Placeholder Content Image

Eye infections might seem like a minor complaint – but in some cases they can cause blindness and even death

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/adam-taylor-283950">Adam Taylor</a>, <a href="https://theconversation.com/institutions/lancaster-university-1176">Lancaster University</a></em></p> <p>When you think of eye infections, what comes to mind? Puffy, swollen bruised feeling eyelids that get glued together with gunk overnight? That feeling of having grit in your eye that can’t be cleaned away? Eye infections may seem like a relatively minor – if unsightly and inconvenient – complaint, but they can also be far more serious.</p> <p>Take the deadly outbreak of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5022785/">antibiotic resistant</a> bacteria <a href="https://www.cff.org/managing-cf/burkholderia-cepacia-complex-b-cepacia"><em>Burkholderia cepacia</em></a> in 2023-24, for example.</p> <p>Between January 2023 and February 2024, contaminated brands of lubricating eye gel were linked to the infection of at least 52 patients. <a href="https://www.independent.co.uk/news/health/contaminated-eye-gel-outbreak-death-b2523446.html">One person died</a> and at least 25 others suffered serious infections.</p> <p>The outbreak has now subsided and products are <a href="https://www.gov.uk/drug-device-alerts/specific-brands-of-carbomer-eye-gel-recall-of-aacarb-eye-gel-aacomer-eye-gel-and-puroptics-eye-gel-potential-risk-of-infection-dsi-slash-2023-slash-11#update-2-april-2024">back on the shelves</a> but it isn’t the first time that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8335909/">medicinal products</a> have led to outbreaks of <em>B cepacia</em>.</p> <p>The bacterium is an opportunistic pathogen known to pose a significant risk to people with cystic fibrosis, chronic lung conditions and weakened immune systems. The infection likely progresses from the mucous membranes of the eyelids to the lungs where it leads to pneumonia and septicaemia causing <a href="https://erj.ersjournals.com/content/17/2/295">death in days</a>.</p> <p>But it’s not just <em>B cepacia</em> that can threaten our health. Something as simple as rubbing our eyes can introduce pathogens leading to infection, blindness and, in the worst case, death.</p> <p>Bacteria account for up to <a href="https://pubmed.ncbi.nlm.nih.gov/16148850/">70% of eye infections</a> and globally <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9032492/">over 6 million people</a> have blindness or moderate visual impairment from ocular infection. Contact lens wearers are at <a href="https://www.aao.org/eye-health/diseases/contact-lens-related-eye-infections">increased risk</a>.</p> <figure><iframe src="https://www.youtube.com/embed/pWsx8i1kaxs?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p>The eye is a unique structure. It converts light energy to chemical and then electrical energy, which is transmitted to the brain and converted to a picture. The eye uses about <a href="https://www.ncbi.nlm.nih.gov/books/NBK11556/">6 million cones and 120 million rods</a> which detect colour and light.</p> <p>Eye cells have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8775779/">no ability to regenerate</a> so, once damaged or injured, cannot be repaired or replaced. The body tries its best to preserve the eyes by encasing them in a <a href="https://www.ncbi.nlm.nih.gov/books/NBK531490/">bony protective frame</a> and <a href="https://www.ncbi.nlm.nih.gov/books/NBK482428/">limiting exposure</a> having eyelids to defend against the environmental damage and ensure the eyes are kept lubricated.</p> <p>Despite our bodies’ best efforts to shield the eyes from harm, there are a number of common eye infections that can result from introducing potential pathogens into the eyes.</p> <h2>Conjunctivitis</h2> <p>The outer-most layer of the eye, the sclera, bears the brunt of exposure and to help protect it, it is lined by a thin moist membrane called the <a href="https://my.clevelandclinic.org/health/body/24329-conjunctiva">conjunctiva</a>.</p> <figure><iframe src="https://www.youtube.com/embed/RZ4danuJwd0?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p>The conjunctiva is <a href="https://innovations.bmj.com/content/9/4/253">highly vascularised</a>, which means it has lots of blood vessels. When microbes enter the eye, it is this layer that mounts an immune response causing <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8328962/">blood vessels to dilate</a> in the conjunctiva. This results in <a href="https://www.cdc.gov/conjunctivitis/about/symptoms.html">“pink eye”</a>, a common form of conjunctivitis. Conjunctivitis can be caused by bacteria, allergens or viruses and typically heals by itself.</p> <h2>Blepharitis</h2> <p>Blepharitis is an inflammation of the eyelid and usually affects both sides. It can cause itchy eyes and dandruff-like flakes. It’s most commonly caused by <a href="https://www.tandfonline.com/doi/pdf/10.3109/09273948.2013.870214"><em>Staphylococcus</em> bacteria</a>, or the <a href="https://cks.nice.org.uk/topics/blepharitis/background-information/causes/">dysfunction of the glands</a> of the eyelids. It can be treated by <a href="https://www.nhs.uk/conditions/blepharitis/">cleaning the eyes</a> regularly.</p> <h2>Stye</h2> <p>A stye (also called <a href="https://www.college-optometrists.org/clinical-guidance/clinical-management-guidelines/hordeolum">hordeolum</a>) is a painful infection of the upper or lower eyelid. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5370090/">Internal styes</a> are caused by infection of an oil-producing gland inside the eyelid, whereas <a href="https://pubmed.ncbi.nlm.nih.gov/28723014/">external styes</a> develop at the base of the eyelash because of an infection of the hair follicle. Both are caused by bacteria, typically <a href="https://jamanetwork.com/journals/jamaophthalmology/fullarticle/1874715">the <em>S aureus</em> form of the <em>Staphylococcus</em> species</a>.</p> <figure><iframe src="https://www.youtube.com/embed/INKrGOdy824?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p>Styes can be treated by holding a clean flannel soaked in warm water against the affected eye for five to ten minutes, three or four times a day. Do not try to burst styes – this could spread the infection.</p> <h2>Keratitis</h2> <p>Keratitis is the inflammation of the cornea, the transparent part of the eye that light passes through. The cornea is part of the eye’s main barrier against dirt, germs, and disease. Severe keratitis can cause ulcers, damage to the eye and even blindness.</p> <p>The most common type is bacterial keratitis; however, it can also be caused by <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7998329/">amoeba</a>, which can migrate to other parts of the body – including the brain – and cause infection and <a href="https://theconversation.com/nasal-rinsing-why-flushing-the-nasal-passages-with-tap-water-to-tackle-hay-fever-could-be-fatal-225811">even death</a>.</p> <p>Noninfectious keratitis is most commonly caused by wearing contact lenses for too long, especially while sleeping. This can cause scratches, dryness and soreness of the cornea, which leads to inflammation.</p> <h2>Uveitis</h2> <p><a href="https://www.nhs.uk/conditions/uveitis/">Uveitis</a> is inflammation of the middle layer of the eye. Although relatively rare, it is a serious condition and usually results from viral infections such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8501150/">herpes simplex</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/29023181/">herpes zoster</a> or <a href="https://link.springer.com/chapter/10.1007/978-3-319-09126-6_40">trauma</a>. Depending on where the inflammation is in the eye, the symptoms can be anything from redness, pain and floaters to blurred vision and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1772296/">partial blindness</a>.</p> <h2>Exogenous endophthalmitis</h2> <p>This is a rare but serious infection caused by eye surgery complications, penetrating ocular trauma (being stabbed in the eye with a sharp object) or foreign bodies in the eye. Foreign bodies can be anything from dirt and dust to small projectiles such as shards of metal from drilling, explosives or soil from farm machinery and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7286045/">many other sources</a>.</p> <h2>Dacryocystitis</h2> <p>Dacryocystitis is the inflammation of the nasolacrimal sac, which drains tears away from the eye into the nose. This condition can be <a href="https://pubmed.ncbi.nlm.nih.gov/8443113/">acute</a>, <a href="https://www.nature.com/articles/6700662">chronic</a> or <a href="https://www.jebmh.com/articles/a-study-of-congenital-dacryocystitis.pdf.pdf">acquired at birth</a>. Most cases are caused by <a href="https://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-020-01792-4"><em>Streptococcus pneumoniae</em> and <em>Staphylococcus aureus</em></a> bacteria.</p> <p>The condition mainly affects newborns and those over 40. Seventy-five per cent of cases are women and it’s most commonly found in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6039673/">white adults</a>. It can lead to the stagnation of tears, creating a breeding ground for microbes.</p> <h2>Careful with contacts</h2> <p>Proper eye hygiene reduces the risk of all these conditions – and this is even more important for contact lens wearers.</p> <figure><iframe src="https://www.youtube.com/embed/uENHAntJOIA?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p>Appropriate hygienic cleaning of lenses is paramount. <a href="https://pubmed.ncbi.nlm.nih.gov/30789440/">Non-sterile water</a>, <a href="https://www.aao.org/eye-health/glasses-contacts/contact-lens-care">spit</a> and other fluids can transfer <a href="https://www.science.org/content/article/bacteria-living-your-contact-lens-solution">potentially dangerous</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3482476/">microbes</a> into the eye – a warm, moist environment that makes an ideal breeding ground for bacteria – leading to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9542356/">localised infection</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3972779/">blindness</a> or progress to a more serious <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9835757/">systemic infection or death</a>.</p> <p>Any persistent and painful redness or swelling of eyes should be checked by a registered health professional.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><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/227252/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/adam-taylor-283950">Adam Taylor</a>, Professor and Director of the Clinical Anatomy Learning Centre, <a href="https://theconversation.com/institutions/lancaster-university-1176">Lancaster University</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/eye-infections-might-seem-like-a-minor-complaint-but-in-some-cases-they-can-cause-blindness-and-even-death-227252">original article</a>.</em></p> </div>

Body

Placeholder Content Image

Considering taking a weight-loss drug like Ozempic? Here are some potential risks and benefits

<p><a href="https://theconversation.com/profiles/lauren-ball-14718">Lauren Ball</a>, <em><a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a></em> and <a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, <em><a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a></em></p> <p>After weight-loss drugs like Ozempic exploded onto the market, celebrities and social media influencers were quick to spruik their benefits, leading to their rapid rise in use. In the last three months of 2022, clinicians in the United States alone wrote <a href="https://www.washingtonpost.com/business/2023/09/27/ozempic-prescriptions-data-analysis/">more than nine million prescriptions</a> for these drugs.</p> <p>As they’ve grown in popularity, we’ve also heard more about the potential side effects – from common gastrointestinal discomforts, to more serious mental health concerns.</p> <p>But what does the science say about how well Ozempic and Wegovy (which are both brand names of the drug semaglutide) work for weight loss? And what are the potential side effects? Here’s what to consider if you or a loved one are thinking of taking the drug.</p> <h2>Potential benefits</h2> <p><strong>1) It’s likely to help you lose weight</strong></p> <p>The largest, well-conducted <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">research study</a> of semaglutide was from United Kingdom in 2021. Some 1,961 people who were classified as “overweight” or “obese” were randomly assigned to have either semaglutide or a placebo and followed for 68 weeks (about 1.3 years). All participants also had free access to advice about healthy eating and physical activity.</p> <p>The study found those taking semaglutide lost weight – significantly more than people who had the placebo (-14.9% of their body weight compared with -2.4% of body weight).</p> <p>In another <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">study</a> in the United States, one health-care clinic gave 408 people weekly injections of semaglutide. Over the first three months, those included in the final analysis (175 people) lost an average of 6.7kg. Over the first six months, they lost an average of 12.3kg.</p> <p>Large weight losses have been found in a more <a href="https://www.nature.com/articles/s41591-022-02026-4">recent trial</a> of semaglutide, suggesting weight loss is a very likely outcome of ongoing use of the medication.</p> <p><strong>2) It may reduce your chronic disease risk factors</strong></p> <p>When people in the overweight or obese weight categories lose <a href="https://www.sciencedirect.com/science/article/pii/S1550413116300535">at least 5%</a> of their body weight, physiological changes often occur beyond a change in weight or shape. This <a href="https://www.nih.gov/news-events/nih-research-matters/research-context-obesity-metabolic-health">might include</a> lowered cholesterol levels, lowered blood pressure and lowered blood glucose levels, which all reduce the risk of chronic diseases.</p> <p>In one of the semaglutide <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">trials</a>, most people (87.3%) lost at least 5% of their body weight. Although most of the large studies of semaglutide excluded people with metabolic health conditions such as type 2 diabetes, metabolic health gains were <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">observed</a>, including lowered blood pressure, blood glucose levels and fasting blood lipid (fat) levels.</p> <p>In the UK <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">study</a> from 2021, people taking semaglutide had greater improvements in physical capabilities and risk factors for heart disease and diabetes, including reductions in waist circumference, markers of inflammation, blood pressure and blood glucose levels.</p> <p><strong>3) It might improve your quality of life, emotional wellbeing or sense of achievement</strong></p> <p>The original trial of semaglutide did not focus on this bundle of benefits, but further follow-ups show additional benefits associated with the medication. Compared to the placebo, people taking semaglutide saw significant <a href="https://www.tandfonline.com/doi/full/10.1080/00325481.2022.2150006">improvements</a> in their physical functioning and perceptions of their general health, social functioning and mental health.</p> <p>Anecdotally (not based on scientific research), people using semaglutide, such as <a href="https://people.com/oprah-winfrey-reveals-weight-loss-medication-exclusive-8414552">Oprah Winfrey</a>, report a reclaiming or turning point of their life, social situation and body image.</p> <h2>What about the risks?</h2> <p><strong>1) You may experience gastrointestinal symptoms</strong></p> <p>In the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">US clinical trial</a>, nearly half (48.6%) of people taking semaglutide reported experiencing adverse effects. Nausea and vomiting were the most frequently experienced (36.6%) followed by diarrhea (8.6%), fatigue (6.3%) and constipation (5.7%).</p> <p>In the UK study, nausea and diarrhoea were also commonly reported.</p> <p>In <a href="https://www.nejm.org/doi/10.1056/NEJMoa2032183?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub%20%200pubmed">another trial</a>, many participants (74.2%) using semaglutide reported gastrointestinal symptoms. However, nearly half (47.9%) using the placebo also reported gastrointestinal symptoms, indicating that symptoms may be similar to those experienced during normal daily living.</p> <p>Most gastrointestinal symptoms were mild to moderate in severity, and resolved for most people without the need to stop participating in the study.</p> <p><strong>2) You might feel fatigued</strong></p> <p>Fatigue was the second most common side effect for participants in the US <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">clinical trial</a>, affecting 6.3% of participants.</p> <p><strong>3) You might be among the minority who don’t tolerate the drug</strong></p> <p>Australia’s Therapeutic Goods Administration (TGA) has <a href="https://www.tga.gov.au/news/safety-alerts/compounding-safety-information-semaglutide-products">approved</a> Ozempic as safe to use, for the treatment of type 2 diabetes but it has not yet been approved for weight loss. The TGA has also <a href="https://www.tga.gov.au/resources/prescription-medicines-registrations/wegovy-novo-nordisk-pharmaceuticals-pty-ltd">approved Wegovy</a> (a higher dose of semagtlutide) for weight loss, however it’s not yet available in Australia.</p> <p>In the US <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">clinical trial</a>, no unexpected safety issues were reported. However, five patients (2.9%) had to stop taking the medication because they could not tolerate the adverse effects. Fifteen (8.6%) had to either reduce the dose or remain on the same dose to avoid the adverse effects.</p> <p>In <a href="https://www.nejm.org/doi/10.1056/NEJMoa2032183?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub%20%200pubmed">other studies</a>, some patients stopped the trial due to gastrointestinal symptoms being so severe they could not tolerate continuing.</p> <p>More severe safety concerns reported in <a href="https://www.nejm.org/doi/10.1056/NEJMoa2032183?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub%20%200pubmed">studies</a> include gallbladder-related disorders (mostly cholelithiasis, also known as gallstones) in 34 patients (2.6%) and mild acute pancreatitis in three patients (0.2%). All people recovered during the trial period.</p> <p>A 2024 European <a href="https://link.springer.com/article/10.1007/s11096-023-01694-7">study</a> analysed psychiatric adverse events associated with semaglutide, liraglutide and tirzepatide (which work in a similar way to semaglutide). Between January 2021 and May 2023, the drug database recorded 481 psychiatric events (about 1.2% of the total reported) associated with these drugs. About half of these events were reported as depression, followed by anxiety (39%) and suicidal ideation (19.6%). Nine deaths and 11 life-threatening outcomes were reported during the study period.</p> <p>Due to the severity and fatal outcomes of some of these reports, <a href="https://www.fda.gov/drugs/drug-safety-and-availability/update-fdas-ongoing-evaluation-reports-suicidal-thoughts-or-actions-patients-taking-certain-type">the US Food and Drug Administration</a> investigated further but did not find evidence that use of these medicines caused suicidal thoughts or actions.</p> <p><strong>4) It might be difficult to access</strong></p> <p>Despite being considered safe, the TGA has <a href="https://www.tga.gov.au/safety/shortages/medicine-shortage-alerts/update-prescribers-advised-not-start-new-patients-ozempic#:%7E:text=Ozempic%27s%20TGA%2Dapproved%20indication%20is,consult%20the%20appropriate%20prescribing%20guidelines.">warned</a> significant Ozempic access barriers are likely to continue throughout 2024.</p> <p>To manage the shortage, pharmacists are instructed to give preference to people with type 2 diabetes who are seeking the medication.</p> <p><strong>5) You might not always get clear information from vested interests</strong></p> <p>Given the popularity of Ozempic and Wegovy, health organisations such as the World Obesity Federation have expressed <a href="https://www.theguardian.com/society/2023/mar/12/orchestrated-pr-campaign-how-skinny-jab-drug-firm-sought-to-shape-obesity-debate">concern</a> about the medication’s marketing, PR and strong <a href="https://www.theguardian.com/australia-news/2023/jan/06/tga-investigates-influencers-after-diabetes-drug-ozempic-promoted-as-weight-loss-treatment">social media presence</a>.</p> <p>Some journalists have <a href="https://www.theguardian.com/society/2023/mar/12/orchestrated-pr-campaign-how-skinny-jab-drug-firm-sought-to-shape-obesity-debate">raised conflict of interest concerns</a> about the relationship between some obesity researchers and Novo Nordrisk, Ozempic and Wegovy’s manufacturer. The worry is that researchers might be influenced by their relationship with Novo Nordrisk to produce study results that are more favourable to the medications.</p> <h2>Bottom line</h2> <p>Ozempic is a medication that should be used in conjunction with your health care provider. But remember, weight is only one aspect of your health and wellbeing. It’s important to take a holistic view of your health and prioritise eating well, moving more and getting enough sleep.</p> <hr /> <p><em>Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-132745">Ozempic series</a> here.</em><!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><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/219312/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/lauren-ball-14718">Lauren Ball</a>, Professor of Community Health and Wellbeing, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> and <a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, Lecturer, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/considering-taking-a-weight-loss-drug-like-ozempic-here-are-some-potential-risks-and-benefits-219312">original article</a>.</em></p>

