clinical psychologist and clinical psychology graduate student, our research has focused on how eating disorders develop and what keeps them going. Pertinent to society’s focus on weight-related goals, our research has examined associations between weight loss and eating disorder symptoms. <h2>Eating disorders and ‘weight suppression’</h2> In eating disorders research, the state of maintaining weight loss is referred to as “weight suppression.” Weight suppression is typically defined as the difference between a person’s current weight and their highest lifetime weight (excluding pregnancy). Despite the belief that weight loss will improve body satisfaction, we found that in a sample of over 600 men and women, weight loss had no impact on women’s negative body image and was associated with increased body dissatisfaction in <a href="https://doi.org/10.1016/j.bodyim.2023.01.011">men</a>. Importantly, being more weight suppressed has been associated with the <a href="https://doi.org/10.1093/ajcn/nqaa146">onset of eating disorders</a>, including anorexia nervosa and bulimia nervosa. <a href="https://doi.org/10.1007/s11920-018-0955-2">One proposed explanation</a> for the relationship between weight suppression and eating disorders is that maintaining weight loss becomes increasingly difficult as body systems that <a href="https://doi.org/10.3945/ajcn.110.010025">reduce metabolic rate and energy expenditure, and increase appetite</a>, are activated to promote weight gain. There is growing awareness that <a href="https://doi.org/10.1136/bmj.g2646">weight regain is highly likely following conventional diet programs</a>. This might lead people to engage in more and more extreme behaviours to control their weight, or they might shift between extreme restriction of food intake and episodes of overeating or binge eating, the characteristic symptoms of bulimia nervosa. <h2>Ozempic and other semaglutide drugs</h2> Semaglutide drugs like Ozempic and Wegovy are part of a class of drug called <a href="https://pdf.hres.ca/dpd_pm/00067924.PDF">glucagon-like peptide-1 agonists (GLP-1As)</a>. These drugs work by mimicking the hormone GLP-1 to interact with neural pathways that signal satiety (fullness) and slow stomach emptying, leading to reduced food intake. Although GLP-1As are indicated to treat Type 2 diabetes, <a href="https://www.cbc.ca/news/canada/london/ozempic-off-label-1.6884141">they are increasingly prescribed off-label</a> or being <a href="https://www.bbc.com/news/health-67414203">illegally purchased</a> without a prescription because of their observed effectiveness at inducing weight loss. Although medications like Ozempic do often lead to weight loss, the rate of weight loss may <a href="https://doi.org/10.1001/jama.2021.3224">slow down or stop over time</a>. Research by Lindsay Bodell, one of the authors of this story, and her colleagues on weight suppression may help explain why effects of semaglutides diminish over time, as <a href="https://doi.org/10.1016/j.physbeh.2019.112565">weight suppression is associated with reduced GLP-1 response</a>. This means those suppressing their weight could become less responsive to the satiety signals activated by GLP-1As. Additionally, weight loss effects are only seen for as long as the medication is taken, meaning those who take these drugs to achieve some weight loss goal are <a href="https://doi.org/10.1111/dom.14725">likely to regain most, if not all, weight lost</a> when they stop taking the medication. <h2>Risks of dieting and weight-loss drugs</h2> The growing market for off-label weight loss drugs is concerning, because of the exacerbation of <a href="https://theconversation.com/ozempic-the-miracle-drug-and-the-harmful-idea-of-a-future-without-fat-211661">weight stigma</a> and the serious <a href="https://doi.org/10.1016/j.jand.2022.01.004">health risks</a> associated with unsupervised weight loss, including developing eating disorders. Researchers and health professionals are already raising the alarm about the use of GLP-1As in children and adolescents, due to concerns about their possible <a href="https://doi.org/10.1017/cts.2023.612">impact on growth and development</a>. Moreover, popular weight-loss methods, whether they involve pills or “crash diets,” often mimic symptoms of eating disorders. For example, intermittent fasting diets that involve long periods of fasting followed by short periods of food consumption may mimic and <a href="https://doi.org/10.1016/j.eatbeh.2022.101681">increase the risk of developing binge eating problems</a>. The use of diet pills or laxatives to lose weight has been found to increase the risk of <a href="https://doi.org/10.2105/AJPH.2019.305390">being diagnosed with an eating disorder in the next one to three years</a>. Drugs like Ozempic may also be <a href="https://doi.org/10.1002/eat.24109">misused by individuals already struggling with an eating disorder</a> to suppress their appetite, compensate for binge eating episodes or manage fear of weight gain. Individuals who are already showing signs of an eating disorder, such as limiting their food intake and intense concerns about their weight, may be most at risk of spiralling from a weight loss diet or medication into an eating disorder, <a href="https://doi.org/10.1002/eat.24116">even if they only lose a moderate amount of weight</a>. People who are dissatisfied with their weight or have made multiple attempts to lose weight often feel pressured to try increasingly drastic methods. However, any diet, exercise program or weight-loss medication promising a quick fix for weight loss should be treated with extreme caution. At best, you may gain the weight back; at worst, you put yourself at risk for much more serious eating disorders and other health problems.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/221514/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/samantha-withnell-1504436">Samantha Withnell</a>, PhD Candidate, Clinical Psychology, <a href="https://theconversation.com/institutions/western-university-882">Western University</a> and <a href="https://theconversation.com/profiles/lindsay-bodell-1504260">Lindsay Bodell</a>, Assistant Professor of Psychology, <a href="https://theconversation.com/institutions/western-university-882">Western University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-dieting-weight-suppression-and-even-misuse-of-drugs-like-ozempic-can-contribute-to-eating-disorders-221514">original article</a>.

Body

Flight attendant reveals why you should never use the toilet paper on a plane

A flight attendant has revealed the gross reason why you should never use the toilet paper on a plane journey. The seasoned cabin crew member, an American woman named Cheryl, shared the three things she would never do on a plane after seeing what really goes on behind closed doors on an aircraft. Her first tip for any traveller was not to use the toilet paper in a plane bathroom. Sharing her tips in a TikTok video, she wrote, "If you examine the toilet paper, I promise you're going to see water droplets on it, or what you think are water droplets." "I don't think we can trust most men to make it in the toilet on a normal day, let alone flying at 36,000 feet with turbulence." To combat this, the flight attendant recommends bringing a travel pack of tissues in your hand luggage to use instead. She also warned her viewers against wearing shorts on their next flight. "I would never wear shorts on a plane. You're going to freeze to death," she said. Cheryl pointed out another valid reason to opt for long pants on a flight, stating, "Say we have an evacuation. You have to go down the slide. Your butt cheeks are going to be sizzled off.” Lastly, Cheryl urged travellers to never book less than a three-hour connection between flights. "Delays can happen for a million and one reasons. The likelihood that you're going to miss your connection is pretty high if you're booking shorter than three hours," she said. Image credits: TikTok

Travel Tips

What happens to your liver when you quit alcohol

<a href="https://theconversation.com/profiles/ashwin-dhanda-1359529">Ashwin Dhanda</a>, <a href="https://theconversation.com/institutions/university-of-plymouth-717">University of Plymouth</a> According to Greek mythology, Zeus punished Prometheus for giving fire to humans. He chained Prometheus up and set an eagle to feast on his liver. Each night, the liver grew back and each day, the eagle returned for his feast. In reality, can a liver really grow back? The liver is the largest internal organ in the human body. It is needed for hundreds of bodily processes, including breaking down toxins such as alcohol. As it is the first organ to “see” alcohol that has been drunk, it is not surprising that it is the most susceptible to alcohol’s effects. However, other organs, including the brain and heart, can also be damaged by long-term heavy alcohol use. As a liver specialist, I meet people with alcohol-related liver disease every day. It is a <a href="https://britishlivertrust.org.uk/information-and-support/liver-conditions/alcohol-related-liver-disease/">spectrum of disease</a> ranging from laying down of fat in the liver (fatty liver) to scar formation (cirrhosis) and it usually doesn’t cause any symptoms until the very late stages of damage. At first, alcohol makes the liver fatty. This fat causes the liver to become inflamed. In response, it tries to heal itself, producing scar tissue. If this carries on unchecked, the whole liver can become a mesh of scars with small islands of “good” liver in between – cirrhosis. In the late stages of cirrhosis, when the liver fails, people can turn yellow (jaundice), swell with fluid and become sleepy and confused. This is serious and can be fatal. Most people who regularly drink more than the recommended limit of 14 units of alcohol per week (about six pints of normal strength beer [4% ABV] or about six average [175ml] glasses of wine [14% ABV]) will have a fatty liver. Long-term and heavy alcohol use increases the risk of developing <a href="https://www.nhs.uk/conditions/alcohol-related-liver-disease-arld/">scarring and cirrhosis</a>. <h2>Good news</h2> Fortunately, there is good news. In people with fatty liver, after only two to three weeks of giving up alcohol, the liver can heal and looks and functions <a href="https://arcr.niaaa.nih.gov/volume/41/1/natural-recovery-liver-and-other-organs-after-chronic-alcohol-use">as good as new</a>. In people with liver inflammation or mild scarring, even within seven days of giving up alcohol, there are noticeable reductions in liver <a href="https://www.mdpi.com/2072-6643/13/5/1659">fat, inflammation and scarring</a>. Stopping alcohol use for several months lets the liver heal and return to normal. In heavy drinkers with more severe scarring or liver failure, giving up alcohol for several years reduces their chance of <a href="https://www.cghjournal.org/article/S1542-3565(22)01113-2/fulltext">worsening liver failure and death</a>. However, people who drink heavily can be physically dependent on alcohol and stopping suddenly can cause alcohol withdrawal. In its mild form, it causes shaking and sweating. But if severe, it can cause hallucinations, fits and even death. Going “cold turkey” is never recommended for heavy drinkers, who should seek medical advice about how to safely give up alcohol. <h2>Other benefits</h2> Giving up drinking also has positive effects on <a href="https://alcoholchange.org.uk/blog/benefits-of-dry-january-and-when-you-can-expect-to-see-them">sleep, brain function and blood pressure</a>. Avoiding alcohol for long periods also reduces the risk of several types of <a href="https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/alcohol-and-cancer">cancer</a> (including liver, pancreas and colon) and the risk of <a href="https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/effects-of-alcohol-on-your-heart">heart disease and stroke</a>. However, alcohol is not the only cause of ill health. Giving it up has many health benefits, but it is not a panacea. It should be seen as part of a healthy lifestyle, including a balanced diet and regular physical exercise. So, to answer the question posed by the myth of Prometheus, the liver has an amazing power to repair itself after it has been damaged. But it cannot grow back as new if it was already severely scarred. If you stop drinking and only have a fatty liver, it can quickly turn back to normal. If you had a scarred liver (cirrhosis) to start with, stopping alcohol will allow some healing and improved function but can’t undo all the damage that has already been done. If you want to look after your liver, drink in moderation and have two to three alcohol-free days each week. That way, you won’t have to rely on the liver’s magical self-healing power to stay healthy.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/220490/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/ashwin-dhanda-1359529">Ashwin Dhanda</a>, Associate Professor of Hepatology, <a href="https://theconversation.com/institutions/university-of-plymouth-717">University of Plymouth</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-happens-to-your-liver-when-you-quit-alcohol-220490">original article</a>.

Body

Thinking of using an activity tracker to achieve your exercise goals? Here’s where it can help – and where it probably won’t