Body

Placeholder Content Image

Eating some chocolate really might be good for you – here’s what the research says

<p><em><a href="https://theconversation.com/profiles/dan-baumgardt-1451396">Dan Baumgardt</a>, <a href="https://theconversation.com/institutions/university-of-bristol-1211">University of Bristol</a></em></p> <p>Although it always makes me scoff slightly to see Easter eggs making their first appearance in supermarkets at the end of December, there are few people who aren’t delighted to receive a bit of chocolate every year.</p> <p>It makes sense that too much chocolate would be bad for you because of the high fat and sugar content in most products. But what should we make of common claims that eating some chocolate is actually good for you?</p> <p>Happily, there is a fair amount of evidence that shows, in the right circumstances, chocolate may be both beneficial for your heart and good for your mental state.</p> <p>In fact, chocolate – or more specifically cacao, the raw, unrefined bean – is a medicinal wonder. It contains many different active compounds which can evoke pharmacological effects within the body, like medicines or drugs.</p> <p>Compounds that lead to neurological effects in the brain have to be able to cross the <a href="https://link.springer.com/chapter/10.1007/978-3-642-13443-2_7">blood-brain barrier</a>, the protective shield which prevents harmful substances – like toxins and bacteria – entering the delicate nervous tissue.</p> <p>One of these is the compound <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3672386/">theobromine</a>, which is also found in tea and contributes towards its bitter taste. Tea and chocolate also contain caffeine, which theobromine is related to as part of the purine family of chemicals.</p> <p>These chemicals, among others, contribute to chocolate’s addictive nature. They have the ability to cross the blood-brain barrier, where they can influence the nervous system. They are therefore known as <a href="https://pubmed.ncbi.nlm.nih.gov/15549276/">psychoactive</a> chemicals.</p> <figure><iframe src="https://www.youtube.com/embed/HloqayQdR6M?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p>What effects can chocolate have on mood? Well, <a href="https://academic.oup.com/nutritionreviews/article/71/10/665/1931144?login=false">a systematic review</a> looked at a group of studies which examined the feelings and emotions associated with consuming chocolate. Most demonstrated improvements in mood, anxiety, energy and states of arousal.</p> <p>Some noted the feeling of guilt, which is perhaps something we’ve all felt after one too many Dairy Milks.</p> <h2>Health benefits of cocoa</h2> <p>There are other organs, aside from the brain, that might benefit from the medicinal effects of cocoa. For centuries, chocolate has been used as a medicine to treat a <a href="https://pubmed.ncbi.nlm.nih.gov/10917925/">long list of diseases</a> including anaemia, tuberculosis, gout and even low libido.</p> <p>These might be spurious claims but there is evidence to suggest that eating cacao has a positive effect on the cardiovascular system. First, it can prevent <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8068178/">endothelial dysfunction</a>. This is the process through which arteries harden and get laden down with fatty plaques, which can in turn lead to heart attacks and strokes.</p> <p>Eating dark chocolate may also reduce <a href="https://www.sciencedirect.com/science/article/pii/S1537189115001135?via%3Dihub">blood pressure</a>, which is another risk factor for developing arterial disease, and prevent formation of clots which block up blood vessels.</p> <figure><iframe src="https://www.youtube.com/embed/8VUcPCbSSCY?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p>Some studies have suggested that dark chocolate might be useful in adjusting ratios of <a href="https://pubmed.ncbi.nlm.nih.gov/20968113/">high-density lipoprotein cholesterol</a>, which can help protect the heart.</p> <p>Others have examined insulin resistance, the phenomenon associated with Type 2 diabetes and weight gain. They suggest that the <a href="https://www.sciencedirect.com/science/article/pii/S0963996900000697#:%7E:text=Cocoa%20is%20rich%20in%20polyphenols%20particularly%20in%20catechins,and%20cocoa%20powder%20have%20been%20published%20only%20recently.">polyphenols</a> – chemical compounds present in plants – found in foodstuffs like chocolate may also lead to <a href="https://pubmed.ncbi.nlm.nih.gov/29993262/">improved control of blood sugars</a>.</p> <h2>Chocolate toxicity</h2> <p>As much as chocolate might be considered a medicine for some, it can be a poison for others.</p> <p>It’s well documented that the ingestion of caffeine and theobromine is highly toxic for domestic animals. Dogs are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4801869/">particularly affected</a> because of their often voracious appetites and generally unfussy natures.</p> <p>The culprit is often dark chocolate, which can provoke symptoms of agitation, rigid muscles and even seizures. In certain cases, if ingested in high enough quantities, it can lead to comas and abnormal, even fatal heart rhythms.</p> <p>Some of the compounds found in chocolate have also been found to have potentially negative effects in humans. Chocolate is a source of oxalate which, along with calcium, is one of the main components of <a href="https://pubmed.ncbi.nlm.nih.gov/20301742/">kidney stones</a>.</p> <p>Some clinical groups have advised against consuming oxalate rich foods, such as spinach and rhubarb – and chocolate, for those who suffer from recurrent kidney stones.</p> <p>So, what should all this mean for our chocolate consumption habits? Science points in the direction of chocolate that has as high a cocoa solid content as possible, and the minimum of extras. The potentially harmful effects of chocolate are more related to fat and sugar, and may counteract any possible benefits.</p> <p>A daily dose of 20g-30g of plain or dark chocolate with cocoa solids above 70% – rather than milk chocolate, which contains fewer solids and white chocolate, which contains none – could lead to a greater health benefit, as well as a greater high.</p> <p>But whatever chocolate you go for, please don’t share it with the dog.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><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/226759/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/dan-baumgardt-1451396"><em>Dan Baumgardt</em></a><em>, Senior Lecturer, School of Physiology, Pharmacology and Neuroscience, <a href="https://theconversation.com/institutions/university-of-bristol-1211">University of Bristol</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/eating-some-chocolate-really-might-be-good-for-you-heres-what-the-research-says-226759">original article</a>.</em></p>

Body

Placeholder Content Image

Not all mourning happens after bereavement – for some, grief can start years before the death of a loved one

<p><em><a href="https://theconversation.com/profiles/lisa-graham-wisener-1247893">Lisa Graham-Wisener</a>, <a href="https://theconversation.com/institutions/queens-university-belfast-687">Queen's University Belfast</a> and <a href="https://theconversation.com/profiles/audrey-roulston-1512057">Audrey Roulston</a>, <a href="https://theconversation.com/institutions/queens-university-belfast-687">Queen's University Belfast</a></em></p> <p>For many people, grief starts not at the point of death, but from the moment a loved one is diagnosed with a life-limiting illness.</p> <p>Whether it’s the diagnosis of an advanced cancer or a non-malignant condition such as dementia, heart failure or Parkinson’s disease, the psychological and emotional process of grief can begin many months or even years before the person dies. This experience of mourning a future loss is known as <a href="https://link.springer.com/referenceworkentry/10.1007/978-3-319-69892-2_1006-1">anticipatory grief</a>.</p> <p>While not experienced by everyone, anticipatory grief is a <a href="https://spcare.bmj.com/content/bmjspcare/early/2022/02/10/bmjspcare-2021-003338.full.pdf?casa_token=IWNMDFN5SoIAAAAA:2EybwyPcKu73VdrACTNk7jITor-mMIXK8rv76arXgdjV9cA2Y0MV0LyZLLwcYe1rZUAQymOzFYo">common</a> part of the grieving process and can include a range of conflicting, often difficult thoughts and emotions. For example, as well as feelings of loss, some people can experience guilt from wanting their loved one to be free of pain, or imagining what life will be like after they die.</p> <h2>Difficult to define, distressing to experience</h2> <p>Anticipatory grief has proved <a href="https://journals.sagepub.com/doi/full/10.1177/02692163221074540#bibr13-02692163221074540">challenging to define</a>. A <a href="https://journals.sagepub.com/doi/full/10.1177/02692163221074540#bibr13-02692163221074540">systematic review</a> of research studies on anticipatory grief identified over 30 different descriptions of pre-death grief. This lack of consensus has limited research progress, because there’s no shared understanding of how to identify anticipatory grief.</p> <p>Therese Rando, a <a href="https://www.taylorfrancis.com/chapters/edit/10.4324/9781315800806-9/grief-mourning-accommodating-loss-therese-rando">prominent theorist</a>, has proposed that anticipatory grief can help prepare for death, contributing to a more positive grieving experience post-bereavement. Rando also suggests that pre-death mourning can aid with adjustment to the loss of a loved one and reduce the risk of <a href="https://www.cruse.org.uk/understanding-grief/effects-of-grief/complicated-grief/">“complicated grief”</a>, a term that describes persistent and debilitating emotional distress.</p> <figure><iframe src="https://www.youtube.com/embed/AapGn60DZSA?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p>But pre-death mourning doesn’t necessarily mean grief will be easier to work through once a loved one has died. Other <a href="https://www.sciencedirect.com/science/article/pii/S0277953621005724?casa_token=I9mbdSv3d3gAAAAA:MqxN5X_iWbcqa6BYj7IXmImUviheOQWAVA4UBy6795UDuS1uOHG9b245qMkyOiLcvjv_SU6yVA">research evidence</a> shows that it’s possible to experience severe anticipatory grief yet remain unprepared for death.</p> <h2>Carers should seek support</h2> <p>Carers of people with life-limiting illnesses may notice distressing changes in the health of their loved ones. Witnessing close-up someone’s deterioration and decline in independence, memory or ability to perform routine daily tasks, such as personal care, is a painful experience.</p> <p>It is essential, then, for carers to acknowledge difficult emotions and seek support from those around them – especially because caring for a loved one at the end of their life <a href="https://www.mind.org.uk/information-support/helping-someone-else/carers-friends-family-coping-support/your-mental-health/">can be an isolating time</a>.</p> <p>Where possible, it can also be beneficial for carers to offer their loved one <a href="https://compassionatecommunitiesni.com/our-programs/dying-to-talk/">opportunities to reflect</a> on significant life events, attend to unfinished business, and to discuss preferences for funeral arrangements. For some, this may involve supporting loved ones to reconnect with friends and family, helping them to put legal or financial affairs in order, talking about how the illness is affecting them, or making an <a href="https://www.england.nhs.uk/publication/universal-principles-for-advance-care-planning/">advance care plan</a>.</p> <figure><iframe src="https://www.youtube.com/embed/wrJaTXW1Xvk?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <h2>Talking is key</h2> <p>Living with altered family dynamics, multiple losses, transition and uncertainty can be <a href="https://www.tandfonline.com/doi/full/10.1080/07481187.2021.1998935">distressing for all family members</a>. It may be difficult to manage the emotional strain of knowing death is unavoidable, to make sense of the situation, and to <a href="https://hospicefoundation.ie/i-need-help/i-am-seriously-ill/how-to-talk-to-those-you-care-about/">talk about dying</a>.</p> <p>However, talking is key in <a href="https://www.cruse.org.uk/about/blog/important-conversations-death/">preparing for an impending death</a>. Organisations who offer specialist palliative care have information and trained professionals to help with difficult conversations, including <a href="https://www.mariecurie.org.uk/help/support/diagnosed/talking-children/children">talking to children</a> about death and dying.</p> <p>Navigating anticipatory grief can involve self-compassion for both the patient and carer. This includes acknowledging difficult emotions and treating oneself with kindness. Open communication with the person nearing the end of their life can foster emotional connection and help address their concerns, alongside support from the wider circle of family and friends.</p> <p>Extending empathy and understanding to those nearing death – and those grieving their impending loss – will help contribute to a compassionate community that supports those experiencing death, dying and bereavement.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><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/221629/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/lisa-graham-wisener-1247893">Lisa Graham-Wisener</a>, Lecturer of Health Psychology, <a href="https://theconversation.com/institutions/queens-university-belfast-687">Queen's University Belfast</a> and <a href="https://theconversation.com/profiles/audrey-roulston-1512057">Audrey Roulston</a>, Professor of Social Work in Palliative Care, <a href="https://theconversation.com/institutions/queens-university-belfast-687">Queen's University Belfast</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/not-all-mourning-happens-after-bereavement-for-some-grief-can-start-years-before-the-death-of-a-loved-one-221629">original article</a>.</em></p>