<a href="https://theconversation.com/profiles/corneel-vandelanotte-209636">Corneel Vandelanotte</a>, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a> It’s that time of year when many people are getting started on their resolutions for the year ahead. Doing more physical activity is a popular and <a href="https://link.springer.com/article/10.1007/s13668-016-0175-5">worthwhile</a> goal. If you’re hoping to be more active in 2024, perhaps you’ve invested in an activity tracker, or you’re considering buying one. But what are the benefits of activity trackers? And will a basic tracker do the trick, or do you need a fancy one with lots of features? Let’s take a look. <h2>Why use an activity tracker?</h2> One of the <a href="https://doi.org/10.1186/s12966-020-01001-x">most powerful predictors</a> for being active is whether or not <a href="https://www.sciencedirect.com/science/article/abs/pii/S0140673621026301">you are monitoring</a> how active you are. Most people have a vague idea of how active they are, but this is inaccurate a lot of the time. Once people consciously start to keep track of how much activity they do, they often realise it’s less than what they thought, and this motivates them to be more active. You can self-monitor without an activity tracker (just by writing down what you do), but this method is hard to keep up in the long run and it’s also a lot less accurate compared to devices that track your every move 24/7. By tracking steps or “activity minutes” you can ascertain whether or not you are meeting the <a href="https://www.health.gov.au/topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians/for-adults-18-to-64-years">physical activity guidelines</a> (150 minutes of moderate to vigorous physical activity per week). It also allows you to track how you’re progressing with any personal activity goals, and view your progress over time. All this would be difficult without an activity tracker. Research has shown the most popular brands of activity trackers are generally reliable when it comes to tracking basic measures such as <a href="https://doi.org/10.2196/18694">steps</a> and <a href="https://doi.org/10.1123/jmpb.2019-0072">activity minutes</a>. <h2>But wait, there’s more</h2> Many activity trackers on the market nowadays track a range of other measures which their manufacturers promote as important in monitoring health and fitness. But is this really the case? Let’s look at some of these. Resting heart rate This is your heart rate at rest, which is normally somewhere <a href="https://www.healthdirect.gov.au/resting-heart-rate">between 60 and 100 beats per minute</a>. Your resting heart rate will gradually go down as you become fitter, especially if you’re doing a lot of high-intensity exercise. Your risk of dying of any cause (all-cause mortality) is much lower when you have a <a href="https://pubmed.ncbi.nlm.nih.gov/28552551/">low resting heart rate</a>. So, it is useful to keep an eye on your resting heart rate. Activity trackers are pretty good at tracking it, but you can also easily measure your heart rate by monitoring your pulse and using a stopwatch. Heart rate during exercise Activity trackers will also measure your heart rate when you’re active. To improve fitness efficiently, professional athletes focus on having their heart rate in certain “<a href="https://chhs.source.colostate.edu/how-to-target-heart-rate-training-zones-effectively/">zones</a>” when they’re exercising – so knowing their heart rate during exercise is important. But if you just want to be more active and healthier, without a specific training goal in mind, you can exercise at a level that feels good to you and not worry about your heart rate during activity. The <a href="https://doi.org/10.1097/HCO.0000000000000437">most important thing</a> is that you’re being active. Also, a dedicated heart rate monitor with a strap around your chest will do a much better job at measuring your actual heart rate <a href="https://doi.org/10.1038/s41746-020-0226-6">compared</a> to an activity tracker worn around your wrist. Maximal heart rate This is the hardest your heart could beat when you’re active, not something you could sustain very long. Your maximal heart rate is not influenced by how much exercise you do, or your fitness level. Most activity trackers <a href="https://jamanetwork.com/journals/jamacardiology/article-abstract/2566167">don’t measure it accurately</a> anyway, so you might as well forget about this one. VO₂max Your muscles need oxygen to work. The more oxygen your body can process, the harder you can work, and therefore the fitter you are. VO₂max is the volume (V) of oxygen (O₂) we could breathe maximally (max) over a one minute interval, expressed as millilitres of oxygen per kilogram of body weight per minute (ml/kg/min). Inactive women and men would have a VO₂max lower than 30 and 40 ml/kg/min, respectively. A reasonably good VO₂max would be mid thirties and higher for women and mid forties and higher for men. VO₂max is another measure of fitness that <a href="https://doi.org/10.1001/jamanetworkopen.2018.3605">correlates well</a> with all-cause mortality: the higher it is, the lower your risk of dying. For athletes, VO₂max is usually measured in a lab on a treadmill while wearing a mask that measures oxygen consumption. Activity trackers instead look at your running speed (using a GPS chip) and your heart rate and compare these measures to values from other people. If you can run fast with a low heart rate your tracker will assume you are relatively fit, resulting in a higher VO₂max. These estimates are <a href="https://doi.org/10.1007/s40279-021-01639-y">not very accurate</a> as they are based on lots of assumptions. However, the error of the measurement is reasonably consistent. This means if your VO₂max is gradually increasing, you are likely to be getting fitter. So what’s the take-home message? Focus on how many steps you take every day or the number of activity minutes you achieve. Even a basic activity tracker will measure these factors relatively accurately. There is no real need to track other measures and pay more for an activity tracker that records them, unless you are getting really serious about exercise.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/219235/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/corneel-vandelanotte-209636">Corneel Vandelanotte</a>, Professorial Research Fellow: Physical Activity and Health, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/thinking-of-using-an-activity-tracker-to-achieve-your-exercise-goals-heres-where-it-can-help-and-where-it-probably-wont-219235">original article</a>.

Body

Christmas drinks anyone? Why alcohol before bedtime leaves you awake at 3am, desperate for sleep

<a href="https://theconversation.com/profiles/madeline-sprajcer-1315489">Madeline Sprajcer</a>, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a>; <a href="https://theconversation.com/profiles/charlotte-gupta-347235">Charlotte Gupta</a>, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a>; <a href="https://theconversation.com/profiles/chris-irwin-249481">Chris Irwin</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a>; <a href="https://theconversation.com/profiles/grace-vincent-1484516">Grace Vincent</a>, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a>, and <a href="https://theconversation.com/profiles/saman-khalesi-366871">Saman Khalesi</a>, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a> You’ve come home after a long day at work, you have dinner, put the kids to bed, and then you have your usual nightcap before drifting off to sleep. Or, perhaps you’re at the pub for the work Christmas party, and you think you’ll just have one more drink before heading home. That last drink might help you fall asleep easily. But your nightcap can also wreck a good night’s sleep. How could it do both? Here’s what’s going on in your body when you drink alcohol just before bedtime. And if you want to drink at the Christmas party, we have some tips on how to protect your sleep. <h2>What happens to my body when I drink?</h2> Soon after you drink, alcohol enters your bloodstream and travels to your brain. <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1530-0277.1998.tb03695.x">There</a>, it affects chemical messengers known as neurotransmitters and <a href="https://pubmed.ncbi.nlm.nih.gov/2700603/">slows down communication</a> between nerve cells. Certain <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4040959/">regions of the brain</a> are particularly vulnerable to the effects of alcohol. When alcohol interacts with cells in these regions, the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826822/">overall effect</a> leads to those characteristic feelings of relaxation, lowered inhibitions, slurred speech, and may induce feelings of drowsiness and lethargy. Alcohol can also have immediate effects on the heart and circulatory system. Blood vessels widen, resulting in a <a href="https://link.springer.com/article/10.1007/s11906-021-01160-7">drop in blood pressure</a>, which can make you feel dizzy or lightheaded. <h2>What happens soon after a nightcap?</h2> Drinking alcohol before sleeping is like flipping a switch. At first, alcohol has a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826822/">sedative effect</a> and you will probably feel <a href="https://pubmed.ncbi.nlm.nih.gov/23347102/">more relaxed</a> and <a href="https://www.nature.com/articles/s41598-020-62227-0#:%7E:text=In%20this%20large%2C%20population%20based,sleep%20(cross%20sectional%20analyses).">drift off easily</a>. At this point, you still have a high level of alcohol in your blood. But don’t be fooled. As your body <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5821259/">processes the alcohol</a>, and the night goes on, alcohol actually <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/acer.12621">disrupts your sleep</a>. <h2>And later that night?</h2> As your body processes the alcohol and your blood alcohol level drops, your brain rebounds from the drowsiness you would have felt earlier in the night. This disturbs your sleep, and can wake you up <a href="https://journals.sagepub.com/doi/10.1300/J465v26n01_01">multiple times</a>, particularly in the second half of the night. You may also have vivid and stressful <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5821259/">dreams</a>. This sleep disruption is mainly to the deep, “rapid eye movement” or REM sleep. This type of sleep plays an important role in regulating your emotions and for your cognitive function. So not getting enough explains why you wake up feeling pretty lousy and groggy. Drinking alcohol before bedtime also tends to mean you <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775419/?source=post_page---------------------------">sleep less overall</a>, meaning important rest and recharge time is cut short. There are also <a href="https://pubmed.ncbi.nlm.nih.gov/31234199/">long-term impacts</a> of alcohol on sleep. Moderate and heavy drinkers consistently have <a href="https://academic.oup.com/sleepadvances/article/3/1/zpac023/6632721">poor sleep quality</a> and more <a href="https://www.nature.com/articles/s41598-020-62227-0#:%7E:text=In%20this%20large%2C%20population%20based,sleep%20(cross%20sectional%20analyses).">sleep disturbances</a> over time. <h2>How about the Christmas party then?</h2> If you plan to drink this holiday season, here are some tips to minimise the effect of alcohol on your sleep: <ul> <li> swap every other drink. Try swapping every second drink for a non-alcoholic drink. The more alcohol you drink, <a href="https://academic.oup.com/sleep/article/44/1/zsaa135/5871424?casa_token=okbJAuf8TXUAAAAA:ye_q-DACToxvj8H3IVaiKrjNkDhHZnl-LKJdds3iteaKyzJFuHUzitlRv45DqxNO-FraDRAlQMV53z8">the more</a> sleep disruption you can expect. Reducing how much you drink in any one sitting can minimise the effect on your sleep </li> <li> avoid drinking alcohol close to bedtime. If you give your body a chance to process the alcohol before you go to sleep, your sleep will be less disrupted </li> <li> eat while you drink. Drinking on an empty stomach is going to worsen the effects of alcohol as the alcohol will be absorbed <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1467-3010.2006.00588.x?casa_token=TQiCqcbasYAAAAAA:GbEvnTT82aB3_sPfmJLOQXIV3ivjnbZdIoP2_XZBa8IDZ0YLaPxNfE6DMHLgH7obnpA22VDsM4vyGZV4dQ">faster</a>. So try to eat something while you’re drinking </li> <li> ditch the espresso martinis and other caffeinated drinks. <a href="https://www.sciencedirect.com/science/article/pii/S1087079207000937?casa_token=NJsobF-C-vwAAAAA:opzPjrglPdZTwXEo7rHil5vm0a1K3KmXw9vp0Het-eRHZEWbfRAA40vgicU3Z5kC8x7uEJF39C8">Caffeine</a> can make it hard to get to sleep, and hard to stay asleep </li> <li> be careful if you have sleep apnoea. People who have sleep apnoea (when their upper airway is repeatedly blocked during sleep) can be even more impacted by drinking alcohol. That’s because alcohol can act as a muscle relaxant, <a href="https://academic.oup.com/sleep/article/5/4/318/2753287">leading to</a> more snoring, and lower oxygen levels in the blood. If you have sleep apnoea, limiting how much alcohol you drink is the best way to avoid these effects </li> <li> drink plenty of water. Staying hydrated will help you <a href="https://academic.oup.com/sleep/article/42/2/zsy210/5155420">sleep better</a> and will hopefully stave off the worst of tomorrow’s hangover.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/216834/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> </li> </ul> <a href="https://theconversation.com/profiles/madeline-sprajcer-1315489">Madeline Sprajcer</a>, Lecturer in Psychology, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a>; <a href="https://theconversation.com/profiles/charlotte-gupta-347235">Charlotte Gupta</a>, Postdoctoral research fellow, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a>; <a href="https://theconversation.com/profiles/chris-irwin-249481">Chris Irwin</a>, Senior Lecturer in Nutrition and Dietetics, School of Health Sciences & Social Work, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a>; <a href="https://theconversation.com/profiles/grace-vincent-1484516">Grace Vincent</a>, Senior Lecturer, Appleton Institute, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a>, and <a href="https://theconversation.com/profiles/saman-khalesi-366871">Saman Khalesi</a>, Senior Lecturer and Discipline Lead in Nutrition, School of Health, Medical and Applied Sciences, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/christmas-drinks-anyone-why-alcohol-before-bedtime-leaves-you-awake-at-3am-desperate-for-sleep-216834">original article</a>.