Caring

Placeholder Content Image

12 super simple ways to save some cash

<p>Saving money is a lot easier said than done. Whether you’ve got a holiday you’re thinking about taking, or you just want to make day to day life a little less stressful, there is a range of strategies you can employ to put a couple of dimes together. Here are 12 tips to cut costs:</p> <p>1. Don't buy luxury, sometimes the budget brands are just as good and save you heaps.</p> <p>2. Read the junk mail and compare offers because you can get a better deal where you didn't think you could.</p> <p>3. Cut unnecessary expenses and reduce, if possible, the necessary expenses as well.</p> <p>4. Buy used goods, it's cheaper and you can haggle.</p> <p>5. See if you can switch power companies. I'm aware of several people who are saving $250 a year.</p> <p>6. Borrow books and movies from the library or movie store - it's free or low cost compared to buying new and it's fast.</p> <p>7. Barter with family and friends, it's free and everyone wins.</p> <p>8. Take advantage of specials, sales and deals including buying in bulk, it can save you more than you realise.</p> <p>9. Walk, bike or car pool or use other public transport, it's good for the environment and saves you money.</p> <p>10. Shop around for the best deal, it might be better elsewhere.</p> <p>11. Follow insurance company advice: Don't smoke, do have alarms and do get multi policies - it protects you and saves cash.</p> <p>12. Have a savings account with all the savings from this and don't touch it, you will be amazed at what you have saved in a short time.</p> <p><em>Written by John Murphy. Republished with permission of <a href="http://www.stuff.co.nz/" target="_blank" rel="noopener"><strong><span style="text-decoration: underline;">Stuff.co.nz</span></strong></a>.</em></p> <p><em>Image credits: Getty Images </em></p>

Money & Banking

Placeholder Content Image

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

<p><em><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></em></p> <p>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.</p> <p>But you may not be aware that mixing certain medicines with alcohol can increase the effects and put you at risk.</p> <p>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.</p> <h2>How alcohol and medicines interact</h2> <p>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.</p> <p><iframe id="JCh01" class="tc-infographic-datawrapper" style="border: none;" src="https://datawrapper.dwcdn.net/JCh01/1/" width="100%" height="400px" frameborder="0"></iframe></p> <p>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.</p> <p>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.</p> <p>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>.</p> <p>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.</p> <p>Combining alcohol with ibuprofen can lead to a higher risk of stomach upsets and stomach bleeds.</p> <p>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>.</p> <p>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.</p> <h2>Who is at most risk?</h2> <p>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.</p> <p>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>.</p> <p>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.</p> <p>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.</p> <h2>What drugs can’t you mix with alcohol?</h2> <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> <p>If you do want to drink alcohol while being on medication, discuss it with your doctor or pharmacist first.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><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" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/nial-wheate-96839"><em>Nial Wheate</em></a><em>, 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></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/why-its-a-bad-idea-to-mix-alcohol-with-some-medications-223293">original article</a>.</em></p>

Body

Placeholder Content Image

How can I get some sleep? Which treatments actually work?

<p><em><a href="https://theconversation.com/profiles/alexander-sweetman-1331085">Alexander Sweetman</a>, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a>; <a href="https://theconversation.com/profiles/jen-walsh-1468594">Jen Walsh</a>, <a href="https://theconversation.com/institutions/the-university-of-western-australia-1067">The University of Western Australia</a>, and <a href="https://theconversation.com/profiles/nicole-grivell-1468590">Nicole Grivell</a>, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a></em></p> <p>Do you have difficulty falling asleep? Do you stay awake for a long time at night? Do these sleep problems make you feel fatigued, strung-out, or exhausted during the day? Has this been happening for months?</p> <p>If so, you’re not alone. About <a href="https://www.sleephealthfoundation.org.au/special-sleep-reports/chronic-insomnia-disorder-in-australia">12-15%</a> of Australian adults have chronic insomnia.</p> <p>You might have tried breathing exercises, calming music, white noise, going to bed in a dark and quiet bedroom, eating different foods in the evening, maintaining a regular sleep pattern, or reducing caffeine. But after three to four weeks of what seems like progress, your insomnia returns. What next?</p> <h2>What not to do</h2> <p>These probably won’t help:</p> <ul> <li> <p><strong>spending more time in bed</strong> often results in more time spent <em>awake</em> in bed, which can make <a href="https://theconversation.com/how-do-i-stop-my-mind-racing-and-get-some-sleep-207904">insomnia patterns worse</a></p> </li> <li> <p><strong>drinking coffee and taking naps</strong> might help get you through the day. But <a href="https://theconversation.com/nope-coffee-wont-give-you-extra-energy-itll-just-borrow-a-bit-that-youll-pay-for-later-197897">caffeine</a> stays in the system for many hours, and can disrupt our sleep if you drink too much of it, especially after about 2pm. If naps last for more than 30 minutes, or occur after about 4pm, this can reduce your “sleep debt”, and can make it <a href="https://theconversation.com/why-do-i-fall-asleep-on-the-sofa-but-am-wide-awake-when-i-get-to-bed-208371">more difficult</a> to fall asleep in the evening</p> </li> <li> <p><strong>drinking alcohol</strong> might help you fall asleep quicker, but <a href="https://journals.sagepub.com/doi/10.1300/J465v26n01_01">can cause</a> more frequent awakenings, change how long you sleep, change the time spent in different “stages” of sleep, and reduce the overall quality of sleep. Therefore, it is not recommended as a sleep aid.</p> </li> </ul> <h2>What to do next?</h2> <p>If your symptoms have lasted more than one or two months, it is likely your insomnia requires targeted treatments that focus on sleep patterns and behaviours.</p> <p>So, the next stage is a type of non-drug therapy known as cognitive behavioural therapy for insomnia (or <a href="https://www.sleepprimarycareresources.org.au/insomnia/cbti">CBTi</a> for short). This is a four to eight week treatment that’s been shown to be <a href="https://doi.org/10.1016/j.smrv.2022.101687">more effective</a> than sleeping pills.</p> <p>It involves education about sleep, and offers psychological and behavioural treatments that address the underlying causes of long-term insomnia.</p> <p>You can do this one-on-one, in a small group with health professionals trained in CBTi, or via self-guided <a href="https://www.sleepprimarycareresources.org.au/insomnia/cbti/referral-to-digital-cbti-programs">online programs</a>.</p> <p>Some GPs are trained to offer CBTi, but it’s more usual for specialist <a href="https://psychology.org.au/find-a-psychologist">sleep psychologists</a> to offer it. Your GP can refer you to one. There are some Medicare rebates to subsidise the cost of treatment. But many psychologists will also charge a gap fee above the Medicare subsidy, making access to CBTi a challenge for some.</p> <p><a href="https://doi.org/10.12703%2Fr%2F11-4">About 70-80%</a> of people with insomnia sleep better after CBTi, with improvements lasting <a href="https://doi.org/10.1016/j.smrv.2019.08.002">at least a year</a>.</p> <h2>What if that doesn’t work?</h2> <p>If CBTi doesn’t work for you, your GP might be able to refer you to a specialist sleep doctor to see if other sleep disorders, such as <a href="https://doi.org/10.1016/j.smrv.2016.04.004">obstructive sleep apnoea</a>, are contributing to your insomnia.</p> <p>It can also be important to manage any mental health problems such as <a href="https://doi.org/10.5694/mja2.51200">depression and anxiety</a>, as well as physical symptoms such as pain that can also disrupt sleep.</p> <p>Some lifestyle and work factors, such as shift-work, might also require management by a specialist sleep doctor.</p> <h2>What about sleeping pills?</h2> <p>Sleeping pills are <a href="https://www.sleepprimarycareresources.org.au/insomnia/pharmacological-therapy">not the recommended</a> first-line way to manage insomnia. However, they do have a role in providing short-term, rapid relief from insomnia symptoms or when CBTi is not accessible or successful.</p> <p>Traditionally, medications such as benzodiazepines (for example, temazepam) and benzodiazepine receptor agonists (for example, zolpidem) have been used to help people sleep.</p> <p>However, these can have <a href="https://doi.org/10.1136/bmj.38623.768588.47">side-effects</a> including a risk of falls, being impaired the next day, as well as tolerance and dependence.</p> <p>Melatonin – either prescribed or available from pharmacies for people aged 55 and over – is also often used to manage insomnia. But the <a href="https://doi.org/10.1016/j.smrv.2022.101692">evidence suggests</a> it has limited benefits.</p> <h2>Are there new treatments? How about medicinal cannabis?</h2> <p>Two newer drugs, known as “orexin receptor antagonists”, are available in Australia (suvorexant and lemborexant).</p> <p>These block the wake-promoting pathways in the brain. <a href="https://doi.org/10.4088/PCC.22nr03385">Early data suggests</a> they are effective in improving sleep, and have lower risk of potential side-effects, tolerance and dependence compared with earlier medicines.</p> <p>However, we don’t know if they work or are safe over the long term.</p> <p><a href="https://doi.org/10.1093/sleep/zsab149">Medicinal cannabis</a> <a href="https://doi.org/10.1111/jsr.13793">has only in recent years</a> <a href="https://doi.org/10.1093/sleepadvances/zpac029.048">been studied</a> as a treatment for <a href="https://doi.org/10.1093/sleepadvances/zpac029.005">insomnia</a>.</p> <p>In an Australian survey, <a href="https://doi.org/10.2147/nss.s390583">more than half</a> of people using medicinal cannabis said they used it to treat insomnia. There are reports of <a href="https://doi.org/10.1371/journal.pone.0272241">significant benefit</a>.</p> <p>But of the four most robust studies so far, <a href="https://doi.org/10.1093/sleep/zsab149">only one</a> (led by one of us, Jen Walsh) has demonstrated an improvement in insomnia after two weeks of treatment.</p> <p>So we need to learn more about which cannabinoids – for example, delta-9-tetrahydrocannabinol, cannabidiol or cannabinol – and which doses may be beneficial. We also need to learn who can benefit most, and whether these are safe and effective over the long term.</p> <h2>What now?</h2> <p>If you’ve had trouble sleeping for a short time (under about a month) and nothing you try is working, there may be underlying reasons for your insomnia, which when treated, can provide some relief. Your GP can help identify and manage these.</p> <p>Your GP can also help you access other treatments if your insomnia is more long term. This may involve non-drug therapies and/or referral to other services or doctors.</p> <hr /> <p><em>For more information about insomnia and how it’s treated, see the Sleep Health Foundation’s <a href="https://www.sleephealthfoundation.org.au/sleep-disorders/insomnia-2">online resource</a>.</em><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/212964/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/alexander-sweetman-1331085">Alexander Sweetman</a>, Research Fellow, College of Medicine and Public Health, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a>; <a href="https://theconversation.com/profiles/jen-walsh-1468594">Jen Walsh</a>, Director of the Centre for Sleep Science, <a href="https://theconversation.com/institutions/the-university-of-western-australia-1067">The University of Western Australia</a>, and <a href="https://theconversation.com/profiles/nicole-grivell-1468590">Nicole Grivell</a>, Research Coordinator and final year PhD Candidate at FHMRI Sleep Health, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-can-i-get-some-sleep-which-treatments-actually-work-212964">original article</a>.</em></p>

Body

Placeholder Content Image

How some people can end up living at airports for months – even years – at a time

<p><em><a href="https://theconversation.com/profiles/janet-bednarek-144872">Janet Bednarek</a>, <a href="https://theconversation.com/institutions/university-of-dayton-1726">University of Dayton</a></em></p> <p>In January 2021, local authorities arrested a 36-year-old man named Aditya Singh <a href="https://news.yahoo.com/man-living-o-hare-3-001000925.html">after he had spent three months living at Chicago’s O'Hare International Airport</a>. Since October, he had been staying in the secure side of the airport, relying on the kindness of strangers to buy him food, sleeping in the terminals and using the many bathroom facilities. It wasn’t until an airport employee asked to see his ID that the jig was up.</p> <p>Singh, however, is far from the first to pull off an extended stay. <a href="https://udayton.edu/directory/artssciences/history/bednarek_janet.php">After more than two decades studying the history of airports</a>, I’ve come across stories about individuals who have managed to take up residence in terminals for weeks, months and sometimes years.</p> <p>Interestingly, though, not all of those who find themselves living in an airport do so of their own accord. This group includes Mehran Karimi Nasseri, who famously lived in Paris’ Charles de Gaulle Airport for 18 years and inspired the movie “The Terminal.” <a href="https://www.npr.org/2022/11/12/1136307777/the-terminal-movie-merhan-karimi-nasseri-dies-paris-airport">Nasseri died</a> on November 12, 2022.</p> <h2>Blending in with the crowd</h2> <p>Whether it’s in video games like “<a href="https://www.microsoft.com/en-us/p/airport-city/9wzdncrfjchj?activetab=pivot:overviewtab">Airport City</a>” or scholarship on topics like “<a href="https://airporturbanism.com/">airport urbanism</a>,” I’ll often see the trope that airports are like “mini cities.” I can see how this idea germinates: Airports, after all, have <a href="https://theconversation.com/as-you-travel-pause-and-take-a-look-at-airport-chapels-87578">places of worship</a>, policing, hotels, fine dining, shopping and mass transit.</p> <p>But if airports are cities, they’re rather strange ones, in that those running the “cities” prefer that no one actually takes up residence there.</p> <p>Nonetheless, it is possible to live in airports because they do offer many of the basic amenities needed for survival: food, water, bathrooms and shelter. And while airport operations do not necessarily run 24/7, airport terminals often open very early in the morning and stay open until very late at night.</p> <p>Many of the facilities are so large that those determined to stay – such as the man at O'Hare – can find ways to avoid detection for quite some time.</p> <p>One of the ways would-be airport residents avoid detection is to simply blend in with the crowds. Before the pandemic, U.S. airports handled 1.5 million to 2.5 million passengers <a href="https://www.tsa.gov/coronavirus/passenger-throughput">on any given day</a>.</p> <p>Once the pandemic hit, the numbers dropped dramatically, falling below 100,000 during the early weeks of the crisis in the spring of 2020. Notably, the man who lived at O'Hare for a little over three months arrived in mid-October 2020 as passenger numbers <a href="https://www.tsa.gov/coronavirus/passenger-throughput">were experiencing a rebound</a>. He was discovered and apprehended only in late January 2021 – right when passenger numbers dropped considerably after the <a href="https://www.tsa.gov/coronavirus/passenger-throughput">holiday travel peaks</a> and during <a href="https://www.bbc.com/news/world-us-canada-54966531">the resurgence of the coronavirus</a>.</p> <h2>Living in limbo</h2> <p>Not all of those who find themselves sleeping in a terminal necessarily want to be there.</p> <p>Travel by air enough and chances are that, at one time or another, you’ll find yourself in the category of involuntary short-term airport resident.</p> <p>While some people may book flights that will require them to stay overnight at the airport, others find themselves stranded at airports because of missed connections, canceled flights or bad weather. These circumstances seldom result in more than a day or two’s residency at an airport.</p> <p>Then there are those who unwittingly find themselves in an extended, indefinite stay. Perhaps the most famous involuntary long-term resident was <a href="https://www.gq.com/story/merhan-nasseri-charles-de-gaulle-stuck">Mehran Karimi Nasseri</a>, the airport dweller whose story inspired “<a href="https://www.imdb.com/title/tt0362227/">The Terminal</a>.”</p> <p>Nasseri, an Iranian refugee, was en route to England via Belgium and France in 1988 when he lost the papers that verified his refugee status. Without his papers, he could not board his plane for England. Nor was he permitted to leave the Paris airport and enter France. He soon became an international hot potato as his case bounced back and forth among officials in England, France and Belgium. At one point French authorities offered to allow him to reside in France, but Nasseri turned down the offer, reportedly because he wanted to get to his original destination, England. And so he stayed at Charles de Gaulle Airport for nearly 18 years. He left only in 2006, <a href="https://www.csmonitor.com/2004/0621/p11s02-almo.html">when his declining health required hospitalization</a>. Prior to his death in November 2022, he had returned to the airport on his own accord, and was staying in Terminal 2F when he suffered the heart attack that killed him.</p> <p>Other long-term airport residents include Edward Snowden, the NSA leaker, who spent <a href="https://www.theregister.com/2016/09/12/edward_snowden_wikileaks_sarah_harrison/">more than a month in a Russian airport in 2013</a> before receiving asylum. And then there is <a href="http://news.bbc.co.uk/2/hi/africa/4673103.stm">the saga of Sanjay Shah</a>. Shah had traveled to England in May 2004 on a British overseas citizen passport. Immigration officials, however, refused him entry when it was clear he intended to immigrate to England, not merely stay there the few months his type of passport allowed. Sent back to Kenya, Shah feared leaving the airport, as he had already surrendered his Kenyan citizenship. He was finally able to leave after an airport residency of just over a year when British officials granted him full citizenship.</p> <p>More recently, the coronavirus pandemic has created new long-term involuntary airport residents. For example, an Estonian named Roman Trofimov arrived at Manila International Airport on a flight from Bangkok on March 20, 2020. By the time of his arrival, Philippine authorities had ceased issuing entry visas to limit the spread of COVID-19. Trofimov spent over 100 days in the Manila airport until personnel at the Estonian embassy <a href="https://www.news.com.au/travel/travel-updates/travel-stories/man-trapped-in-manila-airport-for-100-days-amid-coronavirus-pandemic/news-story/09bfee03d3d1f23ca28f1fd97fa99109">were finally able to get him a seat on a repatriation flight</a>.</p> <p>[<em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://theconversation.com/us/newsletters/weekly-highlights-61?utm_source=TCUS&amp;utm_medium=inline-link&amp;utm_campaign=newsletter-text&amp;utm_content=weeklysmart">You can get our highlights each weekend</a>.]</p> <h2>The homeless find refuge</h2> <p>While most involuntary airport residents long to leave their temporary home, there are some who have voluntarily attempted to make an airport their long-term abode. Major airports in both the United States and Europe have long functioned – though largely informally – as homeless shelters.</p> <p>Though homelessness and the homeless have a long history in the United States, many analysts see the 1980s as an important turning point in that history, as many factors, including federal budget cuts, the deinstitutionalization of the mentally ill and gentrification, <a href="https://www.ncbi.nlm.nih.gov/books/NBK519584/">led to a sharp rise in the number of homeless</a>. It is in that decade that you can find the earliest stories about the homeless living at U.S. airports.</p> <p>In 1986, for example, <a href="https://www.chicagotribune.com/news/ct-xpm-1986-12-12-8604020917-story.html">the Chicago Tribune wrote about Fred Dilsner</a>, a 44-year-old former accountant who had been living at O'Hare in Chicago for a year. The article indicated that homeless individuals had first started showing up at the airport in 1984, following the completion of the Chicago Transit Authority train link, which provided easy and cheap access. The newspaper reported that 30 to 50 people were living at the airport, but that officials expected the number could climb to 200 as the winter weather set in.</p> <p>This issue has persisted into the 21st century. News stories from 2018 reported a rise in the number of homeless at several large U.S. airports over the previous few years, including at <a href="https://www.usatoday.com/story/travel/flights/todayinthesky/2018/02/12/atlantas-homeless-fill-atrium-worlds-busiest-airport-overnight/328388002/">Hartsfield-Jackson Atlanta International Airport</a> and at <a href="https://www.wbal.com/article/325387/3/growing-number-of-homeless-people-find-refuge-at-airport">Baltimore/Washington International Thurgood Marshall Airport</a>.</p> <p>The coronavirus pandemic has added an additional public health concern <a href="https://saportareport.com/amid-pandemic-city-plan-directs-homeless-sleeping-at-airport-to-supportive-services/columnists/sean-keenan/seankeenan/">for this group of airport denizens</a>.</p> <p>For the most part, airport officials have tried to provide aid to these voluntary residents. At Los Angeles International Airport, for example, officials have deployed crisis intervention teams to work <a href="https://www.nbclosangeles.com/investigations/lax-homeless-problem-bathrooms-waste/2278989/">to connect the homeless to housing and other services</a>. But it’s also clear that most airport officials would prefer a solution <a href="https://www.ajc.com/news/local/homeless-spending-night-hartsfield-jackson-prompt-police-monitoring/XKhpdJ8QZliOtGYutCsZOO/">where airports no longer operated as homeless shelters</a>.</p> <p><em>This is an updated version of an article originally published on March 3, 2021.</em><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/154336/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/janet-bednarek-144872">Janet Bednarek</a>, Professor of History, <a href="https://theconversation.com/institutions/university-of-dayton-1726">University of Dayton</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-some-people-can-end-up-living-at-airports-for-months-even-years-at-a-time-154336">original article</a>.</em></p>

International Travel

Placeholder Content Image

Taking an antidepressant? Mixing it with other medicines – including some cold and flu treatments – can be dangerous

<p><em><a href="https://theconversation.com/profiles/treasure-mcguire-135225">Treasure McGuire</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a></em></p> <p>In the depths of winter we are more at risk of succumbing to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522168/">viral respiratory infections</a> – from annoying sore throat, common cold and sinusitis, to the current resurgence of respiratory syncytial virus (RSV), influenza and COVID.</p> <p>Symptoms of upper respiratory tract infection range in severity. They can include fever, chills, muscle or body aches, cough, sore throat, runny or stuffy nose, earache, headache, and fatigue. Most antibiotics target bacteria so are <a href="https://pubmed.ncbi.nlm.nih.gov/32495003/">not effective</a> for viral infections. Many people seek relief with over-the-counter medicines.</p> <p>While evidence varies, guidelines suggest medicines taken by mouth (such as cough syrups or cold and flu tablets) have a <a href="https://pubmed.ncbi.nlm.nih.gov/25420096/">limited but potentially positive</a> short-term role for managing upper respiratory infection symptoms in adults and children older than 12. These include:</p> <ul> <li>paracetamol or ibuprofen for pain or fever</li> <li>decongestants such as phenylephrine or pseudoephedrine</li> <li>expectorants and mucolytics to thin and clear mucus from upper airways</li> <li>dry cough suppressants such as dextromethorphan</li> <li>sedating or non-sedating antihistamines for runny noses or watery eyes.</li> </ul> <p>But what if you have been prescribed an antidepressant? What do you need to know before going to the pharmacy for respiratory relief?</p> <h2>Avoiding harm</h2> <p>An audit of more than 5,000 cough-and-cold consumer enquiries to an Australian national medicine call centre found questions frequently related to drug-drug interactions (29%). An 18-month analysis showed 20% of calls <a href="https://pubmed.ncbi.nlm.nih.gov/26590496/">concerned</a> potentially significant interactions, particularly with antidepressants.</p> <p>Australia remains in the “<a href="https://www.aihw.gov.au/mental-health/topic-areas/mental-health-%20prescriptions#Prescriptionsbytype">top ten</a>” antidepressant users in the <a href="https://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_PHMC">OECD</a>. More than <a href="https://www.aihw.gov.au/mental-health/topic-areas/mental-health-prescriptions">32 million</a> antidepressant prescriptions are dispensed on the Pharmaceutical Benefits Scheme each year.</p> <p>Antidepressants are commonly prescribed to manage symptoms of anxiety or depression but are also used in chronic pain and incontinence. They are classified primarily by how they affect chemical messengers in the nervous system.</p> <p>These classes are:</p> <ul> <li><strong>selective serotonin reuptake inhibitors (SSRI)</strong> such as fluoxetine, escitalopram, paroxetine and sertraline</li> <li><strong>serotonin and noradrenaline reuptake inhibitors (SNRI)</strong> such as desvenlafaxine, duloxetine and venlafaxine</li> <li><strong>tricyclic antidepressants (TCA)</strong> such as amitriptyline, doxepin and imipramine</li> <li><strong>monoamine oxidase inhibitors (MAOI)</strong> such as tranylcypromine</li> <li><strong>atypical medicines</strong> such as agomelatine, mianserin, mirtazapine, moclobemide, reboxetine and vortioxetine</li> <li><strong>complementary medicines</strong> including St John’s wort, S-adenosyl methionine (SAMe) and L-tryptophan</li> </ul> <p>Medicines within the same class of antidepressants have similar actions and side-effect profiles. But the molecular differences of individual antidepressants mean they may have different interactions with medicines taken at the same time.</p> <h2>Types of drug interactions</h2> <p>Drug interactions can be:</p> <ul> <li><strong>pharmacokinetic</strong> – what the body does to a drug as it moves into, through and out of the body. When drugs are taken together, one may affect the absorption, distribution, metabolism or elimination of the other</li> <li><strong>pharmacodynamic</strong> – what a drug does to the body. When drugs are taken together, one may affect the action of the other. Two drugs that independently cause sedation, for example, may result in excessive drowsiness if taken together.</li> </ul> <p>There are many <a href="https://wchh.onlinelibrary.wiley.com/doi/pdf/10.1002/pnp.429">potential interactions</a> between medications and antidepressants. These include interactions between over-the-counter medicines for upper respiratory symptoms and antidepressants, especially those taken orally.</p> <p>Concentrations of nasal sprays or inhaled medicines are generally lower in the blood stream. That means they are less likely to interact with other medicines.</p> <h2>What to watch for</h2> <p>It’s important to get advice from a pharmacist before taking any medications on top of your antidepressant.</p> <p>Two symptoms antidepressant users should monitor for shortly after commencing a cough or cold medicine are central nervous system effects (irritability, insomnia or drowsiness) and effects on blood pressure.</p> <p>For example, taking a selective SSRI antidepressant and an oral decongestant (such as pseudoephedrine or phenylephrine) can cause irritability, insomnia and affect blood pressure.</p> <p>Serotonin is a potent chemical compound produced naturally for brain and nerve function that can also constrict blood vessels. Medicines that affect serotonin are common and include most antidepressant classes, but also decongestants, dextromethorphan, St John’s wort, L-tryptophan, antimigraine agents, diet pills and amphetamines.</p> <p><a href="https://reference.medscape.com/drug-interactionchecker">Combining drugs</a> such as antidepressants and decongestants that both elevate serotonin levels can cause irritability, headache, insomnia, diarrhoea and blood pressure effects – usually increased blood pressure. But some people experience orthostatic hypotension (low blood pressure on standing up) and dizziness.</p> <p>For example, taking both a serotonin and SNRI antidepressant and dextromethorphan (a cough suppressant) can add up to high serotonin levels. This can also occur with a combination of the complementary medicine St John’s Wort and an oral decongestant.</p> <p>Where serotonin levels are too high, <a href="https://pubmed.ncbi.nlm.nih.gov/15666281/">severe symptoms</a> such as confusion, muscle rigidity, fever, seizures and even death have been reported. Such symptoms are rare but if you notice any of these you should stop taking the cold and flu medication straight away and seek medical attention.</p> <h2>Ways to avoid antidepressant drug interactions</h2> <p>There are a few things we can do to prevent potentially dangerous interactions between antidepressants and cold and flu treatments.</p> <p><strong>1. Better information</strong></p> <p>Firstly, there should be more targeted, consumer-friendly, <a href="https://www.webmd.com/interaction-checker/default.htm">online drug interaction information</a> available for antidepressant users.</p> <p><strong>2. Prevent the spread of viral infections as much as possible</strong></p> <p>Use the non-drug strategies that have worked well for COVID: regular hand washing, good personal hygiene, social distancing, and facemasks. Ensure adults and children are up to date with immunisations.</p> <p><strong>3. Avoid potential drug interactions with strategies to safely manage symptoms</strong></p> <p>Consult your pharmacist for strategies most appropriate for you and only use cold and flu medications while symptoms persist:</p> <ul> <li>treat muscle aches, pain, or a raised temperature with analgesics such as paracetamol or ibuprofen</li> <li>relieve congestion with a nasal spray decongestant</li> <li>clear mucus from upper airways with expectorants or mucolytics</li> <li>dry up a runny nose or watery eyes with a non-sedating antihistamine.</li> </ul> <p>Avoid over-the-counter cough suppressants for an irritating dry cough. Use a simple alternative such as honey, steam inhalation with a few drops of eucalyptus oil or a non-medicated lozenge instead.</p> <p><strong>4. Ask whether your symptoms could be more than the common cold</strong></p> <p>Could it be influenza or COVID? Seek medical attention if you are concerned or your symptoms are not improving. <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/208662/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/treasure-mcguire-135225">Treasure McGuire</a>, Assistant Director of Pharmacy, Mater Health SEQ in conjoint appointment as Associate Professor of Pharmacology, Bond University and as Associate Professor (Clinical), <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/taking-an-antidepressant-mixing-it-with-other-medicines-including-some-cold-and-flu-treatments-can-be-dangerous-208662">original article</a>.</em></p>