Body

Do you really need antibiotics? Curbing our use helps fight drug-resistant bacteria

<a href="https://theconversation.com/profiles/minyon-avent-1486987">Minyon Avent</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a>; <a href="https://theconversation.com/profiles/fiona-doukas-1157050">Fiona Doukas</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/kristin-xenos-1491653">Kristin Xenos</a>, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Antibiotic resistance occurs when a microorganism changes and no longer responds to an antibiotic that was previously effective. It’s <a href="https://thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00502-2/fulltext">associated with</a> poorer outcomes, a greater chance of death and higher health-care costs. In Australia, antibiotic resistance means some patients are admitted to hospital because oral antibiotics are <a href="https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance">no longer effective</a> and they need to receive intravenous therapy via a drip. Antibiotic resistance is rising to high levels in certain parts of the world. Some hospitals <a href="https://www.reactgroup.org/news-and-views/news-and-opinions/year-2022/the-impact-of-antibiotic-resistance-on-cancer-treatment-especially-in-low-and-middle-income-countries-and-the-way-forward/">have to consider</a> whether it’s even viable to treat cancers or perform surgery due to the risk of antibiotic-resistant infections. Australia is <a href="https://www.safetyandquality.gov.au/our-work/antimicrobial-resistance/antimicrobial-use-and-resistance-australia-aura/aura-2023-fifth-australian-report-antimicrobial-use-and-resistance-human-health">one of the highest users</a> of antibiotics in the developed world. We need to use this precious resource wisely, or we risk a future where a simple infection could kill you because there isn’t an effective antibiotic. <h2>When should antibiotics not be used?</h2> Antibiotics only work for some infections. They work against bacteria but <a href="https://www.safetyandquality.gov.au/publications-and-resources/resource-library/do-i-really-need-antibiotics">don’t treat</a> infections caused by viruses. Most community acquired infections, even those caused by bacteria, are likely to get better without antibiotics. Taking an antibiotic when you don’t need it won’t make you feel better or recover sooner. But it can increase your chance of side effects like nausea and diarrhoea. Some people think green mucus (or snot) is a sign of bacterial infection, requiring antibiotics. But it’s actually <a href="https://www.safetyandquality.gov.au/sites/default/files/2023-11/aura_2023_do_i_really_need_antibiotics.pdf">a sign</a> your immune system is working to fight your infection. <h2>If you wait, you’ll often get better</h2> <a href="https://www.tg.org.au/">Clinical practice guidelines</a> for antibiotic use aim to ensure patients receive antibiotics when appropriate. Yet 40% of GPs say they prescribe antibiotics <a href="https://doi.org/10.1071/HI13019">to meet patient expectations</a>. And <a href="https://pubmed.ncbi.nlm.nih.gov/35973750/">one in five</a> patients expect antibiotics for respiratory infections. It can be difficult for doctors to decide if a patient has a viral respiratory infection or are at an early stage of serious bacterial infection, particularly in children. One option is to “watch and wait” and ask patients to return if there is clinical deterioration. An alternative is to prescribe an antibiotic but advise the patient to not have it dispensed unless specific symptoms occur. This can <a href="https://doi.org/10.1002/14651858.CD004417.pub5">reduce antibiotic use by 50%</a> with no decrease in patient satisfaction, and no increase in complication rates. <h2>Sometimes antibiotics are life-savers</h2> For some people – particularly those with a weakened immune system – a simple infection can become more serious. Patients with life-threatening suspected infections should receive an appropriate antibiotic <a href="https://www.safetyandquality.gov.au/our-work/clinical-care-standards/antimicrobial-stewardship-clinical-care-standard">immediately</a>. This includes serious infections such as <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/bacterial-meningitis#:%7E:text=What%20is%20bacterial%20meningitis%3F,can%20cause%20life%2Dthreatening%20problems.">bacterial meningitis</a> (infection of the membranes surrounding the brain) and <a href="https://clinicalexcellence.qld.gov.au/priority-areas/safety-and-quality/sepsis/adult-sepsis#:%7E:text=Adult%20patients%20with%20sepsis%20also,adult%20emergency%20department%20sepsis%20pathway.">sepsis</a> (which can lead to organ failure and even death). <h2>When else might antibiotics be used?</h2> Antibiotics are sometimes used to prevent infections in patients who are undergoing surgery and are at significant risk of infection, such as those undergoing bowel resection. These patients will <a href="https://www.tg.org.au">generally receive</a> a single dose before the procedure. Antibiotics may also <a href="https://www.tg.org.au">be given</a> to patients undergoing chemotherapy for solid organ cancers (of the breast or prostate, for example), if they are at high risk of infection. While most sore throats are caused by a virus and usually resolve on their own, some high risk patients with a bacterial strep A infection which can cause “scarlet fever” are given antibiotics to prevent a more serious infection like <a href="https://www.rhdaustralia.org.au/">acute rheumatic fever</a>. <h2>How long is a course of antibiotics?</h2> The recommended duration of a course of antibiotics depends on the type of infection, the likely cause, where it is in your body and how effective the antibiotics are at killing the bacteria. In the past, courses were largely arbitrary and based on assumptions that antibiotics should be taken for long enough to eliminate the infecting bacteria. More recent research does not support this and shorter courses are <a href="https://www.acpjournals.org/doi/full/10.7326/M19-1509">nearly always as effective as longer ones</a>, particularly for community acquired respiratory infections. For <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736742/">community acquired pneumonia</a>, for example, research shows a three- to five-day course of antibiotics is at least as effective as a seven- to 14-day course. The “take until all finished” approach is no longer recommended, as the longer the antibiotic exposure, the greater the chance the bacteria will develop resistance. However, for infections where it is more difficult to eradicate the bacteria, such as tuberculosis and bone infections, a combination of antibiotics for many months is usually required. <h2>What if your infection is drug-resistant?</h2> You may have an antibiotic-resistant infection if you don’t get better after treatment with standard antibiotics. Your clinician will collect samples for lab testing if they suspect you have antibiotic-resistant infection, based on your travel history (especially if you’ve been hospitalised in a country with high rates of antibiotic resistance) and if you’ve had a recent course of antibiotics that hasn’t cleared your infection. Antibiotic-resistant infections are managed by prescribing broad-spectrum antibiotics. These are like a sledgehammer, wiping out many different species of bacteria. (Narrow-spectrum antibiotics conversely can be thought of as a scalpel, more targeted and only affecting one or two kinds of bacteria.) Broad-spectrum antibiotics are usually more expensive and come with more severe side effects. <h2>What can patients do?</h2> Decisions about antibiotic prescriptions should be made using <a href="https://www.safetyandquality.gov.au/our-work/partnering-consumers/shared-decision-making/decision-support-tools-specific-conditions">shared decision aids</a>, where patients and prescribers discuss the risks and benefits of antibiotics for conditions like a sore throat, middle ear infection or acute bronchitis. Consider asking your doctor questions such as: <ul> <li>do we need to test the cause of my infection?</li> <li>how long should my recovery take?</li> <li>what are the risks and benefits of me taking antibiotics?</li> <li>will the antibiotic affect my regular medicines?</li> <li>how should I take the antibiotic (how often, for how long)?</li> </ul> Other ways to fight antibiotic resistance include: <ul> <li>returning leftover antibiotics to a pharmacy for safe disposal</li> <li>never consuming leftover antibiotics or giving them to anyone else</li> <li>not keeping prescription repeats for antibiotics “in case” you become sick again</li> <li>asking your doctor or pharmacist what you can do to feel better and ease your symptoms rather than asking for antibiotics.</li> </ul> <a href="https://theconversation.com/profiles/minyon-avent-1486987">Minyon Avent</a>, Antimicrobial Stewardship Pharmacist, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a>; <a href="https://theconversation.com/profiles/fiona-doukas-1157050">Fiona Doukas</a>, PhD candidate, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/kristin-xenos-1491653">Kristin Xenos</a>, Research Assistant, College of Health, Medicine and Wellbeing, School of Biomedical Science and Pharmacy, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/do-you-really-need-antibiotics-curbing-our-use-helps-fight-drug-resistant-bacteria-217920">original article</a>.