Body

Placeholder Content Image

6 reasons cats need some indoor rules

<p><strong>Kitty cat behaviours</strong></p> <p>Cat behaviour is both wildly entertaining and, at times, perplexing. Even the most in-tune owner has to wonder why cats knock things over, why cats love boxes or why cats meow at people but chirp at birds and squirrels. What cat lovers do know is that kitties crave spaces with bird’s-eye views to observe their world – you know, like kitchen counters. </p> <p>But if you’re trying to keep foods toxic to cats away from your little lion, or you’re just fed up with constantly cleaning your kitchen to get rid of cat hair and little pieces of cat litter, here’s how to keep cats off counters for good.</p> <p><strong>Why do cats like to climb on counters?</strong></p> <p>It’s a curious conundrum: Why do cats hate water yet jump on kitchen counters to play with a dripping faucet? An even more puzzling question: Why do cats like to hang out on our countertops in the first place?</p> <p>“Cats are both predators and prey, so being able to survey their territory from above keeps them safe from predators and allows them to spot prey to catch,” says Samantha Bell, a cat expert with Best Friends Animal Society. That’s understandable, but domestic cats don’t have to catch their food, and they certainly don’t have to worry about predators, so why do they like to be up on the counter so much?</p> <p>“Counters are so attractive to cats because they’re up high, sturdy, right in the middle of the action and full of food,” Bell says. (Which may be one reason your cat licks you when you’re making a meal – it smells food on your hands.)</p> <p>Your actions can reinforce this counter-jumping habit. If you pet and talk to your cat while it’s on the counter, it’ll quickly learn that this is a place where it can get attention, says Dr Ragen T.S. McGowan, an animal behaviour scientist with Purina. “Many cats will jump up on the counter just to be close to human family members,” she says.</p> <p><strong>Can you train a cat to not be on your counters?</strong></p> <p>Absolutely, but there are two vital cat facts you should know when it comes to how to keep cats off counters, Bell says. To start, you can’t extinguish instinctive behaviours, like climbing high to be near the action.</p> <p>Furthermore – and this is a biggie – punishment doesn’t work. In fact, it can even cause cat anxiety and destructive behaviours. Here are a few ways you can teach your kitty to stay off your counters for good.</p> <p><strong>Remove the reward</strong></p> <p>You can train a cat to do a lot of things, and yes, staying off the counters is one of them. Here’s a critical question to ask when figuring out how to keep cats off counters: What is your cat’s reward for counter surfing?</p> <p>We know our feline friends hop on countertops to get food and attention and to socialise with humans. Maybe your cat is motivated by one or all of those factors. Or maybe it loves watching birds out the kitchen window. Whatever the case may be, you can train a cat to stay off the counters by removing rewards and positive reinforcement, McGowan says.</p> <p>Let’s say your cat is curious about the water dripping from the sink tap, likes to watch birds out the window or wants to nibble on food left on the counter. “Remove the reward by drawing the shades, fixing the tap or removing food from the countertops when possible,” says McGowan.</p> <p>And don’t fall into the trap of rewarding this bad behaviour. “For many cats, even the act of picking them up off the counter is rewarding and thus reinforces the behaviour,” says McGowan. Think about it: Your cat may rub against you while it’s on the counter and purr when you pick it up – both ways cats show affection. When you pick it up, you’re giving affection and attention and essentially telling your cat that climbing on the counter is a good way to get cuddles.</p> <p><strong>Redirect the cat's attention</strong></p> <p>Your cat may be climbing to get your attention, but before you give in and pet it, redirect its attention from the counter. “If their motivation is touch [being picked up or petted], then tossing a treat or toy and petting them only after they are on the floor can help to redirect them,” says McGowan.</p> <p>As tempting as it is, don’t pet your cat when it’s on the counter, as this can inadvertently reward the behaviour. Instead, call your cat to another part of the kitchen before giving it a treat or toy. Otherwise, McGowan says, it might learn a new trick: “If I get on the counter, Mum or Dad will throw a treat.”</p> <p>Consistently provide the rewards when your cat is not on the counter, and it’ll learn that being in other places gets it a reward, according to McGowan.</p> <p><strong>Teach it that counters are boring</strong></p> <p>It’s the old switcheroo! With this technique, you’re training your cat to choose a new place to hang out, one that’s still at the height level it prefers. Place a tall chair or stool near the counter, then reward your four-legged friend each time it sits there.</p> <p>We know what you’re thinking: This sounds counterintuitive. Won’t the cat use the barstool to jump onto the counter? “Yes, but they were getting on the counter anyway. The point is that you only reward them when they’re on the stool,” says Bell. “When you catch your cat on the stool, reward them with something of great value to them.”</p> <p>Don’t place the cat on the stool yourself. But you can lure it up to the stool by putting treats on it. If your cat jumps up on the counter during this training phase, play it cool. Remember, some cats have learned that being picked up from the counter means they’re going to get affection and cuddles. “Don’t say anything. Don’t look at them. Just quickly and gently set them on the ground,” says Bell.</p> <p>The goal is to show your cat there is nothing exciting about being on the counter. It only gets rewarded when it’s on the stool or high chair. “They learn quickly which location gets rewarded,” Bell adds.</p> <p>Granted, training takes some time and patience, but once cats realise rewards come when they’re on the barstool, you’ll have cat-free counters, Bell says. Once your pet nails the behaviour, you can stop giving it treats every time it gets on the stool. “That could cause a slot machine behaviour effect of ‘I’ll keep trying until I win,’” she says.</p> <p><strong>Set up cat-climbing alternatives</strong></p> <p>You’ve probably heard the saying “location, location, location.” It tops the wish list of most hopeful home buyers. For cats, that location is vertical. “Cats are drawn to high places to perch and survey the world, as they feel more secure from a high vantage point,” McGowan says. You can satisfy their desire for elevated living without sacrificing your clean countertops.</p> <p>For a simple and free option, Bell suggests putting a nightstand close to a dresser so your cat can easily jump to the dresser. Make it extra comfy and put a cosy blanket or cat bed on top of the dresser.</p> <p>You can give your cat a bird’s-eye view with products that put it at eye level with the action – wall shelves and bridges, window seats perfect for cat naps and cat trees with built-in scratching posts, toys and plush hideaways. Next, find the answer to a question every cat-parent has had once in their life – do cats know their names?</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a href="https://www.readersdigest.co.nz/food-home-garden/pets/6-reasons-cats-need-some-indoor-rules" target="_blank" rel="noopener">Reader's Digest</a>. </em></p>

Family & Pets

Placeholder Content Image

How do I stop my mind racing and get some sleep?

<p><em><a href="https://theconversation.com/profiles/alexander-sweetman-1331085">Alexander Sweetman</a>, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a></em></p> <p>Martin turns off the light to fall asleep, but his mind quickly springs into action. Racing thoughts about work deadlines, his overdue car service, and his father’s recent surgery occupy his mind.</p> <p>As he struggles to fall asleep, the hours start to creep by. He becomes frustrated about how he will cope tomorrow. This is a pattern Martin has struggled with for many years.</p> <p>But what’s going on when your mind is racing at night? And how do you make it stop?</p> <h2>It can happen to anyone</h2> <p>In bed, with no other visual or sound cues to occupy the mind, many people start to have racing thoughts that keep them awake. This can happen at the start of the night, or when they awake in the night.</p> <p>The good news is there are effective ways to reduce these racing thoughts, and to help get some sleep. To do this, let’s take a step back and talk about insomnia.</p> <h2>What is insomnia?</h2> <p>If you are like Martin, you’re not alone. Right now, up to six in every ten people have regular <a href="https://www.sleepprimarycareresources.org.au/insomnia/epidemiology">insomnia symptoms</a>. One in ten have had these symptoms for months or years.</p> <p>Insomnia includes trouble falling asleep at the start of the night, waking up during the night, and feelings of daytime fatigue, concentration difficulties, lethargy or poor mood.</p> <p>Just like Martin, many people with insomnia find as soon as they get into bed, they feel alert and wide awake. So what’s going on?</p> <p>The more time we spend in bed doing things other than sleep, the more our brain and body start to learn that bed is a place for these non-sleep activities.</p> <p>These activities don’t just include worrying. They can be using a mobile phone, watching TV, eating, working, arguing, smoking or playing with pets.</p> <p>Gradually, our brains can learn that bed is a place for these other activities instead of rest and sleep. Over time the simple act of getting into bed can become a trigger to feel more alert and awake. This is called “<a href="https://www.med.upenn.edu/cbti/assets/user-content/documents/ppsmmodelsofinsomnia20115theditionproof.pdf">conditioned insomnia</a>”.</p> <p>Here are six ways to spend less time awake in bed with racing thoughts.</p> <h2>1. Re-learn to associate bed with sleep</h2> <p><a href="https://www.sleepprimarycareresources.org.au/insomnia/bbti/insomnia-stimulus-control-therapy">Stimulus control therapy</a> can <a href="https://www.med.upenn.edu/cbti/assets/user-content/documents/Bootzin%201972.pdf">help</a> re-build the relationship between bed and sleep.</p> <p>Follow these simple steps every night of the week:</p> <ul> <li> <p>only use your bed for sleep and intimacy. All other activities should occur out of bed, preferably in another room</p> </li> <li> <p>only go to bed if you are feeling sleepy (when your eyes are heavy and you could easily fall asleep). If you are not feeling sleepy, delay getting into bed. Use this time to do something relaxing in another room</p> </li> <li> <p>if you are still awake after about 15 minutes in bed, get out of bed and go to another room. Do something else relaxing until you are feeling sleepy again, such as reading a book, listening to the radio, catching up on some chores or doing a crossword puzzle. Avoid anything too stimulating such as work or computer gaming</p> </li> <li> <p>repeat the above two steps until you are asleep within about 15 minutes. This can take several cycles of getting in and out of bed. But during this time, you body’s natural need for sleep will increase, and you will eventually fall asleep within 15 minutes of getting into bed</p> </li> <li> <p>get out of bed at the same time each morning, no matter how much you slept the night before</p> </li> <li> <p>avoid long daytime naps, which can make it harder to fall asleep that night.</p> </li> </ul> <p>Over several nights, this therapy builds the relationship between bed and sleep, and reduces the relationship between bed and feeling alert and having racing thoughts.</p> <h2>2. Distract yourself with fond thoughts</h2> <p>Negative thoughts in bed or worrying about the consequences of losing sleep can make us feel more alert, worried, and make it more difficult to sleep.</p> <p>So try something called “<a href="https://doi.org/10.1016/j.beth.2012.07.004">cognitive re-focusing</a>”. Try to replay a fond memory, movie, or TV show in your mind, to distract yourself from these negative thoughts.</p> <p>Ideally, this will be a memory you can recall very clearly, and one that causes neutral or slightly positive feelings. Memories that are overly positive or negative might cause an increase in alertness and mental activity.</p> <h2>3. Relax into sleep</h2> <p><a href="https://www.sleepprimarycareresources.org.au/insomnia/bbti/insomnia-relaxation-techniques">Relaxation therapy</a> for insomnia aims to <a href="https://www.sciencedirect.com/science/article/abs/pii/B9780123815224000043">reduce alertness</a> and improve sleep.</p> <p>One way is to progressively tense and relax muscle groups throughout your body, known as <a href="https://youtu.be/pyxvL1O2duk">guided progressive muscle relaxation therapy</a>.</p> <p>You could also try breathing exercises, soothing music, visual imagery or other <a href="https://www.sleephealthfoundation.org.au/cognitive-behavioural-therapy-for-insomnia-cbt-i.html">relaxation exercises</a> that feel right for you.</p> <p>Part of relaxing into sleep is avoiding doing work in the late evening or screen-based activities right before bed. Give yourself a “buffer zone”, to allow yourself time to start relaxing before getting into bed.</p> <h2>4. Worry earlier in the day</h2> <p>Schedule some “<a href="https://www.psychologytoday.com/au/blog/what-mentally-strong-people-dont-do/201811/simple-effective-trick-stop-worrying-so-much">worry time</a>” earlier in the day, so these thoughts don’t happen at night. It can also help to write down some of the things that worry you.</p> <p>If you start to worry about things during the night, you can remind yourself you have already written them down, and they are waiting for you to work through during your scheduled “worry time” the next day.</p> <h2>5. Know waking in the night is normal</h2> <p>Knowing that brief awakenings from sleep are completely normal, and not a sign of ill health, may help.</p> <p>Sleep occurs in different “cycles” during the night. Each cycle lasts for about 90 minutes, and includes different stages of light, deep, and dreaming (REM) sleep.</p> <p>Most of our deep sleep occurs in the first half of the night, and most of our light sleep in the second half.</p> <p>Everyone experiences brief awakenings from sleep, but most people don’t remember these the next morning.</p> <h2>6. What if these don’t work?</h2> <p>If these don’t work, the most effective next step is “cognitive behavioural therapy for insomnia” or CBT-i.</p> <p>This non-drug therapy targets the underlying causes of insomnia, and leads to <a href="https://doi.org/10.1016/j.smrv.2019.08.002">long-lasting improvements</a> in sleep, mental health and daytime function.</p> <p>You can do a self-guided online program, or access it via your GP or a psychologist. More details, including links to online programs, are available via the <a href="https://www.sleephealthfoundation.org.au/cognitive-behavioural-therapy-for-insomnia-cbt-i.html">Sleep Health Foundation</a>.</p> <p>We are providing free access to online CBT-i through a research study. To find out more, <a href="https://www.flinders.edu.au/people/alexander.sweetman">contact me</a>.</p> <hr /> <p><em>The Sleep Health Foundation has several <a href="https://www.sleephealthfoundation.org.au/fact-sheets.html">evidence-based resources</a> about sleep health and insomnia.<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/207904/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></em></p> <p><em><a href="https://theconversation.com/profiles/alexander-sweetman-1331085">Alexander Sweetman</a>, Research Fellow, College of Medicine and Public Health, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-do-i-stop-my-mind-racing-and-get-some-sleep-207904">original article</a>.</em></p>

Mind

Placeholder Content Image

How scammers use psychology to create some of the most convincing internet cons – and what to watch out for

<p><a href="https://theconversation.com/profiles/stacey-wood-473147"><em>Stacey Wood</em></a><em>, <a href="https://theconversation.com/institutions/scripps-college-2153">Scripps College</a> and <a href="https://theconversation.com/profiles/yaniv-hanoch-1341108">Yaniv Hanoch</a>, <a href="https://theconversation.com/institutions/university-of-southampton-1093">University of Southampton</a></em></p> <p><a href="https://www.experian.co.uk/blogs/latest-thinking/fraud-prevention/cybercrime-fraud-most-common-crime-uk/">Online fraud is today’s most common crime</a>. Victims are often told they are foolish for falling for it, but fraudsters use psychological mechanisms to infiltrate the defences of their targets, regardless of how intelligent they are.</p> <p>So it’s important to keep up with the latest scams and understand how they work.</p> <p>Recently, consumer protection magazine Which? <a href="https://www.which.co.uk/news/article/the-4-most-convincing-scams-weve-seen-in-2023-so-far-a7bRP9s0KJvG">identified some of the most convincing scams of 2023</a>. These scams all have one thing in common – they insidiously take advantage of people’s cognitive biases and psychological blind spots.</p> <p>They included “pig butchering” a way of fattening up victims with affection, the missing person scam which involves posting fake content on social media pages, the traditional PayPal scam, and a new scam called the “fake app alert” in which malware is hidden on apps that look legitimate.</p> <h2>Pig butchering</h2> <p>In our work as fraud psychology researchers we have noticed a trend towards hybrid scams, which combine different types of fraud. Hybrid scams often involve crypto investments and <a href="https://www.psychologytoday.com/us/blog/the-fraud-crisis/202210/new-scams-committed-forced-trafficked-labor">sometimes use trafficked labour</a> In the US alone, <a href="https://www.fbi.gov/contact-us/field-offices/springfield/news/internet-crime-complaint-center-releases-2022-statistics">the FBI recently reported</a> that people lost US $3.3 billion (£2.6 billion) in 2023 to investment fraud.</p> <p>Pig butchering is a long-term deception. <a href="https://www.cnbc.com/2023/05/02/pig-butchering-scammers-make-billions-convincing-victims-of-love.html">This type of scam</a> combines elements of <a href="https://www.actionfraud.police.uk/a-z-of-fraud/romance-scams">romance scams</a> with an investment con. The name comes from the strategy of <a href="https://www.theguardian.com/money/2023/may/22/dating-cons-and-dodgy-apps-among-most-common-scams-says-uk-watchdog">“fattening up” a victim with affection before slaughter</a>.</p> <p>It will usually begin with <a href="https://www.which.co.uk/policy-and-insight/article/pig-butchering-among-most-convincing-scams-of-2023-so-far-which-warns-aDRtr4I1UT1R">standard scam approach like a text</a>, social media message, or an introduction at a job board site.</p> <p>Victims may have their guard up at first. However, these scams can unfold over months, with the scammer slowly gaining the victims’ trust and initiating a romantic relationship all the while learning about their vulnerabilities.</p> <p>For example, details of their financial situation, job stresses, and dreams about the life they want. Romance scammers often saturate their targets with affection and almost constant contact. Pig butchering sometimes involves several trafficked people working as a team to create a single persona.</p> <p>Once the victim depends on the scammer for their emotional connection, the scammer introduces the idea of making an investment and uses fake crypto platforms to demonstrate returns. The scammers may use legitimate sounding cryptocoins and platforms. Victims can invest and “see” strong returns online. In reality, their money is going directly to the scammer.</p> <p>Once a victim transfers a substantial amount of money to the con artist, they are less likely to pull out. This phenomenon is known as the <a href="https://www.sciencedirect.com/science/article/abs/pii/0749597885900494">“sunk cost fallacy”</a>. Research has shown people are likely to carry on investing money, time and effort in activities they have already invested in and ignore signs the endeavour isn’t in their best interests.</p> <p>When the victim runs out of money or tries to withdraw funds, they are blocked.</p> <p>The victim is left with not only financial devastation, but also the loss of what they may imagine to be their most intimate partnership. They are often <a href="https://cloud-platform-e218f50a4812967ba1215eaecede923f.s3.amazonaws.com/uploads/sites/6/2021/12/VC-Who-Suffers-Fraud-Report-1.pdf">too embarrassed to discuss the experience</a> with friends and family or to report to the police.</p> <h2>PayPal scams</h2> <p>Fake payment requests are a common attack that works by volume rather than playing the long game. Payment requests appear to come from a genuine PayPal address. Fraudulent messages typically begin with a generic greeting, an urgent request and a fake link.</p> <p>For example, Dear User: You’ve received a payment, or you have paid too much. Please click link below for details. Users are directed to a spoofed website with a legitimate sounding name such as www.paypal.com/SpecialOffers and asked to enter their account information and password.</p> <p>Both of us have received these scam requests – and even we found them difficult to discern from legitimate PayPal request emails. These scams work through mimicry and play on the human tendency to trust authority. Legitimate PayPal correspondence is usually automatic bot language, so it is not difficult to imitate.</p> <p>But remember, genuine messages from PayPal <a href="https://www.paypal.com/ca/for-you/account/security/fraud-dangers#:%7E:text=Any%20email%20from%20PayPal%20will,bank%20account%2C%20or%20credit%20card.">will use your first and last name</a>.</p> <h2>The missing person scam</h2> <p>This seems to be a new scam that exploits a person’s kindness. In the past, charity scams involved posing as charitable organisation responding to a <a href="https://www.aarp.org/money/scams-fraud/info-2019/charity.html">recent, real calamity</a>.</p> <p>The new missing person scam is more sophisticated. The initial plea is a <a href="https://www.thesun.co.uk/tech/20875699/facebook-fake-missing-child-scam-warning/">fake missing person post</a> that generates likes and shares, increasing its credibility and exposure. Then the fraudster edits the content to create an investment scheme which now has the veneer of legitimacy.</p> <p>This scam may work because the initial consumers are unaware that the content is fraudulent, and there is no obvious request. In psychology, this type of persuasion is known as “<a href="https://thedecisionlab.com/reference-guide/psychology/social-proof">social proof</a>” – the tendency of individuals to follow and copy behaviour of others.</p> <h2>Fake app alerts</h2> <p>People post mobile apps, designed to steal users’ personal information, on the Google Play or Apple app store.</p> <p>The app often has a <a href="https://www.edinburghnews.scotsman.com/news/crime/another-person-comes-forward-after-banking-app-scam-3584340">legitimate function</a>, which gives it a cover. Consumers unknowingly jeopardise their private information by downloading these apps which use malware to access additional information.</p> <p>Although there has been <a href="https://tech.co/news/fake-android-apps-delete">media coverage of Android security issues</a>, many users assume malware <a href="https://www.ben-evans.com/benedictevans/2020/8/18/app-stores">cannot bypass app store screening</a>. Again, this scam plays on people’s <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2F0021-9010.92.3.639">trust in authority figures</a> to keep tjem safe.</p> <p>Discuss any investment opportunities with friends, family members or professionals. It’s much easier said than done, but exercising caution one of the best strategies to reduce the chance of becoming a fraud victim.</p> <p>Scammers count on people paying little to no attention to their emails or messages before clicking on them or providing valuable information. When it comes to scams, the devil is in the missing details.<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/207759/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/stacey-wood-473147">Stacey Wood</a>, Professor of Psychology, <a href="https://theconversation.com/institutions/scripps-college-2153">Scripps College</a> and <a href="https://theconversation.com/profiles/yaniv-hanoch-1341108">Yaniv Hanoch</a>, Professor in Decision Science, <a href="https://theconversation.com/institutions/university-of-southampton-1093">University of Southampton</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-scammers-use-psychology-to-create-some-of-the-most-convincing-internet-cons-and-what-to-watch-out-for-207759">original article</a>.</em></p>

Technology

Placeholder Content Image

Many people are tired of grappling with long COVID – here are some evidence-based ways to counter it

<p><a href="https://theconversation.com/profiles/kyle-b-enfield-1409764">Kyle B. Enfield</a>, <em><a href="https://theconversation.com/institutions/university-of-virginia-752">University of Virginia</a></em></p> <p>A patient of mine, once a marathon runner, now gets tired just walking around the block. She developed COVID-19 during the 2020 Christmas holiday and saw me during the summer of 2021. Previously, her primary care doctor had recommended a graded exercise program. But exercise exhausted her. After months of waiting, she finally had an appointment at our post-COVID-19 clinic at the University of Virginia.</p> <p>She is hardly alone in her extended search for answers. Studies suggest that <a href="https://doi.org/10.1016/S0140-6736(22)01214-4">from 10%</a> to <a href="https://doi.org/10.1016/j.eclinm.2022.101762">45% of COVID-19 survivors</a> have at least <a href="https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html">one of the following symptoms three months after recovery</a>: fatigue, cough, shortness of breath, difficulty sleeping, difficulty with daily activities or mental fogginess, otherwise known as “brain fog.”</p> <p>There are many names for this condition: <a href="https://theconversation.com/long-covid-stemmed-from-mild-cases-of-covid-19-in-most-people-according-to-a-new-multicountry-study-195707">long COVID</a>, long-haul COVID, post-acute COVID-19 syndrome and chronic COVID. Patients report that their symptoms, or the severity of them, <a href="http://dx.doi.org/10.1136/bmjgh-2021-007004">fluctuate over time</a>, which <a href="https://theconversation.com/deciphering-the-symptoms-of-long-covid-19-is-slow-and-painstaking-for-both-sufferers-and-their-physicians-164754">makes diagnosis and treatment difficult</a>.</p> <h2>A response to infection</h2> <p>Researchers and doctors have seen <a href="https://doi.org/10.2340/16501977-2694">similar recovery patterns from other viruses</a>, including <a href="https://www.cdc.gov/vhf/ebola/about.html">Ebola</a> and Middle East Respiratory Syndrome, <a href="https://www.lung.org/lung-health-diseases/lung-disease-lookup/middle-eastern-respiratory-syndrome-mers">or MERS</a>, which is another coronavirus.</p> <p>This suggests that the illness we see following a bout with COVID-19 may be part of a patient’s response to the infection. But doctors and researchers do not yet know why some patients go on to have persistent symptoms.</p> <p>My clinical practice and academic research <a href="https://scholar.google.com/scholar?as_ylo=2022&amp;q=Kyle+Enfield&amp;hl=en&amp;as_sdt=0,47">focus on critically ill patients</a>. Most of my patients now are people who had COVID-19 with various levels of severity.</p> <p>I often tell these patients that we are still learning about this disease, which wasn’t part of our vernacular before 2020. Part of what we do at the clinic is help patients understand what they can do at home to start improving.</p> <figure><iframe src="https://www.youtube.com/embed/ype9O4rD3Gk?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption><span class="caption">For millions of Americans, COVID-19 is still a part of their lives.</span></figcaption></figure> <h2>Dealing with fatigue</h2> <p><a href="https://doi.org/10.1038/s41598-021-95565-8">Chronic fatigue</a> can greatly affect quality of life. Exercise limitations can have their roots in problems with the lung, heart, brain, muscles or all of the above.</p> <p>Graded exercise therapy works for some but not all patients. Graded exercise is the slow introduction of exercise, starting slowly and gradually increasing in load over time. Many are frustrated because they feel more exhausted after exercising or even doing the routine tasks of daily living. The lack of progress <a href="https://doi.org/10.1016/j.jpsychores.2019.109893">leads to feelings of depression</a>.</p> <p>The condition of feeling more exhausted after exercise <a href="https://www.cdc.gov/me-cfs/healthcare-providers/clinical-care-patients-mecfs/treating-most-disruptive-symptoms.html">is called post-exertional malaise</a>, which is defined as physical and mental exhaustion after an activity, often 24 hours later, that is out of proportion with the activity.</p> <p>For example, you feel good today and decide to go for a walk around the block. Afterward you are fine, but the next day your muscles ache and all you can do is lie on the couch. Some patients don’t even have the energy to answer emails. Rest or sleep do typically relieve the fatigue. There is no one-size-fits-all approach to treatment; the severity and frequency of post-exertional malaise varies from person to person.</p> <h2>Signs and symptoms</h2> <p>Fatigue following any illness is common, as is exercise intolerance. So when should you see a medical professional? Diagnostic testing for post-exertional malaise exists, but it’s not readily available to all patients. These questions may provide clues to whether or not you are experiencing it:</p> <ul> <li>Does it take more than one day to recover to your usual baseline activity?</li> <li>Do you feel unwell, weak, sleep poorly or have pain when recovering from activity?</li> <li>Are you feeling limited in your ability to do your daily tasks after activity?</li> <li>Does exercise activity affect you positively?</li> <li>Do you have soreness and fatigue after nonstrenuous days, or mental fatigue after strenuous or nonstrenuous activities?</li> </ul> <p>All of these can be clues to discuss with your primary care provider, who may want to do additional testing to confirm the diagnosis, such as a <a href="https://me-pedia.org/wiki/Two-day_cardiopulmonary_exercise_test">two-day cardiopulmonary exercise test</a>.</p> <p>Before your appointment, there are a few things you can do at home that may help.</p> <h2>Taking it easy</h2> <p>One of those techniques is pacing, or activity management, an approach that balances activities with rest.</p> <p>The <a href="https://www.rcot.co.uk/">Royal College of Occupational Therapists</a> and the <a href="https://ics.ac.uk/">Intensive Care Society</a>, both in the U.K., developed what they call the <a href="https://www.rcot.co.uk/conserving-energy">3Ps – Pace, Plan and Prioritize</a>.</p> <p>Pacing yourself means breaking down activities into smaller stretches with frequent breaks rather than doing it all at once. An example would be to climb a few steps and then rest for 30 seconds, instead of climbing all the stairs at once.</p> <p>Planning involves looking at the week’s activities to see how they can be spread out. Think about the ones that are particularly strenuous, and give yourself extra time to complete them.</p> <p>This helps with prioritizing – and recognizing those tasks that can be skipped or put off.</p> <h2>Focusing on the breathing</h2> <p>Some patients with long COVID develop abnormal breathing patterns, including shallow rapid breathing, known as hyperventilating, or breath-holding. Either of these patterns can make you feel short of breath.</p> <p>Symptoms of abnormal breathing patterns include frequent yawning, throat-clearing, experiencing pins-and-needles sensations, palpitations and chest pain. Don’t ignore these symptoms, because they can be signs of serious medical problems like <a href="https://www.cdc.gov/heartdisease/heart_attack.htm">heart attacks</a> and <a href="https://www.cdc.gov/heartdisease/atrial_fibrillation.htm">abnormal heart rhythms</a>. Once those are ruled out, it is possible to relearn to breathe properly.</p> <p>You can <a href="https://longcovid.physio/breathing-pattern-disorders">practice these techniques at home</a>. The simple version: Find a comfortable position – either lying down or sitting upright with your back supported. Place one hand on your chest and the other over your belly button. Exhale any stale air out of your lungs. Then breathe in through your nose and into your abdomen, creating a gentle rise in the belly.</p> <p>You should feel the hand resting on your belly button move up and down. Try to avoid short, shallow breaths into the upper chest. Slowly exhale all the air out of your lungs. The goal is to take around eight to 12 breaths per minute.</p> <p>Focus on a longer exhale than inhale. For example, inhale as described for a count of two, then exhale for a count of three, as a starting point. If you take one breath every five seconds, you will be breathing 12 breaths per minute. As you get more comfortable with this, you can increase the time to further reduce your breaths per minute.</p> <figure><iframe src="https://www.youtube.com/embed/tEmt1Znux58?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption><span class="caption">Box breathing is easy to learn and you can do it anywhere, anytime.</span></figcaption></figure> <p>A more advanced tool <a href="https://www.youtube.com/watch?v=a7uQXDkxEtM">is called box breathing</a>: Breathe in for a count of four to five, holding your breath for a count of four to five, breathing out for a count of four to five and hold that for a count of four to five.</p> <p>Long COVID patients who use these techniques show improvement in <a href="https://doi.org/10.1016/S2213-2600(22)00125-4">symptoms of breathlessness and sense of well-being</a>.</p> <h2>The road to recovery</h2> <p>The patient I referred to earlier did all of these things. As we worked with her, we discovered she had multiple reasons for her symptoms. In addition to overbreathing and symptoms of post-exertion malaise, she had a new cardiac problem, possibly related to her COVID-19 illness, that made her <a href="https://doi.org/10.1161/JAHA.121.024207">heart work less well during exercise</a>. Now she is recovering; while not back to marathon running, she is feeling better.</p> <p>Currently there is no cure for long COVID, though we hope research will lead to one. <a href="https://clinicaltrials.gov/ct2/results?cond=long+covid&amp;term=&amp;cntry=&amp;state=&amp;city=&amp;dist=">Clinical trials looking at potential therapies</a> are continuing. In the meantime, people should be cautious about using medications that are not proved to help – and if you’re having symptoms, get evaluated.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><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/201451/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/kyle-b-enfield-1409764">Kyle B. Enfield</a>, Associate Professor of Medicine, <a href="https://theconversation.com/institutions/university-of-virginia-752">University of Virginia</a></em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/many-people-are-tired-of-grappling-with-long-covid-here-are-some-evidence-based-ways-to-counter-it-201451">original article</a>.</em></p> <p><em>Images: Getty</em></p>

Body

Placeholder Content Image

The reason some planes skip row numbers

<p dir="ltr">When it comes to boarding a flight, a lot of people have specific preferences on where they want to sit, while others simply leave it up to chance. </p> <p dir="ltr">The next time you’re looking for your seat on your next flight, pay close attention to the row numbers and see if you notice anything strange. </p> <p dir="ltr">According to <em><a href="https://www.euronews.com/travel/2023/03/21/which-airlines-skip-row-13-and-where-does-the-superstition-come-from">EuroNews</a></em>, a lot of aircrafts have been known to skip over rows, specifically rows 13, 14 and 17. </p> <p dir="ltr">The skipping of these numbers stems largely from superstitious passengers, with the number 13 being widely considered as “unlucky”. </p> <p dir="ltr">The superstition around the number originates largely from Christia scripture, as the disciple who betrayed Jesus Christ, Judas Iscariot, was the 13th guest at the last supper.</p> <p dir="ltr">The number 14 is considered unlucky in Chinese culture, as it phonetically sounds like the words “will die”. </p> <p dir="ltr">As for the number 17, Italian culture often steers clear of the number due to its Roman meaning. </p> <p dir="ltr">"This fear stems from the fact that the number 17's Roman numeral, XVII, is an anagram of VIXI, which means 'I have lived' in Latin. Some consider this a bad omen as it implies that death is just around the corner," explains <a href="https://www.abodeitaly.com/blog/why-italians-unlucky-day-is-friday-the-17th">Abode Italy.</a></p> <p dir="ltr">According to <em>EuroNews</em>, there are a few airlines that avoid the unlucky rows altogether.</p> <p dir="ltr">Ryanair, Air France, Singapore Airlines, Cathay Pacific, Qatar Airlines, Lufthansa, and Emirates have been known to skip over the three unlucky numbers. </p> <p dir="ltr">So the next time you’re boarding a flight, check to see if your chosen airline has indulged the superstitions or if any brave passengers have chosen to risk flying in the “dangerous” rows. </p> <p dir="ltr"><em>Image credits: Getty Images</em></p>