Body

Drinking alcohol this Christmas and New Year? These medicines really don’t mix

<a href="https://theconversation.com/profiles/nial-wheate-96839">Nial Wheate</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/jessica-pace-1401278">Jessica Pace</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> A glass or two of champagne with Christmas lunch. A cool crisp beer at the beach. Some cheeky cocktails with friends to see in the New Year. There seem to be so many occasions to unwind with an alcoholic drink this summer. But if you’re taking certain medications while drinking alcohol, this can affect your body in a number of ways. Drinking alcohol with some medicines means they may not work so well. With others, you risk a life-threatening overdose. Here’s what you need to know if you’re taking medication over summer and plan to drink. <h2>Why is this a big deal?</h2> After you take a medicine, it travels to the stomach. From there, your body shuttles it to the liver where the drug is metabolised and broken down before it goes into your blood stream. Every medicine you take is provided at a dose that takes into account the amount of metabolism that occurs in the liver. When you drink alcohol, this is also broken down in the liver, and it can affect how much of the drug is metabolised. Some medicines are metabolised more, which can mean not enough reaches your blood stream to be effective. Some medicines are metabolised less. This means you get a much higher dose than intended, which could lead to an overdose. The effects of alcohol (such as sleepiness) can act in addition to similar effects of a medicine. Whether or not you will have an interaction, and what interaction you have, depends on many factors. These include the medicine you are taking, the dose, how much alcohol you drink, your age, genes, sex and overall health. Women, older people and people with liver issues are more likely to have a drug interaction with alcohol. <h2>Which medicines don’t mix well with alcohol?</h2> Many medicines interact with alcohol regardless of whether they are prescribed by your doctor or bought over the counter, such as <a href="https://www.drugs.com/article/herbal-supplements-alcohol.html">herbal medicines</a>. 1. Medicines + alcohol = drowsiness, coma, death Drinking alcohol and taking a medicine that depresses the <a href="https://adf.org.au/drug-facts/depressants/">central nervous system</a> to reduce arousal and stimulation can have additive effects. Together, these can make you extra drowsy, slow your breathing and heart rate and, in extreme cases, lead to coma and death. These effects are more likely if you use more than one of this type of medicine. Medicines to look out for include those for depression, anxiety, schizophrenia, pain (except <a href="https://www.nps.org.au/australian-prescriber/articles/alcohol-and-paracetamol">paracetamol</a>), sleep disturbances (such as insomnia), allergies, and colds and flu. It’s best not to drink alcohol with these medicines, or to keep your alcohol intake to a minimum. 2. Medicines + alcohol = more effects Mixing alcohol with some medicines increases the effect of those medicines. One example is with the sleeping tablet zolpidem, which is <a href="https://www.tga.gov.au/news/product-recalls/zolpidem-stilnox">not to be taken with alcohol</a>. Rare, but serious, side effects are strange behaviour while asleep, such as sleep-eating, sleep-driving or sleep-walking, which are more likely with alcohol. 3. Medicines + craft beer or home brew = high blood pressure Some types of medicines only interact with some types of alcohol. Examples include some medicines for depression, such as phenelzine, tranylcypromine and moclobemide, the antibiotic linezolid, the Parkinson’s drug selegiline, and the cancer drug procarbazine. These so-called <a href="https://www.mydr.com.au/medicine/monoamine-oxidase-inhibitors-maois-for-depression/">monoamine oxidase inhibitors</a> <a href="https://www.health.qld.gov.au/__data/assets/pdf_file/0020/145802/oncol_maoi.pdf">only interact with</a> some types of boutique and artisan beers, beers with visible sediment, Belgian, Korean, European and African beers, and home-made beers and wine. These types of alcohol contain high levels of tyramine, a naturally occurring substance usually broken down by your body that doesn’t ordinarily cause any harm. However, monoamine oxidase inhibitors prevent your body from breaking down tyramine. This increases levels in your body and can cause your blood pressure to rise to dangerous levels. 4. Medicines + alcohol = effects even after you stop drinking Other medicines interact because they affect the way your body breaks down alcohol. If you drink alcohol while using such medicines you may you feel nauseous, vomit, become flushed in the face and neck, feel breathless or dizzy, your heart may beat faster than usual, or your blood pressure may drop. This can occur even after you stop treatment, then drink alcohol. For example, if you are taking metronidazole you should avoid alcohol both while using the medicine and for at least 24 hours after you stop taking it. An example of where alcohol changes the amount of the medicine or related substances in the body is acitretin. This medication is used to treat skin conditions such as severe psoriasis and to prevent skin cancer in people who have had an organ transplant. When you take acitretin, it changes into another substance – <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2017-CMI-02034-1&d=20221221172310101">etretinate</a> – before it is removed from your body. Alcohol increases the amount of etretinate in your body. This is especially important as etretinate can cause birth defects. To prevent this, if you are a woman of child-bearing age you should avoid alcohol while using the medicine and for two months after you stop taking it. <h2>Myths about alcohol and medicines</h2> Alcohol and birth control One of the most common myths about medicines and alcohol is that you can’t drink while using <a href="https://youly.com.au/blog/sexual-reproductive-health/does-alcohol-make-the-pill-less-effective/">the contraceptive pill</a>. It is generally safe to use alcohol with the pill as it <a href="https://www.healthline.com/health/womens-health/birth-control-and-alcohol#:%7E:text=There's%20a%20bit%20of%20good,a%20less%20effective%20birth%20control.">doesn’t directly affect</a> how well birth control works. But the pill is most effective when taken at the same time each day. If you’re drinking heavily, you’re more likely to forget to do this the next day. Alcohol can also make some people nauseous and vomit. If you vomit within three hours of taking the pill, it will not work. This increases your risk of pregnancy. Contraceptive pills can also affect your response to alcohol as the hormones they contain can change the way your body <a href="https://americanaddictioncenters.org/alcoholism-treatment/birth-control">removes alcohol</a>. This means you can get drunk faster, and stay drunk for longer, than you normally would. Alcohol and antibiotics Then there’s the myth about not mixing alcohol with any <a href="https://theconversation.com/mondays-medical-myth-you-cant-mix-antibiotics-with-alcohol-4407">antibiotics</a>. This only applies to <a href="https://www.healthdirect.gov.au/medicines/medicinal-product/aht,21161/metronidazole">metronidazole</a> and <a href="https://www.healthdirect.gov.au/medicines/brand/amt,1011571000168100/linezolid-apo">linezolid</a>. Otherwise, it is generally safe to use alcohol with antibiotics, as alcohol does not affect how well they work. But if you can, it is best to avoid alcohol while taking antibiotics. Antibiotics and alcohol have similar side effects, such as an upset stomach, dizziness and drowsiness. Using the two together means you are more likely to have these side effects. Alcohol can also reduce your energy and increase how long it takes for you to recover. <h2>Where can I go for advice?</h2> If you plan on drinking alcohol these holidays and are concerned about any interaction with your medicines, don’t just stop taking your medicines. Your pharmacist can advise you on whether it is safe for you to drink based on the medicines you are taking, and if not, provide advice on alternatives.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/196646/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/nial-wheate-96839">Nial Wheate</a>, Associate Professor of the Sydney Pharmacy School, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/jessica-pace-1401278">Jessica Pace</a>, Associate Lecturer, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/drinking-alcohol-this-christmas-and-new-year-these-medicines-really-dont-mix-196646">original article</a>.

Caring

Should we still be using RATs to test for COVID? 4 key questions answered

<a href="https://theconversation.com/profiles/hassan-vally-202904">Hassan Vally</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> We’re currently navigating <a href="https://www.thenewdaily.com.au/life/health/2023/11/15/covid-australia-eighth-wave">an eighth wave</a> of <a href="https://theconversation.com/were-in-a-new-covid-wave-what-can-we-expect-this-time-216820">COVID infections</a> in Australia. However the threat COVID poses to us is significantly less than it has ever been, thanks to immunity we’ve acquired through <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00801-5/fulltext">a combination</a> of prior infection and vaccination. That said, COVID is by no means behind us. The threat of severe illness remains higher for many people, and we’re all potentially at risk of developing <a href="https://www.health.gov.au/topics/covid-19/long-covid">long COVID</a>. While many people appear to be doing fewer rapid antigen tests (RATs) than they used to – if any at all – with rising cases, and as we head towards the festive season, testing continues to be important. So what do you need to know about testing in this wave? Here are four key questions answered. <h2>1. When should I do a RAT?</h2> There are a few situations where determining your COVID status is important to inform your actions, particularly during an uptick in infections. With more circulating virus, your index of suspicion that you have COVID if you’re experiencing cold-like symptoms should be higher. RATs work best when they’re used to confirm whether you have COVID when you <a href="https://www.tga.gov.au/products/covid-19/covid-19-tests/how-testing-works-covid-19">have respiratory symptoms</a> and are infectious. So the primary use of RATs should be to determine your COVID status when you’re sick. A positive test should prompt you to isolate, and if you’re eligible, to seek antivirals. Testing might also be worthwhile if you’ve come into contact with someone with COVID but you haven’t developed symptoms. If you find you have in fact contracted the virus, you can take steps to avoid spreading it to other people (you can infect others even <a href="https://www.healthline.com/health/what-is-asymptomatic-covid#prevalence">when you’re asymptomatic</a>). This is especially important if you’re going to be socialising in large groups or in contact with people who are vulnerable. Another situation in which to consider testing, particularly at this time of year, is before attending large social gatherings. While the reliability of a RAT is never perfect, do the test as close to the event as possible, because your disease status <a href="https://www.businessinsider.com/omicron-rapid-test-hour-before-party-not-day-before-expert-2021-12">can change quickly</a>. <h2>2. Should I test multiple times?</h2> Yes. RATs are not as sensitive as PCR tests, which is the trade-off we make for being able to do this test at home and <a href="https://www.wsj.com/articles/public-health-officials-pursue-covid-19-tests-that-trade-precision-for-speed-11599562800">getting a rapid result</a>. This means that while if you test positive with a RAT you can be very confident you have COVID, if you test negative, you cannot be as confident that you don’t have COVID. That is, the test may give you a false negative result. Although RATs from different manufacturers have different accuracies, all RATs approved by Australia’s Therapeutic Goods Administration must have a sensitivity of <a href="https://www.tga.gov.au/products/covid-19/covid-19-tests/covid-19-rapid-antigen-self-tests-home-use/covid-19-rapid-antigen-self-tests-are-approved-australia#:%7E:text=For%20rapid%20antigen%20tests%2C%20this,specificity%20of%20at%20least%2098%25.">at least 80%</a>. The way to increase your confidence in a negative result is to do multiple RATs serially – each negative test increases the confidence you can have that you don’t have COVID. If you have symptoms and have tested negative after your first RAT, <a href="https://www.fda.gov/medical-devices/safety-communications/home-covid-19-antigen-tests-take-steps-reduce-your-risk-false-negative-results-fda-safety">the advice</a> is to repeat the test after 48 hours, and potentially a third time after another 48 hours if the second test is also negative. <h2>3. Do RATs detect the latest variants?</h2> Since RATs <a href="https://www.healthdirect.gov.au/covid-19/testing#:%7E:text=Rapid%20antigen%20tests%2C%20or%20RATs,of%20proteins%20of%20the%20virus.">detect particular surface proteins</a> on SARS-CoV-2 (the virus that causes COVID), it’s theoretically possible that as the virus evolves, the reliability of these tests may be affected. However, RATs were designed to detect a part of the virus that is not as likely to mutate, so the hope is these tests <a href="https://www.health.com/do-covid-tests-work-new-variants-7967102">will continue to hold up</a> as SARS-CoV-2 evolves. The performance of RATs is continually being assessed by manufacturers. So far, there’s been no change reported in the ability of these tests to <a href="https://www.ama.com.au/articles/tga-updated-advice-rats-nearing-expiry-and-rats-efficacy-current-strains#:%7E:text=The%20TGA%20has%20received%20evidence,19%20RAT%20post%2Dmarket%20review.">detect the latest variants</a>. <h2>4. Can I rely on expired RATs?</h2> At this point in the pandemic, you might have a few expired tests at the back of your cupboard. Technically the most appropriate advice is to say you should never use a diagnostic test <a href="https://www.tga.gov.au/products/covid-19/covid-19-tests/covid-19-rapid-antigen-self-tests-home-use/covid-19-rapid-antigen-self-tests-are-approved-australia">past its expiry date</a>. As a general principle the performance of a test cannot be guaranteed beyond this date. The risk is that over time the components of the RAT degrade and if you use a test that’s not working optimally, it’s more likely to indicate <a href="https://www.health.com/can-you-use-expired-covid-test-6827970">you don’t have COVID</a> when you actually do, which may have consequences. However, as for all things COVID, the answer is not so black and white. Since these tests were new when they were introduced earlier in the pandemic, manufacturers didn’t have specific data on their performance over time, and so the expiry dates given were necessarily conservative. It’s likely these tests will work beyond the expiry dates on the packet, but just how long and how well they work is a bit of an unknown, so we need to be cautious. The other thing to consider is ensuring you store RATs correctly. Storage instructions should be found on the packet, but the key issue is making sure they’re not exposed to extreme temperatures. In particular, <a href="https://7news.com.au/lifestyle/health-wellbeing/how-to-properly-store-your-at-home-covid-19-rapid-antigen-tests-c-5465412">high temperatures</a> may damage the chemicals in the test which may reduce its sensitivity. <h2>The path from here</h2> Regular upticks in COVID cases are something we’re going to have to get used to. At these times, we should all be a bit more cautious about looking after ourselves and others as we go about our lives. What this looks like will vary for different people depending on their personal circumstances. However, being up to date with <a href="https://theconversation.com/what-are-the-new-covid-booster-vaccines-can-i-get-one-do-they-work-are-they-safe-217804">booster vaccinations</a>, having a plan for <a href="https://www.health.gov.au/topics/covid-19/oral-treatments">accessing antivirals</a> if you’re eligible, <a href="https://theconversation.com/with-covid-surging-should-i-wear-a-mask-217902">wearing masks</a> in high-risk settings and testing all continue to play an important role in responding to COVID.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/218016/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/hassan-vally-202904">Hassan Vally</a>, Associate Professor, Epidemiology, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/should-we-still-be-using-rats-to-test-for-covid-4-key-questions-answered-218016">original article</a>.