Travel Tips

Placeholder Content Image

Some skincare rules were made to be broken

<p dir="ltr">Beauty influencer Natalie O’Neill has gained quite the following on TikTok with her honest beauty advice, and has now shared her three least favourite - and most overrated - pieces of skincare advice. </p> <p dir="ltr">As anyone with sensitive skin knows, there’s no one-size-fits-all solution, though it doesn’t stop us from trying every new hack and ‘groundbreaking’ product to hit the market. </p> <p dir="ltr">But according to Natalie, that in itself can be causing half the trouble. Her answer? Focus on the basics - cleansing, toning, and moisturising - and stop following these three popular but probably doomed-to-failed ‘rules’. </p> <ol> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Exfoliating </p> </li> </ol> <p dir="ltr">“The first one is exfoliation,” she said. “Ask any dermatologist, they will tell you you don’t need to exfoliate every day. Skin care brands have exfoliating products that they want to sell to you, and you will use them up quicker if you exfoliate every day. </p> <p dir="ltr">“The only thing is, your skin doesn’t need to be exfoliated every day. And if you do that you probably will have worse skin. We are conditioned to feel like skin needs exfoliation, but it actually exfoliates itself. It has its own natural turnover, it doesn’t need you to interact with it all the time.” </p> <p dir="ltr">Natalie suggested instead just protecting skin, keeping it hydrated, and exfoliating maybe once every one to two weeks at most.</p> <ol start="2"> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Vitamin C</p> </li> </ol> <p dir="ltr">“In at number two is vitamin C,” Natalie continued. “I’ve said it once and I’ll say it again, several dermatologists that I follow don’t use vitamin C. It’s not that necessary, and it can actually be one of the most irritating ‘actives’ available.”</p> <p dir="ltr">After going on to list some popular online dermatologists that she knows don’t consider it important either, Natalie said that “again, it’s the brands telling you that you need to use it every day. And actually, you don’t.</p> <p dir="ltr">“And you might find that if you stop using it you would have much calmer skin. That’s what I found.”</p> <ol start="3"> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Skin cycling </p> </li> </ol> <p dir="ltr">Skin cycling is a skincare routine that calls for ‘rest days’, where the skin is given time to ‘repair’ itself after using products. Supposedly, this has the added benefit of preventing the likes of irritation and inflammation. </p> <p dir="ltr">“I know that the person who invented it is on this app [TikTok], I know that, I respect her,” Natalie began for her third take. “In a way, skin cycling has helped lots of people, and that’s a good thing. </p> <p dir="ltr">“But let me ask you this - if those people weren’t using chemical exfoliants and retinoids prior to doing skin cycling, it would therefore make sense that they are now experiencing good results after using chemical exfoliants and retinoids.</p> <p dir="ltr">“On one hand I do understand why people do skin cycling, because it makes a complicated subject a lot easier to absorb and implement in your daily life. But on the other hand, it’s not really anything new.”</p> <p dir="ltr">Her answer? “Use your retinoid or your chemical exfoliant more consistently” to see better results.</p> <div class="mol-embed" style="margin: 0px 0px 8px; padding: 0px; min-height: 1px; letter-spacing: -0.16px; text-align: center; font-family: graphik, Arial, sans-serif; font-size: 16px; background-color: #ffffff;"> <blockquote id="v40902513402405736" class="tiktok-embed" style="margin: 18px auto; padding: 0px; min-height: 1px; letter-spacing: -0.01em; position: relative; width: 605px; box-sizing: border-box; line-height: 1.15; overflow: hidden; text-size-adjust: 100%; font-family: proxima-regular, PingFangSC, sans-serif; max-width: 605px; min-width: 325px;" cite="https://www.tiktok.com/@natalie_oneillll/video/7199658807738371333" data-video-id="7199658807738371333" data-embed-from="oembed"><p><iframe style="letter-spacing: -0.01em; border-width: initial; border-style: none; width: 605px; height: 758px; display: block; visibility: unset; max-height: 758px;" src="https://www.tiktok.com/embed/v2/7199658807738371333?lang=en-GB&amp;referrer=https%3A%2F%2Fwww.dailymail.co.uk%2Ffemail%2Fbeauty%2Farticle-11856147%2FBeauty-buff-Natalie-ONeill-transformed-skin-shares-three-overrated-bits-skincare-advice.html&amp;embedFrom=oembed" name="__tt_embed__v40902513402405736" sandbox="allow-popups allow-popups-to-escape-sandbox allow-scripts allow-top-navigation allow-same-origin"></iframe></p></blockquote> </div> <p dir="ltr"><em>Images: TikTok</em></p>

Beauty & Style

Placeholder Content Image

“I’ve written some real stinkers”: Billy Joel reveals controversial songs

<p>Singer and songwriter Billy Joel has revealed two non “woke” songs that may not have been written given today’s political climate.</p> <p>The Piano Man singer is one of the best-selling musicians to date, but the 73-year-old admitted in an interview with the <em>LA Times</em> that if he were to do it all over again, he would take away “at least 25 per cent” of his songs.</p> <p>“I’ve written some real stinkers I wish I could take back,” he said, citing ‘When in Rome’ from his 1989 album <em>Storm Front</em> and ‘C’était Toi’ from 1980’s <em>Glass Houses</em>.</p> <p>“I don’t even speak French, so I don’t know what I was doing. Sometimes I’d get six or seven songs I thought were pretty damn good, then there’d be a couple of squeeze-outs at the end just to fill up the album. I realise now I shouldn’t have done that.”</p> <p>Joel released 12 successful pop and rock albums between 1971 and 1993 but then stopped writing new material, save for <em>Fantasies and Delusions</em>, his 2001 album of classical compositions.</p> <p>Joel also told the <em>LA Times</em> that he didn’t make that decision “based on whether it was right or wrong”.</p> <p>“It just felt like it was time for me to stop writing songs,” he said. “I didn’t have the same motivation anymore. You need inspiration to create good new music, and if you don’t have it, don’t bother. Get off the treadmill, for Christ’s sake.”</p> <p>He was asked whether he considered “the current cultural and political climate” when organising a setlist, Joel said that it crossed his mind with a song such as ‘Captain Jack’, which references “the junkies and the closet queens”.</p> <p>“You mean are they woke? It crosses my mind,” he admitted.</p> <p>“But ‘Captain Jack’ has gotten real boring to me. The verse is just two chords over and over again, and it’s this dreary story of some suburban kid jacking off at home. My mind starts to wander during the song, so I don’t do it even though people want to hear it.”</p> <p>He agreed that ‘Only the Good Die Young’ was also a tough sell by ‘modern woke standards’. The song, featured on 1977’s <em>The Stranger</em>, was written from the perspective of a young man determined to have sex with a Catholic girl.</p> <p>The song has not aged well by today’s standards, with lyrics such as, “come out Virginia, don’t let me wait, you Catholic girls start much too late” and “they say there’s a heaven for those who will wait, some say it’s better, but I say it ain’t”.</p> <p>“It’s occurred to me recently that I’m trying to talk some poor innocent woman into losing her virginity because of my lust,” Joel said.</p> <p>“It’s kind of a selfish song — like, who cares what happens to you? What about what I want? But on the other hand, it was of its time. This was written in the mid-‘70s, and I was trying to seduce girls. Why bulls**t about it?”</p> <p><em>Image credit: Getty</em></p>

Music

Placeholder Content Image

For some LGBTQ+ older people, events like World Pride can be isolating – we need to better understand how to support them

<p><a href="https://sydneyworldpride.com/">World Pride</a> has come to Sydney, with the annual <a href="https://sydneyworldpride.com/events/mardi-gras-parade/">Mardi Gras Parade</a> on Saturday having returned to its Oxford Street home for the first time in three years.</p> <p>The 17-day festival is expected to host 500,000 participants over more than 300 events. It is an opportunity to celebrate all things queer, and a good time to take stock of the changes LGBTQ+ older people have experienced, and the challenges they continue to face.</p> <p>LGBTQ+ people aged in their 70s, 80s and 90s have witnessed extraordinary social change regarding gender and sexual diversity. For example, in Australia, same-sex marriage is now legal, <a href="https://www.scientificamerican.com/article/where-transgender-is-no-longer-a-diagnosis/">Gender Identity Disorder</a> has been removed as a clinical diagnosis, and all states have an equal age of consent for homosexual and heterosexual sex.</p> <p>These have been hard-fought gains after many years of adversity and advocacy on the part of LGBTQ+ older people, among others.</p> <p>Each year, the <a href="https://www.78ers.org.au/">78ers</a> – who were involved in the Sydney marches and protests between June and August 1978 – take pride of place towards the front of the parade.</p> <h2>Loneliness and social isolation</h2> <p>Despite these achievements, the consequences of living most of one’s life in a homophobic and transphobic society have been considerable, particularly in terms of mental illness and social isolation.</p> <p><a href="https://www.tandfonline.com/doi/abs/10.1080/00918369.2021.2005999?journalCode=wjhm20">Australian</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/34326557/">US</a> research indicates loneliness is more common among lesbian, gay and bisexual older people than the general population. This is particularly so for those who live alone and are not in a relationship. Similar findings are reported in relation to <a href="https://www.lgbtagingcenter.org/resources/pdfs/LGBT%20Aging%20and%20Health%20Report_final.pdf">transgender older people</a>, although more research is needed.</p> <p><a href="https://www.tandfonline.com/doi/abs/10.1080/00918369.2021.2005999?journalCode=wjhm20">Loneliness</a> is also more common among lesbian and gay older people who are disconnected from LGBTQ+ communities and who hold negative attitudes towards their own same-sex attraction.</p> <p>For LGBTQ+ older people experiencing social isolation and loneliness, what might be their experience of watching World Pride from a distance? What might it be like navigating rainbow paraphernalia while shopping at <a href="https://www.coles.com.au/about/sustainability/better-together/our-team/pride">Coles</a> (a World Pride partner)? How might they perceive the glitz and glamour of the Mardi Gras Parade?</p> <p>World Pride may be challenging for those who don’t feel an attachment to LGBTQ+ communities or who feel negative about their own sexuality. And this may reinforce a sense of disconnection.</p> <p>But some may gain comfort from witnessing the sense of community on display. It may even strengthen their perceived connection to other LGBTQ+ people. And, for those who are not open about their sexuality or authentic gender, it may support their journey to “come out” later in life.</p> <h2>The impact of discrimination</h2> <p>For many LGBTQ+ older people, the experience of discrimination remains very real in their lives. <a href="https://pubmed.ncbi.nlm.nih.gov/33770516/">Past and recent discrimination</a> leads to delays seeking treatment and support, simply because people expect to be discriminated against when accessing services.</p> <p>In Australia, previous discrimination has been found to predict <a href="https://www.tandfonline.com/doi/abs/10.1080/00918369.2021.2005999?journalCode=wjhm20">loneliness</a> and <a href="https://www.cambridge.org/core/journals/ageing-and-society/article/abs/recent-versus-lifetime-experiences-of-discrimination-and-the-mental-and-physical-health-of-older-lesbian-women-and-gay-men/90988215582414EA0AB7936B6384FC97">lower mental health</a> among older lesbian and gay people. In the US, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6779303/">microaggressions</a> – small everyday interactions that reinforce the experience of being “other” – have predicted greater impairment, higher rates of depression and lower quality of life among LGBTQ+ people aged 80 and over.</p> <p>There remain major gaps in evidence on the issues faced by LGBTQ+ older people, particularly for bisexual, queer, transgender and nonbinary older people. This is mainly due to the failure to systematically collect inclusive data on gender and sexual diversity, through variables such as those recommended by the <a href="https://www.abs.gov.au/statistics/standards/standard-sex-gender-variations-sex-characteristics-and-sexual-orientation-variables/latest-release">Australian Bureau of Statistics</a>.</p> <h2>Strengths and resilience</h2> <p>This year, older people seemed to occupy a more prominent place in the Mardi Gras Parade. Perhaps this is because of the natural ageing of our community activists. Older people were also represented in the wider World Pride festival, such as in the theatre production <a href="https://sydneyworldpride.com/events/all-the-sex-ive-ever-had/">All the Sex I’ve Ever Had</a>, in which older Sydney residents reflect on the evolution of their sexuality over the course of their lives.</p> <p>A festival like World Pride showcases the strengths and resilience of LGBTQ+ people and communities. The organisation of such an event should not be underestimated. This reflects LGBTQ+ people’s high level of civic engagement and commitment to giving back to society, as demonstrated by their greater likelihood of being <a href="https://www.tandfonline.com/doi/abs/10.1080/0312407X.2021.1899256">volunteers</a> and <a href="https://www.caregiving.org/wp-content/uploads/2020/05/2015_CaregivingintheUS_Final-Report-June-4_WEB.pdf">caregivers</a>. And the contribution of volunteers and caregivers during the HIV/AIDS crisis of the 1980s and ‘90s is not forgotten.</p> <p>LGBTQ+ older people generally are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241752/">resilient and maintain good health</a>. Many report increased <a href="https://link.springer.com/article/10.1007/s13178-021-00653-z">confidence and self-esteem</a>, compared with when they were younger. And many have created their own families – their families of choice – to support each other in later life.</p> <p>But we don’t know enough about their needs and how to provide them with inclusive services as they get older. World Pride is an opportunity to reflect on the hard-won gains but not ignore the challenges ahead.</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a href="https://theconversation.com/for-some-lgbtq-older-people-events-like-world-pride-can-be-isolating-we-need-to-better-understand-how-to-support-them-200533" target="_blank" rel="noopener">The Conversation</a>. </em></p>

Caring

Placeholder Content Image

Jamie Lee Curtis looks back on some of her most iconic roles

<p>Whether you know her from her <em>Halloween </em>‘scream queen’ roots or her comedic prowess in the body swap <em>Freaky Friday</em>, Jamie Lee Curtis is an actress who needs no introduction. </p> <p>The star - who had been credited in an astounding 80 projects before her first ever Academy Awards nomination in 2023 for her role in <em>Everything Everywhere All at Once </em>- has seen and done it all. Beginning her career at the age of 19, Curtis has spent the years since adding success after success to her resume, and proving her doubters wrong at almost every turn. </p> <p>And in a candid interview with <em>Yahoo Entertainment</em>, the actress opened up about some of the most memorable roles that have steered her journey in Hollywood. </p> <ul> <li><strong>Laurie Strode, <em>Halloween </em>(1978)</strong></li> </ul> <p>Curtis made her film debut on the set of John Carpenter’s cult classic <em>Halloween</em>, and though the film (and its entire franchise) is considered to be one of the most influential horror films of all time, the then-19-year-old Curtis found nothing to be scared of while filming. </p> <p>The reason? Nick Castle, who played the film’s main antagonist Michael Myers, was too much of a delight to instill real terror in Curtis. </p> <p>“Here's the problem,” she explained. “He's played by Nick Castle, who was one of John's best friends. He had two little kids, his wife was around, and he's this funny guy. And he's also a very talented director and he's a musician. So I cannot lie to you and tell you I was so frightened." </p> <ul> <li><strong>Tess Coleman, <em>Freaky Friday</em> (2003)</strong></li> </ul> <p>Curtis was actually a last minute replacement for Annette Bening in the 2003 body swap comedy <em>Freaky Friday</em>, but that certainly didn’t put a damper on her experience. </p> <p>The actress became fast friends with Lindsay Lohan while playing the mother-daughter duo, and the pair have remained in contact ever since. In a fun friendship anecdote, Curtis shared how she has a test in place to find out whether or not it is Lohan texting her, or some sneaky stranger. </p> <p>"There's a song called 'Like I Love You' by Justin Timberlake. Lindsay and I were doing a scene in a car, and there was a lot of time in between takes, and there's a rap in the middle of that song by Clipse. She and I were trying to learn the words, and we were, like, sitting there with a pad,” she said. </p> <p>“We were writing them down,” Curtis continued. “And then we would do the scene, and then we'd play the song and try to lip-sync the few words that we knew. I'm telling you, we laughed. And that is my secret code with her. 'What was the song we were lip-syncing to in the car?'”</p> <p>She then confessed that while she may have given away their secret code, she wasn’t worried - the two have a second one, just in case. </p> <ul> <li><strong>Helen, <em>True Lies </em>(1994)</strong></li> </ul> <p>Although Curtis has said that the 1994 James Cameron blockbuster tops the list of her favourite filming experiences, featuring everything from a striptease to an intense helicopter stunt scene, she almost didn’t star at all, with co-star Arnold Schwarzenegger hesitant about signing her on to play his wife in the action packed project.</p> <p>When explaining why, Curtis noted that Arnold knew her “as Tony’s daughter”. Her father, Tony Curtis, had starred in the only film Schwarzenegger had directed, the 1992 <em>Christmas in Connecticut</em>. </p> <p>"He only knew me as Tony's daughter,” she said. “He loved Tony Curtis, so I'm sure Arnold just looked at me like it'd be like kissing your niece or something ... I guarantee, in fact, he did not want me to be in that movie. I think he just thought it would be weird. We knew each other a little bit socially. I just don't think he thought of me as his leading lady, I think he thought of me as Tony's little girl. And it was Jim who said, 'no, I've written this for her. She's the one to do this with you’.”</p> <p>Schwarzenegger, of course, eventually came around on the idea. And the rest, as they say, is history. </p> <p><em>Images: Getty</em></p>

Movies

Placeholder Content Image

What makes some art so bad that it’s good?