Body

5 reasons why climate change may see more of us turn to alcohol and other drugs

<a href="https://theconversation.com/profiles/helen-louise-berry-8608">Helen Louise Berry</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> and <a href="https://theconversation.com/profiles/francis-vergunst-230743">Francis Vergunst</a>, <a href="https://theconversation.com/institutions/university-of-oslo-934">University of Oslo</a> Climate change will affect every aspect of our <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01859-7/fulltext">health and wellbeing</a>. But its potential harms go beyond the body’s ability to handle extreme heat, important as this is. Extreme weather events, such as floods, droughts, storms and wildfires, are becoming more frequent and severe. These affect our <a href="https://pubmed.ncbi.nlm.nih.gov/36165756/">mental health</a> in a multitude of <a href="https://www.nature.com/articles/s41558-018-0102-4">ways</a>. Coping with climate change can be overwhelming. Sometimes, the best someone can do is to seek refuge in alcohol, tobacco, over-the-counter and prescription drugs, or other psychoactive substances. This is understandable, but dangerous, and can have serious consequences. We outline <a href="https://journals.sagepub.com/doi/full/10.1177/17456916221132739">five ways</a> climate change could increase the risk of harmful substance use. <h2>1. Mental health is harmed</h2> Perhaps the most obvious way climate change can be linked to harmful substance use is by damaging mental health. This <a href="https://onlinelibrary.wiley.com/doi/10.1111/dar.12448">increases the risk</a> of new or worsened substance use. People with a mental disorder are <a href="https://www.hindawi.com/journals/psychiatry/2018/5697103/">at high risk</a> of also having a <a href="https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-11-25#:%7E:text=Prevalence%20of%20comorbidity%20in%20epidemiological%20studies&text=Among%20subjects%20with%20an%20alcohol,a%20comorbid%20SUD%20%5B39%5D.">substance-use disorder</a>. This often precedes their mental health problems. Climate change-related increases in the number and nature of extreme events, in turn, are escalating risks to mental health. For example, extreme heat is linked to increased <a href="https://pubmed.ncbi.nlm.nih.gov/27727320/">distress</a> across the whole population. In extreme heat, more people go to the <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2789481">emergency department</a> for psychiatric problems, including for <a href="https://www.sciencedirect.com/science/article/abs/pii/S0048969720338249">alcohol</a> and <a href="https://www.nature.com/articles/s43856-023-00346-1">substance use</a> generally. This is even true for <a href="https://www.sciencedirect.com/science/article/pii/S0048969720325572">a single very hot day</a>. Post-traumatic stress disorder, depression, anxiety and <a href="https://onlinelibrary.wiley.com/doi/abs/10.5694/mja13.10307">other mental health</a> problems are <a href="https://www.frontiersin.org/articles/10.3389/fpubh.2019.00367/full">common</a> at the time of extreme weather events and can persist for months, even years afterwards, especially if people are exposed to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9116266/">multiple events</a>. This can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6101235/">increase</a> the likelihood of using substances as a way to cope. <h2>2. Worry increases</h2> With <a href="https://climatecommunication.yale.edu/publications/climate-change-in-the-american-mind-beliefs-attitudes-december-2022/">increasing public awareness</a> of how climate change is endangering wellbeing, people are <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/articles/worriesaboutclimatechangegreatbritain/septembertooctober2022#:%7E:text=The%20level%20of%20worry%20about,lives%20right%20now%20(29%25).">increasingly worried</a> about what will happen if it remains unchecked. Worrying isn’t the same as meeting the criteria for a mental disorder. But <a href="https://www.undp.org/publications/peoples-climate-vote">surveys</a> show climate change generates complex emotional responses, <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(21)00278-3/fulltext">especially in children</a>. As well as feelings of worry, there is anxiety, fear, guilt, anger, grief and helplessness. Some <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2904966/">emotional states</a>, such as <a href="https://www.pnas.org/doi/full/10.1073/pnas.1909888116">sadness</a>, are linked with long-term tobacco use and also make substance use <a href="https://pubmed.ncbi.nlm.nih.gov/16011392/">relapse</a> more likely. <h2>3. Physical injuries hurt us in many ways</h2> Physical injuries caused by extreme weather events – such as smoke inhalation, burns and flood-related cuts and infections – increase the risk of harmful substance use. That’s partly because they <a href="https://pubmed.ncbi.nlm.nih.gov/20033251/">increase</a> the risk of psychological distress. If injuries cause long-term illness or disability, consequent feelings of hopelessness and depression can dispose some people to self-medicate with alcohol or other drugs. Substance use itself can also generate long-term physiological harm, disabilities or other chronic health problems. These are <a href="https://www.tandfonline.com/doi/abs/10.3109/00952999609001655">linked with</a> higher rates of harmful substance use. <h2>4. Our day-to-day lives change</h2> A single catastrophic event, such as a storm or flood, can devastate lives overnight and change the way we live. So, too, can the more subtle changes in climate and day-to-day weather. Both can disrupt behaviour and routines in ways that risk new or worsened substance use, for example, using stimulants to cope with fatigue. Take, for example, hotter temperatures, which disrupt <a href="https://www.cell.com/one-earth/fulltext/S2590-3322(22)00209-3?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS2590332222002093%3Fshowall%3Dtrue">sleep</a>, undermine <a href="https://jhr.uwpress.org/content/57/2/400">academic performance</a>, <a href="https://www.nature.com/articles/s41562-017-0097">reduce physical activity</a>, and promote <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(22)00173-5/fulltext">hostile language</a> and <a href="https://www.cambridge.org/core/elements/abs/climate-change-and-human-behavior/F64471FA47B8A6F5524E7DDDDE571D57">violent behaviour</a>. <h2>5. It destabilises communities</h2> Finally, climate change is destabilising the socioeconomic, natural, built and geopolitical <a href="https://www.nature.com/articles/s41558-018-0102-4">systems</a> on which human wellbeing – <a href="https://theconversation.com/climate-change-and-health-ipcc-reports-emerging-risks-emerging-consensus-24213">indeed survival</a> – depends. Damaged infrastructure, agricultural losses, school closures, homelessness and displacement are significant <a href="https://www.nature.com/articles/s41558-018-0102-4">sources of psychosocial distress</a> that prompt acute (short-term) and chronic (long-term) stress responses. <a href="https://doi.org/10.1196/annals.1441.030">Stress</a>, in turn, can <a href="https://doi.org/10.1007/s002130100917">increase</a> the risk of <a href="https://link.springer.com/article/10.1007/s002130100917">harmful substance use</a> and make people more likely to relapse. <h2>Why are we so concerned?</h2> Substance-use disorders are economically and socially <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30337-7/fulltext">very costly</a>. Risky substance use that doesn’t meet the criteria for a formal diagnosis <a href="https://digitalcommons.fiu.edu/srhreports/health/health/32/">can also harm</a>. Aside from its direct physical harm, harmful substance use disrupts <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3843305/">education</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3234116/">employment</a>. It increases the risk of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676144/">accidents</a> and <a href="https://www.tandfonline.com/doi/abs/10.1080/09595230600944479">crime</a>, and it undermines social relationships, intimate <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4795906/#:%7E:text=Results%20indicated%20that%20alcohol%20use,drinkers%20with%20low%20relationship%20satisfaction.">partnerships</a> and <a href="https://www.cambridge.org/core/journals/development-and-psychopathology/article/abs/longitudinal-relations-between-parental-drinking-problems-family-functioning-and-child-adjustment/CE508589A9E799FD6DC9E23DF364FB8F">family functioning</a>. <h2>Politicians take note</h2> As we head towards the <a href="https://www.cop28.com">COP28 global climate talks</a> in Dubai, climate change is set to hit the headlines once more. Politicians know climate change is undermining human health and wellbeing. It’s well past time to insist they act. As we have seen for populations as a whole, there are multiple possible ways for climate change to cause a rise in harmful substance use. This means multidimensional <a href="https://www.nature.com/articles/s41558-018-0102-4">prevention strategies</a> are needed. As well as addressing climate change more broadly, we need strategies including: <ul> <li> supporting vulnerable individuals, especially <a href="https://journals.sagepub.com/doi/full/10.1177/21677026211040787">young people</a>, and marginalised commmunities, who are <a href="https://www.nature.com/articles/s41558-018-0102-4">hit hardest</a> by extreme weather-related events </li> <li> focusing health-related policies more on broadscale health promotion, for example, healthier eating, active transport and community-led mental health support </li> <li> investing in climate-resilient infrastructure, such as heat-proofing buildings and greening cities, to prevent more of the destabilising effects and stress we know contributes to mental health problems and harmful substance use. </li> </ul> There is now <a href="https://news.un.org/en/story/2022/10/1129912">no credible pathway</a> to avoiding dangerous climate change. However, if <a href="https://carnegieendowment.org/2023/01/12/climate-protests-tracking-growing-unrest-pub-88778#:%7E:text=These%20are%20just%20a%20few,even%20more%20numerous%20and%20influential.">increasing rates</a> of climate protests are anything to go by, the world may finally be ready for radical change – and perhaps for reduced harmful substance use.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/217894/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/helen-louise-berry-8608">Helen Louise Berry</a>, Honorary Professor, Centre for Health Systems and Safety Research, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> and <a href="https://theconversation.com/profiles/francis-vergunst-230743">Francis Vergunst</a>, Associate Professor, Psychosocial Difficulties, <a href="https://theconversation.com/institutions/university-of-oslo-934">University of Oslo</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/5-reasons-why-climate-change-may-see-more-of-us-turn-to-alcohol-and-other-drugs-217894">original article</a>.

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Drugs like Ozempic won’t ‘cure’ obesity but they might make us more fat-phobic

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