<p>“<a href="http://www.imdb.com/title/tt3521126/?ref_=fn_al_tt_1">The Disaster Artist</a>” – which earned James Franco a Golden Globe for his portrayal of director Tommy Wiseau – tells the story of the making of “<a href="http://www.imdb.com/title/tt0368226/?ref_=nv_sr_1">The Room</a>,” a film that’s been <a href="http://www.nytimes.com/2013/10/06/books/review/the-disaster-artist-by-greg-sestero-and-tom-bissell.html">dubbed</a>“the Citizen Kane” of bad movies. </p> <p>Not everyone likes “The Room.” (Critics certainly don’t – it has a <a href="https://www.rottentomatoes.com/m/the_room_1998/">26 percent rating</a> on Rotten Tomatoes.) But lots of folks love it. It plays at midnight showings at theaters across North America, and it’s a testament to a movie’s awfulness (and popularity) that, years later, it became the subject of a different movie. </p> <p>We usually hate art when it seems like it’s been poorly executed, and we appreciate great art, which is supposed to represent the pinnacle of human ingenuity. So, this raises a deeper question: What’s the appeal of art that’s so bad it’s good? (We could call this kind of art “good-bad art.”) Why do so many people grow to love good-bad art like “The Room” in the first place?</p> <p><a href="https://link.springer.com/article/10.1007%2Fs10790-016-9569-2">In a new paper</a> for an academic journal of philosophy, my colleague Matt Johnson and I explored these questions.</p> <h2>The artist’s intention is key</h2> <p>A Hollywood outsider named Tommy Wiseau produced, directed and starred in “<a href="http://www.imdb.com/title/tt0368226/">The Room</a>,” which was released in 2003. </p> <p>The film is full of failures. It jumps between different genres; there are absurd non-sequiturs; storylines are introduced, only to never be developed; and there are three sex scenes in the first 20 minutes. Wiseau poured substantial cash into the film – <a href="http://www.vulture.com/2013/06/the-room-10th-anniversary-history.html">it cost</a>around US$6 million to make – so there’s some degree of professional veneer. But this only accentuates its failure. </p> <p>Good-bad art doesn’t just happen at the movies. On TV, there was “<a href="https://en.wikipedia.org/wiki/Dark_Shadows">Dark Shadows</a>,” a low-budget vampire soap opera from the 1970s. In Somerville, Massachusetts, you can visit MOBA – <a href="http://www.museumofbadart.org/">the Museum of Bad Art</a> – dedicated to paintings that are so bad they’re good. The poet <a href="https://www.theparisreview.org/blog/2014/12/01/the-poetaster/">Julia Moore</a> (1847-1920) was ironically known as “The Sweet Singer of Michigan” for her <a href="http://homepages.wmich.edu/%7Ecooneys/txt/Moore/Chicago.Fire.html">deliciously terrible poetry</a>. And the recent film “<a href="http://www.imdb.com/title/tt4136084/?ref_=nv_sr_1">Florence Foster Jenkins</a>” tells the true story of an opera singer with a <a href="https://www.youtube.com/watch?v=Hcs9yJjVecs">tone-deaf voice</a> so beloved that she sold out Carnegie Hall.</p> <p>In good-bad art, it seems that the very features that make something bad – a horrible voice, cheesy verses or an absurd storyline – are what end up drawing people in. </p> <p>So we need to look at what’s “bad” about good-bad art in the first place. We equated artistic “badness” with artistic failure, which comes from failed intentions. It occurs when the creator didn’t realize their vision, or their vision wasn’t good in the first place. (MoBA, for instance, requires that its art comes from genuine attempts.) </p> <p>You might think a movie’s bad when it’s very silly, whether it’s “<a href="http://www.imdb.com/title/tt0417148/">Snakes on a Plane</a>” or “<a href="http://www.imdb.com/title/tt2724064/">Sharknado</a>.” You might think that “<a href="https://en.wikipedia.org/wiki/The_Rocky_Horror_Picture_Show">The Rocky Horror Picture Show</a>” is bad because it looks schlocky. </p> <p>But these films aren’t failures. “Snakes on a Plane” is supposed to be silly; “The Rocky Horror Picture Show” is supposed to look schlocky. So we can’t categorize these works as so bad they’re good. They’re successful in the sense that the writers and directors executed their visions. </p> <p>Our love for good-bad art, on the other hand, is based upon failure.</p> <h2>How not to appreciate bad art</h2> <p>So how could artistic failure ever be the basis for goodness?</p> <p>A pretty natural answer here is that we like good-bad art because we take a general pleasure in the failure of others. Our pleasure, say, at MoBA, is a particular kind of schadenfreude – the German word for taking joy in another’s misfortune. This view doesn’t have an official name, but we could call this “the massive failure view.” (The great Canadian humorist Stephen Leacock <a href="https://www.amazon.com/Humor-humanity-introduction-study-humor/dp/B00085RDMU">held this view</a>, arguing that singer Julia Moore’s earnest ineptitude made her work funnier.) If this view were right, our enjoyment of “The Room” would be morally suspect; it’s not healthy to get our kicks from the misfortune of others.</p> <p>Fortunately for lovers of good-bad art, we believe this “massive failure theory” of good-bad art is false, for two reasons.</p> <p>First, it doesn’t feel like we are enjoying pure failure in works like “The Room.” Our enjoyment seems to go much deeper. We laugh, but our enjoyment also comes from a kind of bewilderment: How could anyone think that this was a good idea?</p> <p>On his podcast, comedian Marc Maron recently <a href="http://www.wtfpod.com/podcast/episode-870-james-franco">interviewed Franco</a> about “The Disaster Artist.” Maron was a little uneasy about the film; to him, it seemed as if Franco were taking a gleeful delight in Wiseau’s failure. </p> <p>But Franco resisted this: “The Room” isn’t just great because it fails, he explained; it’s great because it fails in such a confounding way. Somehow, through its many failures, the film totally captivates its viewers. You find yourself unable to look away; its failure is gorgeously, majestically, bewildering.</p> <p>Second, if we were just enjoying massive failure, then any really bad movie would be good-bad art; movies would simply have to fail. But that’s not how good-bad art works. In good-bad art, movies have to fail in the right ways – in interesting or especially absurd ways. </p> <p>Some bad art is too bad – it’s just boring, or self-indulgent or overwrought. Even big failures aren’t enough to make something so bad it’s good. </p> <h2>The right way to appreciate bad art</h2> <p>We argue that good-bad artworks offer a brand of bizarreness that leads to a distinct form of appreciation.</p> <p>Many works – not just good-bad artworks – are good because they are bizarre. Take David Lynch’s films: Their storylines can possess a strange, dreamy logic. But good-bad art offers a unique kind of bizarreness. As with the <a href="https://en.wikipedia.org/wiki/David_Lynch_filmography">films of David Lynch</a>, we’re bewildered when we watch “The Room.” But in Lynch’s movies, you know that the director at least intentionally included the bizarre elements, so there’s some sense of an underlying order to the story. </p> <p>In good-bad art like “The Room,” that underlying order falls out from beneath you, since the bizarreness is not intended.</p> <p>This is why fans of good-bad art strongly insist that their love for it is genuine, not ironic. They love it as a gorgeous freak accident of nature, something that turned out beautifully – not despite, but because of the failure of its creators. </p> <p>Maybe, then, when we delight in good-bad art, we are taking some comfort: Our projects might fail, too. But even beauty can blossom out of failure.</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a href="https://theconversation.com/what-makes-some-art-so-bad-that-its-good-89737" target="_blank" rel="noopener">The Conversation</a>. </em></p>

Art

Placeholder Content Image

There’s a serious ethical problem with some sunscreen testing methods – and you’re probably not aware of it

<p>As summer approaches, we need to start remembering to slip on sun-protective clothing, slop on sunscreen, slap on a hat, seek shade where possible, and slide on sunglasses.</p> <p>When it comes to sunscreen, we all know we need to wear it to protect against the harmful effects of ultraviolet (UV) radiation, which can cause skin cancer.</p> <p>But what about the sun protection factor, known as the SPF rating, we see on our sunscreen bottles? It indicates the level of protection – but is it always what it says it is, and how is it actually tested?</p> <h2>Risking human health for SPF testing</h2> <p>While there have been some cases of <a href="https://www.tga.gov.au/news/news/sunscreen-testing-ama-laboratories-condition-listing">sunscreens not matching up to their SPF claims</a>, this is the exception and not the norm.</p> <p>In Australia, we can be comfortable knowing these products are tightly regulated to ensure they are safe and meet their claimed SPF rating, according to current SPF testing methods.</p> <p>However, problems arise when it comes to how sunscreens are tested for their SPF rating. Most people would not be aware that the SPF value on their sunscreen bottles is determined by testing on humans.</p> <p>Ultimately, this means we are risking people’s health to test how effective our sunscreens are – and we urgently need to change this.</p> <h2>How is sunscreen SPF tested?</h2> <p>Once a sunscreen formulation has been developed by a manufacturer it needs to go through testing to ensure it only contains approved ingredients, and ultimately, that it does what it says it does.</p> <p>All sunscreen products available in Australia are <a href="https://www.tga.gov.au/news/news/about-sunscreens">tested according to the Australian Standard to determine the SPF</a>. This is great and provides assurance of safety and quality for the consumer – but the problem is with how this testing is done.</p> <p>Currently, testing sunscreens on humans is the approved international standard to rate the UV protection level of a sunscreen. This testing involves volunteers wearing strictly defined amounts of sunscreen and being exposed to artificial solar <a href="https://www.arpansa.gov.au/understanding-radiation/what-is-radiation/non-ionising-radiation/ultraviolet-radiation">UV radiation</a>. </p> <p>Performance is measured by determining the time it takes for erythema or redness to occur. <a href="https://www.cancer.org.au/about-us/policy-and-advocacy/prevention-policy/national-cancer-prevention-policy/skin-cancer-statistics-and-issues/sunburn">This is, basically, sunburn</a>; based on this, an SPF rating is assigned.</p> <h2>Why is human testing of SPF a problem?</h2> <p>If sunscreens only contain approved ingredients we know are safe, is it really a problem they are tested on humans?</p> <p>Sadly, yes. Human testing involves exposing people to harmful UV radiation, which we know can cause skin and eye damage, <a href="https://www.arpansa.gov.au/understanding-radiation/radiation-sources/more-radiation-sources/sun-exposure">as well as being the leading cause of skin cancer</a>. This alone is <a href="https://www.phrp.com.au/wp-content/uploads/2022/03/PHRP3212205.pdf">unethical and unjustifiable</a>.</p> <p>There are also other issues associated with testing sunscreen on humans. For example, the <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/phpp.12095">use of erythema to determine sunscreen effectiveness is highly subjective</a>, and may differ from one person to another, even for those with the same <a href="https://www.arpansa.gov.au/sites/default/files/legacy/pubs/RadiationProtection/FitzpatrickSkinType.pdf">skin type</a>. This makes the reliability of such testing methods questionable.</p> <p>Further, testing is only done on a small number of people (a minimum of <a href="https://www.tga.gov.au/sites/default/files/australian-regulatory-guidelines-for-sunscreens.pdf">ten people is required in Australia</a>). This is great for exposing as few people as possible to harmful UV radiation to determine a product’s SPF rating – but not so great when it comes to inclusiveness.</p> <p>Testing such a small number of people is not representative. It does not include all skin types and leads to real <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/ics.12333">challenges in achieving reproducible results</a> across different laboratories testing the same product.</p> <p>The testing itself is also very expensive. This adds to the already high cost of buying sunscreens, and potentially limits manufacturers from developing new and better products.</p> <p>These, along with many other issues, highlight the urgency for non-human (in vitro) testing methods of a sunscreen’s effectiveness to be developed.</p> <h2>Human-free SPF testing technology is in development</h2> <p>While efforts have been made to develop non-human testing methods, <a href="https://www.sciencedirect.com/science/article/pii/S0165993622002072">there remain several challenges</a>. <a href="https://www.karger.com/Article/Abstract/292777">These include</a> the materials used to simulate human skin (also known as substrates), difficulties in applying the sunscreen to these substrates, reproducibility of results, and ensuring that results are the same as what we see with human testing.</p> <p>However, scientists at <a href="https://www.rmit.edu.au/">RMIT University</a>, with support from the Australian Radiation Protection and Nuclear Safety Agency (<a href="https://www.arpansa.gov.au/">ARPANSA</a>) and the <a href="https://www.cancervic.org.au/">Cancer Council Victoria</a>, are <a href="https://www.sciencedirect.com/science/article/pii/S0165993622002072">working on a solution to this problem</a>.</p> <p>So far, they have developed a prototype sensor that <a href="https://www.nature.com/articles/s41467-018-06273-3">changes colour when exposed to UV radiation</a>. This <a href="https://www.nature.com/articles/s41467-018-06273-3/figures/5">sensor</a> could be customised for human-free sunscreen testing, for example.</p> <p>Reliable in vitro testing methods will mean in the future, sunscreen manufacturers would be able to quickly make and test new and better sunscreens, without being limited by the time and cost constraints involved with human testing.</p> <p>So the next time you buy a bottle of sunscreen, look to purchase the highest-rated sunscreen of SPF 50+ – and know that work is underway on getting that rating classified in a more ethical way.</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a href="https://theconversation.com/theres-a-serious-ethical-problem-with-some-sunscreen-testing-methods-and-youre-probably-not-aware-of-it-195359" target="_blank" rel="noopener">The Conversation</a>. </em></p>

Beauty & Style